The Deductible First HDHP plan requires you to live within the plans’ Northern California service area and to receive care from Western Health Advantage providers. This means you have access to Western Health Advantage providers only, except when you need emergency care. You share in the cost of your care through co-payments, coinsurance, and deductibles.
For any service other than preventative services, a member must meet the calendar year deductible FIRST before ANY plan benefits will be paid. A member will pay 100% of the doctor office visits, radiology services, lab tests, prescriptions, hospitalizations, etc., until the calendar year deductible is met. Once the deductible is satisfied, covered medical, hospital, and prescription benefits will be provided for a copayment or coinsurance amount.
See the Medical Plan Comparison Chart for more information about deductibles, out-of-pocket maximums, and plan benefits.
Employees who have an HRA (Health Reimbursement Arrangement), or an FSA (Flexible Spending Account), may submit Western Health Advantage out-of-pocket expenses for reimbursement.
Take Note… If you (the employee) elect to enroll in this Deductible First HDHP, which qualifies as an HSA-qualified high deductible health plan, and you have a Flexible Spending Account and/or a Health Reimbursement Arrangement (HRA), be advised that under IRS rules you are NOT allowed to contribute to a Health Savings Account (HSA). Because FSA and HRA accounts can be used to reimburse your out-of-pocket medical expenses, the IRS does not allow you to also contribute to a Health Savings Account at the same time, as it is considered prohibited health coverage.