Human Resources Benefits Unit

Western Health Advantage Hospital Services DHMO

The Hospital Services DHMO plan requires you to live within the plan’s Northern California service area and to receive your non-emergency care from Western Health Advantage providers. You share in the cost of your care through copayments, coinsurance, and deductibles.

Most doctor’s office visits, radiology services, lab tests and prescriptions are available for copay or coinsurance amount, even before you have reached the calendar year deductible. Hospitalizations, in-patient, and out-patient surgeries are subject to the calendar year deductible before plan benefits will be paid.

Employees who have an HRA (Health Reimbursement Arrangement), or an FSA (Flexible Spending Account), through COBRA or another employer, may submit Western Health Advantage out-of-pocket expenses for reimbursement.

Plan Information Western Health Advantage Hospital Services DHMO
Calendar Year Deductible

$1,500 Self-Only Enrollment
$1,500 Any one member in a family of two or more
$3,000 Family of two or more

Calendar Year Out of Pocket Maximum
(Including Deductibles, Co-pays, and Coinsurance)

$4,000 Self-Only Enrollment
$4,000 Any one member in a family of two or more
$8,000 Family of two or more

Lifetime MaximumNone
Dependent Children Eligibility

Any Dependent child under age 26

Disabled: No age limit

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ServiceWestern Health Advantage Hospital Services DHMO
Physician & Specialist Office Visits$20 copay, no deductible
Preventive Care Adult Routine CareNo Charge, no deductible
Preventive Care Adult Routine Care OB/GYNNo Charge, no deductible
Diagnostic Imaging, Lab, and X-Ray

Diagnostic Lab: No charge, no deductible

Diagnostic X-ray: No charge, no deductible 

Physical Therapy (Medically necessary treatment only)$20 co-pay, no deductible
Chiropractic and AcupunctureChiropractic: $15 Copay, no deductible up to 20 visits per year
Acupuncture: $15 Copay, no deductible up to 20 visits per year
Mental Health & Substance Use Disorder
(Outpatient)
 $20 copay, no deductible  

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ServiceWestern Health Advantage Hospital Services DHMO
Inpatient Hospital and Physician Services20% Coinsurance after deductible
Outpatient Surgery20% Coinsurance after deductible
Maternity20% Coinsurance after deductible
Emergency Room20% Coinsurance after deductible
Ambulance$150 per trip, no deductible
Mental Health & Substance Use Disorder (Inpatient)20% Coinsurance after deductible
Skilled Nursing Facility20% Coinsurance, no deductible
Up to 100 days per benefit
Home Health

No Charge, no deductible 

Up to a 100 visits per year 

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ServiceWestern Health Advantage Hospital Services DHMO
Generic or Tier 1$10 copay up to a 30 day supply, no deductible
Formulary Brand or Tier 2$30 copay up to a 30 day supply, no deductible
Non-Formulary Brand or Tier 3$50 copay up to a 30 day supply, no deductible
Mail Order Benefit Generic or Tier 1$20 copay up to a 100 day supply, no deductible
Mail Order Benefit Formulary Brand or Tier 2$60 copay up to a 100 day supply, no deductible
Mail Order Benefit Non-Formulary Brand or Tier 3$100 copay up to a 100 day supply, no deductible
Mandatory Mail OrderNo
Mandatory Generic ProgramYes

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Contact Information

Benefits Unit

Human Resources Department

Business Hours
Monday – Friday
8:00 AM – 5:00 PM
Contact us by Phone
Address
575 Administration Drive
Room 116 B
Santa Rosa, CA 95403
38.465237, -122.725363

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