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.