Deductible: 

Your health care plan has a deductible. The deductible is the amount you pay each year for most covered medical and prescription services and supplies before WHA will cover those services. The premium and the deductible are separate. Your premium is the monthly amount you pay to the health carrier for benefit coverage. Premiums do not count toward the deductible in your health plan.

Copayments: 

Your plan may also require you to pay copayments after you meet your annual deductible. These are typically smaller dollar amounts or percentages for covered services.

OOP Maximum: 

Once your deductible and copayment costs reach your annual OOP maximum amount, you are done. WHA will cover 100 percent of your covered services for the remainder of the calendar year.

Western Health Advantage partners with leading service providers to ensure that our members get the best rates available. This means that you’ll enjoy consistent savings on your health care services and supplies.

Use our medical service cost estimator to see what is the estimated cost of a specific service you intend to receive.

Covered non-preventive medical and prescription expenses apply toward the deductible, as described in the plan. Examples include charges for office visits with doctors, inpatient and outpatient hospital services, diagnostic tests, and covered prescription drug expenses.

Payments you make for prescriptions covered under your plan will apply to your deductible and OOP maximum. It’s important to note that covered prescriptions must be obtained from a participating provider and must be run through WHA’s contracted pharmacy benefit manager in order to be applied. Prescriptions obtained from a non-participating provider are limited to emergent situations or urgent situations arising outside of WHA's service area.

Be sure to present your WHA member ID card to your provider. If a copayment is due at the time of service, you can use your HSA debit card to pay from funds you’ve deposited in your account. Keep all of your receipts in a safe place.

In most cases, you will be billed for covered office visits, labs and other health care services. These bills are qualified medical expenses and can be paid out of your HSA.