It's Your Choice 2013 - Decision Guide (ET-2128d-13) - ETF

WEA Trust PPO – East
(800) 279-4000 or (608) 276-4000
weatruststatehealthplan.com
Overall Quality Rating
See Report Card section
What’s New for 2013
An easy way for all eligible family members
to earn a $150 prepaid cash card. You
just need to complete our online health
assessment and submit verifiable results
for blood pressure, body mass index, and
fasting cholesterol and glucose.
Also, six more counties—Adams, Juneau,
Langlade, Lincoln, Menominee and Taylor—
join the WEA Trust PPO East Network, which
now totals 37 counties and covers most of
eastern Wisconsin.
Provider Directory
Go to weatruststatehealthplan.com. From
there, you may search for a doctor or print
from a PDF. You may also call customer
service at (800) 279-4000 for assistance.
How WEA Trust PPO East is Unique
WEA Trust PPO East is a preferred provider
plan that allows you to see any provider
and receive benefits—a broader alternative
to HMOs that limit choices. Services
received from non-network providers are
covered too, but reimbursed at a lesser
benefit level. (Also see Care Outside Service
Area section.)
Referrals and Prior Authorizations
Referrals are not necessary. Some services
require prior authorization—see a complete
list at weatruststatehealthplan.com or call
customer service at (800) 279-4000.
Care Outside Service Area
If you see a non-network provider,
WEA Trust will pay for covered services
at 70% of our maximum allowable fee,
subject to an annual deductible of $1,000
individual/$2,000 family. For emergency
and urgent care, use WEA Trust PPO East
Network providers
wherever possible.
Mental and Behavioral
Health Services
WEA Trust covers mental
and behavioral health
in the same manner as
other medical services.
No referrals are needed.
Dental Benefits (Contact Qualified Plan
plan for full details.)
Non-Qualified Plan
Preventive Services: See Glossary for definitions
Covered at 100%:
Exams, cleanings two times per year;
bite-wing X-rays; fluoride treatments and
sealants for dependent children.
Restorative Services: 80% coverage for
fillings, extractions and periodontal services.
50% coverage for crowns and onlays, but
does not include implant crowns.
Annual Benefit Maximum: $1,000 per
individual. No deductible.
Orthodontics: 50% coverage for
dependents up to age 19, with an individual
lifetime maximum of $1,500.
Dental network: Click Find a Dentist at
weatruststatehealthplan.com or call
customer service at (800) 279-4000. You
may see any dentist, but reimbursement for
non-network providers is limited by
WEA Trust’s maximum reimbursement
amount. Using non-network providers will
likely increase your out-of-pocket costs.
Health Risk Assessment Information at:
weatrust.com/rewards
Decision Guide Page 55