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

WEA Trust PPO – Northwest
(800) 279-4000 or (608) 276-4000
weatruststatehealthplan.com
Not Available
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, Clark County joins the WEA Trust PPO
Northwest Network, which now totals 19
counties.
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 Northwest is Unique
WEA Trust PPO Northwest 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 reimburse 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 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 plan for full
details.)
Qualified Plan
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:
weatrust.com/rewards
Decision Guide Page 56