Western Health Advantage Bay Area Expansion Rates, Guidelines, Networks.
2018 New WHA Provider Networks
Western Health Advantage (WHA) is now available in the Bay Area for large and small group employers. Our partnership with Canopy Health, co-founded by John Muir Health and UCSF, provides access to providers who are some of the most skilled and respected in the United States, and the numerous renowned hospitals and care centers at which they practice have long been recognized for their medical excellence, advanced technology, and compassionate care.
WHA now serves 13 Northern California counties and provides access to 25 hospitals and major medical centers and 5,800 doctors for commercial group business through WHA’s Network A.
Individual plan enrollees as well as employers who participate with WHA within Covered California for Small Business (CCSB)* will remain with WHA’s existing service area and providers through WHA’s Network B.
*Groups who currently participate in CCSB will only have WHA plans available to them until their renewal due to our non-certification request for 2018.
Provider Search
There will be a complete refresh of our provider search tool at choosewha.com/directory. Any public search will begin with a brief questionnaire to direct the user to the appropriate network. Our refresh incorporates changes to be compliant with all provisions of SB-137. Please note that Canopy Health PCPs will be loaded initially with specialists shortly thereafter.
As you know, UC Davis Health terminated their agreement with WHA effective 2018. WHA’s Sacramento-Solano network remains strong with providers available through Hill Physicians, Mercy Medical Group, Woodland Clinic, and NorthBay Healthcare. Members who currently have a UC Davis PCP will have until December 15 to change their doctor or they will be auto-assigned to a new provider. Please review or distribute as necessary our Changing Your PCP flyer which includes dedicated transition lines for each of our medical groups.
Plan Changes for 2018
The only large group plan slated for changes next year is the Western 1800/0 HDHP HMO. To maintain HSA compatibility under the IRS rules, we need to increase the deductible amount for an Individual with Family coverage (from $2,600 currently to $2,700). This change will go into effect upon the group’s renewal.
Small Group: including Regions 4 and 8 – San Francisco and San Mateo; 5 – Contra Costa; 6 – Alameda
Here is a summary of the changes that will go in effect upon the group’s renewal:
- Premium calculation for dependents – the rate bands have changed and ages 14-21 will experience a rate change every year; a family will be charged for the three oldest children under 21.
- Plan names may have changed – most specifically, we’ve added the metal tier, actuarial value, plan type and incorporated the reference to use Capital to identify plans similar to those offered on the state exchange.
- Some plans have minor copayment and out of pocket amount changes (even with lower amounts!) or changes to the deductible. These changes are in response to maintaining either the actuarial value of the metal tier or HSA compatibility with the IRS rules.
- Gateway 5200 Bronze 60 HDHP HMO – to simplify benefits and make this plan more attractive to the market, we are changing the office visit from a 30% copayment to a flat $30 per visit.
- Chiropractic services – we have added our standard chiropractic benefit to a couple of our mirror HDHPs, the Capital 2000 Silver 70 HDHP HMO and Capital 4800 Bronze 60 HDHP HMO. We are pleased to state that chiropractic and acupuncture services with Landmark Healthcare are now included with all WHA standard plans.
- Optional Rider for Adult Dental – we experienced a premium decrease for our adult dental rider with DeltaCare DHMO.
Other enhancements on all plans:
Active&Fit Direct™ > WHA has teamed up with several fitness centers to make exercise convenient. With over 8,000 fitness centers, members can enjoy working out at any fitness center in the Active & Fit Direct network for a $25 enrollment + $25/month. Interested members can learn more by visiting mywha.org/gyms.
Smart90® with Express Scripts® > WHA is delivering more choices for 90-day fills of maintenance medications. WHA members are now able to request a three-month supply of retail maintenance drugs at a Walgreens pharmacy. Members need a prescription with at least a three-month refill indicated. Note: The Smart90 program applies only to Walgreens and does not apply to specialty drugs. Members may also continue to obtain their maintenance medications through our mail order program.
$0 cost, high-value drugs > In response to the high cost of some drugs, WHA has made certain non-preventive drugs – that are equally or more effective than their high cost alternatives – available to our member at no cost (after deductible, if applicable). WHA members with prescription coverage will have no copayment for these medications at the pharmacy or with their mail order fill.