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Basic Plan Benefits

 

Western Health Advantage (HMO)

2022 Basic Plan Highlights
Your Benefits Your Cost
Hospital (inpatient and outpatient) No cost1
Office visits (primary care physicians and specialist) $15 per visit
Diagnostic x-ray and laboratory services No cost
Ambulance No cost
Urgent Care Virtual Visit/Urgent Care Center $15/$15 per visit
Emergency room $50 per visit2
Chiropractic $15 per visit3
Acupuncture $15 per visit3

1Except for $15/visit for physical, occupational, and speech therapy performed on an outpatient basis. 2Waived if hospitalized as an inpatient or for observation as an outpatient. 3Up to 20 combined visits in a calendar year.

 Annual Out of Pocket  Maximum
Individual $1,500 Family $3,000

 


2022 Basic Plan Rates: Region 1

Posted rates do not reflect employer contribution amounts.

State Employees and Retired Annuitants Monthly Rates
Single 2-Party Family
$741.26 $1,482.52 $1,927.28
 
Contracting Agency Employees and Retired Annuitants Monthly Rates
Single 2-Party Family
$741.26 $1,482.52 $1,927.28

 

 

Open Enrollment Booklet

Open Enrollment Booklet

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