2023 Basic Plan Benefits

 

Western Health Advantage (HMO)

2023 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

 

Evidence of Coverage and Benefits Matrix

Evidence of Coverage & Benefits Matrix

Summary of Benefits and Coverage

Summary of Benefits & Coverage

2023 Basic Plan Rates: Region 1

Posted rates do not reflect employer contribution amounts.

State Employees and Retired Annuitants Monthly Rates
Single 2-Party Family
$760.17 $1,520.34 $1,976.44
 
Contracting Agency Employees and Retired Annuitants Monthly Rates
Single 2-Party Family
$760.17 $1,520.34 $1,976.44

 

 

Open Enrollment Booklet

Open Enrollment Booklet

Health Plan Basics

 

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Update Monday July 22: A widespread computer software outage continues to impact systems across the globe. Health care services in Northern California may be experiencing some disruption. WHA encourages members to call ahead to your provider if you have an appointment scheduled this week.