|Medicare Advantage Plan||Effective 01.01.23|
|Monthly Plan Premium||$331.11 per member per month1
You must continue to pay your Medicare Part B premium
|Deductible||$0 – There is no yearly deductible for medical services|
|Out-of-Pocket Responsibility||Your yearly limit(s) for this plan – $1,500|
|Covered Benefits||What You Pay|
|Inpatient Hospital Coverage2,3||$0 copay|
|Doctor’s office visits: Primary care physician and Specialist2,3||$0 copay|
|Preventive care||$0 copay|
|Urgently needed services||$0 copay|
|Lab services and X-ray||$0 copay|
|Value-Added Services||What You Pay|
|Routine chiropractic and acupuncture||$15 copay; up to 20 combined visits annually|
|Over-the-counter credits||$100 per quarter|
|Fitness program||$0 copay|
|Eyewear allowance||up to $200 every two years|
|1Individual subscriber premium only 2Services may require prior authorization 3Services may require a referral from your doctor|
Hard copies of WHA MyCare Select (HM0) plan documents are available by calling WHA Member Services at 888.WHA.PERS or by filling out the online request form.
Through WHA’s secure, member-only website, you will find a wealth of resources to help you make the most of your health plan’s benefits and services. Signing up is easy! To get started, follow the prompts at mywha.org/MyCareLogin. All it takes is some basic information along with a valid email address.
Once registered, you’ll be able access the details of your personal benefit information online, 24 hours a day, 7 days a week. Take advantage of these online tools:
If you need help finding a doctor or have questions about covered services, fill out the form below or call Western Health Advantage Member Services at 888.WHA.PERS (888.942.7377 toll-free; 711 TTY, available seven days a week, 7 a.m. to 8 p.m. Translation services and assistance are available.