Effective January 1, 2020, Western Health Advantage will no longer offer access to John Muir Health, UC San Francisco, Santa Clara County IPA or Canopy Health affiliated hospitals in San Francisco, San Mateo, Santa Clara, Alameda, and Contra Costa counties.
What counties are in WHA's 2020 service area?
Effective January 1, 2020, Western Health Advantage's service area will include the following counties:
- El Dorado (partial coverage)
- Placer (partial coverage)
What hospitals are in WHA's 2020 network?
Effective January 1, 2020, Western Health Advantage's provider network will include the following hospitals:
North Bay Area
Am I still eligible for WHA coverage?
I am covered through my employer
To remain a member of WHA, subscribers and dependents must live or work within the WHA service area, meaning that either the primary workplace or primary residence is within the WHA service area. If a subscriber or dependent no longer lives or works in the WHA service area, they are no longer eligible for coverage. Log into your MyWHA account to see your Evidence of Coverage and Disclosure Form (EOC/DF) for complete details.
I am covered through CoveredCA or direct with WHA
To remain a member of WHA, subscribers and dependents must live within the WHA Service Area, meaning that the primary residence is within the WHA service area. Log into your MyWHA account to see your Evidence of Coverage and Disclosure Form (EOC/DF) for complete details.
What if my primary care physician (PCP) is affiliated with Canopy Health?
You can continue to see your current Canopy Health PCP through December 31, 2019.
If you remain eligible for coverage with WHA, you will be required to select a new PCP before the end of the year. To ensure an easy transition, we encourage you to choose your new PCP prior to November 30, 2019. If you do not select a new PCP by November 30, WHA will assign one for you.
There are two convenient ways that you can choose a new PCP:
- Change your doctor online through your personal MyWHA account
- Change your doctor over the phone by calling WHA Member Services at 888.563.2250
As always, you can change your PCP at any time. The effective date of your new PCP can be as early as the first day of the month following the date you provided notification. You can also change your PCP up to 60 days in advance, meaning that on November 1, 2019 you can choose a new PCP for January 1, 2020. You must wait until the effective date before seeking care from your new PCP, or the services may not be covered.
Once you’ve selected your new PCP, we recommend that you schedule a new patient appointment to discuss any health issues you’re experiencing, questions or concerns you have and medications you’re currently taking. Your new PCP will coordinate, as necessary, new prescriptions and referrals to participating specialists.
What if I am currently undergoing treatment from a specialist who is affiliated with Canopy Health?
I remain eligible for coverage with WHA after January 1, 2020
If you are currently seeing a Canopy Health specialist, you may qualify for Continuity of Care (CoC) until it is safe to move to a specialist in your new medical group. Typically, CoC is for an acute condition, a serious chronic condition, a pregnancy, a terminal illness, care of a newborn, and performance of previously approved surgery. To learn if you're eligible for continuity of care, contact WHA Member Services.
My coverage with WHA will terminate on January 1, 2020
If you are currently undergoing an active course of treatment for certain medical conditions, you may be eligible for continuity of care with your WHA provider under your new health plan. Contact your new health plan to find out if you qualify and how to apply.
I’m taking medications prescribed by a Canopy Health provider. What happens when I change PCPs?
You and your new PCP will discuss, at your new patient appointment, any health issues you’re experiencing, questions or concerns you have and medications you’re currently taking. Your new PCP will coordinate the replacement of needed prescriptions. To ensure you don’t run out of your medications before you have your new prescriptions, make sure to:
- Refill any current prescriptions before your PCP changes
- Take advantage of a 90-day supply of maintenance medications through ESI’s mail order program
- Schedule your new patient appointment
Note: If your current prescription still has refills, and is not greater than one (1) year old, your refills are still valid.
How do I obtain my medical records?
It's a good idea to bring a copy of your medical records to your new patient appointment with your new PCP.
To request copies of your medical records, you will need to contact your PCP's office. Tip: You can use your MyWHA mobile app to easily locate the number of your PCP's office.