How does a deductible health plan work?

Your deductible is the total amount you will pay annually for certain covered medical and prescription services and supplies before WHA will cover expenses.

Copayments are typically smaller dollar amounts or percentages. Some plans will always have you pay a copayment for a service while other plans only require one once you reach your annual deductible.

Once your deductible and copayment costs reach your annual out-of-pocket (or OOP) maximum, you are done paying for expenses. WHA will cover 100 percent of your covered services for the remainder of the calendar year.

Here's a quick look at two different deductible plans:

  Deductible Plan A Deductible Plan B
Deductible  $2,000 Individual $5,000 Individual
OOP Maximum  $6,250 Individual $6,250 Individual
Preventive Care  covered in full covered in full
Office Visit  $45 visit $60 per visit after deductible is met

 


Top 3 things to know when you are on a deductible health plan:
 

1.

Preventive care is no-cost. 

Preventive health care services such as your annual wellness visit and immunizations are FREE. Remember: It’s unwise to avoid the doctor when you have a problem. If an urgent care situation arises while you’re in WHA’s service area, call your primary care physician. Delaying care could cost you substantially more.


wellness exam

2.

Estimate your medical service costs.

Knowing the cost of a service or procedure in advance can help you better plan your health care expenses. When your doctor determines that you need a medical service or procedure, ask for the current procedural terminology (CPT) or revenue code associated with this service. Utilize WHA's Service Cost Estimatortool to estimate the cost of this service.


Estimate medical costs

3.

Track your deductible and OOP.

WHA provides members an accumulator tool.  This tool is very helpful resource to members on a deductible plan as it allows you to verify that the amount you are being billed by your provider was properly applied to your deductible. In addition, it tracks your annual OOP maximum. Once your deductible and OOP have been met, you are no responsible for medical expenses for the remainder of the calendar year.

Using the accumulator

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