Western Health Advantage
Group Health Plans
About Western Health Advantage
Western Health Advantage has a passion for health care. The organization is committed to delivering quality care to employers and employees, while supporting medical innovation and promoting improved health to suit the diverse needs of Northern California. For more than 20 years, Western Health Advantage has been a reliable partner to businesses and employees – helping thousands of Californians stay healthy and establish a long-term relationship of trust with their physicians.
Consistently recognized for delivering member value, Western Health Advantage has a provider network that includes major hospitals and medical centers and thousands of doctors and specialists in its 14 county service area: Alameda, Colusa, Contra Costa, El Dorado, Marin, Napa, Placer, Sacramento, San Francisco, San Mateo, Santa Clara, Solano, Sonoma, and Yolo counties.
Quick Plan Highlights
Here are some of our most popular Western Health Advantage health plans along with a high level snapshot of plan coverage and out-of-pocket costs. To view a complete list of Western Health Advantage coverage options, click Download All Plans below to see the most current plan information.
These plans are effective as of: 1/1/19
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Bronze HMO B
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Silver HMO A
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Gold HMO A
Network Full Calendar Year Deductible None Out-of-Pocket Max Ind/Fam: $6,750 / $13,5001 Dr. Office Visit (PCP): $40 Copay Urgent Care: $100 Copay Emergency Room $300 Copay -
Platinum HMO A
Network Full Calendar Year Deductible None Out-of-Pocket Max Ind/Fam: $4,000 / $8,0005 Dr. Office Visit (PCP): $25 Copay Urgent Care: $50 Copay Emergency Room $150 Copay
Gold HMO A
| Network | Full | |
|---|---|---|
| Calendar Year Deductible | None | |
| Out-of-Pocket Max Ind/Fam: | $6,750 / $13,5001 | |
| Dr. Office Visit (PCP): | $40 Copay | |
| Urgent Care: | $100 Copay | |
| Emergency Room | $300 Copay |
Platinum HMO A
| Network | Full |
|---|---|
| Calendar Year Deductible | None |
| Out-of-Pocket Max Ind/Fam: | $4,000 / $8,0005 |
| Dr. Office Visit (PCP): | $25 Copay |
| Urgent Care: | $50 Copay |
| Emergency Room | $150 Copay |
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Footnotes
1) The annual out-of-pocket maximum is the total amount the member must pay for certain services in a calender year.
2) The annual out-of-pocket maximum is the total amount the member must pay for certain services in a calendar year.
4) Percentage co-payment amounts are based on WHA’s contracted rates with the provider of service.
5) The annual out-of-pocket maximum is the total amount the member must pay for certain services in a calendar year.
7) The deductible and annual out-of-pocket maximum amounts are embedded, i.e. each member in the family must meet the individual amount or the family must meet the familyamount before benefits will apply for that member.
9) Deductible waived for first three non-preventive care visits.
11) Covered in full after out-of-pocket maximum is met.
13) The deductible and annual out-of-pocket maximum amounts are embedded, i.e. each member in the family must meet the individual amount or the family must meet the family amount before benefits will apply for that member.
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