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.

Western Health Advantage Bronze HMO A

Network	Full
Calendar Year Deductible*	$6,300 / $12,600^{1, 7} (applies to Max OOP)
Out-of-Pocket Max Ind/Fam	$7,000 / $14,000^{2, 7}
Dr. Office Visit (PCP)	$75 Copay⁹
Urgent Care	$75 Copay¹
Emergency Room (copay waived if admitted)	100%^{1, 11}

* All services are subject to the deductible unless otherwise stated.
1. Medical or prescription services may be subject to a deductible. The member must pay for these services when services are rendered until the deductible is met in that calendar year. Charges under the deductible are based on WHA’s contracted rates with the provider of service.
2. 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 family
amount 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.

Western Health Advantage Silver HMO A

Network	Full
Calendar Year Deductible*	$2,000 / $4,000^{1, 13} (applies to Max OOP)
Out-of-Pocket Max Ind/Fam	$7,000 / $14,000^{2, 13}
Dr. Office Visit (PCP)	$50 Copay (ded waived)
Urgent Care	$100 Copay¹
Emergency Room (copay waived if admitted)	80%^{1, 4}

* All services are subject to the deductible unless otherwise stated.
1. Medical or prescription services may be subject to a deductible. The member must pay for these services when services are rendered until the deductible is met in that calendar year. Charges under the deductible are based on WHA’s contracted rates with the provider of service.
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.
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.

Western Health Advantage 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 (copay waived if admitted)	$300 Copay

* All services are subject to the deductible unless otherwise stated.
1. Medical or prescription services may be subject to a deductible. The member must pay for these services when services are rendered until the deductible is met in that calendar year. Charges under the deductible are based on WHA’s contracted rates with the provider of service.

Western Health Advantage Platinum HMO A

Network	Full
Calendar Year Deductible*	None
Out-of-Pocket Max Ind/Fam	$4,000 / $8,000¹
Dr. Office Visit (PCP)	$25 Copay
Urgent Care	$50 Copay
Emergency Room (copay waived if admitted)	$150 Copay

* All services are subject to the deductible unless otherwise stated.
1. The annual out-of-pocket maximum is the total amount the member must pay for certain services in a calendar year.

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