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Non-Medicare Plans - Summary of Benefits


                       
WSHIP’s non-Medicare plans are currently CLOSED to NEW enrollment


Effective January 1, 2014, only individuals enrolled in a WSHIP non-Medicare plan prior to December 31, 2013 and individuals residing in a county where an individual plan (other than a catastrophic plan) is not offered during defined open enrollment or special enrollment periods will be eligible for WSHIP non-Medicare plans.  Individual coverage is currently available in all counties, therefore, WSHIP’s non-Medicare plans are closed to new enrollment. 


 

Click on the desired plan below to view the Summary of Benefits for that plan. 

Preferred Provider Plans
Preferred Provider Plan is a comprehensive plan that pays 80% of allowable charges for covered medical services provided by network providers; 60% when services are provided by non-network providers. You pay an annual deductible of $500, $1,000, $2,500 or $5,000, and  specified copays for generic, preferred brand, and nonpreferred covered medications. Separate medical and prescription drugs annual out-of-pocket expense limits also apply.

HSA Qualified Preferred Provider Plan is a high deductible health plan (HDHP) that can be used with a federally qualified Health Savings Account (HSA). It is the same plan as our Preferred Provider Plan (pays 80% for network providers, 60% for non-network providers) except that it has a combined medical and prescription drug $3,000 deductible, and 20% coinsurance for all covered medications.  Annual out-of-pocket expense limits also apply.

Limited Preferred Provider Plan A is a less comprehensive plan that pays 80% of allowable charges for covered medical services provided by network providers; 60% when services are provided by non-network providers.  You pay an annual deductible of $1,500, and specified copays for generic, preferred brand, and nonpreferred covered medications.  This plan pays a maximum of $3,000 for prescription drugs per calendar year.  Separate medical and prescription drugs annual out-of-pocket expense limits also apply.

Standard Plan
Standard Plan is a plan that provides the same level of benefits (80%) for covered medical services provided by network and non-network providers.  You pay an annual deductible of $500, $1,000 or $1,500, and specified copays for generic, preferred brand, and nonpreferred covered medications. Separate medical and prescription drugs annual out-of-pocket expense limits also apply.