Summary of Coverage

WSHIP NON-MEDICARE PLAN OPTIONS

Click on the desired plan below to view the summary of coverage for that plan.

WSHIP offers five comprehensive non-Medicare plans for new enrollees (each with a pharmacy benefit). Each plan has one or more choices of deductible, coinsurance, drug copays and out-of-pocket maximums.

Standard Plan is a plan where you can see any doctor you choose while paying a fixed percentage of medical charges in addition to an annual deductible of $500, $1,000 or $1,500. Your out-of-pocket costs may be lower if you receive services from a provider who is part of the First Choice Health Network. This plan is not available to Medicare eligible enrollees.

Preferred Provider Plan. This plan gives you the option of choosing any provider but pays a higher percentage of allowed charges if you choose a provider who is part of the First Choice Health Network. You pay a fixed percentage of medical charges depending on whether you receive services from a network or non-network provider in addition to an annual deductible of $500, $1,000, $2,500 or $5,000. This plan is not available to Medicare eligible enrollees.

HSA Qualified Preferred Provider Plan is a high deductible health plan (HDHP) that can be used with a federally qualified Health Savings Account (HSA). You have the option of choosing any provider but the plan pays a higher percentage of allowed charges if you choose a provider who is part of the First Choice Health Network. You pay a fixed percentage of medical charges depending on whether you receive services from a network or non-network provider. The plan has a combined Medical and Prescription Drug $3,000 deductible. Enrollees must not be eligible for Medicare coverage.

Limited Preferred Provider Plan A allows the option of choosing any provider but pays a higher percentage of allowed charges if you choose a provider who is part of the First Choice Health Network. You pay a fixed percentage of medical charges depending on whether you receive services from a network or non-network provider. The plan has only one deductible, $1,500. The maximum benefit paid per calendar year for prescription drugs is $3,000. Reduced benefits on this plan help to reduce premium cost. Enrollees must not be eligible for Medicare coverage.

Limited Preferred Provider Plan B has no maternity coverage. It allows the option of choosing any provider but pays a higher percentage of allowed charges if you choose a provider who is part of the First Choice Health Network. You pay a fixed percentage of medical charges depending on whether you receive services from a network or non-network provider. The plan has only one deductible, $1,500. The maximum benefit paid per calendar year for prescription drugs is $2,000. Reduced benefits on this plan help to reduce premium cost. Enrollees must not be eligible for Medicare coverage.

Check with your medical providers for their participation in the First Choice Network or call First Choice at 1.800.231.6935, press option 3, to verify if your health care provider participates in the network. You can also review the First Choice Provider network on this website.

(NON-MEDICARE COMPARISON CHART)

WSHIP MEDICARE PLAN OPTIONS

Basic Plan is a Medicare eligible plan open to new enrollment and is for persons enrolled in Medicare Part A and Part B. WSHIP pays as secondary insurance and covers patient responsibility for eligible expenses.

Basic Plus Plan is closed to new enrollment.

PLAN 2 is closed to new enrollment. (Plan 2 has been discontinued as of December 31st, 2007 .)

Pharmacy Benefits - Medco Health prescription drug network. The pharmacy network, a benefit under all plans, gives you access to a nationwide network of pharmacies. By using the pharmacy network you will benefit from negotiated discounts on prescription drugs (upon presentation of your prescription identification card). All drugs, supplies, medicines and pharmacy services must be obtained at a network pharmacy, except for the following: (a) drugs dispensed by an emergency care provider when related emergency care services are covered under the WSHIP policy; (b) a network pharmacy is not available within a 30-mile radius of your home or network provider's office; or (c) antigen and allergy vaccine. Pharmacy services are not subject to the annual deductible, instead they require a per prescription copayment. The pharmacy benefit has an out-of-pocket expense limit separate from the medical out-of-pocket expense limit.