No matter which plan design option you choose, the in-network coverage is the same (Uniform Benefits). The plan designs generally differ in monthly premiums, cost-sharing and whether or not there is out-of-network coverage. The Health Plan and High Deductible Health Plan (HDHP) plan designs only cover out-of-network benefits for emergency and urgent care services. Choose a plan design that fits best with your situation.

The Comparison of Medical Benefits table below shows the breakdown of your costs by plan design. This is not a complete list of covered services—see the Certificate of Coverage for detailed information.

Note: Prescription drug (Rx) coverage is included with your health insurance coverage. See the Comparison of Pharmacy Benefits chart for more information on differences in cost-sharing by plan design.

Plan Design Options

Health Plan Design Access Plan HDHP Design Access HDHP
Monthly Premiums

(does not include crafts workers or employees paying less than half-time rates)

Employees covered by WRS

With Dental:

$88 Individual

$219 Family

Without Dental:

$85 Individual

$211 Family

Graduate/Short-Term Academic Staff

With Dental:

$45.50 Individual

$113.50 Family

Without Dental:

$42.50 Individual

$105.50 Family

Employees covered by WRS

With Dental:

$266 Individual

$664 Family

Without Dental:

$263 Individual

$656 Family

Graduate/Short-Term Academic Staff

With Dental:

$134.50 Individual

$336 Family

Without Dental:

$131.50 Individual

$328 Family

Employees covered by WRS

With Dental:

$33 Individual

$82 Family

Without Dental:

$30 Individual

$74 Family

Graduate/Short-Term Academic Staff

Not eligible

Employees covered by WRS

With Dental:

$211 Individual

$527 Family

Without Dental:

$208 Individual

$519 Family

Graduate/Short-Term Academic Staff

Not eligible

Cost Per Visit

(See Breakdown of Costs by Plan Design below)

$$$$ $$$$ $$$$ $$$$
Health Insurance Plan Carrier See Health Plan Map Administered by WEA Trust See Health Plan Map Administered by WEA Trust
Statewide / Nationwide Access

All plans include nationwide pharmacy coverage; visit www.navitus.com for in-network pharmacies

Local, county-based coverage area.

See Health Plan Map for more details.

Yes Local, county-based coverage area.

See Health Plan Map for more details.

Yes
Out-of-Network Benefits Emergency and urgent care only. Yes Emergency and urgent care only. Yes
Health Savings Account (HSA) Required Not allowed with this plan design. Not allowed with this plan design Yes- Employer may contribute $. Yes- Employer may contribute $.

Breakdown of Your Costs by Plan Design

Health Plan Design

Access Plan

(In-Network)

Access Plan

(Out-of-Network)

HDHP Design

Access HDHP

(In-Network)

Access HDHP

(Out-of-Network)

Annual Medical Deductible

Counts toward out-of-pocket limit (OOPL)

$250 individual / $500 family

Medical deductible does not apply to office visit copays, preventive services or prescription drugs.

After an individual within a family plan meets the $250 deductible, benefits apply as described below.

 

$500 individual / $1,000 family

Medical deductible does not apply to office visit copays, preventive services or prescription drugs.

After an individual within a family plan meets the $500 deductible, benefits apply as described below.

$1,500 individual / $3,000 family

Must be met before coverage begins; for family coverage, the full family deductible must be met.

Combined medical and Rx.

$2,000 individual / $4,000 family

Must be met before coverage begins; for family coverage, the full family deductible must be met.

Combined medical and Rx.

Primary Care Physician (PCP) Office Visit

Additional services such as lab work, X-rays, etc., count toward deductible and coinsurance.

Includes:
Internist
General Physician
Family Practitioner
Pediatrician
Gynecologist / Obstetrician
Nurse Practitioner
Physician Assistant
Chiropractor
Physical / Occupational / Speech Therapy in an office visit setting

$15 copay per visit up to OOPL

Does not count toward deductible.

After deductible:

You pay 30% coinsurance up to OOPL.

After deductible:

$15 copay per visit up to OOPL.

After deductible:

You pay 30% coinsurance up to OOPL.

Specialty Office Visit

Additional services such as lab work, X-rays, etc., subject to deductible and coinsurance

Includes:
Specialty Providers
Urgent Care
Vision Exam in an office visit setting.

$25 copay per visit up to OOPL

Does not count toward deductible.

After deductible:

You pay 30% coinsurance up to OOPL.

After deductible:

$25 copay per visit up to OOPL.

After deductible:

You pay 30% coinsurance up to OOPL.

Annual Medical Coinsurance

Applies to medical services except for office visit or emergency room copays and preventive services

After deductible:

You pay 10% coinsurance up to OOPL.

After deductible:

You pay 30% coinsurance up to OOPL.

After deductible:

You pay 10% coinsurance up to OOPL.

After deductible:

You pay 30% coinsurance up to OOPL.

Preventive Services

For additional information see: healthcare.gov/preventive-care-benefits

Plan pays 100% Plan pays 100% Plan pays 100% Plan pays 100%
 Transplants

Heart, liver, kidney with pancreas, heart with lung, lung

After deductible:

You pay 10% coinsurance up to OOPL.

After deductible:

You pay 30% coinsurance cost up to OOPL.

After deductible:

You pay 10% coinsurance up to OOPL

After deductible:

You pay 30% coinsurance up to OOPL.

Mental Health/Alcohol & Drug Abuse

Paid until OOPL is met

Additional services such as lab work, assessments, etc., are subject to deductible and coinsurance

Outpatient services: $15 copay per visit

Inpatient & covered transitional services: After deductible, you pay 10% coinsurance up to OOPL.

After deductible:

You pay 30% coinsurance up to OOPL.

After deductible:

Outpatient services: $15 copay per visit

Inpatient & covered transitional services: After deductible, you pay 10% coinsurance up to OOPL.

After deductible:

You pay 30% coinsurance up to OOPL.

Emergency Room

Copay waived if admitted as an inpatient directly from the emergency room or for observation for 24 hours or longer

$75 copay per visit

Copay counts toward deductible.

Deductible and coinsurance applies to services beyond the copay up to the OOPL.

$75 copay per visit

Counts toward in-network deductible.

In-network deductible and coinsurance applies to services beyond the copay up to the OOPL.

After deductible:

$75 copay per visit

Copay counts toward deductible.

Coinsurance applies to services beyond the copay up to the OOPL.

After in-network deductible:

$75 copay per visit

Copay counts toward deductible.

In-network deductible and coinsurance applies to services beyond the copay up to the OOPL.

Annual Medical Out-of-Pocket Limit (OOPL)

 

$1,250 individual / $2,500 family

(separate OOPL for prescription drugs)

$2,000 individual / $4,000 family

(separate OOPL for prescription drugs)

$2,500 individual / $5,000 family

(medical and prescription drug expenses count toward OOPL)

For family coverage, you must meet the full family OOPL before your plan pays 100%.

$3,800 individual / $7,600 family

(medical and prescription drug expenses count toward OOPL).

For family coverage, you must meet the full family OOPL before your plan pays 100%.

last updated: 10/03/2018