Overall Performance Rating
Local Access Plan
Administered by WEA Trust
Open Enrollment October 2 - 27, 2017
If you are currently enrolled in the Local Access Plan and do not wish to change plans during open enrollment, you will automatically be enrolled in Local Access Plan for 2018.
What’s New for 2018
- WEA Trust is the new administrator of the Local Access Plan. If you are currently enrolled in the Local Access Plan and take no action to change health plans during It’s Your Choice, you will be automatically enrolled with WEA Trust and will receive new ID cards in the mail prior to January 1, 2018.
- Benefits are changing. For a quick summary, see the Comparison of Benefit Options. Highlights are summarized below:
- The medical In-Network coinsurance and out-of-pocket limit (OOPL) is eliminated for most services, except for durable medical equipment, certain hearing aids and cochlear implants.
The prescription drug Level 1 & 2 OOPL is lowering to $600 individual / $1,200 family from $1,000 individual / $2,000 family.
- The Emergency room copay has lowered to $60 from $75.
- Durable medical equipment (DME) In-Network coinsurance is remaining at 20% to be paid by the member. DME will accumulate to a $500 individual medical OOPL.
- Newly covered:
- Organ transplant coverage has expanded to include heart, liver, kidney with pancreas, heart with lung and lung.
- Adult hearing aids and cochlear implants
- Vision exams
- Smoking cessation
- No longer covered
- Surgical treatment of obesity
- Certain oral surgery procedures
- Genetic testing or counseling unless medically necessary to diagnose or treat an existing illness
- Clinical trials unless mandated by law
- There are some In-Network provider changes in Wisconsin and nationwide. For more detail, visit the Provider Directory via the link below.
- Primary Care Physician (PCP) selection is required. You and your family members must select a PCP for your care. If you don’t, WEA Trust will assign one to you, notify you in writing, and inform you how to change this PCP selection. Contact WEA Trust for more information.
- WEA Trust’s Amwell telehealth service is expanding with the addition of online therapy services. Since 2015, thousands of WEA Trust members have used Amwell for on-demand video doctor visits. Now you can also use Amwell to schedule an appointment with a highly trained therapist or psychologist. And instead of waiting weeks or months to see someone, Amwell therapists are available within a week, and sometimes even the same day. Scheduled therapy visits on Amwell are:
- 45-minute, video-based appointments on your smartphone, tablet, or computer
- With licensed and specially-trained therapists or psychologists
- Available seven days a week, from 7 a.m. to 11 p.m.
- An alternative to in-person behavioral health visits
The Local Access Plan (formerly Standard Plan) is a comprehensive Preferred Provider Organization (PPO) that provides you with freedom of choice among health systems and providers both statewide and nationwide. Lower out-of-pocket costs are available by using preferred or in-network providers, which are available nationwide. See the Comparison of Benefit Options online for more details and the Certificate of Coverage for complete information.
Go to weatruststatehealthplan.com/providers to search for providers or to access a directory. To request a printed directory be mailed to you, call 1-866-485-0630.
Referrals, Prior Authorizations
Prior authorization is required for certain services and procedures before you receive care. A list of services requiring preauthorization can be found at weatrust.com/preauthorization. You will receive notification of the approval or denial for the prior authorization.
Prior authorization is required for low back surgery and high-tech radiology services.
The Local Access Plan, offered by WEA Trust, will reimburse for covered services at 70% of our maximum allowable fee, subject to a $1,000 individual, $2,000 family deductible with a $4,000 individual, $8,000 family out-of-pocket limit.
The Local Access Plan offers health systems and providers both statewide and nationwide.
Emergency and Urgent Care Outside Service Area
If you require emergency or urgent care when outside of the network, seek care at the nearest medical facility. Contact 1-866-485-0630 or your primary care physician if assistance is needed to determine the appropriate level of care. Follow-up care must be performed by a network provider to receive network benefits.
Mental, Behavioral Health and Substance Abuse Services
No prior authorization is required for outpatient services from a network provider, except for psychiatric and neuropsychiatric testing. Prior authorization is required for in-patient and transitional care. For other services, contact 1-866-485-0630.
WEA Trust contracts with a variety of health care provider systems that offer their own nurselines. A list of those nurselines can be found at weatruststatehealthplan.com/nurseline.
Every effort has been made to ensure that this information is accurate, but may be subject to change. Please note revision dates located at the bottom of each page. In the event of conflicting information, federal law, state statute, state health contracts and/or policies and provisions established by the State of Wisconsin Group Insurance Board shall be followed.
This page was last modified on: 11/1/2017 3:00:02 PM