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Wisconsin Department of Employee Trust Funds header image It's Your Choice 2019 Local Deductible Health Plan Insurance Program
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2019 It's Your Choice - Local Deductible Health Plan Insurance for Employees and Retirees
Wisconsin Department Of Employee Trust Funds It's Your Choice 2019


Local Deductible Plan
Insurance for Employees
and Retirees
(PO4, PO14)


Local Access Plan

Administered by WEA Trust
1-866-485-0630
weatruststatehealthplan.com

Open Enrollment October 1 - 26, 2018

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 2019.

What’s New for 2019

WEA Trust will be offering two enhanced care programs for Local Access Plan members in 2019. The first program—aimed at one of life’s most common ailments—offers a new way to manage low back pain. The WEA Trust Low Back Pain Program, powered by Kiio™, is a scientifically-backed, individualized program. This free program, which uses a mobile app on your smartphone or tablet, takes you through exercise routines created by experts in spine physical therapy for your specific type of low back pain.  The exercise programs use clinically proven methods to improve low back pain and keep you on the go.

Local Access Plan members with Type 1 or Type 2 diabetes will have access to our Livongo for Diabetes™ program. This cutting-edge program includes a smart touchscreen glucose meter, instant transmission of your data and support from Certified Diabetes Educators when you need it. It combines technology and trained staff to help you better manage your disease.

General Information

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.

Provider Directory

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.

Out-of-Network Care

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.

Service Area

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.

24-Hour Nurseline

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.

Disclaimer:
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: 9/7/2018 11:15:36 AM