Description

The State Maintenance Plan, or SMP, is a health plan that offers Uniform Benefits . SMP is designed to provide a health plan option for members who live or work in areas without adequate access to in-network providers or hospitals.

What’s New for 2020

SMP will only be offered in Forest County for 2020.

WEA Trust will continue to pilot programs for SMP members in 2020.

  • Low back pain program: If you are among the 80% of people who will experience low back pain at some point in your life, our program powered by Kiio™ could help you. The program uses a mobile app to guide you through exercise routines personalized for your specific pain. More information at WEAtrust.com/LowBackPain.
  • Innovative diabetes program: WEA Trust members with Type 1 or Type 2 diabetes will have access to our Livongo for Diabetes™ program. Livongo combines innovative technology and trained staff to help you better manage your disease. This cutting-edge program includes a smart touchscreen glucose meter with real time feedback, unlimited test strips mailed directly to your home and 24/7 support from a Certified Diabetes Educator. More information at WEATrust.com/Livongo

Provider Directory

Go to weatruststatehealthplan.com/providers to search for providers or to access a SMP directory. To request a printed directory be mailed to you, call 1-866-485-0630.

Referrals, Authorizations, Out-of-Network

You must get a referral approved by WEA Trust before getting care outside the WEA Trust SMP network. Your provider must request the referral. It is ultimately the member ’s responsibility to make sure the referral is submitted and approved prior to receiving services.

Prior authorization is required for certain services and procedures before you receive care. Without an approved prior authorization, WEA Trust may deny payment. A list of services requiring preauthorization can be found at weatrust.com/members/preauthorization-information. You will receive notification of the approval or denial for the prior authorization.

Out-of-Network Care

WEA Trust will reimburse for covered services at 50% of our maximum allowable fee, subject to a $5,000 individual, $10,000 family deductible .

Emergency and Urgent Care

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

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. A list of services requiring preauthorization can be found at weatrust.com/members/preauthorization-information. For other services, contact 1-866-485-0630. Review the Uniform Benefits certificate for details.

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.

Virtual Visits

What if health care was as convenient as Amazon Prime? Or as easy as Netflix? With WEA Trust’s telehealth service, powered by Amwell, health care is delivered to you, on your terms.

Use Amwell to have a video visit with a doctor or therapist on your smartphone, tablet, or computer. Providers on Amwell treat, diagnose and even prescribe—helping you feel better faster. You’ll get quality care from your own home, for a more affordable price than in-person visits.

Visit weatrust.com/amwell or call 1-800-SEE-DOCS for more information or to get started.

Care Outside the Service Area

SMP, offered by WEA Trust, will reimburse for covered services at 50% of our maximum allowable fee, subject to a $5,000 individual, $10,000 family deductible .

Major Health Systems

Available in select counties. See provider directory.

Full Service Areas

Forest County

Limited Service Areas

Minnesota, Michigan
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