Western Health Advantage (WHA) is a regional HMO (Health Maintenance Organization) serving Sacramento, Placer, El Dorado, Yolo, Solano, Marin, Napa and Sonoma counties.
How the plan works
- You choose a primary care physician (PCP) who coordinates your care and refers you to specialists when medically necessary.
- You pay a copayment for medical services and prescription drugs.
- To obtain covered services, you must see a contracted provider. You must have prior authorization from your PCP to see a specialist. Members can self-refer within the network for their annual eye exam and to see an OB/GYN.
- WHA’s Advantage Referral program allows you to see almost any specialist in its network, regardless of their medical group affiliation. You will receive notification with details once the referral is processed, and you may then set an appointment with the specialist.
- WHA covers you for urgent care and emergency care services when you are outside of our service area. Anytime you travel 100 miles or more away from home, including internationally, you are also eligible for services through Assist America. Services include medical consultation and referrals for emergency and non-emergent conditions, care of a minor child and lost luggage or document assistance while traveling.
- In-network behavioral health benefits are provided by Optum.
- When a generic drug is available and you choose the brand-name drug, you must pay the difference between the cost of the brand and the generic plus the $5 generic copay. With prior authorization, exceptions for medical necessity can be made.
Best fit for you if:
- You live in the Davis–Sacramento area or the counties of Marin, Napa or Sonoma.
- You want low monthly premiums
- You want low, predictable out-of-pocket costs
- You like having one doctor manage your care
- You are happy with the selection of providers
Monthly plan costs
|$53,000 and under||$17.78||$32.00||$38.94||$53.14|
|$156,001 and above||$129.14||$232.45||$271.42||$374.71|
Rates for union-represented employees are subject to ongoing collective bargaining as appropriate.
Typical out-of-pocket costs
- Office visit/urgent care visit: $20 (preventive care has no charge)
- Emergency room: $75
- Hospital stay: $250
- Prescription drugs: $5, generic; $25, brand name; $40, non-formulary
WHA began mailing ID cards to new members on Dec. 21, 2016. You may also order a copy of your ID card on the WHA website or call 888-563-2250 to request your ID number.