Western Health Advantage (WHA) is a regional HMO (Health Maintenance Organization) serving Sacramento, Placer, El Dorado, Colusa, Yolo, Solano, Marin, Napa and Sonoma counties.

Plan changes

Cost sharing is eliminated for low- to moderate-dose statins for cardiovascular disease prevention, provided certain criteria are met.

Although UC Davis Health has modified its agreement with Western Health Advantage, UC WHA members and their families may continue to see their current UC Davis Medical Group primary care physician (PCP) or select a UC Davis Medical Group PCP in the future. While your PCP choices remain unchanged in 2018, UC WHA members will not have access to the Advantage Referral program, which allows for specialty referrals across medical groups. The following rules will apply:

  • WHA members who want to access UC Davis Health facilities or specialists must be assigned to the UC Davis Medical Group for primary care.
  • WHA members may only be referred to specialists outside their assigned medical group in cases of medical necessity, or where the member’s assigned medical group does not have the specialty services available within its network.
  • Self-referrals for OB-GYN care and annual eye exams must remain within the member’s assigned medical group.

For details, including options for UC members who are currently accessing specialty care through Advantage Referral, call WHA’s Coverage Transition Team at 916-246-7494 or visit mywha.org/PCPtransition.

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 their assigned medical group for their annual eye exam and to see an OB/GYN.
  • WHA covers you for urgent care and emergency care services when you are outside of our service area.
  • 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 served by WHA
  • 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 for faculty and staff

Retiree plan costs chart »

Pay Band
(per annum)
Self Self +
Child(ren)
Self +
Adult
Family
$54,000 and under $19.78 $35.60 $43.32 $59.12
$54,001–$107,000 $55.83 $100.49 $125.62 $170.26
$107,001–$161,000 $92.83 $167.09 $199.38 $273.62
$161,001 and above $131.14 $236.05 $275.80 $380.69
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