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 for 2019

There are no changes to out-of-pocket costs for Western Health Advantage.

Members age 18 and over are eligible for Optum Real Appeal Effect — a 12-month weight loss program designed to reduce the risk of Type 2 diabetes through semi-monthly coaching classes and supplemental videos.

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
$56,000 and under $21.23 $38.22 $46.50 $63.47
$56,001–$111,000 $57.28 $103.11 $128.80 $174.61
$111,001–$167,000 $94.28 $169.71 $202.56 $277.97
$167,001 and above $132.59 $238.67 $278.98 $385.04
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

ID cards

WHA mails ID cards to new members. You may also order a copy of your ID card on the WHA website or call 888-563-2252 to request your ID number.