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

Pharmacists must dispense a prescription for Schedule II controlled substances as a partial fill, if requested by the patient or physician, with the copayment prorated accordingly. No additional fees can be assessed for subsequent partial fills if the full copay was collected at the first partial fill.

Members are required to pay the difference between a brand name and a generic drug, plus the generic copayment, when the generic is available. (Exceptions for medical necessity are available via prior authorization. If approved, the applicable brand copayment applies.) In a change this year, this penalty does not contribute to the plan's out-of-pocket maximum.

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