A fixed amount that the participant pays for a covered service, usually when the service is received. The amount varies by plan type.
The amount a participant pays prior to the time the insurer starts to pay unless the plan offers a co-payment arrangement.
The portion of the claims liability that is shared between the participant and WEBT. WEBT uses a percentage method of 80%/20% to $7,500 with each participant being liable for $1,500 and WEBT liable for $6,000 after the deductible has been met.
The total coinsurance and medical copayment amounts for covered services that are a participant's responsibility during a single calendar year.
The total deductible and medical cost share maximum amounts for covered services that are a participant's responsibility during a single calendar year.
The total copayment and coinsurance amounts for covered services that are a participant's responsibility under the prescription drug benefit during a calendar year.
The deductible and coinsurance are on a calendar year basis, from January 1, to December 31.
Yes, even if your doctor directs you toward the emergency room.
No, x-rays and/or labs are always subject to deductible and coinsurance.
No, WEBT does not require a referral to see a specialist. However, the specialist may require a referral from your primary care provider.
WEBT does not exclude any pre-existing conditions, including employee or spousal pregnancies.
If your employer offers more than one option to its employees, then you may change your deductible option during the month of May for a July 1 effective date. Contact your employer for appropriate paperwork.
- Provide services to participants at a reduced cost
- File claims on behalf of participants
- Cannot balance bill for charges above the contracted allowance
- Services provided may cost the participant more
- Does not file claims on behalf of participants
- Is able to balance bill for charges above the contracted allowance
- Services provided may not be covered or only partially covered
Covered employees and covered spouses are eligible for maternity coverage. Dependent children are not eligible for maternity coverage.
MRIs are covered subject to deductible and coinsurance. However, if more than one MRI is performed on the same day, then benefits for the technical component will be limited to 50% of the allowable charge for each MRI after the first.
Please contact your human resources department regarding all changes.
The new spouse will be effective on the date of the legally recognized marriage, provided that the application, along with documentation verifying the marriage, is received by the employer within thirty (30) days after the date of the marriage.
Newborn children will be effective on the date of birth, provided that the completed application for coverage of the newborn child is received by the employer within sixty-one (61) days of the child's date of birth.
Coverage will end the end of the month following a final divorce decree or legal separation.
The end of the month in which a dependent child attains age twenty-six (26).
COBRA is a continuation of your current benefits. Participants may qualify for continued coverage under this plan for 18 months. The cost of the coverage is the responsibility of the participant and the rate will be 2% higher than the current rate.
Open enrollment is the period of time where individuals that did not enroll during their initial eligibility may enroll without a qualifying event. For WEBT, this occurs every November for an effective date of the following January 1st. Please contact your employer for appropriate paperwork.