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The chart below shows the four deductible options that are available to WELS VEBA health plan members. Besides the differences in deductible amounts and coinsurance percentages, covered services and benefit levels for Plan Options 1, 2 and 4 are the same and are listed in the second section below. Please note that coverage for certain benefits under Plan Option 3 may be different due to IRS regulations because Plan Option 3 is an HSA-compliant High Deductible Health Plan (HDHP). Further details regarding Plan 3 can be found by clicking here.
Please note: The following is a summary of the available health benefits under WELS VEBA. Please refer to the applicable plan document on the Health Resources page for details regarding benefits and exclusions.
Benefits Payable at 100%
- Ambulance Service (Air ambulance must be determined medically necessary)
- Colonoscopies, if obtained by a Network provider (1 per Plan Year)
- Home Health Care (50 nursing visits per Plan Year)
- Mammograms, if obtained by a Network provider (1 per Plan Year)
- Prostate Screenings, if obtained by a Network provider (1 per Plan Year)
- Skilled Nursing Facility Care (30 days per Plan year)
- Second Opinion
- Transplants provided by a BQCT facility (Maximum Benefit Amount applies; other Transplant Services are subject to separate rules)
Benefits Subject to Deductible and Coinsurance
- Biofeedback for Illness (10 sessions per Plan Year)
- Chemotherapy
- Chiropractor Services (24 manipulations, 1 set of spine or cervical x-rays, and 1 initial examination per Plan Year)
- Durable Medical Equipment (rental or initial purchase)
- Home Health Care Services (other than nursing visits)
- Hospital Benefits
- Hospice Care
- Maternity Benefits (48 hours Hospital care following normal delivery; 96 hours Hospital care following delivery by cesarean section)
- Mental Health Benefits (Inpatient treatment requires precertification)
- Newborn Infants (One Deductible Amount may apply)
- Nutritional Counseling (6 visits per Plan Year)
- Oral Surgery
- Orthoptic/Vision Therapy (1 initial exam and 4 therapy sessions per lifetime)
- Other Covered Expenses
- Outpatient Surgery
- Physical Medicine, Occupational Therapy and Speech Therapy (combined limit of 40 treatments per Plan Year)
- Preventive Care
- Physician's Services
- Sleep Studies (2 per lifetime)
- Substance Abuse Benefits (Inpatient treatment requires precertification)
- Transplant Services provided by a POS, PPO, or Non-Network Facility (Deductible Amount, Co-Payment and Maximum Benefit Amount apply)
Benefits Payable at 50% (not subject to deductible and coinsurance)
- Repair or Replacement Costs of Durable Medical Equipment
- Infertility Treatment (Maximum lifetime benefit: $5,000 per family)
- Routine Vision Care (Maximum annual benefit: 50% of the first $250 per covered family member)
Prescription Drug Benefits
Please refer to the Prescription Drug page for specific details regarding the Prescription Drug benefits offered by the WELS VEBA Group Health Care Plan.
For further information regarding the benefits provided by the WELS VEBA health plan, please contact Anthem customer service at 1-877-512-7875.
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