Summary
When a service is covered under WELS VEBA, the reimbursement you will receive for this service depends on your deductible and co-payment options.
Deductibles
Deductibles are the amount of the covered expenses you must pay each year before WELS VEBA will reimburse you. WELS VEBA has four deductible options for health benefits: $500, $1000, $2400, and $3000 per individual. If you have covered dependents under WELS VEBA, the family deductible is double the individual deductible for the $500, $1000, and $3000 options, while the $2400 HSA-compliant option maintains a $4000 family deductible.
Example
For example, if you have a family plan and are covered by the $500 annual deductible, WELS VEBA will not apply more than $500 to any one family member. After the $500 individual deductible has been met, the remaining $500 can be applied to multiple family members.
| Family Plan $500 Individual / $1000 Family Deductible |
| Family Member |
Accumulated Claims |
| Father |
$500 |
| Mother |
$200 |
| Daughter |
$200 |
| Son |
$100 |
| Total Applied to Family Deductible: |
$1000 |
Co-Payments
After you satisfy the annual deductible, the portion of the covered medical expenses you pay is called the "Co-Payment." WELS VEBA has an out-of-pocket maximum for each deductible option. This means that once your expenses reach the out-of-pocket maximum in a given calendar year, the reasonable and customary fee for covered benefits will be paid in full by WELS VEBA (unless otherwise specified in the WELS VEBA booklet).
A member may experience additional costs if a medical provider charges more than WELS VEBA's usual, customary and most commonly accepted allowance (UCM). The member would be responsible for the difference. If services provided were not a payable benefit under WELS VEBA, the member again would be responsible for the charges.
Plan Options
The following is an outline of options available under WELS VEBA:
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