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 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, $2500, 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 $2500 HSA-compliant option maintains a $4000 family deductible.
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
|Total Applied to Family Deductible:
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.
The following is an outline of options available under WELS VEBA: