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Explanation of Deductibles

 
 

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, $2500, and $3500 per individual. If you have covered dependents under WELS VEBA, the family deductible is double the individual 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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