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Dane FAQs

Frequently Asked Questions

You can click on the categories below to view answers to some of the common questions we have encountered while welcoming Dane County. You can also check out the original FAQ that we handed out at the informational meetings.

Have a question that isn't answered below? Let us know!

Q:General

Who is WEA Trust?

The WEA Trust is an independent, not-for-profit insurance company. Since 1970, we’ve provided quality insurance to exceptional public workers in Wisconsin. We started off serving school districts, but today we serve all public employees. In fact, we’ve grown to become the third-largest insurer in the Wisconsin State Health Plan and are available in 62 counties. We also insure hundreds of school districts and other municipalities throughout Wisconsin.

Q:Pharmacy

Are contraceptives available at $0 copay?

All generic and Tier 2 contraceptives are covered at $0 copay. Tier 3 contraceptives are covered at $40 copayment.

Is WEA honoring the 34-day dispensing limit or maintaining its current 30-day dispensing limit?

Yes you will be able to receive a 34-day supply for one month (and one copay) and 102-day supply for three months (and three copays).

What if my prescription is denied at the pharmacy and they say I do not have coverage?

Either you or the pharmacy should contact us at 800.279.4000 to determine what the problem is.

Can I get a 102-day supply of a prescription drug at the pharmacy for 2 copays?

A 102-day supply of a medication at a retail pharmacy will require three copays. A 102 -day supply through our home delivery service will apply two copays.

If I don't want to go through step therapy can I just get the prescription and pay the $40 copay?

Step therapy requirements for new prescriptions will always apply. All tier 3 drugs require a $40 copay, whether it’s subject to step therapy or not.

Can I get my prescription filled out of state?

The pharmacy network is nationwide and includes all major chains and most retail pharmacies.

Q:Transition Issues

How many ID cards will I receive? What do I do if I need more?

You will receive 2 ID cards. If you need more cards, you can order them at weatrust.com/Dane or call our customer service department.

Will I need to complete a form to enroll?

If you and your dependents are already covered by Physicians Plus, there is no need Complete an enrollment form for the transfer of insurers. If you are applying through Open Enrollment or as a new hire, you will need to submit an enrollment form to Dane County. This form is available at weatrust.com/Dane.

Will I need to complete paperwork to add my spouse and/or children?

Active employees must submit an enrollment form to Dane County to add any dependents not currently covered through Physicians Plus. Retires can only add new dependent(s) within 30 days of a qualifying event (marriage, birth of a child) and the enrollment form must then be completed and submitted to Dane County.

Q:Provider Network

Are Group Health Cooperative physicians covered?

Yes, as a non-network provider. If you were previously seeing a GHC doctor through the POS plan, this coverage will be comparable to what you previously had.

Q:Out-of-State Benefits

If I am traveling outside of the USA, what coverage will I have?

Non-emergency services provided out of the United States are not covered.

How will follow up care received out-of-state work?

Follow-up care from out-of-state, non-network providers may be authorized for a period of time, on a case-by-case basis.

Q:Good Health Bonus / Wellness

Am I required to participate in the HRA?

No. Participation in the Health Risk Assessment (HRA) is voluntary. However, to earn a $25 Visa prepaid card, you will need to complete the online HRA at www.trustinyourhealth.com by August 26, 2016.

Does my employer or the insurance company see the detailed information I provide on the HRA?

Your employer does not see your HRA results. The Trust does have access to the data but does not make claims or eligibility decisions based on your Health Assessment results. 

Q:Benefit Schedule / Coverage

I've met my $200/$400 deductible (or out of pocket maximum) w/PPlus, will I have to meet a new deductible or out of pocket max?

We will update your deductibles and out-of-pocket maximums in our system through the remainder of this year. A new deductible / out-of-pocket maximum period will apply starting January, 2014.

How are infertility services covered?

Coverage is limited to in-network providers only. Medical costs for infertility is limited to $4,000 per member per lifetime and paid at 50%. A separate lifetime limit of $2,000 per member per lifetime applies for drugs used to treat infertility (paid at 50%). Coinsurance for infertility treatment does not count towards either the medical or drug maximum out-of-pocket limit.

Is there a lifetime maximum?

Beginning January 1, 2014, no lifetime or annual maximums are allowed for benefits considered Essential under the Affordable Care Act. Treatment for infertility is not an Essential Health Benefit and therefore, the lifetime limit is allowed.

Why doesn’t WEA cover acupuncture?

WEA Trust provides access to complementary and alternative medicine, including acupuncture, through a discount network. See our website for more details on how to access discounts for these services.

Is vision covered?

A routine vision exam is covered and subject to a copayment. Vision correction materials, such as glasses and contacts are not covered.

How does WEA Trust cover hearing aids?

The plan will cover one hearing aid per ear once every three years for members less than 18 years of age and once per lifetime for members 18 years of age or older. The annual limit of $500 per hearing aid will no longer be allowable, starting January 1, 2014, under the Affordable Care Act.

Can I go to any emergency room?

We reimburse for emergency services provided in an emergency room. Use of an emergency room is subject to a $50 copay, which will be waived if you are admitted to the hospital from the emergency room.

What cost-sharing applies to the maximum out-of-pocket limit?

Copays, deductible, and coinsurance paid by members count towards the maximum out-of-pocket. Cost- sharing for services that are not Essential Health Benefits, such as coinsurance for infertility services do not count. Other out-of-pocket costs, such as penalties or costs paid for non-covered services, do not count towards your maximum-out-of-pocket limit. See your policy for details.

Is maintenance chiropractic care covered?

Maintenance chiropractic care is not covered.

Q:Care Management

How will care management transfer over?

We will work with to transition anyone receiving care management with Physicians Plus to a Trust care manager.

Q:Preauthorization

How does preauthorization work?

The Trust lists services requiring preauthorization on our website at weatrust.com/preauthorization. The member or their provider notifies us of their intent to seek services that require preauthorization. The provider of the services is contacted by WEA to obtain necessary clinical/medical/code information to determine medical necessity/appropriateness and then approves/deny service. Provider is notified of outcome. Provider and member are notified of denials.

If I had a procedure/equipment approved by Physicians Plus, will it be approved with WEA?

If it is a covered benefit and is medically necessary and appropriate, we will approve it.

If my child is in physical therapy, what will happen if therapy continues beyond 12/1?

You should show your provider your new ID card when receiving services after 12/1. Your provider will call WEA to obtain authorization for any ongoing services.

What happens if I don't get my services preauthorized before I receive them?

If a member fails to get preauthorization for those services that require it, we may deny the claim. If asked, we may review the claim and if we determine that we will cover it, a penalty of 50% up to $500 will apply.

Q:Dental

Is there a change to our dental coverage?

Like most health plans, the WEA Trust covers limited dental services, including services related to injury to your teeth and oral surgery to remove impacted wisdom teeth. WEA Trust is not taking over any other dental coverage paid for by your employer.


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