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
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.