Regulations and Compliance

State and Federal Regulations for Health Insurance


WEA Trust is required to meet state and federal regulations for health insurance companies. Among those are the Health Insurance Portability and Accountability Act (HIPAA) and the Patient Protection and Affordable Care Act. WEA Trust is also accountable to the Office of the Commissioner of Insurance for the State of Wisconsin for compliance with state regulations.
 


Health Care Reform

Health Care Reform, sometimes referred to as “ObamaCare” is officially known as PPACA – Patient Protection and Affordable Care Act, or simply the Affordable Care Act. It has many provisions that became effective on different dates between 2010 and 2018.

WEA Trust is committed to meet or exceed the provisions of all insurance laws on or before the effective dates. PPACA changes that became effective in 2010 and 2011 include:

•    Adult dependent coverage up to age 26, regardless of marital or student status
•    More preventative health screenings without deductibles or copays
•    Better coverage for certain mental health conditions
•    Clarified or required standardized language for benefits that you already had

Helpful information regarding Health Care Reform

These new laws are anything but simple, and the amount of information available can be overwhelming. To ease your search for reliable information, we have provided these links to official information on Health Care Reform.

Links to Reliable Information

Federal

Department of Health and Human Services (HHS) – Health Care Reform Website
National Association of Insurance Commissioners (NAIC) – Health Care Reform Website

Wisconsin
Wisconsin Officer of the Commissioner of Insurance (OCI)

For Employers
Department of Labor Health Care Reform Website

 


Women’s Health and Cancer Rights Act

On October 21, 1998, President Clinton signed into law the Women’s Health and Cancer Rights Act of 1998. Under this legislation, group health plans that provide coverage for mastectomies also are required to cover reconstructive surgery and breast prosthesis (such as implants) following a mastectomy.

Under this law, members of WEA Trust receive coverage for the following mastectomy-related procedures:

•    Reconstruction of the breast on which the mastectomy was performed
•    Surgery and reconstruction of the unaffected breast to produce a symmetrical appearance
•    Breast prosthesis (artificial substitute)
•    Treatment for physical complications of all stages of the mastectomy, including lymphedema

For questions regarding this information, please contact the WEA Trust Customer Service Team.
 


Office of the Commissioner of Insurance

The Office of the Commissioner of Insurance (OCI) for the state of Wisconsin was created by the legislature in 1871. The original intent of OCI has not changed drastically over the years. In 1871, OCI was vested with broad powers to ensure that the insurance industry responsibly and adequately met the insurance needs of Wisconsin citizens. Today, OCI’s mission is to lead the way in informing and protecting the public and responding to its insurance needs.
http://www.oci.wi.gov


Privacy Practices

For information about how your medical information may be used or disclosed and how you can get access to it, please read our Notice of Privacy Practices.

 


WEA Trust State Health Plan Discrimination Notice

 

Discrimination is Against the Law

WEA Trust complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. WEA Trust does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

WEA Trust provides free aids and services to people with disabilities to communicate effectively with us, such as qualified sign language interpreters and written information in other formats.

WEA Trust provides free language services to people whose primary language is not English, such as qualified interpreters and information written in other languages.

If you need these services, contact Customer Service, 866.485.0630.

If you believe that WEA Trust has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Heidi Folmer, Grievance Appeal Manager, 45 Nob Hill Road, Madison, WI 53713; call 866.485.0630, fax 608.276.9119; or email: memberrights@weatrust.com. 

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Heidi Folmer is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1.800.368.1019, 800.537.7697 (TDD).

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.


No Surprises Act and Transparency in Coverage Rule

For more information about balance billing under the No Surprises Act, please read Your Rights and Protections Against Surprise Medical Bills.

 
Machine Readable Files

The files below contain cost information that can help you understand how much you might pay out-of-pocket for certain covered items and services. Please note that the amounts in these files may not represent the final amount that you will pay out-of-pocket.

NOTE: If a selected file is blank, no data was found.
 
There are certain factors that may impact whether a particular item or service is covered, and determine your final out-of-pocket costs. These include, but are not limited to:

  • Your plan’s deductible, copayment, and/or coinsurance amounts.
  • Prior authorization requirements, which are based on whether the item or service is:
    • Needed to diagnose or treat an illness or injury;
    • Medically necessary; and
    • Medically appropriate.
  • Whether the provider is in-network or out-of-network.
  • Your plan’s maximum out-of-pocket limit, and whether you have met it for the current plan year.
  • Stated benefit limits.

For more information, please see your member certificate and benefit summary, or call Customer Service at 800.279.4000.

Name Updated Size
WEA-INSURANCE-CORPORATION_WEA-TRUST_ALLOWED_AMOUNTS.json 9/4/2022 1:50:37 AM 253 KB
WEA-INSURANCE-CORPORATION_WEA-TRUST_IN-NETWORK-RATES.json 9/4/2022 2:00:06 AM 188898 KB