Imagine someone said to you, “I’d like to give you five hundred dollars.” “What’s the catch?” you might ask. “There’s only one restriction… You have to use the money on something to improve your health.” Pretty much anyone would agree to this offer – you would think.
The Health Plan’s Wellness benefit provides up to $500 to help Participants (and their dependents…up to $1,500 per family) improve their health. You don’t have to first meet the $300 annual deductible before accessing your Wellness Benefits. And yet, while over 20,100 writers (and their dependents) are eligible for the Wellness benefit, less than half that number use any of their Wellness benefits, and an even smaller number use all of their Wellness benefits available to them each year.
ELIGIBLE VS. ACTUAL USERS
|Number of patients who used the Wellness benefit in 2015
|Number of patients who used all of the Wellness benefit in 2015
|Most common Wellness services utilized in 2015
|Physical exam to include routine tests and/or immunizations, followed by genetic testing
Note: For network providers, immunizations and genetic testing are covered under Preventive Care
Using your Wellness benefit is simple; just call and make your appointment. When you or your provider submits a claim to the Health Fund; all eligible services will be applied towards your Wellness benefit up to the $500 annual maximum.
Please note: If the Wellness benefit maximum is exhausted, eligible Wellness Care expenses will be considered under the medical plan, subject to the annual deductible, medical necessity review and plan cost sharing requirements. (The Wellness benefit is not available under the Low Option Plan).
So, what can the Wellness benefit be used for? Here is a partial list of the services it will cover:
- Annual Routine Physical Exam**
- Annual Routine Pap Smear
- Annual Well Woman Exam
- Annual Mammogram (Screenings/Routine)
- Breast Cancer (BRCA) Breast Cancer susceptibility gene test
- Dyslipidemia Screening – Cholesterol testing (lab work)
- (Age 0-7) paid under medical, subject to annual deductible and coinsurance
- (Age 7+) paid under wellness (up to $500 annual maximum benefit). Anything over the maximum limit will be considered under the medical plan
- Genetic Testing
- Routine Prostate Specific Antigen (PSA) test to detect prostate cancer
- Nutritional Counseling
- Nutritional Testing
- Newborn Screening (routine testing for newborns)
- Weight management – the Health Fund will cover the program fees only, i.e., Weight Watchers, Jenny Craig, and Lindora. (Note: the Health Fund will not share cost for dietary food supplies or supplements)
**If you are in Southern California and you schedule your routine physical exam at one of the UCLA Health/TIHN locations, only $200 will be applied to your annual Wellness Benefit leaving you up to $300 to spend on other eligible services.
All eligible Wellness care expenses are reimbursed at 100% of either the contracted rate or the allowed amount after Reasonable and Customary (R&C) limits have been applied.
To maximize your Wellness Benefit, it is to your advantage to utilize in-network physicians. Anthem Blue Cross negotiates rates with doctors and other healthcare providers to help save you money. If you use in-network providers, you are not responsible for the amount over the contracted rate of any eligible Wellness care expense, even if the provider bills a higher amount.
When you receive eligible Wellness care services from a non-network provider, “Reasonable and Customary” (R&C) limits are applied. This means that any amount above the R&C limit is not considered an eligible expense and you are responsible for paying that amount.
As you can see, considerable resources are available. If you want to know whether or not something not on the list might be covered, just call the Participant Services Department at (818) 846-1015 or (800) 227-7863 (follow the menu prompts). PWGA representatives will be glad to answer your questions.
Make this your healthiest year ever. You have up to $500 ($1,500 per family) annually in Wellness benefits available to you to help you reach your goals; and improve your health.