Western Health Advantage Unveils Extensive 2024 Commercial Plan Updates

Western Health Advantage (WHA) has been working to expand many benefits and programs. Here are some of their updates for 2024.

Updates across all plans — large group, small group, and individual:

• Nurse Advice Line — starting in January, WHA’s nurse advice services will be supported by FoneMed, which will continue offering WHA members 24-hour telephone access to registered nurses to answer health questions and help direct care. Because of this change, new ID cards with the new advice line number will be issued in December for all WHA members. 
  • View and download WHA’s refreshed Convenient Care brochure highlighting access to virtual, urgent, and emergency care, as well as how to get care while traveling.
• Expanded Disease Management programs — currently all of WHA’s commercial plans include support for chronic conditions, including asthma, coronary artery disease, and diabetes through their health solutions partner, Optum. Starting in January, this program expands to include congestive heart failure and chronic obstructive pulmonary disease (COPD), offering members with these chronic illnesses added support and resources to better manage and control their condition.
  • Members may access the program with a referral from their physician or case manager, or they can self-refer by contacting WHA Member Services (learn more at mywha.org/dm).
• Other benefit changes effective on January 1, 2024 — in compliance with SB 523, Contraceptive Equity Act of 2022, WHA’s family planning services have been expanded to include vasectomies and FDA-approved over-the-counter contraceptives at $0 cost to the member. To access OTC contraceptives, members simply need to visit an in-network pharmacy. If a generic is available for a brand-name product, the generic must be used for the $0 cost-share benefit.
• Refreshed look for WHA Copayment Summaries — you may notice a new look to their copayment summaries, whether the current plan year or the 2024 plan year. Please be aware to use the applicable version based on the group’s renewal date. Note: their 2024 benefit plans are pending regulatory approval.
  • Visit WHA’s Broker Download Webpage to access 2023 and 2024 copayment summaries.

2024 Updates specific to Large Groups: 

• Additional change to benefit plans — other than those stated above, the only plans with benefit changes for 2024 are related to WHA’s high-deductible health plans (HDHPs). They have, under IRS guidelines, increased some deductible amounts on certain HDHPs. 
• WHA’s Family Diversity and Pregnancy Support program — WHA is offering this benefit automatically included with all large group plans upon the group’s renewal. There is no premium adjustment for this benefit, and employers may elect to decline the benefit. 
• New optional wellness rider: Healthy Lifestyles program — Starting in January, WHA is offering a combined Healthy Lifestyles program that adds Pregnancy and Postpartum Support services to their Real Appeal Weight Loss Program and Quit for Life programs. Employers will know they are taking care of their employees and families by offering this combined Healthy Lifestyles wellness package.
• View the 2024 Benefit Comparison for Large Groups that incorporates all of these changes. 

2024 Updates Specific to Small Groups: 

• Changes to benefit plans — in addition to the changes stated above, certain copayments, deductibles, or out-of-pocket maximum amounts have changed on some plans. These changes are in response to actuarial value calculations under the ACA or IRS guidelines for HDHPs. You may also notice some plan name changes.  
• New plans! Starting in January, WHA is offering two new small group benefit plans that will be sold directly from WHA:
  • Gateway 40 Gold 80 HMO — a gold-tier plan that does not have a deductibl
  • Gateway 1600 Gold 80 HDHP HMO — a gold-tier HSA-compatible plan with a lower deductible amount
• Update to pediatric vision services and vision optional riders — WHA’s MES Vision contract is ending at year's end as MES Vision has been sold to another company. With this contractual change, WHA is moving their pediatric eyewear services to EYEXAM of California, Inc. and its affiliate, Eyemed Vision Care, LLC, effective January 1, 2024. Pediatric members will continue to use WHA medical providers for their annual exam and access eyewear benefits through EyeMed, the vision network for Eyexam. Unfortunately, this change poses a disruption to WHA’s groups who purchased an optional vision plan rider. After months of exploring options for potential replacement coverage, WHA has not been provided with an adequate solution for these plans, resulting in the decision to terminate the optional riders as of December 31. WHA is working with these affected groups and their broker directly; please contact WHA for further details if needed. 
• Expanded wellness offerings — starting in January, WHA is embedding their new wellness coaching, support, and resources to include Real Appeal Weight Loss, and Pregnancy and Postpartum Support services in partnership with Maven. Small group members already access the benefits of the Quit for Life smoking-cessation program.  
• View and download the 2024 Benefit Comparison for Small Groups that incorporates all of these changes.