Frequently Asked Questions re: WHHS 2024 Health Care Benefits Program

Q1: Why is the medical care benefit plan changing?

A1: The medical care benefit plan currently offered by WHHS is not in line with the market.  Board policies require that our benefit plans fall within the market range.  The new plans show progress to better aligning us with the market range.

Q2: I do not live in Fremont, and cannot receive care in the Washington Hospital Healthcare System.  How will the benefit plan changes impact me?

A2: There will be no change from the current benefit plans.  Blue Shield has been the Tier 2 provider network for many years, and will remain the Tier 2 network.  Therefore, you will be able to continue to access your Blue Shield provider(s) the same as you do today.

Q3: Is the Blue Shield provider network changing?

A3: No, we will continue to use the same Blue Shield network used under the current WHHS medical care benefit plans.  You will be able to continue to see your current doctor(s) as long as he/she continues his/her relationship with Blue Shield.

Q4: What is the difference between Tier 1, 2 and 3?

A4: The Tiers do not change from the current benefit plans.  The Tier differences are:

• Tier 1 = Washington Hospital Facilities (including surgery centers), outpatient clinics, hospital affiliated providers (i.e. Dr. Dearborn and Dr. Sah), Washington Hospital based providers (i.e. Washington Radiology Medical Group, Sound Physicians) and Washington Township Medical Foundation Providers.

• Tier 2 = Blue Shield of California PPO Providers and Facilities

• Tier 3 = Providers not in Tier 1 or 2

Q5: How much will my bi-weekly contribution be with the new plans?

A5: The bi-weekly contribution for the new base benefit plan (Core Choice) will be slightly less than what the majority of employees are currently paying for their WHHS benefit plans.  Bi-weekly contributions for the Core Choice plan are as follows:

There will also be a “buy-up” option (Choice Plus) available.  More information related to the Choice Plus plan will be available during Open Enrollment.

Q6: What if I don’t make a selection during the Open Enrollment session?

A6: We encourage all employees eligible for the open enrollment to actively select a plan. Employees that do not select a plan during the January – February 2024 Open Enrollment session will automatically be enrolled in the Core Choice Plan.

Q7: How do the plan options differ from my current WHHS Employee plan?

 A7: The Plan designs are very similar to your current plan but there are some differences from the current plan.   For example, all WTMF physicians are included in the WHHS Tier 1, which means you will have a fixed copayment for all WTMF Physicians and none of the services you receive from a WTMF physician will be subject to deductibles. 

At your request, we can further discuss changes.  Please submit any specific inquiries to Benefits@whhs.com. 

Q8: How will the plan options differ if I use WHHS services, such as lab or imaging?

A8: With the exception of ER services, both new plans will be similar to your current plan.  When an employee or dependent receives services at a Washington Hospital Facility, the facility co-pay will be $0.  Copays for lab, x-ray, and urgent care at Washington Hospital will continue to be $0.  As in the past, you will still be responsible for the copays associated with other physician services, such as physician office visits.

Q9: Is there a change with Delta Dental, VSP Vision Plan, or the Rx Plan?

A9: No, all these plans remain as part of your benefits. However, there will now be Dental and Vision buy-up plans available.

Q10: Can I enroll my dependents into one plan and enroll myself into the other plan?

A10: No, dependents must follow the same plan as the Employee.

Q11: Is there a copay for annual preventive care?

A11: There is no charge for certain covered annual preventive care received from a Tier 1 or Tier 2 provider, including

• Routine physical exam
• Ear/eye exam for dependent child through 18 years of age
• Immunizations according to age schedule
• Routine mammograms

Q12: Can I change plans if I have a new baby (or adopt), lose other coverage or marry before the next open enrollment session?

A12: Yes, qualifying life events such as marriage, birth/adoption, or loss of other coverage enable employees to make mid-year benefit changes.

Q13: If I don’t like the plan I select, when can I switch plans?

A13: After open enrollment in January – February 2024, Employees will have an opportunity to reassess plan options and switch during the next open enrollment, which takes place in November 2024 for a January 1, 2025 effective date.  However, qualifying life events such as marriage, birth/adoption, or loss of other coverage enable employees to make mid-year benefit changes.

Q14: Can I opt out of Washington Hospital health benefit plan options if I can receive health benefits through another source (like my spouse)?

A14:  WHHS provides coverage for all benefit eligible employees.  At this time there is no waiving of coverage for our employees.   However, WHHS employees do have the option to waive coverage for a spouse or certified domestic partner.

Q15: Does out-of-state coverage change?

A15:  No, the out-of-state coverage does not change.

Q16:  How can I find an in-network provider for medical, dental, and vision services?

A16:  You can find instructions on how to search online for in-network providers on our intranet:

            –Path:  Employees > Human Resources > Benefits

            –Hyperlink:  Benefits – Home

Q17:  If WTMF doesn’t have a physician trained in a specialty that I require and I am referred to a non-WTMF doctor, will the services be covered as Tier 1 or 2?

A17: In this instance, the physician would be covered at the Tier 2 level if the physician is a participating provider in the Blue Shield network.