Your WGAT medical has the dual goal of controlling your out-of-pocket costs while expanding the network of available providers.
The Western Growers Assurance Trust (WGAT) Western Preferred Advantage Plan partners with the Anthem Blue Cross network of preferred providers.
The calendar year medical deductible is the amount you must pay for covered services before the Plan begins to pay benefits each year (except for preventive care and prescription drug benefits). See the WGAT Summary of Benefits for a list of preventive care benefits.
Medical deductible is $150 deductible per covered person (up to a $300 family maximum) each calendar year. The deductible does not apply to preventive care or prescription drug benefits.
Note: Infertility treatment has a separate $500 deductible each calendar year.
Once enrolled, you may schedule appointments with Anthem Blue Cross network providers for you and your covered dependents. Be sure to verify your coverage with the Fund Office before scheduling.
Your Plan has an out-of-pocket limit which is the most you could pay in a calendar year for covered services. The per-person out-of-pocket limit is $12,500. If you have covered family members, they must meet their individual out-of-pocket limits until the overall family out-of-pocket limit of $25,000 is met.
TIP: Remember to present your Anthem Blue Cross identification card to your medical provider when seeking benefits. Verify that the providers and facilities participate in the PPO network.
After you meet your calendar year medical deductible explained above, most covered services are paid based on the Anthem Blue Cross PPO network rate or non-PPO Reasonable & Customary rate, whichever applies.
Click here to search the Anthem Blue Cross extensive participating provider network. The easiest way is to register or log into your account at www.anthem.com/ca/find-care/. You can view, save electronically and print a copy of your Evidence of Coverage Certificate of Insurance. This certificate is a summary of your medical benefits contract and what is covered under the plan.
You may also contact the Fund Office if you need help. Mention you are covered under the Landscape, Irrigation and Lawn Sprinkler Industry Health & Welfare Trust.
TIP: Choose PPO network providers (doctors, hospitals, labs) that participate in the Anthem Blue Cross PPO network. If you use out-of-network providers, your out-of-pocket costs may be higher. Search for PPO providers at www.anthem.com/ca/find-care/ or by using the Anthem Blue Cross of California mobile app.
REMINDER: Call 9-1-1 if you experience a life-threatening emergency. Or go to an emergency room immediately. If it’s not an emergency, look for the nearest PPO network urgent care center. Your out-of-pocket costs will be more affordable.
Click here for Frequently Asked Questions.
