The WellPremium Medical Enhanced line of plans includes the WellPremium benefit coverage. The WellPremium benefit is designed to help cover your everyday needs such as doctor visits, labs, X-rays and urgent care while the Medical Enhanced plans are designed to help cover surgeries and hospitalization.
The WellPremium plan is designed to help cover everyday needs from bumps and bruises to broken bones for a $0 deductible. After the deductible is met, there is a usually a co-pay or co-insurance for covered services. This plan has a $0 deductible and $0 co-insurance and covers doctor visits, urgent care, labs, radiology and images for an associated co-pay. The WellPremium plan is guaranteed-issue and has no pre-existing condition restrictions.
The Medical Enhanced plans are designed to cover many of your needs inside a facility. The plan helps cover hospitalization, inpatient and outpatient surgery, emergency room, dialysis and chemotherapy at 80/20 coinsurance. The plan pays 80% and the member pays 20% of the claim after the deductible has been met. There are three plan options that members can choose: the WellPremium Enhanced 10.0, WellPremium Enhanced 5.0, and WellPremium Enhanced 2.5. The different numbers refer to the three deductibles and out-of-pocket and annual maximums that are included in each plan. The plans have a 12-month pre-existing condition clause and require preauthorization for coverages such as hospitalization, inpatient and outpatient surgery, dialysis and chemotherapy. There is no preauthorization required for the emergency room.