The questions and answers shown below pertain to employees (and family members, if applicable) who are enrolled in the AHBA’s group health program. If your employer offers medical benefits through a different carrier, please contact us.
If you moved, got legally married, had a child (dependent), or have a new registered domestic partner to add to your health plan, you’ll need to let us know. You’ll also need to let your employer know. If you’re adding a newborn baby to your health plan, you’ll need to do it before your baby is 31 days old. Please fill out this enrollment card, sign it, and give it to your employer. They’ll send it to us.
The emergency room is for actual emergencies. Difficulty breathing, a serious burn, bleeding that won’t stop, poisoning, and broken bones are examples of emergencies.
It’s important to have a family doctor to go to when you don’t have an emergency – like if you just need an annual check-up, have a bad cold or cough, or need to be tested for conditions like high cholesterol or diabetes. This kind of doctor is also called a Primary Care Doctor, or a Primary Care Physician.
If you need to go to a specialist, like an allergist or cardiologist, you can make an appointment with one without seeing your family doctor first. We can help you find a specialist who is part of our health plan if you’d like – just call us at (707) 963-7191 or (800) 282-2603.
If you go to the emergency room when you don’t have an emergency, it will probably cost more money and take a lot more time. Plus, it’s important to build a relationship with your family doctor or your specialist. That way, you’ll have someone you know and trust, and someone who knows your preferences and concerns.
If you can’t get to the doctor or aren’t sure if you need to go – and if it’s not an emergency – you can use Doctor on Demand. This lets you talk to a doctor, 24 hours a day, 365 days a year, without leaving your house. In most cases, you’ll pay $10.
Yes. Please call us at (800) 282-2603, or email us. We can give you a list of doctors and hospitals near you. Before you call us, you might want to think about if you want a female or male doctor, and if you want one who speaks Spanish. That way, we can help find you a doctor who will be a good match for you.
You can also ask people at work if they have a doctor who they like and trust. Their doctors will be part of the same health plan as yours, and that’s important – otherwise you’ll end up paying more money.
You can also search for a doctor online. Click Here for instructions (English and Spanish).
This depends on three main items: Your deductible, your co-insurance, and if you have your procedure in or out of “network.”
- Your deductible is the fixed amount of money that you need to pay before Western Growers Assurance Trust will pay anything.
- Your co-insurance is your share of the cost for your medical procedure. It’s the amount of money that you have to pay after you’ve paid your deductible.
- Your “network” are the doctors, hospitals, and facilities that are part of your health plan. If you have your medical procedure done “out of network,” it will cost you a lot more money – so it’s important to have your procedure done “in network.”
Please call us at (707) 963-7191 or (800) 282-2603 to review your benefits.
It usually takes 30 days to process a claim. Sometimes claims are delayed because they need more information from your doctor, or for other reasons. Please call us at (707) 963-7191 or (800) 282-2603 and we can research your claim for you. You can also look at the status of your claim online at HealthView.
Your Explanation of Benefits (EOB) is not a bill. It’s a document that explains how much Western Growers Assurance Trust paid for your medical treatments. It is for your information only, and you do not need to pay anything on it. If you owe money, you will get a bill from your doctor, hospital, other healthcare provider.
You should keep a copy of your EOB in case you need it in the future. It should match any invoices you receive from your medical care provider. To see a sample of an EOB so that you can understand it better, click here. If you have questions about it, call us at (707) 963-7191.
If you prefer to get your EOBs by email, you can register at HealthView.
Prescription drugs vary in cost for three main reasons:
- Type of prescription: Generic drugs are the least expensive type of prescription. They are a copy of “brand name” drugs, and they work exactly the same – but, they cost less money. If your doctor prescribes a “brand name” drug to you, ask if you can get it as a generic. If not, the amount you pay (your co-pay) will be higher.
- Type of drug: There are certain prescription drugs called “Non-Formulary Drugs,” and you’ll pay more for these than for generic or brand name drugs. And if there’s a prescription drug that you need for a very serious or life-threatening condition, you might need to get permission – called “authorization” – first. You’ll do this through Pinnacle Health Solutions. These kinds of prescriptions are called “specialty drugs.” You’ll pay a percentage of the price of this kind of prescription.
- Where you get your prescription: You might be able to save money on your prescription drugs by shopping around at different pharmacies, or by using a mail-order program. More information is below.
- Mail-Order Program: If you have medicine that you take regularly, use our mail-order program. You can get your prescription medicine mailed directly to your home. You’ll get a 90-day supply of your medicine, will save money on your co-pay, and won’t have to go to the pharmacy. Click here for the mail-order registration form in English and Spanish.
- Health Management Program: If you have asthma, diabetes, high blood pressure, and/or high cholesterol, you may be able to get your medicine for free or at a discount through the Health Management Program in English/Spanish. This program also provides free coaching if you want to lose weight or quit smoking.
- Shop around: Different pharmacies have cheaper prescription prices than others. Call Costco, Target, Safeway, CVS, Walgreens, and others. Tell them what your prescription is for and what health plan you have, and they’ll tell you what it will cost.
There are two main times that you’re able to add people to your health plan: When you are hired and during the Open Enrollment period each year. Your employer determines when your Open Enrollment period is, and it usually lasts for 30 days.
There are also special circumstances that let you add yourself and your eligible dependents during the year, like your legal spouse, registered domestic partner, or children. These circumstances are called “qualifying events.” They are usually life-changing events, like getting married or divorced, having a baby, or losing other health coverage.
The list below has examples of “qualifying events” that might let you add yourself or family members to your employer’s health plan. If you have questions or don’t see something on this list, call us at (707) 963-7191 or (800) 282-2603.
- Getting legally married, getting divorced, becoming widowed, or getting a legal separation or annulment.
- Changing how many children (dependents) you have because of birth, death, adoption, or adoption placement.
- Changing employment or employment status for yourself, your spouse, or your dependents.
- Changing health insurance coverage for yourself, your spouse or dependents. This includes getting or losing health insurance at work, through the government (such as Medicare or Medi-Cal), or through school.
- Ability for you, your spouse, or your children to enroll in Medicare or Medi-Cal.
- Moving somewhere where your current health plan is not available for you, your spouse, or your dependent.
- Additional situations that are required by state or federal law.
We take your privacy very seriously and are very careful to protect your personal and private information. All of your health information is confidential and we will not share it with anyone or any organization without your permission.
If you would like Ag Health Benefits Alliance to share your private health information, please complete the Western Growers Assurance Trust’s (WGAT) authorization form in English or in Spanish. You can learn more about WGAT’s privacy policies here.
You can learn more about our privacy practices here.