Medical – Local 6 ONLY
This page applies only to employees represented by Local 6. Note that Local 6 has different benefit rates.
Washington Health offers eligible Local 6 employees two medical plan options: the Washington Health Medical & Rx Plan 500 and the Washington Health Medical & Rx Plan 250. Both plans use a three-tier provider structure, giving you flexibility in where you receive care while helping you manage your out-of-pocket costs. Tier 1 includes services provided at a Washington Hospital facility and generally offers the lowest member cost. Tier 2 includes preferred providers in the Blue Shield of California PPO network. Tier 3 non-preferred care generally results in the highest out-of-pocket costs and may also leave you responsible for charges above the plan’s allowable amount.
Preventive care, such as annual physicals, immunizations and recommended screenings, is covered at 100% when received from eligible in-network providers. When choosing where to receive care, be sure to consider the provider’s tier, since your cost can vary depending on where services are received.
Teladoc Health
Teladoc Health gives you 24/7 access to U.S. board-certified doctors by phone or video for many common, non-emergency medical needs. Teladoc can be a convenient option when you need care quickly, are away from home, or are considering urgent care for a non-emergency condition.
Your cost: $15 copay under both plans for in-network (Tier 1 and Tier 2) benefits.
Get started: Visit Teladoc.com or call 800-TELADOC.
Each plan has different:
- Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
- Out-of-pocket maximums– the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
- Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
- Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
Unless your domestic partner qualifies as your tax dependent under IRS guidelines, contributions for their coverage must be made on an after-tax basis. Additionally, Washington Health’s contributions toward coverage for your domestic partner and their dependents will be treated as taxable income (imputed income) and reported on your W-2 Please consult your tax advisor for guidance on how this may affect your individual tax situation.
Washington Health Medical & Rx Plan 500
Benefit Highlights
You always pay the deductible and copayment ($). Coinsurance (%) shows what you pay after the deductible.
Tier 1 – Services Provided at a Washington Hospital Facility
Annual Deductible (Individual/Family)
$0/$0
Annual Out-of-Pocket Maximum (Individual/Family)
$0/$0
Office Visit
No charge*
Chiropractic
Not covered
Lab and X-ray
No charge
Urgent Care
N/A
Emergency Room Services
$50 per visit (with a $200 individual/$400 family calendar-year out-of-pocket maximum)
Ambulance
N/A
Hospitalization
No charge
Outpatient Surgery
No charge
Tier 2 – Preferred Providers (Blue Shield of California PPO Network)
Annual Deductible (Individual/Family)
$500/$1,000
Annual Out-of-Pocket Maximum (Individual/Family)
$2,300/$4,600
Office Visit
20%*
Chiropractic
20%* (25 visits per year)
Lab and X-ray
20%*
Urgent Care
20%*
Emergency Room Services
$50 per visit + 20% coinsurance for physician services
Ambulance
20%
Hospitalization
15%*
Outpatient Surgery
15%*
Tier 3 – Non-Preferred Providers
Annual Deductible (Individual/Family)
$2,500/$6,000
Annual Out-of-Pocket Maximum (Individual/Family)
$4,500/$8,000
Office Visit
40%*
Chiropractic
40%* (in-network limitations apply)
Lab and X-ray
40%* (hospital: up to $1,500 per day)
Urgent Care
40%*
Emergency Room Services
$50 per visit + 20% coinsurance for physician services
Ambulance
20%
Hospitalization
25%* (up to $1,500 per day)
Outpatient Surgery
25%* (up to $1,500 per day)
*After deductible. WTMF Value Providers can be found on the HR Intranet. The coinsurance waiver applies to the specific physician, not the clinic site.
Prescription Drug – OptumRx
Participating Pharmacy
Annual Deductible
$0
Retail Prescription (Up to a 34-Day Supply)
Generic
$4 per prescription
Preferred Brand
$25 per prescription
Non-Preferred Brand
$40 per prescription
Specialty
$40 per prescription
Mail Service (Up to a 90-Day Supply)
Generic
$8 per prescription
Preferred Brand
$50 per prescription
Non-Preferred Brand
$80 per prescription
Specialty
Not covered
Non-Participating Pharmacy
Members pay the copayment below plus 25% of billed charges.
Annual Deductible
$0
Retail Prescription (Up to a 34-Day Supply)
Generic
$4 per prescription + 25% coinsurance
Preferred Brand
$25 per prescription + 25% coinsurance
Non-Preferred Brand
$40 per prescription + 25% coinsurance
Specialty
Not covered
Mail Service (Up to a 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Non-preferred provider notice: You are responsible for the applicable cost share and any charges above Blue Shield’s allowable amount. Charges above the allowable amount do not count toward the calendar-year deductible or out-of-pocket maximum.
The maximum allowed charge for non-emergency hospital services received from a non-preferred hospital is $1,500 per day. You are responsible for the applicable coinsurance on that amount, plus all charges above $1,500.
Per Pay Period Plan Cost
Your contribution depends on the coverage level you choose.
| Coverage Level | Per Pay Period |
|---|---|
| Employee Only | $0 |
| Employee + Spouse/Domestic Partner | $0 |
| Employee + Child | $0 |
| Family | $0 |
Washington Health Medical & Rx Plan 250
Benefit Highlights
You always pay the deductible and copayment ($). Coinsurance (%) shows what you pay after the deductible.
Tier 1 – Services Provided at a Washington Hospital Facility
Annual Deductible (Individual/Family)
$0/$0
Annual Out-of-Pocket Maximum (Individual/Family)
$0/$0
Office Visit
No charge*
Chiropractic
Not covered
Lab and X-ray
No charge
Urgent Care
N/A
Emergency Room Services
No charge
Ambulance
N/A
Hospitalization
No charge
Outpatient Surgery
No charge
Tier 2 – Preferred Providers (Blue Shield of California PPO Network)
Annual Deductible (Individual/Family)
$250/$500
Annual Out-of-Pocket Maximum (Individual/Family)
$1,500/$3,500
Office Visit
15%*
Chiropractic
15%* (25 visits per year)
Lab and X-ray
15%*
Urgent Care
15%*
Emergency Room Services
15% coinsurance for physician services
Ambulance
15%
Hospitalization
10%*
Outpatient Surgery
10%*
Tier 3 – Non-Preferred Providers
Annual Deductible (Individual/Family)
$1,500/$3,000
Annual Out-of-Pocket Maximum (Individual/Family)
$3,000/$6,000
Office Visit
40%*
Chiropractic
40%* (in-network limitations apply)
Lab and X-ray
40%* (hospital: up to $1,500 per day)
Urgent Care
40%*
Emergency Room Services
15% coinsurance for physician services
Ambulance
15%
Hospitalization
20%* (up to $1,500 per day)
Outpatient Surgery
20%* (up to $1,500 per day)
*After deductible. WTMF Value Providers can be found on the HR Intranet. The coinsurance waiver applies to the specific physician, not the clinic site.
Prescription Drug – OptumRx
Participating Pharmacy
Annual Deductible
$0
Retail Prescription (Up to a 34-Day Supply)
Generic
$4 per prescription
Preferred Brand
$25 per prescription
Non-Preferred Brand
$40 per prescription
Specialty
$40 per prescription
Mail Service (Up to a 90-Day Supply)
Generic
$8 per prescription
Preferred Brand
$50 per prescription
Non-Preferred Brand
$80 per prescription
Specialty
Not covered
Non-Participating Pharmacy
Members pay the copayment below plus 25% of billed charges.
Annual Deductible
$0
Retail Prescription (Up to a 34-Day Supply)
Generic
$4 per prescription + 25% coinsurance
Preferred Brand
$25 per prescription + 25% coinsurance
Non-Preferred Brand
$40 per prescription + 25% coinsurance
Specialty
Not covered
Mail Service (Up to a 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Non-preferred provider notice: You are responsible for the applicable cost share and any charges above Blue Shield’s allowable amount. Charges above the allowable amount do not count toward the calendar-year deductible or out-of-pocket maximum.
The maximum allowed charge for non-emergency hospital services received from a non-preferred hospital is $1,500 per day. You are responsible for the applicable coinsurance on that amount, plus all charges above $1,500.
Per Pay Period Plan Cost
Your contribution depends on the coverage level you choose.
| Coverage Level | Per Pay Period |
|---|---|
| Employee Only | $0 |
| Employee + Spouse/Domestic Partner | $15.87 |
| Employee + Child | $13.29 |
| Family | $29.12 |
Search for a Tier 1 Provider
Click here, then click on Physicians and choose the specialty and distance and then filter. You may also search by clicking “Services” and searching for variety of facilities.
Spousal Waiver Credit: If you waive 2026 medical coverage for your spouse/domestic partner and provide proof they have access to medical/Rx coverage through their own employer, you will receive a credit of $75 per pay period ($1,950 per year) or you may receive $70 per pay period ($1,820 per year for as a part of Local 6). See page 6 of your benefit guide for more details.