Western Health Advantage is committed to ensuring our members have access to the care they need. This benefit helps to cover the costs of certain travel expenses for eligible services that aren’t available within 50 miles of your home,

Benefit Overview

Western Health will help cover the costs of certain expenses related to travel and lodging to obtain medically necessary and prior authorized services. 

• You must need to travel more than 50 miles from your home to receive services.
• Services must be prior authorized in advance of receiving care for eligible services. (Coverage depends on member eligibility at the time of service.)
• You need to pay for your travel and lodging expenses when you are billed. (The costs you pay for travel and lodging do not count toward your maximum out-of-pocket.)
• Reimbursement is up to $250 per day, not to exceed $5,000 per course of treatment, for you and one traveling companion, when necessary (or two parents or two guardians if you’re under 18). 
• You must maintain receipts for all travel, and we may ask for them at any time. The reimbursement form requires your signature, attesting that the travel receipts are accurate and were incurred in accordance with this benefit.

Services Eligible for Reimbursement

• Abortion services
• Bariatric surgery
• Organ and tissue transplants
• Gender-affirming care
• Acute inpatient pediatric care (except direct admission to the neonatal intensive care unit) or specialty inpatient pediatric care (except direct admission to the pediatric intensive care unit)
• Outpatient pediatric hematology and oncology

What expenses can be reimbursed?

• Round trip transportation: to obtain the covered service, to and from the facility from the member’s residence and/or lodging is covered. ( Vehicle mileage is based on the current Internal Revenue Service (IRS) medical mileage reimbursement, which includes gasoline.)
• Lodging: One hotel or motel room for you and one companion. If you’re required to be at the facility before noon on the day of your procedure or service, the night before your procedure or service is also eligible for reimbursement under this daily allowance. 
  • Lodging expenses for your companion for the length of time you’re in the hospital are applicable. (While you are hospitalized, the daily allowance for travel and lodging won’t apply to you.) 
• Meals for you and your traveling companion. (While you are hospitalized, meals will only apply to your traveling companion.)

What expenses cannot be reimbursed? 

• Travel and lodging expenses for services provided fewer than 50 miles from your home
• Travel and lodging expenses for services not prior-authorized by the health plan
• Expenses that exceed the $250 per day limit not to exceed $5,000 per course of treatment 
• Personal care items and over-the-counter medications
• Telephone calls and internet service
• Tips
• Entertainment
• Lost wages
• Alcohol beverages
• Gas/charging fees for personal vehicles
• Parking fees incurred other than at lodging or hospital

How to be Reimbursed

To be reimbursed, submit a Travel and Lodging Reimbursement form to Western Health Advantage. The form can be found online at https://www.westernhealth.com/calpers/downloads/travel-and-lodging-coverage/.

Mail to: 
Western Health Advantage, Attention Claims Department
2349 Gateway Oaks Drive, Suite 100, Sacramento CA 95833

Questions?
Call Member Services at 888.WHA.PERS (888.942.7377); 711 TTY or Visit westernhealth.com/calpers for more information about how to file a claim.