FAQs

Please contact your provider or click on any of the links below for additional information

• Compassion & Choices 
• Online guide for consumers and doctors 
• UCSF/UC Hastings Consortium on Law, Science and Health Policy
• Help line: 800.893.4548

You can obtain the forms that patients and their physicians need to sign at the Medical Board of California.

An appeal is a formal process asking WHA's review doctors to re-evaluate a specialty/service request or payment of a service you already received that was denied or modified in some way. If you are dissatisfied with a decision, you or your designated representative should call Member Services or send a letter in writing to WHA asking for an appeal (re-evaluation). Different doctors will review your case, along with pertinent medical records and other information you and/or your doctor want to submit, and make a second decision. This second decision may agree or disagree with the first.

When you ask for an appeal, an acknowledgement letter of receipt will be sent to you within five (5) calendar days. In most instances, appeal decisions are made within 30 days unless additional information is needed to support your case. You will be notified in writing if a delay may occur beyond 30 days, and if you are dissatisfied with the delay you may file a grievance with the plan by calling WHA Member Services. If you have an urgent medical situation and your doctor feels a quicker decision is needed, he or she may ask for an "expedited" decision, which is made within 72 hours.

Unless you have an expedited situation where your doctor needs immediate notice, written notice will be mailed to you within three (3) calendar days of the decision. The mailed notice will also be sent to your PCP, medical group and in some cases, the specialist. If the appeal decision agrees with the original denial, your doctor(s) will also receive a faxed or electronic notice within one working day of the decision.

If you disagree with the appeal decision made by the plan, legal rights allow you another level of appeal outside the WHA organization. This is called an independent medical review (IMR), which is provided at no cost to you. To ask for an IMR, call the toll free number at the California Department of Managed Health Care (DMHC), 1-888-HMO-2219 or TDD services: 1-877-688-9891. The DMHC is responsible for licensing HMOs in the State of California and its decisions are final and must be carried out by the plan. The DMHC prefers that you complete the appeal process with WHA before you call them. However, you may call the DMHC and ask for an independent review at any time after you receive a denial if it involves a medical necessity decision or experimental request.

If a specialty referral or another service request is denied or modified, you, your PCP, and the specialist or other provider you want to see are all notified in writing of the decision and reasons within a specific timeframe required by law. You or a representative acting on your behalf, including your doctor(s), may appeal the decision to the health plan.
During the appeal process, you and/or your doctor may submit additional information, if any, to help with the decision.  You also have the right to request copies of the information used to make the appeal decision by contacting the Member Services department at 888-563-2250 or (916) 563-2250 (TTY/TDD- (888) 877-5378).

A grievance is a complaint you have about some aspect of your care, or inability to receive services. Resolving grievances is a formal process, but it is different from the appeal process because nothing has been formally denied to you. An appeal is a formal process to re-evaluate the reasons for a denial or modification of a service or payment of a service you already received. A complaint is a simple problem or concern you have with the plan that can be easily resolved during your initial phone call or on the same day you report it to WHA. Complaint resolution does not require a formal process or written notification.

For assistance obtaining mental help benefits coverage information, provider access and claims processing information, please call Member Services or send a secure message. Your coverage depends on your specific plan. Please refer to your Evidence of Coverage and Disclosure Form (EOC/DF) or call Member Services to confirm your coverage. The toll-free phone number to contact your behavioral health provider organization to request these services is located on the back of your WHA identification card.

To find a mental health provider, search Optum Behavioral Health's provider directory. You do not have to register to begin your search. Learn more about behavioral health services by visiting mywha.org/bh.

Ask about copayments. A copay is a charge that you are required to pay out of pocket for a specific service. For instance, you may have a $20 copay for each office visit. In the past, copays for mental health visits may have been greater than those for most medical visits. That should no longer be the case for insurance plans subject to the *parity law.

Ask about your deductible. A deductible is the amount that you must pay out-of-pocket before WHA makes any payments. Depending on your deductible, for instance, you may have to pay $500 or even $5,000 out-of-pocket before WHA will begin making payments on claims. As a result of the *parity law, your deductible should apply to both mental and physical health coverage.

Talk to your provider. When you call to schedule an appointment with a mental health provider, ask if he or she accepts your WHA insurance.

Coordinating medical and mental health services.  Given the complex relationship between the physical health and mental health, communication and coordination between medical and mental health providers is crucial to safe and quality care.  Ask your mental health provider about the importance of coordinating your mental health care with your medical treatment plan.

*The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires group health plans and health insurance issuers to ensure that financial requirements (such as co-pays, deductibles) and treatment limitations (such as visit limits) applicable to mental health or substance use disorder (MH/SUD) benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits.

If you or your family member has a mental health or substance abuse problem that is an emergency seriously threatening your life or health, get help at once. You should do one of these things:

• Call 911
• Go directly to an emergency room
• Call your doctor or therapist for help

If you have a mental health or substance abuse problem that is not an emergency, but you think you need to talk to someone right away, call Optum at 800.765.6820 - 24 hours a day, seven days a week. For UC enrollees, contact Optum for UC at 888.440.8225. If your emergency results in an inpatient admission, you or your provider must notify WHA, as soon as it is reasonably possible, in order to precertify your care.

Case management (CM) is a service available, at no extra cost, to any WHA member meeting program criteria. Typically, CM services are provided to members with complex or multiple medical conditions that require many visits to specialists or when you require multiple services. If you need help managing your healthcare needs, you, a PCP, relative, or anyone else acting on your behalf, can make a referral to your medical group asking for case management assistance. Case managers are experienced nurses who personally help you through the complexities of the healthcare system to make sure you get the care you need and that it is covered by your insurance.

You may ask your PCP to send a case management referral for you or you may call your medical group yourself. To contact your medical group directly, call:

Hill Physicians Medical Group: 800.445.5747
Mercy Medical Group: 916.379.2885
Meritage Medical Network: 800.0874.0840
NorthBay Center for Primary Care: 707.646.4241
Woodland Clinic Medical Group: 530.662.3961 x4361
St. Joseph Health Medical Network: 844.234.0951

If you lose your coverage through your employer group, you may eligible to continue your benefits through COBRA. Under the Consolidated Omnibus Budget Reconciliation Act of 1985 (the federal law usually known simply as “COBRA”) if you lose your coverage under the Western Health Advantage medical plan due to certain “Qualifying Events” you or your spouse or dependent children may be to entitled to elect to continuation coverage at your own expense. Examples of Qualifying Events include divorce, reduction of work hours or termination other than for gross misconduct.

Not everyone is entitled to elect COBRA continuation coverage. In general, COBRA benefits are only available for those covered by a group health plan maintained by an employer with 20 or more employees. However, California has enacted a separate law known as the California Continuation Replacement Act, or “Cal-COBRA” that may give you an additional right to elect continuation coverage. Under Cal-COBRA, you may entitled to elect continuation coverage if you are covered by a small employer (2-19 employees) group health plan and are ineligible to elect federal COBRA coverage. The same Qualifying Events as under COBRA are applicable under Cal-COBRA that entitle you or your spouse or your dependent children to elect continuation coverage at your own expense.

Under both COBRA and Cal-COBRA, all benefits you receive under continuation coverage are the same as the benefits available to active eligible employees and their eligible dependents. Your employer can confirm your eligibility for COBRA or Cal-COBRA continuation coverage. (Individuals who move out of the Western Health Advantage service area are not eligible for COBRA or Cal-COBRA continuation coverage.)

Should you have any questions, please contact our enrollment department at 916.563.2206 or 888.442.2206 toll-free.

Note: The American Rescue Plan Act of 2021 (ARPA) provides temporary premium assistance for continuation of coverage and, where an employer elects to offer another option, an opportunity to choose a different health plan. This premium assistance is available from April 1, 2021 through September 30, 2021. To determine if you are eligible for premium assistance, please contact your employer. 

The term “health care reform” refers to the Affordable Care Act — the federal law that was passed in March 2010 — as well as any state laws passed to put it in place. These laws are intended to help more people get affordable health care coverage and receive better medical care.

The Affordable Care Act requires most U.S. citizens and legal immigrants to have a basic level of health coverage beginning January 1, 2014 through an employer, a government health program or a health plan they purchase themselves. Those who do not have health insurance will pay a tax penalty. 

Some people won’t have to buy insurance. This includes people with certain religious beliefs, members of Native American tribes, undocumented immigrants, and people who are in prison. People whose income is below a certain level are also not required to buy insurance.

If you qualify, the government will provide financial support — called subsidies — to help some people pay for health coverage or care. This support will be determined by a person’s income level and family size. 

If you don’t buy coverage and go without it for three months or longer, you’ll be charged a tax penalty by the government. If you lack coverage for a period of fewer than three months, you will not be charged a penalty for that period of time.

Yes, anyone can get coverage. Insurance companies can no longer deny coverage to anyone who has a medical condition, and you don’t have to pass a medical exam to qualify for coverage.

With Western Health Advantage as your health plan, you can choose from nearly 3,000 primary and specialty care providers as well as 15 hospitals in Northern California. Our members have more choices because they aren't locked into one medical group for specialty care.  To locate a list of available physicians, please refer to the WHA's Online Provider Directory.

With our unique Advantage Referral program, you'll have the flexibility to choose from many specialists in our entire network, not just within your particular medical group.

How much you will pay depends on whether or not you qualify for a subsidy. This number is based on your income and family size.

If you have questions relating to your financial assistance, enrollment, demographic changes, such as a change of address, please contact Covered California at 800.300.1506

For questions related to your health coverage benefits or billing, please contact Western Health Advantage Member Services

Disease management is a multidisciplinary approach to addressing chronic conditions. It allows a health plan and physician to work together to improve a patient's quality of life and reduce the number of complications from a chronic condition.

The programs are managed by Optum^®, a National Committee for Quality Assurance (NCQA) accredited disease management organization, and overseen by WHA.

Depending on the severity of your illness, health care professionals may contact you by telephone and/or send you educational mailers related to your condition. Health professionals coach participants on nutrition, medication management, physical activity and community resources. In addition, your health care provider receives progress reports that may include patient-specific and evidence-based treatment recommendations that allow your physician the opportunity to make any appropriate adjustments to your current plan of care.

WHA identified the following chronic conditions as having the most impact on the health of our commercial members and included them in our disease management programs:
Asthma 5-56 years
Coronary Artery Disease (CAD) 18-64+ years
Diabetes 18-64+ years

If your health care provider told you that you have diabetes, coronary artery disease (CAD) or asthma, you probably already qualify. Discuss the benefits of enrolling in one of the programs with your healthcare provider or contact Optum^® directly.

WHA provides this service as a benefit to our commercial members so there is no additional cost to participate in the program.

Not at all. The programs are voluntary and are available to help those living with specific chronic conditions and to prevent complications that can be life threatening.

No. Employers are not informed which of its employees are enrolled in our disease management programs. Specific employer groups receive general, statistical reports. However, these reports do not include information that specifically identifies individuals.

Members are enrolled using several methods.

Claims data: WHA provides Optum with monthly claims information generated by our medical group in compliance with HIPAA privacy standards. WHA's health care providers are aware of the agreement between WHA and Optum^® and receive updates on their patients' progress.

Self-referral: Members can self-refer by completing the WHA Disease Management Program Referral Form and faxing the form to 916.568.0278 or mailing to WHA at 2349 Gateway Oaks Drive, Suite 100 Sacramento, CA 95833, Attention: HPDM Department.

Contacting WHA directly: Members can call WHA's Member Services department toll-free at 888.563.2250 Monday through Friday between 8 a.m. to 5 p.m. and ask to speak to an HPDM representative about enrolling in our Disease Management Program.

Contacting Optum® directly: Members can call Optum^® and speak to one of their enrollment representatives at 877.793.3655.

Information such as your name, gender, date of birth, phone number, diagnosis and any other information that helps to administer their programs.

Optum complies with all applicable provisions of law relating to the privacy, confidentiality, security, integrity, transmission or exchange of medical, personal, consumer or financial information obtained and maintained by Optum.

Optum is a business associate of WHA and is a covered entity under the HIPAA Privacy and Security Rules. Optum does not use or disclose Protected Health Information (PHI) for any purpose other than as required to perform its agreements with health plans or as otherwise required or permitted by law. Optum uses appropriate safeguards consistent with reasonable practices in the industry to ensure that PHI is not otherwise used or disclosed.

Optum^® currently uses the information we collect in the following areas:

To create general, statistical reports. These reports do not include information that would specifically identify individuals. For example, a report might include such facts as 55 percent of participants have diabetes or 20 percent of participants are receiving telephone contacts.

For other business purposes such as sending you educational mailings, questionnaires, periodic health reminders or other information.

Optum will not contact you via email without your permission except as specified above, or in response to messages sent to our healthcare team through our message system, or in connection with the registration process.

Optum will never release, sell, rent, or otherwise provide any personally identifiable information on any users to any third party, except as set forth in this policy, without your express permission to do so.

Yes. The programs are voluntary and members can choose to "opt in" or "opt out" at any time. Simply contact Optum^® or WHA and let them know which program you would like to enroll in or that you no longer wish to be a participant.

WHA oversees the disease management services while Optum^® makes the necessary contacts by mail and/or phone depending on the severity of the participant's illness

You can address any concerns or complaints to WHA. Formal complaints or grievances must be in writing. Direct your general questions or concerns to one of our Member Service Representatives.

An emergency condition is when you are experiencing extreme or sudden pain or have acute symptoms that require immediate medical diagnosis, care and treatment to avoid disability or death.

Emergency services are those required for an acute medical condition in which a prudent layperson could reasonably expect the absence of immediate medical attention to result in serious jeopardy or harm.

If you have an emergency situation, call 911 or go to the nearest emergency room no matter where you are located. You do not need pre-approval from your physician for initial ER care, but related follow-up care should be provided through your primary care physician.

Urgent care means services that are medically required within a short-time frame, usually within 24 hours, in order to prevent serious deterioration of a member's health due to an unforeseen illness or injury.

If you need medical services after your doctor’s office is closed, follow these steps:

1. Call your doctor’s office.  Your doctor or the doctor on-call will instruct you to seek care at the emergency room, your medical group's contracted urgent care center, or on home care remedies.
2. Call our Nurse Advice phone line.  If you have a medical concern and are not sure what to do, you can call our nurse advice line at 888.656.3574. Available to members, any time of the day or night.
3. Be prepared.  Know the contact information and location of the closest emergency room, your medical group’s urgent care center, poison control, and closest friend/relative.

WHA covers you for Urgent Care and Emergency Care services wherever you are in the world. Please note that emergency room visits are not covered for non-Emergency situations.

Urgent Care
If an Urgent Care situation arises while you are in WHA's Service Area, call your PCP. You can call your doctor at any time of the day, including evenings and weekends. Explain your condition to your PCP or the physician on call and he/she will direct your care. In the event you are not able to reach your PCP, you should go to an Urgent Care facility affiliated with your medical group.

Emergency Care
If an Emergency situation arises whether you are in WHA's Service Area or outside of the Service Area, call "911" immediately or go directly to the nearest hospital emergency room. If you are hospitalized at a non-participating facility because of an emergency, WHA must be notified within twenty-four (24) hours or as soon as possible. If you are unable to make the call, have someone else make it for you, such as a family member, friend, or hospital staff member.

Follow-up care after an emergency room visit is not considered an Emergency situation. If you receive Emergency treatment from an emergency room physician or non-participating provider and you return for follow-up care (for example, removal of stitches or redressing a wound), you will be responsible for the cost of the service. Contact your PCP for all follow-up care.

Visit Urgent and After-Hours Care to learn more.

WHA covers you for urgent care and emergency care services wherever you are in the world. If you are hospitalized at a non-participating facility because of an emergency, WHA or your PCP must be notified within 24 hours of the emergency or as soon as possible. 

Please note that emergency rooms visits are not covered for non-emergency situations. Also, call your PCP for all follow-up care for your emergency treatment. If you return to the emergency room or non-participating provider for follow-up care (for example, removal of stitches or redressing a wound), you will be responsible for the cost of service.  If your emergency health problem requires a specialist, your PCP will refer you to an appropriate participating provider as needed.

Available: Monday – Friday, 8 a.m. to 6 p.m.

Call: 916.563.2250 | 888.563.2250 toll-free 888.877.5378 TDD/TTY

Email: memberservices@westernhealth.com

For 24/7 information, go online: choosewha.com/OE

WHA's Member Services is happy to help you:

• Get started with your WHA coverage
• Choose a PCP or learn how to see a specialist
• Obtain and understand your benefit plan information
• Get care while traveling or in case of an emergency
• Obtain interpretive services or translated printed materials
• Find out what to do if you receive a bill
• File a compliment or complaint
• Receive your Copayment Summary(ies) and/or EOC/DF

PCPs can be practitioners of Family, Internal or General Medicine, Pediatricians and in some cases, Obstetricians and Gynecologists. At the time of enrollment, you are required to select a PCP from one of the medical groups in your provider network. Your provider network and medical group are shown in your welcome kit, at mywha.org and on WHA’s MyWHA mobile app. Your PCP is responsible for coordinating all of your medical care. It is extremely important to get established with your doctor as soon as your coverage becomes effective.

Here are a few questions that may be useful to consider when selecting a new PCP:

• What's the most convenient location for your PCP's office--near work or near home?
• Would you prefer a male or female PCP?
• Would you like to see your PCP in a private office or in a setting that offers multiple services under one roof?
• Do you prefer to speak to your PCP in another language or have specific cultural needs?
• Referrals are a great way to find the right PCP. Can your friends or colleagues recommend a doctor?

To obtain covered services, you must see a contracted provider. Our online provider directory at mywha.org/directory is a great tool to get the most up-to-date information about participating PCPs and specialists in your network. You can also search for a provider by name, provider type, location of the practice(s), medical group affiliation or languages spoken. Printed directories are available upon request.

You can change your PCP online by logging into your MyWHA account or by calling Member Services. Your PCP effective date is the first day of the month following your request. You must wait until the effective date before seeking care from your new PCP or the services may not be covered. Note: PCP changes are not allowed while you are in the hospital or while you are receiving active medical treatment.

Health Maintenance Organizations (HMOs) in California must meet timelines for providing care and services to members seeking treatment. The Timely Access Regulations set specific standards for patients to obtain a medical appointment in certain situations.

Visit Timely Access To Care to learn more.

ID cards are mailed to members’ homes no later than two weeks before their effective date. Replacement ID cards will be issued in the event of a name change or if dependents are added to your coverage. As a member, you can also access and print your ID card at mywha.org or from WHA’s MyWHA mobile app. A copy of your enrollment form or electronic enrollment confirmation can also be used as temporary proof of coverage.

By logging into your MyWHA account at mywha.org, you can access a digital copy of your member ID card (as well your dependent cards, if applicable). Print and/or save your card with just a few clicks.

Available from the iTunes App Store or Android Market Place, the MyWHA Mobile app captures your ID card on-the-go. From your mobile device, view and email an electronic copy of your ID card to yourself or a provider. There is also a fax option from the app. Other benefits of the MyWHA Mobile app:

• Reach your PCP and get directions to his or her office
• View plan details, like service and prescription copayments
• Access our Member Services
• Call NurseLine WHA’s contracted 24-hour nurse hotline service
• Obtain 24-hour mental health services by phone

Certain covered services require Prior Authorization from your PCP's affiliated medical group or from WHA in some cases. If Prior Authorization is not obtained, you may be liable for the payment of services or supplies. WHA and your medical group use qualified physicians and nurses to review service requests to confirm medical necessity and appropriateness. You do not need Prior Authorization for Direct Access services, which include annual eye exams and routine gynecological and obstetrical care from participating providers.

Prior Authorization is required for:

• Services from non-Participating Providers except in Urgent Care or Emergency situations
• Behavioral health services except in Urgent Care or Emergency situations

WHA provides routine and complex Case Management (CM) services available for members who qualify for them—generally, those with conditions that require a high level of coordination of care among multiple specialists and other health care providers—at no additional cost. To learn more about our CM services or to determine if you qualify, contact WHA Member Services.

Additionally, Disease Management (DM) programs are available to members to assist with identifying strategies to optimize their health and reach personal health goals for certain members living with chronic conditions. To learn if you qualify for these no-cost DM programs, visit mywha.org/dm or contact WHA Member Services.

WHA has partnered with Optum to provide our members with innovative ways to lead healthy lifestyles.

Through our MyWHA Wellness webpage, you have access to the Optum Health Portal 24/7 interactive decision aide tool that will guide you through making important health decisions. This tool guides you through important health decisions that combines medical information along with your personal values that help you to make informed decisions about medical tests, medicines, surgeries, and other treatments options. Learn more at mywha.org/healthsupport.

A member may request a second medical opinion regarding any diagnosis and/or any prescribed medical procedure. Members may choose any WHA Participating Provider of the appropriate specialty to render the opinion. All opinions performed by non-Participating Providers require Prior Authorization from WHA or its delegated medical group. All requests for second medical opinions should be directed to the member's PCP.

Typically, out-of-network services are not covered unless in an urgent or emergency situation. However, if you are a new member currently undergoing acute treatment with a non-participating provider, you may qualify for Continuity of Care (CoC). For more information or to obtain a Continuity of Care Request Form, contact WHA Member Services. You may also access the CoC Form online

In certain circumstances, members may temporarily continue care with a non-participating provider. If you are being treated by a provider who has been terminated from WHA's network, or if you are a newly enrolled member who has been receiving care from a provider not in WHA's network, you may continue care with that provider if you meet the Continuity of Care (COC) criteria explained below:

• An acute condition: a medical condition that involves a sudden onset of symptoms due to an illness, injury, or other medical problem that requires prompt medical attention and that has a limited duration. Completion of covered services shall be provided for the duration of the acute condition.
• A serious chronic condition: a serious chronic condition is a medical condition due to disease, illness, or other medical problem or medical disorder that is serious in nature and that persists without full cure, worsens over an extended period of time or requires ongoing treatment to maintain remission or prevent deterioration. Covered services will be provided for the period of time necessary to complete a course of treatment and to arrange for a safe transfer to another provider, as determined by WHA in consultation with the member and the terminated provider or Non-Participating Provider, consistent with good professional practice. Completion of covered services under this paragraph shall not exceed twelve (12) months from the contract termination date or twelve (12) months from the effective date of coverage for a newly enrolled member.
• A pregnancy. Care will be continued for the duration of the pregnancy and the immediate postpartum period.
• A terminal illness: an incurable or irreversible condition that has a high probability of causing death within one year. Care shall be continued for the duration of the terminal illness.
• Care of a newborn child whose age is between birth and thirty-six (36) months. Care shall be continued for up to twelve (12) months.
• Performance of surgery or other procedure that has been authorized by WHA (or its contracted medical group) as part of a documented course of treatment that is to occur within one hundred eighty (180) days.

Please contact Member Services prior to enrollment and no later than thirty (30) days from the effective date of your WHA coverage, or from the date your provider terminated with WHA to request a print copy of the COC form. You may also download an electronic copy of the COC form.

WHA will assist members with transition to other care when benefits end or during transition from pediatric care to adult care.

Transitioning Care When Benefits End

If your benefits are exhausted while you still need care and you are in a case management (CM) or disease management (DM) program, the CM or DM staff can discuss alternatives for continuing care and how to obtain care. If you’re not receiving these health care services, ask to speak to a WHA clinical resource representative who will be happy to assist you. Other alternatives such as Cobra coverage, Conversion/Individual plan, Medi-Cal, ACA Exchange coverage or community resources can be explored to meet your individual needs.

Transitioning from Pediatric to Adult Care

Generally, pediatric patients begin transition of care from a Pediatrician to a Family Practice, Internal Medicine or OB GYN Physician between the ages of 19 to 26 years. However, there are chronic conditions that may warrant a patient to continue their relationship and health care services within the pediatric setting.

WHA encourages members and their families to discuss this important transition with their individual physicians, as this decision should be based on each individual’s health care needs.

A WHA clinical resource representative is available to help should you need assistance in transitioning your health care services or have any questions.  For more information, call member services and ask to speak with a Clinical Resource Nurse.

WHA encourages its practitioners to practice open physician-patient communication and to freely discuss available treatment options, including medication treatment options, with their patients regardless of the patient's benefit coverage limitations. Practitioners shall not be penalized for discussing medically necessary or appropriate care and the available options with their patients.

Coverage Decisions

WHA's physician reviewers make coverage decisions related to appropriateness of care and services using available medical information about the patient and criteria that are based on recognized standards of medical practice. During these reviews, health plan benefits and individual circumstances of the patient are also considered.

Financial incentives or compensation are not linked to these decisions or to the withholding of care. If you would like to learn more about WHA's utilization management processes or receive information about the criteria or guidelines used by WHA to make care and treatment decisions, please contact WHA's member services department.

Utilization Management Criteria

Criteria primarily used by WHA’s physician reviewers to make medical necessity decisions at the health plan level include the following sources:

• MCG® (formerly Milliman Care Guidelines) – Acute, Ambulatory & Chronic Care guidelines
• UpToDate® – Evidence-based physician authored clinical decision support resource
• Hayes New Technology Assessment guidelines – Experimental guidelines
• Optum Complete Guide to Medicare Coverage Issues

Most criteria and guidelines are protected by copyright, however if a service is denied for medical necessity reasons, you will receive written rationale with excerpts or references to the criteria that was used to make the decision.  You will also be provided with information on how to submit an appeal or a request for re-review of your case by another physician if you do not agree. To obtain more information about the utilization management or appeal processes, decision criteria or pharmaceutical management procedures, please contact Member Services and ask for the Medical Management department.

While your PCP will treat most of your health care needs, if your PCP determines that you require specialty care, your PCP will refer you to an appropriate provider. You may have options in specialty care outside of your PCP’s medical group. Learn more at mywha.org/referral.

If you or another covered family member has a serious, complicated medical condition requiring multiple specialists and treatments, you may qualify for our Case Management program. If you qualify, a nurse will personally assist you to obtain the necessary pre-approvals and services you need, as well as provide health plan and community resource information to help you effectively manage your situation.

If you or a family member is experiencing a catastrophic health situation and you think you might benefit from CM assistance, please discuss your concerns with your PCP and ask him or her to make a referral on your behalf. Visit Case Management to learn more.

WHA covers you for Urgent Care and Emergency Care services wherever you are in the world. Please note that emergency room visits are not covered for non-Emergency situations.

Urgent Care
If an Urgent Care situation arises while you are in WHA's Service Area, call your PCP. You can call your doctor at any time of the day, including evenings and weekends. Explain your condition to your PCP or the physician on call and he/she will direct your care. In the event you are not able to reach your PCP, you should go to an Urgent Care facility affiliated with your medical group.

Emergency Care
If an Emergency situation arises whether you are in WHA's Service Area or outside of the Service Area, call "911" immediately or go directly to the nearest hospital emergency room. If you are hospitalized at a non-participating facility because of an emergency, WHA must be notified within twenty-four (24) hours or as soon as possible. If you are unable to make the call, have someone else make it for you, such as a family member, friend, or hospital staff member.

Follow-up care after an emergency room visit is not considered an Emergency situation. If you receive Emergency treatment from an emergency room physician or non-participating provider and you return for follow-up care (for example, removal of stitches or redressing a wound), you will be responsible for the cost of the service. Contact your PCP for all follow-up care.

Visit Urgent and After-Hours Care to learn more.

WHA covers urgent care and emergency care services wherever you are in the world. If you are hospitalized at a non-participating facility because of an emergency, WHA or your PCP must be notified within 24 hours of the emergency or as soon as possible. Please note that emergency room visits are not covered for non-emergency situations. Also, call your PCP for all follow-up care to your emergency treatment. If you return to the emergency room or a non-participating provider for follow-up care (for example, removal of stitches or redressing a wound), you will be responsible for the cost of the service. If your emergency health problem requires a specialist, your PCP will refer you to an appropriate participating provider as needed. If you need assistance with care out of the service area, contact WHA Member Services and ask to speak to a Clinical Resource Nurse.

NurseLine provides access to registered nurses who are ready to answer your specific questions on general health and wellness, 24 hours a day, including making direct referrals to disease management nurses. To speak to a nurse, call 877.793.3655 (800.877.8793 for TTY). You can also chat online with a nurse or send a secure email via mywha.org/healthsupport. Of course, you can always call your PCP’s office if you are unsure if your situation needs immediate attention.

As a member, you and/or your dependents must live or work within the WHA service area zip code. For WHA’s service area map, visit mywha.org/servicearea. If a member or dependent no longer lives in the WHA Service Area, they will no longer be eligible for coverage through WHA. It is important to understand that you must choose a PCP from the WHA network and that you are required to receive all routine and preventive services there. This includes care you may require for routine illnesses such as colds, flu, headaches, minor sprains and other illnesses and injuries that are not classified as urgent or emergency care.

Note: For members with a group plan, please refer to your Evidence of Coverage/Disclosure Form (EOC/DF) and Copayment Summary(ies) for a detailed description of coverage benefits and limitations.

If your dependent child lives outside of our service area, he or she is eligible for in-network coverage only if a full-time student. Note: Those students who reside outside the service area must obtain all routine, preventive and follow-up care from WHA network providers. When outside the service area, these students are covered only for urgent or emergency care.

WHA and our providers support your right to obtain accessible health care. If you have needs with regard to your culture, language, or a disability, please contact your physician’s office first or call WHA’s Member Services.

If you need assistance in a language other than English, WHA offers interpretation services in many languages, including Spanish and American Sign Language, free of charge. Let your physician’s office know when you call for an appointment if you would like this assistance. The deaf and hard of hearing may use WHA’s TTY line at 888.877.5378.

Spanish language versions of all vital and critical plan documents are available to our membership on our website or through WHA Member Services. Translated documents in languages other than Spanish, in large print, in braille, and other formats may be requested through your doctor’s office or WHA’s Member Services Department.

MyWHA Wellness is WHA's wellness program that went into effect on January 1, 2016.  This improved wellness program is provided by Optum  through mywha.org/wellness.  

The goals of MyWHA Wellness are:

• Give you information about your current health.
• Help you set personalized and realistic wellness goals.
• Provide the tools and resources you need to reach your goals.

Start by taking the wellness assessment. It will give you a wellness score, along with a personalized report about your medical and behavioral health risks. You’ll also identify personal goals for improving your health using Optum's tools.

No, the MyWHA Wellness website and services are in no way intended to be professional medical advice, or substitute for professional medical advice, nor do they provide medical services. Furthermore, the MyWHA Wellness website and services are intended for educational purposes only. Products and services available on the MyWHA Wellness website are not insurance. MyWHA Wellness expressly prohibits you from using information and services on its website to diagnose, treat, cure, or prevent any medical condition. WHA recommends that you consult a physician for treatment of any medical condition or medical advice. Application or reliance on any of the content, techniques, ideas, and suggestions accessed through mywha.org/wellness is at your sole discretion and risk.  

If you are an active WHA member, you are eligible. WHA offers the tools provided through MyWHA Wellness as a basic benefit to our members at no additional cost.

No, some personal health improvement programs are not appropriate for individuals who have certain medical or other health conditions. . However, other tools, such as the health library and tracking tools, are appropriate for most individuals.

YES, YOU ARE STRICTLY RESPONSIBLE FOR SEEKING MEDICAL ADVICE FROM A PHYSICIAN PRIOR TO PARTICIPATING IN ANY PERSONAL HEALTH IMPROVEMENT PROGRAM DISCUSSED OR ADDRESSED IN MYWHA WELLNESS. You may not be aware of a medical condition from which you suffer; therefore, you should not participate in the personal health improvement programs discussed in MyWHA Wellness prior to seeking the advice of a physician.

It's easy. Visit mywha.org/wellness. Log in or register in the top right corner. Once you provide the necessary information, you should be able to access the wellness tools right away.

It’s important to take your wellness assessment right away so you can take full advantage of the wellness tools. To do that, after logging in, click on “Get Started” in the wellness assessment box. Then click on “Get Started” again and start answering the questions. You can save and close the program at any time if you don’t have time to complete it all at once. Submit when you are done.

There is no cost to our members for using MyWHA Wellness. WHA offers this program as part of your basic benefit. WHA members with the basic benefit have access to online coaching services. 

The Wellness Assessment is a personalized, confidential tool that can help you identify areas where you may be able to improve your health, as well as recommend personalized programs to support your individual health goals. 

To take your wellness assessment, after logging in at mywha.org/wellness, click on “Get Started” in the wellness assessment box. Then click on “Get Started” again and start answering the questions. You can save and close the program at any time if you don’t have time to complete it all at once. Submit when you are done.

During the initial registration process, MyWHA Wellness collects information from you such as name, gender, date of birth, phone number, email address, and mailing address. Once registered, you may enter health-related information such as weight, height and health habits using certain website features, such as the health progress assessment (HPA) and health trackers.

Personal health information is not provided to employer groups but is provided via an extract for WHA data purposes. A combined risk and engagement information is provided at all purchase levels where data is available. Individual-level engagement activity information is provided at all levels for employer groups to administer their incentive, if applicable (detail reports, HPA completer reports, etc.).

Wellness tools include video and audio online coaching courses, nutrition and exercise planners; and 11 health trackers such as those for your blood sugar, cholesterol, weight, sleep, stress, peak flow and activity level. A health library is available that includes videos and articles with the latest information on a variety of health topics, such as workout tips, help with quitting smoking, yoga, recipes, newsletters and much more.

MyWHA Wellness will not release, sell, rent or trade your personal information to any third party without your permission unless the law requires it or to protect its own rights and properties. Personal information includes, but is not limited to, name, e-mail address, mailing address, phone number, user I.D. and passwords, credit card information and personal health information. Optum never shares any information with any third parties.

Once your wellness assessment is completed changes cannot be made. The same is true for trackers you complete, as that becomes part of your online record. Please remember, personal health information cannot be removed from the system and will be retained for a minimum of seven years in accordance with Optum’s record retention policy. Your member account, however, may be disabled upon written request, using the contact information listed below.

In order to maintain the confidentiality of personal information, MyWHA Wellness through Optum enforces strict company-wide policies regarding privacy, security, and confidentiality in accordance with HIPAA security requirements. Optum secures personal information in an isolated database with tightly restricted access. Only authenticated employees are allowed to gain such access. Review of web security is on an ongoing basis. In addition to daily security administration and response activities, the organization undergoes an overall security review on an annual basis. Optum uses Secure Sockets Layer (SSL) technology to protect the security of online order information.

Call Optum at 877.793.3655, option 3.

Call Optum at 877.793.3655, option 7.

Call 877.719.9004 (Optum’s Service Desk) with any questions about the site or your program. Service Desk Hours are Eastern Time:
Monday to Friday: 8 a.m. to 11 p.m.
Saturday to Sunday: 9 a.m. to 6 p.m.
Excludes nationally-observed holidays.

You should call WHA Member Services at 888.563.2250. Different employer groups may have different arrangements regarding telephonic coaching.

Contact Member Services.

It’s easy! All it takes is some basic information from you along with your WHA member ID number. Simply “Sign Up For MyWHA Tools” and follow the prompts. Once registered, access the details of your personal benefit information online—24 hours a day, 7 days a week.

Once logged in, you will be able to view your plan’s copayment summary(ies), which describe your coverage benefits, as well as your Combined Evidence of Coverage and Disclosure Form (EOC/DF) booklet, where you will find details on your health plan. 

Manage your health plan with these online tools.

• Order/Print ID cards or other printed materials.
• Change your primary care physician (PCP).
• View your preferred drug list (PDL), if you have prescription coverage.
• Review deductible balances, using the accumulator, if you are enrolled on a deductible plan.
• Estimate your service costs.

View online or request a copy by contacting Member Services.

You and any of your covered family members will receive your member ID card(s) inside your Personal Benefits Kit (PBK) or when you make a PCP change. Your PBK will arrive 7-10 days after you enroll in Western Health Advantage. You will need to present your ID card whenever you visit your doctor or another provider. A copy of your online enrollment confirmation or enrollment form can be used as temporary proof of coverage until your card arrives.

Since your PCP coordinates all your covered care, it is important that you are completely satisfied with your relationship with him or her. If you want to choose a different PCP, you can change your PCP online by logging into your MyWHA account or by calling Member Services. WHA will issue you a new ID card confirming your new PCP's name. The effective date is the first day of the month following notification. You must wait until the effective date before seeking care from your new PCP, or the services may not be covered.  Visit Choosing a new a PCP to learn more.

New patient appointments are generally scheduled for a longer timeframe than routine appointments, so please contact your new provider as soon as possible so you can become an established patient. If you wait too long to make a new patient appointment to establish care, your new providers office may not be able accept you because they may have become closed to new patients. 

Establishing a relationship with your primary care physician (PCP) is critical to your ongoing health care needs. Your PCP will coordinate your medical care by direct treatment or referral to a participating specialist.

WHAs Advantage Referral program allows you to see almost any specialist in our network, regardless of their medical group affiliation. While your PCP will typically refer you within his or her affiliated medical group, you are not limited to only those specialists.   Refer to the Provider Directory or call WHA Member Services to ensure that a specialist is the Advantage Referral program.  Your PCP will coordinate a referral if you need to see a specialist. Members can self-refer within the network for their annual eye exam (when covered) and OB/GYN visits. Learn more at mywha.org/advantagereferral. 

Typically, out-of-network services are not covered unless in an urgent or emergency situation. However, if you are a new member currently undergoing acute treatment with a non-participating provider, you may qualify for Continuity of Care. For more information or to obtain a Continuity of Care (CoC) Request Form, contact WHA Member Services. You may also access the CoC Form online at mywha.org.

In certain circumstances, members may temporarily continue care with a non-participating provider. If you are being treated by a provider who has been terminated from WHA's network, or if you are a newly enrolled member who has been receiving care from a provider not in WHA's network, you may continue care with that provider if you meet the Continuity of Care (COC) criteria explained below:

• An acute condition (care continued for the duration of the acute condition)
• A serious chronic condition due to disease, illness, or other medical problem or medical disorder that is serious in nature and that persists without full cure, worsens over an extended period of time or requires ongoing treatment to maintain remission or prevent deterioration
• A pregnancy (care continued for the duration of the pregnancy and the immediate postpartum period)
• A terminal illness, an incurable or irreversible condition that has a high probability of causing death within one year
• Care of a newborn child whose age is between birth and thirty-six (36) months (care continued for a period not to exceed twelve (12) months
• Performance of surgery or other procedure that has been authorized by WHA or the medical group as part of a documented course of treatment that is to occur within one hundred eighty (180) days

If you are a newly enrolled member and you had the opportunity to enroll in a health plan with an out-of-network option, or had the option to continue with your previous health plan or provider, but instead voluntarily chose to change health plans, you are not eligible for Continuity of Care. Please contact Member Services prior to enrollment and no later than thirty (30) days from the effective date of your WHA coverage, or from the date your provider terminated with WHA to request a print copy of the COC form. You may also download an electronic copy of the COC form.

In addition to receiving standard advice for medical issues, Optum's Nurse24^SM provides access to highly-trained registered nurses who are ready to answer your specific questions on general health and wellness, 24 hours a day, including direct referrals to disease management nurses.

Sign up through the Optum Health Portal for access to registered nurses through the Nurse24 private chat or call 877.793.3655.

Of course, you can always call your PCP’s office if you are unsure if your situation needs immediate attention. Your PCP's office number is located on your WHA member ID card. 

Your mental health and substance abuse benefits are provided through Magellan Behavioral Health. You do not need a PCP referral to obtain these services. Visit Behavioral Health Benefits to learn more.

WHA covers you for Urgent Care and Emergency Care services wherever you are in the world. Please note that emergency room visits are not covered for non-Emergency situations.

Urgent Care
If an Urgent Care situation arises while you are in WHA's Service Area, call your PCP. You can call your doctor at any time of the day, including evenings and weekends. Explain your condition to your PCP or the physician on call and he/she will direct your care. In the event you are not able to reach your PCP, you should go to an Urgent Care facility affiliated with your medical group.

Emergency Care
If an Emergency situation arises whether you are in WHA's Service Area or outside of the Service Area, call "911" immediately or go directly to the nearest hospital emergency room. If you are hospitalized at a non-participating facility because of an emergency, WHA must be notified within twenty-four (24) hours or as soon as possible. If you are unable to make the call, have someone else make it for you, such as a family member, friend, or hospital staff member.

Follow-up care after an emergency room visit is not considered an Emergency situation. If you receive Emergency treatment from an emergency room physician or non-participating provider and you return for follow-up care (for example, removal of stitches or redressing a wound), you will be responsible for the cost of the service. Contact your PCP for all follow-up care.

Visit Urgent and After-Hours Care to learn more.

Yes. If you do not choose your own primary care physician (PCP), one will automatically be assigned to you. You must choose a PCP who participates in the Western Health Advantage (WHA) provider network.

Establishing a relationship with your PCP is critical to your ongoing health care needs. Your PCP will coordinate your medical care by direct treatment or referral to a participating specialist. All non-Urgent Care or non-Emergency Care should be received from your PCP or other Participating Provider as referred by your PCP. If you have never been seen by the PCP you choose, please call his/her office before designating him/her as your PCP as some practices may be temporarily closed because they are full. If you do not designate a PCP at the time of enrollment, WHA will assign one for you. To locate a list of available physicians, please refer to the WHA's Online Provider Directory

When you enroll in Western Health Advantage, you must select a primary care physician (PCP) for yourself and each of your covered family members. PCP's can be practitioners of Family, Internal or General Medicine, Pediatricians and in some cases, Obstetricians and Gynecologists. Each family member can choose his/her own PCP from any of our medical groups. Your PCP is responsible for coordinating all of your medical care. It is extremely important to get established with your physician as soon as your coverage becomes effective.  To locate a list of available physicians, please refer to the WHA's Online Provider Directory. You may also request a print copy by calling Member Services.

Since your PCP coordinates all your covered care, it is important that you are completely satisfied with your relationship with him or her.  If you want to choose a different PCP, you can change your PCP online by logging into your MyWHA account or by calling Member Services. The effective date is the first day of the month following notification. You must wait until the effective date before seeking care from your new PCP, or the services may not be covered. 

To obtain covered services, you can search our Online Provider Directory that lists PCPs and specialists in the WHA network. However, we add new providers periodically and others may leave WHA as they retire or relocate. Our online, interactive Provider Directory is a great tool to get the most up-to-date information about participating providers. You can also search for a provider by name, provider type, location of the practice(s), medical group affiliation or languages spoken.

You and any of your covered family members will receive your member ID card(s) inside your Personal Benefits Kit (PBK) or when you make a PCP change. Your PBK will arrive 7-10 days after you enroll in Western Health Advantage. You will need to present your ID card whenever you visit your doctor or another provider. A copy of your online enrollment confirmation or enrollment form can be used as temporary proof of coverage until your card arrives. New ID cards are also mailed whenever a change occurs which affects the information on the card, such as a name change. As a member, you can also access and print your ID card at mywha.org. A copy of your enrollment form or electronic enrollment confirmation can also be used as temporary proof of coverage.

WHA’s Advantage Referral program allows you to see almost any specialist in our network, regardless of their medical group affiliation. While your PCP will typically refer you within his or her affiliated medical group, you are not limited to only those specialists. Refer to the Provider Directory or call WHA Member Services to ensure that a specialist participates in the Advantage Referral program.  Your PCP will coordinate a referral if you need to see a specialist. Members can self-refer within the network for their annual eye exam and OB/GYN visits. Learn more at mywha.org/advantagereferral. 

Note: Specialists who do not participate in the Advantage Referral program are designated in our Provider Directory. UC Davis Medical Group does not participate in the Advantage Referral Program. UC Davis-affiliated enrollees are not eligible to participate in the Program.

No, your PCP and specialist do not have to be in the same medical group. WHA's Advantage Referral system allows more choices. You can select a PCP in one medical group, but when referred for specialty care, you may see a participating specialist in any other WHA medical group. However, not all specialists are in Advantage Referral. To identify those physicians who do not participate, check the online provider directory, or call member services for current status.

As a member of WHA you will receive routine care from your PCP. In most cases, specialty care is also provided by WHA network physicians. Your doctor, medical group, and in some cases, WHA, will decide if you should receive specialty services from a non-network physician based on your individual healthcare needs. To see a non-network physician you must always get pre-approval to ensure coverage, except in emergency situations.

Routine care is treatment of conditions not considered to be an emergency or urgent. Examples include getting immunizations or an annual physical examination.

If you would like a second opinion about a treatment, recommended procedure or surgery, your PCP will make a referral to obtain pre-approval. You can get a second opinion from an appropriate specialist in your own medical group or from a network specialist in another WHA group under the Advantage Referral system. If you want a second opinion from a specialist outside the WHA network, your request will be reviewed at the plan level. If an appropriately qualified specialist is available within the network to provide the second opinion, you will be referred back to your PCP and medical group to obtain pre-approval.

Certain covered services require prior authorization (pre-approval) from your PCP's affiliated medical group, or from WHA in some cases, to make sure they are paid under your health plan benefits. Post-service reviews for requests submitted after the service has already been approved, may not be allowed if the service required prior authorization.

Your PCP should know when pre-approval is needed. PCP staff will notify your medical group or WHA when you need to see a specialist or get another service that requires pre-approval. Decisions are made by qualified medical professionals (doctors, pharmacists and nurses), but only experienced physicians and pharmacists can deny or modify a requested service.

You do not need pre-approval for initial emergency room treatment. You may also see a network eye specialist once a year for a routine eye exam, if covered, and women may access obstetrical or gynecological services without pre-approval. You just need to make sure the specialist is in WHA's provider network. See Provider Directory on this website for participating network specialists or call Member Services.

A decision to pre-approve, modify or deny a specialty or service referral request must be made within certain timeframes. These are based on the urgency of your medical condition and treatment needs, but most decisions are made within five business days of receiving necessary information to make the decision. If fast handling of your case is needed due to urgent medical needs, your doctor may ask for an "expedited" review. These will be completed by the plan as soon as possible based on your situation, but no later than 72 hours of receipt of the request and pertinent information to make a decision. Some services are considered an urgent concurrent review, meaning they are reviewed as you are receiving on-going services. An example of this is when you are in the hospital. Services are reviewed within 24 hours of the hospital's request for approval.

Your doctor(s) and medical group will receive a phone call, fax or electronic notice of the decision within 24 hours of the decision. This is followed by written notice mailed to you, your PCP and the specialist within two days. If denied, the notice includes an explanation of the reasons for the denial or modification and information on how to file an appeal with WHA Member Services. It also includes information on how to contact the California Department of Managed Health Care for an independent review of your case (call toll free at 888.HMO.2219 or TDD services at 877.688.9891).

Insurance eligibility and benefits are verified first to make sure you have effective coverage. Your referral request is also checked to see if the specialty service you need will be provided by a WHA network provider. Experienced reviewers (nurses, pharmacists or doctors) then evaluate your individual situation and compare your relevant medical records against review criteria that are based on recognized standards of practice for your diagnosis. Using established medical criteria helps reviewers decide if requested services are appropriate and medically necessary, and they promote fair and consistent decisions.  During these reviews, Plan benefits and individual circumstances of the patient are also considered. Financial incentives or compensation are not linked to these decisions or to the withholding of care.

Review criteria are based on sound clinical principles and treatment practices, and involve actively practicing board certified specialists in their development. All criteria/guidelines used by WHA and its medical groups must be approved annually by WHA's Quality Committee and Board of Directors to make sure they are still appropriate and current.

Criteria primarily used by WHA’s physician reviewers to make medical necessity decisions at the health plan level include the following sources:

• MCG® (formerly Milliman Care Guidelines) – Acute, Ambulatory & Chronic Care guidelines
• UpToDate® – Evidence-based physician authored clinical decision support resource
• Hayes New Technology Assessment guidelines – Experimental guidelines
• Optum Complete Guide to Medicare Coverage Issues

Most criteria and guidelines are protected by copyright, however if a service is denied for medical necessity reasons, you will receive written rationale with excerpts or references to the criteria that was used to make the decision. You will also be provided with information on how to submit an appeal or a request for re-review of your case by another physician if you do not agree. To obtain more information about the utilization management or appeal processes, decision criteria or pharmaceutical management procedures, please call WHA Member Services at 916.563.2250 and ask for the Medical Management department.

WHA's clinical staff is available by calling Member Services and asking to speak with a Medical Management representative. If you prefer to leave a message for WHA's clinical staff about a UM inquiry or you call after hours, select option 7. The message service is available 24 hours a day/7 days a week. All messages left after hours will be answered with a return call on the next business day. Inquiries can also be faxed directly to WHA's Medical Management department at 916.568.0278.

New diagnostic and surgical procedures, medicines and other healthcare interventions that are not yet considered the usual standard of care and practice (according to national and local medical communities) are reviewed by WHA to see if they are safe and effective before they become covered benefits. If your doctor requests pre-approval for a service that could be considered experimental, it will be forwarded to WHA for investigation and decision-making. WHA reviewers use special new technology assessment criteria developed by Hayes, Inc. to help with these decisions. If no criteria exist for the requested service or it is too new to adequately evaluate through other resources, WHA may forward the case to outside, independent physician reviewers who provide expert opinions and recommendations. Service requests that are determined to be experimental after thorough investigation are not covered benefits.

Sometimes WHA’s investigation will reveal that the new technology is no longer considered experimental and may be included as a regular member benefit. If WHA’s medical professionals decide a new technology is unproven and your doctor’s request is denied, you and/or your doctor have the right to appeal the decision.

For additional information regarding WHA’s Utilization Management decisions and processes, call Member Services and ask to speak with a Clinical Resources nurse.