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Tribal Member Health Plan Information

 

 2018 Tribal Health Plan Chart

In 2015, the Wichita Executive Committee developed a tribal member health care plan to provide access to quality medical, dental, and vision care for all Tribal Members.  Many of our members have no health insurance, and those of us who do have insurance find that the high deductibles and co-pays are often the reason we delay needed healthcare.

The Tribal Member Plan meets the specific needs of all our Tribal Members, regardless of age, residence or existing health conditions.  The Plan gives special consideration to the unique needs of infants, children, working age adults, and elders.  The Plan benefits are unlike any "standard" insurance products.  It is a Native American benefit plan developed by Native Americans for Native Americans. 

The Wichita Executive Committee unanimously approved the Tribal resolution authorizing the implementation of the Wichita and Affiliated Tribes Tribal Member Health Plan 2016, 2017 and 2018.

We believe that the plan will grow to cover more and more benefits in higher amounts in the coming years.   This plan will only be allowed to cover enrolled members of the Wichita and Affiliated Tribes.

Here are some of the highlights:

  • Benefits limit is $1,500 per year
  • YOU WILL NOT GET 1099'S OR HAVE TO PAY TAXES ON THESE SERVICES!
  • Maternity care and newborn baby care
  • Physician office visits, including all child immunizations
  • Inpatient and Outpatient hospital care
  • Emergency room visits
  • Diagnostic testing including CT scans, MRI's, and lab tests
  • Preventive care including mammograms, colonoscopies, and annual physicals
  • Hospice care and hospice supplemental coverage for end of life final expenses
  • Home health nursing care to help our elders who are homebound due to illness
  • Skilled nursing facility care
  • Prescription drug benefits for all ages. This includes our elders who are on Medicare.
  • Dental benefits for all Tribal Members young and old
  • Vision care benefits
  • Each Tribal Member receives his or her own personalized health care identification card that guarantees access to medical, dental and vision care at any provider without complicated paper work or extended delays.  The identification card works the same as any health insurance card.  Our Tribal Member Health Benefit Plan identification card insures "access" to care when we need it, wherever we choose to go.   Networks have been set up all over the country and even out of the country to help make our dollars stretch. This creates minimal out of pocket expense.

 

Each enrolled tribal member will be enrolled in one of the following plans:

Plan A

  • This is for tribal members who have no health care coverage at all. 

 

  • In Network, $20 copay for Physician Office Visits

 

  • Emergency Room is a $100 copay

 

  •  Prescription Copays: $0 Generic. $25 Name Brand Prescriptions (up to $500 each year per member).

 

  • 90% of most other services without a deductible.

 

Plan B

This is for tribal members who already have insurance. This includes Group Health Plans, Medicare, Medicaid or any other type of health insurance coverage already taken.  

  • In Network, no copay for Physician Office Visits

 

  • Emergency Room $25 copay

 

  • Prescriptions: Copays $0 For Prescription balances not paid by the Primary Insurance Payment (up to $500 each year per member).

 

  • All other services pay at 100 percent in network to the plan maximum after the primary coverage has paid.

 

Prescription Drugs

  • RX is limited to $500 per Member per benefit year.

 

Vision Insurance

This will be paid through the VSP network with the following:

  • One Eye Exam every 12 months. Frames or Lenses every 12 months paid at 100% up to $250.

 

Dental Insurance

  • Pays 100% for teeth cleaning, x-rays and twice yearly check ups. 

 

  • Basic services such as fillings will be paid at 90%

 

  • Major services such as crowns will be paid at 80%

 

  • All services are subject to a total of $400 per member per year

 

End of Life Expenses Benefit

  • Hospice Care
  • End of Life Home Care

 

All expenses will be paid directly to the vendor providing the services.

BENEFIT LIMITS WILL NOT EXCEED $1500.  

 

Examples of What Medicare Does Not Cover

Examples of What Soonercare (Oklahoma Medicaid) Covers

Frequently Asked Questions