Jeffrey Wade
Walmart offers its associates a range of health insurance plans, including the Premier Plan, which provides low costs and simple copays. This plan covers serious and complex conditions, giving associates access to specialists and some of the best facilities in the country. Walmart associates can also access virtual care and book appointments with doctors and therapists online 24/7. To learn more about eligibility and how to use your Walmart medical insurance, associates can refer to the Associate Benefits Book or reach out to their local HR representative or the People Services team.
| Characteristics | Values |
|---|---|
| Choice of plans | Various plans, including Premier, Contribution, Saver, Local, and eCommerce |
| Eligibility | Walmart Associates and their dependents |
| Access to doctors | 24/7 access to top-rated doctors online, including primary care and therapy visits |
| Second opinions | Remote second opinions from leading experts |
| LGBTQ+ affirming care | Yes |
| Behavioral health | Yes |
| Medical cost guidance | Guidance on medical costs and whether the quoted price is fair |
| Prescription medication | Prescriptions must be filled at a Walmart or Sam's Club Pharmacy |
| Specialist access | Access to specialists at some of the best facilities in the country for serious and complex conditions |
| Travel and lodging | Covered for treatment of many serious conditions |
| Cost | Low costs and simple copays |
| Exclusions | Not eligible for those enrolled in a Medicare prescription drug plan |
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What You'll Learn
Understanding medical costs and fair pricing
To make informed decisions about your medical care and costs, it is important to have access to reliable information. FAIR Health is an independent, national nonprofit organization that provides fair and neutral information about healthcare costs. They receive over 4 billion healthcare claim records annually from health insurers across the country, which are added to their database of more than 51 billion claim records. This data is used to estimate what providers charge and what insurers pay for healthcare services. FAIR Health offers various tools, such as the Shoppable Services tool, which helps users learn the average price for services in their area. They also provide educational resources, such as articles, videos, and glossaries, to help users understand health insurance plans, medical bills, and how to evaluate different settings for care.
Additionally, Walmart associates can seek support from Included Health, a separate entity that provides guidance on healthcare benefits. Included Health can help Walmart associates understand medical costs and whether the quoted price is fair. They can also assist with exploring different health benefits and arranging remote second opinions from experts.
It is worth noting that doctors also have a role in screening patients for financial harm. Simple questions about a patient's ability to pay for medications or treatments can help identify those at risk for cost-related nonadherence. While doctors may not know the specific details of each patient's insurance plan, having open conversations about finances can lead to finding cheaper alternatives or other solutions.
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Accessing virtual care
Through the Premier Plan, you can access convenient virtual care. This includes a primary care provider that you can see online through Doctor On Demand by Included Health. This service is available 24/7 and can handle your everyday health needs, as well as help manage chronic conditions such as diabetes, high blood pressure, and asthma. You can also get prescriptions with just a video visit and connect with mental health professionals.
Additionally, if you need a second opinion, your Personal Healthcare Assistant can help you get one. This can be useful if you are unsure about a diagnosis or recommended surgery. You can also use other app-based programs for physical therapy and digestive health support.
To access these virtual care services, you can start by visiting the Compare Plans page on the Walmart website to see what is available in your location. You can also refer to the Associate Benefits Book, which contains helpful information about eligibility and your specific plan's benefits.
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$45.5
Choosing the right care
Understanding Your Options:
Walmart offers a range of healthcare plans to fit your unique needs. These include the Premier Plan, Contribution Plan, Saver Plan, Local Plan, and eCommerce Plan. Each plan has different features, coverage levels, and costs. Familiarize yourself with the available options by reviewing the Associate Benefits Book and comparing the Summary of Benefits and Coverage (SBC) for each plan. The SBC provides a standardized format to help you understand and compare your choices.
Virtual Care:
Walmart provides convenient virtual care options for both physical and mental health. Through Doctor On Demand by Included Health, you can connect with a primary care provider online 24/7. This service is especially useful for managing chronic conditions, such as diabetes, high blood pressure, or asthma. Additionally, your virtual primary care provider can facilitate referrals to mental health professionals and other specialists.
In-Network and Out-of-Network Costs:
Understanding the difference between in-network and out-of-network costs is crucial for maximizing your benefits. In-network costs refer to services provided by healthcare providers who have a contract with your insurance company, typically resulting in lower out-of-pocket expenses. Out-of-network costs, on the other hand, are associated with providers who do not have a contract with your insurance company and may lead to higher out-of-pocket payments. The Premier Plan, for example, covers up to 75% of eligible in-network costs and 50% of eligible out-of-network costs for most services.
Walmart Centers of Excellence Program:
For serious or complex medical conditions, the Walmart Centers of Excellence program provides access to specialists at top-tier facilities across the country. This program covers a range of treatments, including heart and spine surgeries, knee and hip replacements, medical record reviews for cancer diagnoses, transplants, weight loss surgery, and fertility care. Treatment for many of these conditions comes at no cost to you, and travel and lodging for you and a caregiver may also be included.
Prescription Medications:
It's important to note that Walmart requires you to use a Walmart or Sam's Club Pharmacy to fill your prescriptions. Additionally, specialty medications may only be available through the Walmart Specialty Pharmacy. Be sure to review the specific requirements and restrictions associated with your chosen plan.
By considering these factors and staying informed about your Walmart medical insurance options, you can make more confident decisions regarding your healthcare choices. Remember to review the available resources, such as the Associate Benefits Book and virtual care options, to ensure you're choosing the right care that best suits your needs.
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Walmart's Centers of Excellence program
Walmart's Centers of Excellence (COE) program was launched around six years ago to control healthcare costs, improve health outcomes, and help sick employees return to work sooner. The program gives employees access to specialists in some of the best facilities in the country, with many conditions covered at no cost to the employee.
The COE program covers complex conditions, including cancer, fertility care, heart surgery, hip and knee replacement, spine or weight loss surgery, and transplants. Treatment, travel, and lodging are covered for most eligible conditions, including travel and lodging for the employee and a caregiver.
Walmart has partnered with leading health centers across the country, including the Mayo Clinic in Minnesota, Florida, and Arizona for transplants, spine surgery, hip and knee replacements, and cancer care; Cleveland Clinic in Cleveland, Ohio for heart surgery; Emory in Atlanta, Georgia for spine surgery and weight loss surgery; and Geisinger Medical Center in Danville, Pennsylvania for spine surgery, hip and knee replacements, and weight loss surgery, among others.
The COE program has been a major success, with over 5,000 Walmart employees participating and more than 95% reporting satisfaction with the care and experience. The program has helped employees avoid unnecessary surgeries, improved health outcomes, and reduced hospital stays and readmission rates.
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Eligibility and enrolment
Eligibility for Walmart's health insurance plans is dependent on a few factors. Firstly, if you are enrolled in a Medicare prescription drug plan, you are not eligible to enrol in any Walmart-sponsored medical plan. Secondly, certain plans are not offered in all locations, so you will need to check what is available in your area.
To check your eligibility, you can refer to the Associate Benefits Book, which contains all the eligibility details. Alternatively, you can reach out to your local HR representative or contact the People Services team at 800-421-1362. They will be able to provide you with eligibility information and answer any questions you may have.
If you are looking for health insurance coverage options for family members who are not eligible for Walmart's benefits, you can reach out to HealthCompare at 877-260-1824. If you need to remove a dependent from your policy, you can do so by visiting One.Walmart.com/Enroll and selecting "Family Status Change". From there, you will complete the Online Enrollment session.
Enrolment in a Walmart health insurance plan can be done online. You can compare the details of different medical plans, including the Premier, Contribution, Saver, and Local plans, by referring to the Summary of Benefits and Coverage (SBC). This will help you understand the costs and benefits associated with each plan so you can choose the one that best fits your needs and location.
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Frequently asked questions
Walmart offers a variety of health insurance plans, including the Premier, Contribution, Saver, and Local plans. You can compare the details of these plans using the Summary of Benefits and Coverage (SBC) format. You can also refer to the Associate Benefits Book for more information about your eligibility and the specific benefits of each plan.
You can enroll in a Walmart-sponsored medical plan online. However, if you are enrolled in a Medicare prescription drug plan, you are not eligible for any Walmart-sponsored medical plans.
Yes, you can cover your family members under your Walmart health insurance plan. If you need to drop a dependent's coverage because they are no longer eligible, you can do so by visiting One.Walmart.com/Enroll and selecting Family Status Change.
Yes, you can use your Personal Healthcare Assistant to get a second opinion from a doctor. You can also use Included Health to get a remote second opinion from a leading expert specializing in your area of need.
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