Who is eligible?
- Wayne County Four Star Health coverage is available to Wayne County businesses with 2 to 100 employees and with 50% of their employees residing here
- Eligible employees must not have participated in an employer sponsored health plan in the last 12 months and half of the group must earn $16.00 or less per hour
- The company must have been in business for a minimum of 6 months
- Because of the nature of the WCFS Program and the support provided to the program from Federal and State funds, the WCFS Program is not considered insurance for purposes of Federal and State insurance regulations. For this reason, the WCFS program , at this time does not offer coverage for dependents up to 26 years old as some more traditional insurance products have offered.
Benefits and Co-pays
| Inpatient Care | |
| Hospitalization* | $100.00 |
| Psychiatric treatment* | $100.00 |
| Maternity - delivery* | $100.00 |
| Emergency Care | |
| Emergency room visit* | $50.00 |
| Outpatient Care | |
| Physician office visits | $15.00 |
| Pre & post-natal maternity | $15.00 |
| Urgent care center visit | $25.00 |
| Ambulance service | 10% coinsurance |
| Surgery facility* | No Co-pay |
| Lab test & radiology | No Co-pay |
| Durable medical equipment* | $50.00 |
| Medical supplies* | $50.00 |
| Psychiatric care | $15.00 |
| Physician surgical care* | No Co-pay |
| Anesthesia services* | No Co-pay |
| Physican consultations | $15.00 |
| Sub abuse care | 10% coinsurance |
| Home health agency visit* | No Co-pay |
| Pharmaceuticals | |
| Generic formulary drugs | $5.00 |
| Brand name drugs* | 50% coinsurance |
| * Benefits with certain annual or lifetime maximum limits. | |
What benefits are covered by Four Star?
Primary Care
The Four Star benefit includes primary care from within any of the health system physician networks. More than 850 doctors participate in Four Star.
Hospitalization
Hospitalization care is covered up to 20 days or $25,000 per year. This includes coverage for semi-private room and board, Intensive Care Unit, and ancillary services.
Emergency Care
Emergency room care is covered up to a maximum of $1,000 per visit to any of the four partner health system ERs.
Outpatient Care
Four Star provides coverage for many outpatient care services, including: Urgent Care, ambulance, lab and x-ray, outpatient surgery, and maternity care.
Pharmaceuticals
The Four Star drug benefit covers up to $2,500 annually and promotes the use of generic drugs with low co-pays.
