Plan Design Summary

The Access HDHP plan design provides the same benefits package as the Access Plan. The difference is that the Access HDHP plan design has a higher deductible and higher out-of-pocket limits.

The Access HDHP plan does not pay any health care costs, including prescriptions, until the annual deductible has been met (with the exception of preventive services and prescriptions mandated by the Patient Protection and Affordable Care Act). After the annual deductible has been met, you will be responsible for office visit copays and applicable coinsurance on non-office visit services, up to the annual out-of-pocket limit.

In exchange for increased cost sharing, this plan design offers a lower monthly premium cost than the Access Plan design and is paired with a required Health Savings Account (HSA) to help pay your out-of-pocket costs. If you enroll in the Access HDHP plan, you must also enroll in the HSA administered by TASC.

  • Uniform Dental benefits may be added for a minimal cost.
  • You can compare the Access HDHP plan design to the other plan designs to determine if it will meet your medical needs.

To see if this may be the right plan design option for you, take this survey.

Eligibility

You are eligible for the Access HDHP if you meet the following requirements:

If you enroll in the Access HDHP, you must also enroll in the HSA. Therefore, you must be eligible for both plans.

Note: Employees who are eligible for the Graduate Assistant benefit package ARE NOT eligible for the Access HDHP plan design.

Provider Network

With the Access HDHP, you may see any doctor or provider of your choice. However, you will receive a higher level of benefits (and pay less out-of-pocket) if you use a preferred or in-network provider. WPS administers the Access Plan.

To see if your doctor or hospital is a preferred or in-network provider, go to: www.wpsic.com/state and click “Find a Doctor”. Choose the “WPS Statewide/National Network for IYC Access” plan to search for a provider in your network. To request a printed directory be mailed to you, call 1-800-634-6448.

You may also see How To Choose Your Group Health Insurance for more information.

Coverage

The table below outlines the schedule of benefits that is administered by WPS for the Access HDHP.

Access HDHP In-Network Out-of-Network
Deductible $1,700 Single/$3,400 Family (combined medical & Rx) $2,000 Individual/ $4,000 Family (combined medical & Rx)
Office Visit Copay After deductible: $15 After deductible: 30% coinsurance
Specialty Office Visit Copay After deductible: $25 After deductible: 30% coinsurance
Coinsurance After deductible: 10% After deductible: 30%
Out-of-Pocket Limit $3,500 Single/$6,550 Family (combined medical & Rx) $3,800 Individual/ $7,600 Family (combined medical & Rx)
Preventive Care Plan pays 100% Subject to the deductible, copays and/or coinsurance

See the Guide to Office Visit Copays for more information on in-network office visit charges.

To see a detailed list of covered benefits, see the Certificate of Coverage.

Pharmacy Benefits

Prescription drug coverage is included in all health plan designs at no additional cost and is provided by Navitus Health Solutions. Under the Access HDHP plan design, you will be responsible for paying the total costs of prescriptions until you meet the deductible.

After you meet the deductible, you will be required to pay either a copay or coinsurance when you buy prescription drugs which is determined by the level of the drug. All covered prescription drugs (Rx) fall into one of four cost-sharing levels, including Level 1 for most generic drugs and Levels 2, 3 and 4 for most brand-name drugs.

To determine what you would pay for prescription drugs, see the Comparison of Pharmacy Benefits.

Uniform Dental Benefits

Uniform Dental provides coverage for diagnostic, preventive and restorative services (such as fillings). It does not include coverage for major dental services such as crowns, root canals or implants. Uniform Dental benefits are administered by Delta Dental of Wisconsin and may be added on to your health insurance coverage for a minimal cost.

Click here to learn more about Uniform Dental benefits.

Premiums

For State Group Health Insurance premiums, see the Premiums page.

Forms & Resources

For all State Group Health Insurance forms and resources, click here.


last updated: 7/10/2017

 

Every effort has been made to ensure this information is current and correct. This page does not guarantee enrollment or the ability to make changes to your benefits.