Access HDHP Plan Design

Plan Design Overview

The Access High Deductible Health Plan (HDHP) provides the same freedom of choice for doctors or hospitals across the country (nationwide coverage) as the Access Plan. The difference is that the Access HDHP has a higher deductible and a lower monthly premium than the Access Plan. In addition, this plan design is paired with a Health Savings Account (HSA) to help you prepare for your out-of-pocket expenses. The Universities of Wisconsin contributes to the HSA and employee contributions are optional (if eligible). Review the HSA web page to determine if you are eligible for the Access HDHP.

• This plan design includes coverage for in-network and out-of-network services.
• Review the Comparison of Health and Pharmacy Benefits (available in the Resources section below) to determine which plan design will best meet your needs.

For detailed information, review the Certificate of Coverage (available in the Resources section below).

Note: Employees eligible for the Graduate Assistant/Short-Term benefit package are not eligible for the Access HDHP or HSA.

Provider Network

You may see the provider of your choice. However, you will receive a higher level of benefit (and pay less out-of-pocket) if you use an in-network provider. To see if your provider and/or hospital of choice is in-network, review the How to Choose Your Health Insurance Plan web page.

Coverage

In-Network Coverage

Uniform Benefits

Uniform Benefits refers to the schedule of in-network benefits for the Access HDHP. The purpose of Uniform Benefits is to help manage the rising cost of health insurance and simplify your selection of a health plan. Since all health insurance plan carriers administer the same schedule of benefits, you can decide which plan to select based on:

• Premium cost
• Quality and member satisfaction
• Provider network
• Referral policies

Uniform Benefits does not mean that all plans will treat all services in an identical manner. Treatment depends on the needs of the patient, the providers involved and the managed care policies and procedures of each health insurance plan carrier.

Preventive Care

Routine preventive care received in-network will be covered at 100%, even if you have not met the deductible. A link to the preventive care services, as identified by the Patient Protection and Affordable Care Act, is available in the Resources section below.

Non-preventive Care

For non-preventive care received in-network, you must meet the in-network annual deductible first. This means that you will pay for all medically necessary services out-of-pocket until you meet the deductible, including prescriptions. Once you meet the deductible, you will pay either an office visit copay (flat dollar amount) or coinsurance (percentage) on other medically necessary services until you reach the annual out-of-pocket limit. After your deductible has been met, you will pay:

• $15 copay for office visits
• $25 copay for specialty office visits (includes specialty providers, urgent care, vision exam)
• Emergency room visits:
  • 2026: $75 copay (waived if admitted to inpatient)
  • 2027: $125 copay (waived if admitted to inpatient)

See the 2026 Guide to Office Visit Copays or 2027 Guide to Office Visit Copays for more information.

In-Network Deductible

The Access HDHP has a non-embedded deductible. This means that if you have family coverage, the full family deductible must be met before services are covered for any individual. This deductible includes medical services and pharmacy benefits and applies to the annual out-of-pocket limit.

• 2026: $1,700 for individual coverage, $3,400 for family coverage
• 2027: $2,000 for individual coverage, $4,000 for family coverage

In-Network Out-of-Pocket Limit

The annual out-of-pocket limit for the Access HDHP includes medical and prescription drug expenses. Once you reach your annual out-of-pocket limit, the plan pays 100% of most covered benefits for the remainder of the calendar year.

• 2026: $2,500 for individual coverage, $5,000 for family coverage
• 2027: $3,500 for individual coverage, $7,000 for family coverage

Out-of-Network Coverage

The table below outlines the schedule of benefits for services received out-of-network. Note: The deductible and out-of-pocket limit amounts are combined for medical services and pharmacy benefits.

Access HDHP	2026 Out-of-Network (your cost)	2027 Out-of-Network (your cost)
Deductible	$2,000 Individual / $4,000 Family	$2,000 Individual / $4,000 Family
Out-of-Pocket Limit	$3,800 Individual / $7,600 Family	$3,800 Individual / $7,600 Family
Coinsurance	30%	30%
Preventive Care	Subject to deductible then coinsurance	Subject to deductible then coinsurance
Office Visits	Subject to deductible then $15 copayment	Subject to deductible then $15 copayment
Specialty Office Visits	Subject to deductible then $25 copayment	Subject to deductible then $25 copayment
Emergency Room Visits	In-network deductible then $75 copayment then 10% coinsurance	In-network deductible then $125 copayment

Pharmacy Benefits

Pharmacy benefits are included in all health plan designs and are administered by Navitus Health Solutions. In the left hand menu, click “Pharmacy Benefits” to learn more.

Uniform Dental Benefits

Uniform Dental Benefits may be added to your health insurance coverage for a minimal cost. In the left hand menu, click “Dental & Vision Insurance” then “Uniform and Preventive Dental” to learn more.

Benefit Premiums

For State Group Health Insurance premiums review the Benefit Premiums web page.

Resources

• Comparison of Health & Pharmacy Benefits pdf
• Health Plan Search
• Preventive Care Services
• Terms and Conditions

Plan Administrators

• State Group Health Insurance: Department of Employee Trust Funds | (877) 533-5020
• Uniform Dental Benefits: Delta Dental of Wisconsin | (844) 337-8383