Plan Design Summary
The Access Plan design provides freedom of choice for doctors or hospitals in Wisconsin and nationwide. A higher level of benefits is available when using preferred or in-network providers, which are available nationwide. In exchange for increased flexibility in medical providers, you pay a higher monthly premium cost. Uniform Dental benefits may be added for a minimal cost.
Generally, you pay the annual deductible then the plan covers a percentage of the cost of your medically necessary care. However, you will be charged only a $15 copay for office visits, or $25 copay for specialty office visits with specialty providers who are in-network. Once you reach your annual out-of-pocket limit, the plan pays 100% of covered benefits for the rest of the year.
You can compare the Access Plan design to the other plan designs to determine if it will meet your medical needs.
You are eligible for the Health Plan design if you are eligible for the State Group Health Insurance plan.
With the Access Plan, 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” 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.
The table below outlines the schedule of benefits that is administered by WPS for the Access Plan.
|Deductible||$250 Individual/$500 family||$500 Individual/$1,000 Family|
|Office Visit Copay||$15||After deductible: 30% coinsurance|
|Specialty Office Visit Copay||$25||After deductible: 30% coinsurance|
|Out-of-pocket Limit||$1,000 Individual/$2,000 Family||$2,000 Individual/$4,000 Family|
|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.
Prescription drug coverage is included in all health plan designs at no additional cost and is provided by Navitus Health Solutions. Prescriptions drugs apply to the annual deductible under the Access Plan design. 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 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.
For State Group Health premiums, see the Premiums page.
Forms & Resources
For all State Group Health Insurance forms and resources, click here.
last updated: 1/20/2017
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.