The Comparison of Medical Benefits table below shows what benefits are covered and what the cost-sharing amounts are for each plan design.

Note: The “OOPL” refers to the annual out-of-pocket limit.

You may also review the Cost-Sharing Illustration to compare these plan designs.


Health Plan Design

HDHP Design

Access Plan (In-Network)

Access Plan (Out-of-Network)

Access HDHP (In-Network)

Access HDHP (Out-of-Network)

Monthly Premiums

(does not include Crafts workers or employees less than half-time)

Employees covered by WRS

With Dental:

$88 Single

$219 Family

Without Dental:

$85 Single

$211 Family

Graduate/Short-Term Academic Staff

With Dental:

$45.50 Single

$113.50 Family

Without Dental:

$42.50 Single

$105.50 Family

Employees covered by WRS

With Dental:

$33 Single

$82 Family

Without Dental:

$30 Single

$74 Family

Graduate/Short-Term Academic Staff

Not eligible

Employees covered by WRS

With Dental:

$266 Single

$664 Family

Without Dental:

$263 Single

$656 Family

Graduate/Short-Term Academic Staff

With Dental:

$134.50 Single

$336 Family

Without Dental:

$131.50 Single

$328 Family

Employees covered by WRS

With Dental:

$211 Single

$527 Family

Without Dental:

$208 Single

$519 Family

Graduate/Short-Term Academic Staff

Not eligible

Annual Medical Deductible $250 individual / $500 family

After an individual within a family plan meets the $250 deductible, benefits apply as described below.

Deductible applies to annual out-of-pocket limit (OOPL)

Medical deductible does not apply to office visit copayments, preventive services* or prescription drugs

$1,500 single / $3,000 family

The deductible must be met before coverage begins; for family coverage, the full family deductible must be met

The deductible includes prescription drugs and applies to the annual OOPL

$250 individual / $500 family

After an individual within a family plan meets the $250 deductible, coinsurance will apply as described
below

Deductible applies to annual OOPL

Medical deductible does not apply to prescription drugs

$500 individual / $1,000 family

$500 individual / $1,000 family

After an individual within a family plan meets the $500 deductible, coinsurance will apply as described
below

Deductible applies to annual OOPL

Medical deductible does not apply to prescription drugs

$1,700 single / $3,400 family

The deductible must be met before coverage begins; for family coverage, the full family deductible must be met

The deductible includes prescription drugs and applies to OOPL

$2,000 single / $4,000 family

The deductible must be met before coverage begins; for family coverage, the full family deductible must be met

The deductible includes prescription drugs and applies to OOPL

Primary Care Physician (PCP) Office Visit Copay
Includes:
Internist
General Physician
Family Practitioner
Pediatrician
Gynecologist / Obstetrician
Nurse Practitioner
Physician Assistant
Chiropractor
Physical / Occupational / Speech Therapy in an office visit setting.
You pay $15 copay per visit up to OOPL

Office visit copays are not subject to the deductible

Additional services such as lab work, X-rays, etc., are subject to the deductible and coinsurance

You pay the full allowed amount of an office visit until deductible is met

After deductible: You pay $15 copay per office visit up to OOPL

Coinsurance will apply to additional services such as lab work, X-rays, etc.

You pay $15 copay per visit up to OOPL

Office visit copays are not subject to the deductible

Additional services such as lab work, X-rays, etc., are subject to the deductible and coinsurance

After deductible: Plan pays 70%, you pay 30% coinsurance up to OOPL

Coinsurance will apply to additional services such as lab work, X-rays, etc

You pay the full allowed amount of an office visit until deductible is met

After deductible: You pay $15 copay per office visit up to OOPL

Coinsurance will apply to additional services such as lab work, X-rays, etc.

After deductible: Plan pays 70%, you pay 30% coinsurance up to OOPL

Coinsurance will apply to additional services such as lab work, X-rays, etc

Specialty Office Visit Copay
Includes:
Specialty Providers
Urgent Care
Vision Exam in an office visit setting.
You pay $25 copay per visit up to OOPL

Office visit copays are not subject to the deductible

Additional services such as lab work, X-rays, etc., are subject to the deductible and coinsurance

You pay the full allowed amount of an office visit until deductible is met

After deductible: You pay $25 copay per office visit up to OOPL

Coinsurance will apply to additional services such as lab work, X-rays, etc.

You pay $25 copay per visit up to OOPL

Office visit copays are not subject to the deductible

Additional services such as lab work, X-rays, etc., are subject to the deductible and coinsurance

After deductible: 30% member cost up to the annual OOPL

Coinsurance will apply to additional services such as lab work, X-rays, etc

You pay the full allowed amount of an office visit until deductible is met

After deductible: You pay $25 copay per office visit up to OOPL

Coinsurance will apply to additional services such as lab work, X-rays, etc.

You pay the full allowed amount of an office visit until deductible is met

After deductible: Plan pays 70%, you pay 30% coinsurance up to OOPL

Coinsurance will apply to additional services such as lab work, X-rays, etc

Annual Medical Coinsurance After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL

Applies to medical services except for office visit or emergency room copays and preventive services*

You pay the full allowed amount of services until deductible is met

After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL

Applies to medical services except for office visit or emergency room copays and preventive services*

After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL

Applies to medical services except for office visit or emergency room copays and preventive services*

After deductible: Plan pays 70%, you pay 30% coinsurance up to OOPL

Applies to medical services except for emergency room copays

You pay the full allowed amount of services until deductible is met

After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL

Applies to medical services except for office visit or emergency room copay and preventive services*

You pay the full allowed amount of services until deductible is met

After deductible: Plan pays 70%, you pay 30% coinsurance up to OOPL

Applies to medical services except for emergency room copays

Annual Medical Out-of-Pocket Limit (OOPL) $1,250 individual / $2,500 family

(separate OOPL for prescription drugs)

$2,500 single / $5,000 family

(medical and prescription drug expenses count toward OOPL)

For family coverage, you must meet the full family OOPL before your plan pays 100%

$1,000 individual / $2,000 family

(separate OOPL for prescription drugs)

$2,000 individual / $4,000 family

(separate OOPL for prescription drugs)

$3,500 single / $6,550 family

(medical and prescription drug expenses count toward OOPL)

For family coverage, you must meet the full family OOPL before your plan pays 100%

$3,800 single / $7,600 family

(medical and prescription drug expenses count toward OOPL)

For family coverage, you must meet the full family OOPL before your plan pays 100%

Routine, preventive services as required by federal law Plan pays 100%, not subject to deductible

For details, visit
healthcare.gov

Plan pays 100%, not subject to deductible

For details, visit
healthcare.gov

Plan pays 100%, not subject to deductible

For details, visit
healthcare.gov

Subject to the deductible and coinsurance Plan pays 100%, not subject to deductible

For details, visit
healthcare.gov

Subject to the deductible and coinsurance
Illness/injury related services beyond the office visit copay (if applicable) After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL

Applies to medical services except for office visit or emergency room copays

You pay the full allowed amount of services until deductible is met

After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL

Applies to medical services except for office visit or emergency room copays

After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL

Applies to medical services except for office visit or emergency room copays

After deductible: Plan pays 70%, you pay 30% coinsurance up to OOPL

Applies to medical services except for emergency room copays

You pay the full allowed amount of services until deductible is met

After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL

Applies to medical services except for office visit or emergency room copays

After deductible: Plan pays 70%, you pay 30% coinsurance up to OOPL

Applies to medical services except for emergency room copays

Emergency Room Copay (Waived if admitted as an inpatient directly from the emergency room or for observation for 24 hours or longer.) You pay $75 copay per visit, then the deductible and coinsurance applies to services beyond the copay up to the OOPL You pay the full allowed amount of services until deductible is met

After deductible: You pay $75 copayment per visit, then coinsurance applies to services beyond the copayment up to the OOPL

You pay $75 copay per visit, then the deductible and coinsurance applies to services beyond the copay up to the OOPL You pay $75 copayment per visit, then in-network deductible and coinsurance applies to services beyond the copayment up to the OOPL You pay the full allowed amount of services until deductible is met

After deductible: You pay $75 copayment per visit, then coinsurance applies to services beyond the copayment up to the OOPL

You pay the full allowed amount of services until deductible is met

After deductible: You pay $75 copayment per visit, then in-network coinsurance applies to services beyond the copayment up to the OOPL

Transplants After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL

Includes bone marrow, parathyroid, musculoskeletal, corneal, kidney, heart, liver, kidney with pancreas, heart with lung, and lung

You pay the full allowed amount of services until the deductible is met

After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL

Includes bone marrow, parathyroid, musculoskeletal, corneal, kidney, heart, liver, kidney with pancreas, heart with lung, and lung

After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL

Includes bone marrow, musculoskeletal, corneal, and kidney

After deductible: Plan pays 70%, you pay 30% coinsurance cost up to OOPL

Includes bone marrow, musculoskeletal, corneal, and kidney

You pay the full allowed amount of services until the deductible is met

After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL

Includes bone marrow, musculoskeletal, corneal, and kidney

You pay the full allowed amount of services
until the deductible is metAfter deductible: Plan pays 70%, you pay 30% coinsurance up to OOPL

Includes bone marrow, musculoskeletal, corneal, and kidney

Mental Health/Alcohol & Drug Abuse Outpatient services: You pay $15 primary care office visit copayment. Additional services such as lab work, assessments, etc., are subject to deductible and coinsurance

Inpatient and covered transitional services: after deductible plan pays 90%, you pay 10% coinsurance up to OOPL

Outpatient services: After deductible, you pay $15 primary care office visit copayment. Additional services such as lab work, assessments, etc., are subject to coinsurance

Inpatient and covered transitional services: after deductible plan pays 90%, you pay 10% coinsurance up to OOPL

Outpatient services: You pay $15 primary care office visit copayment. Additional services such as lab work, assessments, etc., are subject to deductible and coinsurance

Inpatient and covered transitional services: after deductible plan pays 90%, you pay 10% coinsurance up to OOPL

Outpatient, inpatient and covered transitional services: after deductible plan pays 70%, you pay 30% coinsurance up to OOPL Outpatient services: after deductible, you pay $15 primary care office visit copayment. Additional services such as lab work, assessments, etc., are subject to coinsurance

Inpatient and covered transitional services: after deductible plan pays 90%, you pay 10% coinsurance up to OOPL

Outpatient, inpatient and covered transitional services: after deductible plan pays 70%, you pay 30% coinsurance up to OOPL
Hearing aid (per ear) After deductible:

Every three years: Adults pay 20% coinsurance up to plan paid $1,000 (not to OOPL); dependents younger than 18 years pay 10% coinsurance up to OOPL

After deductible:

Every three years: Adults pay 20% coinsurance up to plan paid $1,000 (not to OOPL); dependents younger than 18 years pay 10% coinsurance up to OOPL

After deductible:

Every three years: Dependents younger than 18 years pay 10% coinsurance up to OOPL

After deductible:

Every three years: Dependents younger than 18 years pay 30% coinsurance up to OOPL

After deductible:

Every three years: Dependents younger than 18 years pay 10% coinsurance up to OOPL

After deductible:

Every three years: Dependents younger than 18 years pay 30% coinsurance up to OOPL

Cochlear Implants After deductible:

Adults pay 20% coinsurance for device, surgery for implantation, follow-up sessions (not to OOPL); for hospital charge for surgery, plan pays 90%, you pay 10% coinsurance to OOPL

Dependents (under age 18) pay 10% coinsurance up to OOPL for all services

You pay the full allowed amount of services until deductible is met

After deductible:Adults pay 20% coinsurance for device, surgery for implantation, follow-up sessions (not to OOPL); for hospital charge for surgery, plan pays 90%, you pay 10% coinsurance to OOPL

Dependents (under age 18) pay 10% coinsurance up to OOPL for all services

After deductible: Dependents under 18: plan pays 90%, you pay 10% coinsurance to OOPL for device, surgery, follow-up sessions After deductible: Dependents under 18: plan pays 70%, you pay 30% coinsurance to OOPL for device, surgery, follow-up sessions You pay the full allowed amount of services until deductible is met

After deductible: Dependents under 18: plan pays 90%, you pay 10% coinsurance to OOPL for device, surgery, follow-up sessions

You pay the full allowed amount of services until deductible is met

After deductible: Dependents under 18: plan pays 70%, you pay 30% coinsurance to OOPL for device, surgery, follow-up sessions

Skilled Nursing Facility (non-custodial care) After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL, 120 days per benefit period You pay the full allowed amount of services until deductible is met

After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL, 120 days per benefit period

After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL, 120 days per benefit period After deductible: Plan pays 70%, you pay 30% coinsurance up to OOPL, 120 days per benefit period You pay the full allowed amount of services until deductible is met

After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL, 120 days per benefit period

You pay the full allowed amount of services until deductible is met

After deductible: Plan pays 70%, you pay 30% coinsurance up to OOPL, 120 days per benefit period

Home Health (non-custodial) After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL, 50 visits per year. Plan may approve an additional 50 visits You pay the full allowed amount of services until deductible is met

After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL, 50 visits per year. Plan may approve an additional 50 visits

After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL, 50 visits per year. Plan may approve an additional 50 visits After deductible: Plan pays 70%, you pay 30% coinsurance up to OOPL, 50 visits per year. Plan may approve an additional 50 visits You pay the full allowed amount of services until deductible is met

After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL, 50 visits per year. Plan may approve an additional 50 visits

You pay the full allowed amount of services until deductible is met

After deductible: Plan pays 70%, you pay 30% coinsurance up to OOPL, 50 visits per year. Plan may approve an additional 50 visits

Physical / Speech / Occupational Therapy You pay $15 copay for office visits.

Additional services such as lab work, X-rays, etc. are subject to deductible and coinsurance up to OOPL

50 combined visits per year.

Plan may approve an additional 50 visits per therapy type per year

You pay the full allowed amount of services until deductible is met

After deductible: You pay $15 copay for office visits.

Additional services such as lab work, X-rays, etc. are subject to deductible and coinsurance up to OOPL

50 combined visits per year.

Plan may approve an additional 50 visits per therapy type per year

You pay $15 copay for office visits.

Additional services such as lab work, X-rays, etc. are subject to deductible and coinsurance up to OOPL

50 combined visits per year.

Plan may approve an additional 50 visits per therapy type per year

After deductible: Plan pays 70%, you pay 30% coinsurance up to OOPL

50 combined visits per plan year

Plan may approve an additional 50 visits per therapy type per year

You pay the full allowed amount of services until deductible is met

After deductible: You pay $15 copayment for office visits. Additional services such as lab work, X-rays, etc. are subject to coinsurance up to OOPL

50 combined visits per year

Plan may approve an additional 50 visits per therapy type per year

You pay the full allowed amount of services until deductible is met

After deductible: Plan pays 70%, you pay 30% coinsurance up to OOPL

50 combined visits per plan year

Plan may approve an additional 50 visits per therapy type per year

Durable Medical Equipment After deductible: 20% member cost up to OOPL After deductible: Plan pays 80%, you pay 20% coinsurance up to OOPL You pay the full allowed amount of services until deductible is met

After deductible: Plan pays 80%, you pay 20% coinsurance up to OOPL

After deductible: Plan pays 70%, you pay 30% coinsurance up to OOPL You pay the full allowed amount of services until deductible is met

After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL

You pay the full allowed amount of services until deductible is met

After deductible: Plan pays 70%, you pay 30% coinsurance up to OOPL

Precertification for hospitalizations, high-tech radiology and low back surgery Varies by plan. See plan descriptions and contact your plan Varies by plan. See plan descriptions and contact your plan WPS Medical Management Program WPS Medical Management Program WPS Medical Management Program WPS Medical Management Program
Referrals In-network—varies by plan

Out-of-network— referral is required

In-network—varies by plan

Out-of-network— referral is required

None None None None
Treatment for morbid obesity Excluded Excluded After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL

Surgical treatment requires precertification

After deductible: Plan pays 70%, you pay 30% coinsurance up to OOPL

Surgical treatment requires precertification

You pay the full allowed amount of services until deductible is met

After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL

Surgical treatment requires precertification

You pay the full allowed amount of services until deductible is met

After deductible: Plan pays 70%, you pay 30% coinsurance up to OOPL

Surgical treatment requires precertification

Oral Surgery After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL, 11 procedures You pay the full allowed amount of services until deductible is met

After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL, 11 procedures

After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL, 23 procedures After deductible: Plan pays 70%, you pay 30% coinsurance up to OOPL, 23 procedures You pay the full allowed amount of services until deductible is met

After deductible: Plan pays 90%, you pay 10% coinsurance up to OOPL, 23 procedures

You pay the full allowed amount of services until deductible is met

After deductible: Plan pays 70%, you pay 30% coinsurance up to OOPL, 23 procedures

*Routine, preventive services as required by federal law


last updated: 12/9/2016