Plan Design Overview
With the High Deductible Health Plan (HDHP), you may choose from local health insurance plan carriers that offer the same Uniform Benefits that include medical and pharmacy benefits (at no additional cost). This plan has a higher deductible and the lowest monthly premium.
In exchange for the increased cost sharing, this plan design is paired with a required Health Savings Account (HSA). The HSA will help you prepare for out-of-pocket expenses. The UW System contributes to the HSA and employee contributions are optional (if eligible). Review the HSA web page to determine if you are eligible for the HDHP and HSA.
- Only covers out-of-network benefits for emergency and urgent care services.
- Review the Comparison of Health and Pharmacy Benefits (available in the Forms & Resources section below) to determine which plan design will best meet your needs.
For detailed information, review the Certificate of Coverage (available in the Forms & Resources section below).
Note: Employees eligible for the Graduate Assistant/Short-Term benefit package are not eligible for the HDHP or HSA.
This plan design only covers out-of-network benefits for emergency and urgent care services. For this reason, use the Health Plan Search (available in the Forms & Resources section below) to help you select a health insurance plan carrier that will provide services in the county that you would like to receive them in.
In Network Coverage
Uniform Benefits refers to the schedule of benefits provided by each health insurance plan carrier. The purpose of Uniform Benefits is to help manage the rising cost of health insurance and simplify your selection of a health plan. Because 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 will vary depending on the needs of the patient, the providers involved and the managed care policies and procedures of each health insurance plan carrier.
Routine preventive care will be covered at 100% at in-network providers, 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 Forms & Resources section below.
For non-preventive care received in-network, you must meet the 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. This continues until you reach the annual out-of-pocket limit.
Deductible: $1,500 Individual / $3,000 Family
The 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. 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)
- $75 copay for emergency room visits (waived, if admitted), then deductible and coinsurance apply
- 10% coinsurance on most services except for office visits
See the Guide to Office Visit Copays for more information.
Out-of-Pocket Limit: $2,500 Individual / $5,000 Family
The annual out-of-pocket limit for the HDHP includes both medical and prescription drug expenses. After you reach your annual out-of-pocket limit, the plan pays 100% of most covered benefits for the remainder of the calendar year.
This plan design only covers out-of-network services for emergency and urgent care. Contact your health plan immediately if you seek out-of-network emergency and/or urgent care services.
Pharmacy benefits are included in all health plan designs at no additional cost 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.
For State Group Health Insurance premiums review the Benefit Premiums web page.
Forms & Resources
- Certificate of Coverage
- Health Plan Search
- Preventive Care Services
- Schedule of Benefits
- Terms and Conditions
- State Group Health Insurance: Department of Employee Trust Funds | (877) 533-5020
- Uniform Dental Benefits: Delta Dental of Wisconsin | (844) 337-8383
Every effort has been made to ensure this information is current and correct. Information on this page does not guarantee enrollment, benefits and/or the ability to make changes to your benefits.