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 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 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 Forms & 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. This continues until you reach the annual out-of-pocket limit.
In-Network Deductible: $1,600 Individual / $3,200 Family
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. 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
In-Network Out-of-Pocket Limit: $2,500 Individual / $5,000 Family
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.
Out-of-Network Coverage
The table below outlines the schedule of benefits for services received out-of-network.
| Access HDHP | Out-of-Network (your cost) |
|---|---|
| Deductible | $2,000 Individual / $4,000 Family (combined medical & prescription) |
| Office Visit Copay | After deductible: 30% coinsurance |
| Specialty Office Visit Copay | After deductible: 30% coinsurance |
| Coinsurance | After deductible: 30% coinsurance |
| Out-of-Pocket Limit | $3,800 Individual / $7,600 Family (combined medical & prescription) |
| Preventive Care | Subject to the deductible, copays and/or coinsurance |
Pharmacy Benefits
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.
Benefit Premiums
For State Group Health Insurance premiums review the Benefit Premiums web page.
Forms & Resources
Plan Administrators
- 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.
Updated: 05/29/2024