HDHP Plan Design

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 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 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.

Provider Network

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.

Coverage

In Network Coverage

Uniform Benefits

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.

Preventive Care

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.

Non-preventive Care

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: $1,600 Individual / $3,200 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.

Out-of-Network Coverage

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

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

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