HSHS Healthy Plan - Health Choices EPO Plan
Using Network Providers
Your medical options will be Exclusive Provider Organization (EPO) options that, in most cases, only cover services received from
HSHS/Live360 network providers. This means if you receive care outside the network you will most likely be responsible for the full cost of care.
To determine if you live in the HSHS/Live360 Network Service Area, click
HERE to access a list of designated counties or zip codes. If your address is in the HSHS/Live360 network service area, you'll see providers in the Exclusive Provider Organization (EPO). In most cases, this covers service received only from HSHS/Live360 network providers. This means if you receive care outside the network, you will most likely be responsible for the full cost of care.
If your zip code is not listed and you live in Illinois or outside Wisconsin—your network providers is also the Exclusive Provider Organization (EPO). Since you live outside of the service area, you can also use the
First Health network. In most cases, the plan covers services received from only HSHS/Live360 network providers, and the
First Health network.
Please note, there are excluded providers within the First Health Network. Please view the excluded providers listed below. If you receive care outside these networks, you will most likely be responsible for the full cost of care.
Click
HERE to view our excluded providers/facilities.
When you need care from a non-network provider
- Out-of-network services will not be covered unless you first obtain a referral from your network provider and prior authorization from Health Choice Health Plan.
- Your network provider will need to submit a referral request to Health Choices.
- If First Health is your primary network, you need a referral if the provider required for your care is not in either the HSHS/Live360 or the First Health network.
- In order for services to be covered, the referral needs to be reviewed and approved prior to services being received.
To learn more, contact the Health Choices Customer Service Center at 833-728-0538.
HSHS Healthy Plan - Dean EPO Plan
Using Network Providers
Your medical options will be Exclusive Provider Organization (EPO) options that, in most cases, only cover services received from
HSHS/Prevea360 network providers. This means if you receive care outside the network you will most likely be responsible for the full cost of care.
To determine if you live in the HSHS/Prevea360 network service area, click
HERE to access a list of designated counties or zip codes. If your address is in the HSHS/Prevea360 network service area, you'll see providers in the Exclusive Provider Organization (EPO). In most cases, this covers service received only from HSHS/Prevea 360 network providers. This means if you receive care outside the network, you will most likely be responsible for the full cost of care.
If your zip code is not listed and you live in Wisconsin, your network providers is also the Exclusive Provider Organization (EPO). For 2022, since you live outside of the service area, you can also use the
First Health network. In most cases, the plan covers services received from only HSHS/Prevea360 network providers, and the
First Health network, with the exception of Marshfield or Mayo providers. Care received from Marshfield or Mayo providers without an approved prior authorization from Dean will most likely result in you being responsible for the full cost of care. If you receive care outside these networks, you will most likely be responsible for the full cost of care.
When you need care from a non-network provider
- Out-of-network services will not be covered unless you first obtain a referral from your network provider and prior authorization from Dean Health Plan.
- Your network provider will need to submit a referral request to Dean Health.
- If HealthEOS is your primary network, you need a referral if the provider required for your care is not in either the HSHS/Prevea360 or the HealthEOS network.
- In order for services to be covered, the referral needs to be reviewed and approved prior to services being received.
To learn more, contact the Dean Customer Service Center at 1-888-895-1188.