Health (Wisconsin)
When does health insurance coverage begin?
Your coverage will begin on the 1st of the month on or after your hire date. This applies if you are a newly hired colleague or have transferred from a PRN position to a benefits-eligible position. Coverage for your dependents begins on the same day as your coverage as long as you have enrolled them for health insurance.
If I do not enroll by my enrollment deadline, what coverage will I have?
If you are a new hire and you do not enroll by your enrollment deadline, you will have the following coverage by default:
- Basic Life and AD&D insurance
- Short-Term Disability Coverage
- Long-Term Disability Coverage
What about emergency room care?
If your condition is a true emergency, you will have a $100 copayment for emergency services. This is in addition to your deductible and coinsurance for the medical plan option you select.
For 2021 - If you utilize the emergency room for a non-emergency condition, you will have a $300 copayment in addition to your deductible and coinsurance for the medical plan option you select.
For 2022 - If you utilize the emergency room for a non-emergency condition, you will have a $100 copayment in addition to your deductible and coinsurance for the medical plan option you select.
For True Medical Emergencies:
For an emergency medical condition, the HSHS Healthy Plan provides the same benefit level regardless of the provider who provides your care.
- Medical Emergency and Emergency Accident facility charges are covered at the HSHS benefit level, whether you go to an HSHS or another facility.
- Likewise, Medical Emergency and Emergency Accident Specialist Physician charges are covered at the HSHS Specialist Physician benefit level, regardless of whether the Specialist is an HSHSSpecialist.
- Medical Emergency and Emergency Accident PCP Physician charges are covered at the HSHS Specialist Physician benefit level, if the PCP is an an Out-of-Network PCP.
- True emergencies may include seizures, loss of consciousness, severe and/or persistent chest pain, severe bleeding and shortness of breath.
How can I benefit from using a Network Primary Care Physician (PCP)?
- When you receive care from a network PCP, there’s no deductible and care will be covered at 95% with no office visit copayment.
- More importantly, your Primary Care Physician is the quarterback of your healthcare team.
- A PCP can help you maintain and improve your health and provide direction for any specialist care you need.
How do I find an in-network provider (Dean Health/Prevea360)?
To locate an in-network provider, CLICK HERE.
For help determining which network service area you are in, see the 2022 HSHS Benefits Guide.
If you have a dependent that does not live in the Prevea360 service area, such as a child attending college, you can register your dependent with Dean Health Plan after you receive your Dean Health Plan ID card.
Call Dean Health Plan to get started. Once your dependent is registered, the First Health network will apply for your dependent’s medical plan coverage.
If my doctor recommends that I receive care form a non-network provider, will that care be covered?
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 you have questions about the referral process, contact Dean Health Plan at 1-888-895-1188.