Dean Health Plan
With Dean Health Plan, you can find coverage that fits you. We pride ourselves in looking out for our members when they’re sick and when they’re well by offering great reward programs to help you live healthier. Plus, when you have a question or need help, Dean’s support network is local. Whether you call us, visit us online or in person, you’ll be working with someone who knows what you need. And you can rest assured that wherever you are in southern Wisconsin, trusted Dean doctors, hospitals and clinics are right in your neighborhood.
Plan Options
| Copay Plus Plans | Copay Plus Plans give you the flexibility to balance copays against annual out-of-pocket maximums to meet your budget. |
| Classic Plans | Classic Plans are designed for those who want their health coverage to be as simple as possible. |
| Value Copay Plans | Value Copay Plans build in high deductibles with affordable lower premiums and low out-of-pocket costs. |
| Health Savings Accounts | Health Savings Account (HSA) eligible plans allow you to begin achieving tax savings and are fully compatible with the HSA of your choice. |
| Safety Net Plans | The Safety Net Plan is a catastrophic plan design for individuals under the age of 30 or who meet certain income guidelines. |
Plan Overviews
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When you begin shopping for a Marketplace health plan, you’ll see plan options with different metal tiers such as Gold, Silver and Bronze plans. But the only difference between these plans is how much premium you’ll pay each month and how much you’ll pay for certain medical services. A Bronze plan typically gives you lower monthly premium payments, but potentially higher out-of-pocket costs – if you end up needing a lot of care. And a Gold plan may have higher monthly premiums, but that helps you limit your out-of-pocket costs later. If you’re looking for a balance on your monthly premium payments and your out-of-pocket costs, Silver plans provide just that. And, Silver plans are the only plans with additional out-of-pocket payment reductions (cost sharing reductions)! This helps lower the costs of your copays, deductibles and coinsurance. So, if you are eligible for a subsidy and cost sharing, Silver plans offer the highest value.
Copay Plus & Classic Plan Overview
| Gold Copay Plus 1500X | Silver Copay Plus 2750X | Silver Copay Plus 3500X | Silver Classic 2500X | Silver Classic 3750X | |
| Individual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. | $1,500 | $2,750 | $3,500 | $2,500 | $3,750 |
| Individual Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services | $3,000 | $7,150 | $7,150 | $7,150 | $6,750 |
| Prices before you meet your deductible | |||||
| Primary Care visits | $30 Copay | $30 Copay | $30 Copay | 20% after deductible | 20% after deductible |
| Specialist visits | $60 Copay | $60 Copay | $60 Copay | 20% after deductible | 20% after deductible |
| CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max | 20% | 30% | 20% | 20% | 20% |
| Preventative Exam* | No Charge | ||||
| Urgent Care | $60 Copay | $60 Copay | $60 Copay | 20% after deductible | 20% after deductible |
| Emergency Room | $200 Copay before policy deductible & coinsurance | ||||
| Outpatient Lab/X-ray | 20% after deductible | 30% after deductible | 20% after deductible | 20% after deductible | 20% after deductible |
| Outpatient Surgery | 20% after deductible | 30% after deductible | 20% after deductible | 20% after deductible | 20% after deductible |
| Hospitalization | 20% after deductible | 30% after deductible | 20% after deductible | 20% after deductible | 20% after deductible |
*Preventive exams are covered in accordance with the recommended preventive services as required by the Patient Protection and Affordable Care Act (PPACA). Value Copay Plan Overview
| Gold Value Copay 2650X | Silver Value Copay 5000x | Bronze Value Copay 7150X | |
| Individual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. | $2,650 | $5,000 | $7,150 |
| Individual Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services | $2,650 | $7,150 | $7,150 |
| Prices before you meet your deductible | |||
| Primary Care visits | $25 copay for 3 visits then no charge after ded. | $25 copay for 3 visits then 20% coins. after ded. | $25 copay for 3 visits then no charge after ded. |
| Specialist visits | No charge after deductible | 20% after deductible | No charge after deductible |
| CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max | 0% | 20% | 0% |
| Preventative Exam* | No Charge | ||
| Urgent Care | No charge after deductible | 20% after deductible | No charge after deductible |
| Emergency Room | No charge after deductible | 20% after deductible | No charge after deductible |
| Outpatient Lab/X-ray | No charge after deductible | 20% after deductible | No charge after deductible |
| Outpatient Surgery | No charge after deductible | 20% after deductible | No charge after deductible |
| Hospitalization | No charge after deductible | 20% after deductible | No charge after deductible |
*Preventive exams are covered in accordance with the recommended preventive services as required by the Patient Protection and Affordable Care Act (PPACA).
HSA & Safety Net Plan Overview
| Silver HSA-E 3000X* | Bronze HSA-E 6550X* | Catastrophic Safety Net | |
| Individual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. | $3,000 | $6,550 | $7,150 |
| Individual Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services | $5,000 | $6,550 | $7,150 |
| Prices before you meet your deductible | |||
| Primary Care visits | 20% after deductible | No charge after deductible | $0 copay for 3 visits then no charge after ded. |
| Specialist visits | 20% after deductible | No charge after deductible | No charge after deductible |
| CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max | 20% | 0% | 0% |
| Preventative Exam** | No Charge | ||
| Urgent Care | 20% after deductible | No charge after deductible | No charge after deductible |
| Emergency Room | 20% after deductible | No charge after deductible | No charge after deductible |
| Outpatient Lab/X-ray | 20% after deductible | No charge after deductible | No charge after deductible |
| Outpatient Surgery | 20% after deductible | No charge after deductible | No charge after deductible |
| Hospitalization | 20% after deductible | No charge after deductible | No charge after deductible |
*HSA-E 3000X & 6550X plans carry an embedded deductible when purchasing a family plan. These plans also offer the option to choose Dean’s Focus network (Dane, Sauk & Rock counties only) for additional premium savings.
**Preventive exams are covered in accordance with the recommended preventive services as required by the Patient Protection and Affordable Care Act (PPACA).
Copay Plus 2750X
| Subsidy Level | Standard | 200-250% FPL | 150-200% FPL | 100-150% FPL |
| Individual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. | $2,750 | $2,500 | $400 | $100 |
| Individual Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services | $7,150 | $5,700 | $2,200 | $700 |
| Prices before you meet your deductible | ||||
| Primary Care visits | $30 copay | $30 copay | $30 copay | $15 copay |
| Specialist visits | $60 copay | $60 copay | $60 copay | $30 copay |
| Urgent Care | $60 copay | $60 copay | $60 copay | $60 copay |
| Emergency Room | $200 copay before policy deductible & coinsurance | |||
| Outpatient Lab/X-ray | 30% after deductible | 30% after deductible | 10% after deductible | 5% after deductible |
| Outpatient Surgery | 30% after deductible | 30% after deductible | 10% after deductible | 5% after deductible |
| Hospitalization | 30% after deductible | 30% after deductible | 10% after deductible | 5% after deductible |
| Copay Plus 2750X Prescription Drugs: Tier 1 Generics: $10 Copay • Tier 2 Preferred Brand: $40 Copay • Tier 3 Non-preferred Brand: 50% Coinsurance • Tier 4 Specialty: 50% Coinurance | ||||
Copay Plus 3500X
| Subsidy Level | Standard | 200-250% FPL | 150-200% FPL | 100-150% FPL |
| Individual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. | $3,500 | $3,000 | $400 | $100 |
| Individual Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services | $7,150 | $5,700 | $2,200 | $700 |
| Prices before you meet your deductible | ||||
| Primary Care visits | $30 copay | $30 copay | $30 copay | $15 copay |
| Specialist visits | $60 copay | $60 copay | $60 copay | $30 copay |
| Urgent Care | $60 copay | $60 copay | $60 copay | $30 copay |
| Emergency Room | $200 copay before policy deductible & coinsurance | |||
| Outpatient Lab/X-ray | 20% after deductible | 20% after deductible | 10% after deductible | 5% after deductible |
| Outpatient Surgery | 20% after deductible | 20% after deductible | 10% after deductible | 5% after deductible |
| Hospitalization | 20% after deductible | 20% after deductible | 10% after deductible | 5% after deductible |
| Copay Plus 3500X Prescription Drugs: Tier 1 Generics: $10 Copay • Tier 2 Preferred Brand: $40 Copay • Tier 3 Non-preferred Brand: 50% Coinsurance • Tier 4 Specialty: 50% Coinurance | ||||
Classic 2500X
| Subsidy Level | Standard | 200-250% FPL | 150-200% FPL | 100-150% FPL |
| The Basics | ||||
| Individual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.* | $2,500 | $2,000 | $500 | $100 |
| Individual Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services* | $7,150 | $5,500 | $2,000 | $750 |
| Prices before you meet your deductible | ||||
| Primary Care visits | 20% after deductible | 20% after deductible | 10% after deductible | 5% after deductible |
| Specialist visits | 20% after deductible | 20% after deductible | 10% after deductible | 5% after deductible |
| Urgent Care | 20% after deductible | 10% after deductible | 5% after deductible | 5% after deductible |
| Emergency Room | $200 copay before policy deductible & coinsurance | |||
| Outpatient Lab/X-ray | 20% after deductible | 20% after deductible | 10% after deductible | 5% after deductible |
| Outpatient Surgery | 20% after deductible | 20% after deductible | 10% after deductible | 5% after deductible |
| Hospitalization | 20% after deductible | 20% after deductible | 10% after deductible | 5% after deductible |
| Classic 2500X Prescription Drugs: Tier 1 Generics: $10 Copay • Tier 2 Preferred Brand: $40 Copay • Tier 3 Non-preferred Brand: 50% Coinsurance • Tier 4 Specialty: 50% Coinurance | ||||
Classic 3750X
| Subsidy Level | Standard | 200-250% FPL | 150-200% FPL | 100-150% FPL |
| Individual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.* | $3,750 | $3,450 | $800 | $250 |
| Individual Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services* | $6,750 | $5,000 | $2,350 | $1,000 |
| Prices before you meet your deductible | ||||
| Primary Care visits | 20% after deductible | 10% after deductible | 5% after deductible | 5% after deductible |
| Specialist visits | 20% after deductible | 10% after deductible | 5% after deductible | 5% after deductible |
| Urgent Care | 20% after deductible | 10% after deductible | 5% after deductible | 5% after deductible |
| Emergency Room | $200 copay before policy deductible & coinsurance | |||
| Outpatient Lab/X-ray | 20% after deductible | 10% after deductible | 5% after deductible | 5% after deductible |
| Outpatient Surgery | 20% after deductible | 10% after deductible | 5% after deductible | 5% after deductible |
| Hospitalization | 20% after deductible | 10% after deductible | 5% after deductible | 5% after deductible |
| Classic 3750X Prescription Drugs: Tier 1 Generics: $10 Copay • Tier 2 Preferred Brand: $40 Copay • Tier 3 Non-preferred Brand: 50% Coinsurance • Tier 4 Specialty: 50% Coinurance | ||||
Value Copay 5000X
| Subsidy Level | Standard | 200-250% FPL | 150-200% FPL | 100-150% FPL |
| Individual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.* | $5,000 | $3,250 | $850 | $125 |
| Individual Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services* | $7,150 | $5,700 | $2,100 | $1,000 |
| Prices before you meet your deductible | ||||
| Primary Care visits | $25 copay for 3 visits then 20% coins. after ded. | $25 copay for 3 visits then 20% coins. after ded. | $25 copay for 3 visits then 5% coins. after ded. | $25 copay for 3 visits then 5% coins. after ded. |
| Specialist visits | 20% after deductible | 20% after deductible | 5% after deductible | 5% after deductible |
| Urgent Care | 20% after deductible | 20% after deductible | 5% after deductible | 5% after deductible |
| Emergency Room | $200 copay before policy deductible & coinsurance | |||
| Outpatient Lab/X-ray | 20% after deductible | 20% after deductible | 5% after deductible | 5% after deductible |
| Outpatient Surgery | 20% after deductible | 20% after deductible | 5% after deductible | 5% after deductible |
| Hospitalization | 20% after deductible | 20% after deductible | 5% after deductible | 5% after deductible |
| Value Copay 5000X Prescription Drugs: Tier 1 Generics: $10 Copay • Tier 2 Preferred Brand: $40 Copay • Tier 3 Non-preferred Brand: 50% Coinsurance • Tier 4 Specialty: 50% Coinurance | ||||
HSA-E 3000X
| Subsidy Level | Standard | 200-250% FPL | 150-200% FPL | 100-150% FPL |
| Individual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. | $3,000 | $2,000 | $1,000 | $300 |
| Individual Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services | $5,000 | $5,000 | $2,350 | $1,250 |
| Prices before you meet your deductible | 20% after deductible | |||
| Primary Care visits | 20% after deductible | |||
| Specialist visits | 20% after deductible | |||
| Urgent Care | 20% after deductible | |||
| Emergency Room | 20% after deductible | |||
| Outpatient Lab/X-ray | 20% after deductible | |||
| Outpatient Surgery | 20% after deductible | |||
| Hospitalization | 20% after deductible | |||
| HSA-E 3000X Prescription Drugs: Policy coinsurance after deductible | ||||
*Special Note: These plan options (100-200% FPL) do not meet the IRS qualifications for Health Savings Account (HSA) eligibility.
The list of in-network hospitals include:
• Beaver Dam Community Hospital
• Beloit Memorial Hospital
• Columbus Community Hospital
• Divine Savior Healthcare, Portage
• Edgerton Hospital & Health Services
• Finley Hospital, Dubuque, IA
• Fort Healthcare, Inc., Fort Atkinson
• Grant Regional Health Center, Lancaster
• Gundersen Boscobel Area Health Care
• Memorial Hospital of Lafayette County, Darlington
• Monroe Clinic Hospital
• Moundview Memorial Hospital, Friendship
• Oconomowoc Memorial Hospital
• Reedsburg Area Medical Center
• Richland Hospital, Richland Center
• Ripon Medical Center
• Sauk Prairie Healthcare
• Southwest Health Center, Platteville
• St. Agnes Hospital, Fond du Lac
• St. Joseph’s Health Services
– Gundersen Lutheran,Hillsboro
• SSM Health St. Clare Hospital
– Baraboo
• SSM Health St. Mary’s Hospital – Janesville
• SSM Health St. Mary’s Hospital – Madison
• Stoughton Hospital
• Upland Hills Health, Dodgeville
• Watertown Regional Medical Center
• Waupun Memorial Hospital
• Waukesha Memorial Hosital
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Contact Us
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Phone: (312) 726-6565
Email: [email protected]
Mailing Address:
Dean Health Plan
PO Box 56099
Madison, WI 53705
Dean Health Plan
1277 Deming Way
Madison, WI 53717
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