Arise Health Plan
Arise Health Plan is a fresh choice in a crowd of big, impersonal, national health insurance giants. Their commitment to customers like you is to be easy to work with and as transparent as possible, so that you always understand your benefits. They continue our tradition of Wisconsin-based service and are always looking for ways to make owning and using health insurance easier.
- HMO Standard Plans
- HMO High-Deductible Standard Plans
- POS Standard Plans
- POS High-Deductible Standard Plans
| Bronze | Catastrophic¹ | |
|---|---|---|
| Individual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.² | $7,150 | $7,150 |
| CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max | 0% | 0% |
| 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 | $7,150 |
| Teladoc Visit | No charge after deductible | No charge after deductible |
| Retail Clinic Visit | No charge after deductible | No charge after deductible |
| PCP Visit | No charge after deductible | No charge after deductible |
| Specialty Visit | No charge after deductible | No charge after deductible |
| Emergency Room | No charge after deductible | No charge after deductible |
| Outpatient Lab/X-ray | No charge after deductible | No charge after deductible |
| Outpatient Surgery | No charge after deductible | No charge after deductible |
| Hospitalization | No charge after deductible | No charge after deductible |
¹Catastrophic plan includes 3 FREE PCP visits per year. This plan is only available to people under age 30 or who qualify for a hardship exemption from the Federally Facilitated Marketplace. ²Family deductibles and out-of-pocket limits are 2x the individual amounts
| Bronze | |
| Individual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.¹ | $5,500 |
| CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max | 20% |
| 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 services¹ | $6,500 |
| Teladoc Visit | 20% after deductible |
| Retail Clinic Visit | 20% after deductible |
| PCP Visit | 20% after deductible |
| Specialty Visit | 20% after deductible |
| Emergency Room | 20% after deductible |
| Outpatient Lab/X-ray | 20% after deductible |
| Outpatient Surgery | 20% after deductible |
| Hospitalization | 20% after deductible |
| Prescription Drugs | Preventative: $0
All others: deductible and coinsurance |
| ¹Family deductibles and out-of-pocket limits are 2x the individual amounts. | |
| Outpatient Facility Fee | 20% after ded. |
| Outpatient Surgery Physician/Surgical Services | 20% after ded. |
| Labs & Diagnostics | 20% after ded. |
| Mental/Behavioral Health & Substance Use Disorder Outpatient Services | 30 |
| Rehabilitation Outpatient Services (Includes Speech, Occupational, Physical Therapy) | 20% after ded. |
| Skilled Nursing Facility | 20% after ded. |
| Pediatric Vision- Routine Eye Exam (1 visit per year) | 100% Covered |
| Pediatric Vision- Eyeglasses (frames, 1 per year) | 100% Covered |
| Pedicatric Vision- Lenses (per pair) | 100% Covered |
| Pharmacy
(Generic / Preferred / Non-preferred / Specialty) |
$10 / $50 / 20% after Rx ded. / 20% after Rx ded. |
| Bronze | ||
| Individual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.¹ | In Network | $7,150 |
| Out of Network | $14,300 | |
| CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max | In Network | 0% |
| Out of Network | 30% | |
| 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 services¹ | In Network | $7,150 |
| Out of Network | $20,300 | |
| At Participating Providers² | Teladoc Visit | No charge after deductible |
| Retail Clinic Visit | No charge after deductible | |
| PCP Visit | No charge after deductible | |
| Specialty Visit | No charge after deductible | |
| Emergency Room | No charge after deductible | |
| Outpatient Lab/X-ray | No charge after deductible | |
| Outpatient Surgery | No charge after deductible | |
| Hospitalization | No charge after deductible | |
| Prescription Drugs | Preventative: $0
All others: Ded/Coins |
|
Bronze
| Individual Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim.¹ | In Network | $5,500 |
| Out of Network | $11,000 | |
| CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max | In Network | 20% |
| Out of Network | 50% | |
| 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 services¹ | In Network | $6,550 |
| Out of Network | $21,000 | |
| At Participating Providers² | Teladoc Visit | No charge after deductible |
| Retail Clinic Visit | No charge after deductible | |
| PCP Visit | No charge after deductible | |
| Specialty Visit | No charge after deductible | |
| Emergency Room | No charge after deductible | |
| Outpatient Lab/X-ray | No charge after deductible | |
| Outpatient Surgery | No charge after deductible | |
| Hospitalization | No charge after deductible | |
| Prescription Drugs | Preventative: $0
All others: 20% after deductible |
¹Family deductibles and out-of-pocket limits are 2x the individual amounts. ²Services performed out of network under the POS plan options are subject to the out-of-network deductible and coinsurance. Out-of-network services are not covered under HMO plan options, except in emergency situations. See policy for details.
Arise Health Plan Coverage Map
- Adams
- Brown
- Calumet
- Clark
- Columbia
- Crawford
- Dane
- Dodge
- Door
- Florence
- Fond du Lac
- Forest
- Grant
- Green Lake
- Iron
- Jackson
- Jefferson
- Juneau
- Kenosha
- Kewaunee
- La Crosse
- Langlade
- Lincoln
- Manitowoc
- Marathon
- Marinette
- Marquette
- Milwaukee
- Monroe
- Oconto
- Oneida
- Outagamie
- Ozaukee
- Portage
- Price
- Racine
- Sauk
- Shawano
- Sheboygan
- Taylor
- Trempealeau
- Vernon
- Vilas
- Walworth
- Washington
- Waukesha
- Waupaca
- Waushara
- Winnebago
- Wood
Dental Coverage
Optional Dental Coverage
Optional dental coverage includes a variety of routine, basic, and major dental services.
- Annual Maximum Benefit: $1,200 per individual
- Annual Deductible: $50 per individual
- Out-of-pocket savings for all services provided by Delta Dental PPO dentists
- Higher out-of-pocket costs for services provided by non-Delta Dental PPO dentists
- To find a Delta Dental PPO dentist, visit deltadentalwi.com
- Covers dependent children: up to age 26
Summary of Services
| Diagnostic & Preventative Care | You Pay¹ | Frequency |
| Regular cleanings | 20% | 2 per year |
| Routine exams | 20% | 2 per year |
| Bitewing X-rays | 20% | 1 set per year |
| Full-mouth X-rays | 20% | 1 every 5 years |
| Sealants – per tooth | 20% | 1 per lifetime to age 19 |
| Emergency exam | 20% | |
| Restorative Services² | You pay¹ | Frequency |
| Fillings | 50% | 6-month waiting period |
| Simple extractions | 50% | 6-month waiting period |
| Oral surgery | 50% | 12-month waiting period |
| Endodontic services | 50% | 12-month waiting period |
| Periodontic services² | 50% | 12-month waiting period |
| Crowns | 50% | 12-month waiting period |
| Prosthodontics fixed | 50% | 12-month waiting period |
| Prosthodontics removable | 50% | 12-month waiting period |
¹Percent you pay after $50 deductible is met. ²Provides additional Evidence-Based Integrated Care Plan benefits for people with specific medical conditions. Dental Rates
| Age | Adult Rate¹ |
| <30 | $19.46 |
| 30-34 | $22.73 |
| 35-39 | $24.07 |
| 40-44 | $25.96 |
| 45-49 | $28.60 |
| 50-54 | $30.56 |
| 55-59 | $32.43 |
| 60-64 | $32.43 |
| 65+ | $37.09 |
| # of Children | Child Rate¹ |
| 1 | $19.59 |
| 2 | $39.18 |
| 3+ | 67.46 |
Vision Coverage
Arise members receive FREE access to the EyeMed Vision Care discount program. EyeMed offers substantial savings on eye care and eyewear at thousands of provider locations nationwide. To receive your discount, simply show your Arise member ID card when you visit participating EyeMed providers. Tell them you have EyeMed discount No. 9238064 from Arise. EyeMed’s provider network includes many familiar optical retailers, including LensCrafters, Pearle Vision, Sears Optical, Shopko Eyecare Centers, Target Optical, and more.
Summary of Services
| Eye Exam (with dilaton, as necssary) | $5 off routine exam$5 off contact lens exam |
| Complete Pair Eyeglass Purchase¹ | |
| Frames | |
| Any available frame at provider location | 35% off retail price |
| Standard Plastic Lenses | |
| Single Vision | $50 |
| Bifocal | $70 |
| Trifocal | $105 |
| Lens Options | |
| UV Coating | $15 |
| Tint (solid and gradient) | $15 |
| Standard Scratch-Resistant Coating | $15 |
| Standard Polycarbonate | $40 |
| Standard Anti-Reflective Coating | $45 |
| Standard Progressive (add-on to bifocal) | $65 |
| Other Add-ons and Services | 20% off retail price |
| Contact Lenses (discount applies to materials only) | |
| Conventional | 15% off retail price |
| Laser Vision Correction | |
| LASIK or PRK from U.S. Laser Network | 15% off retail price or 5% off promotional price |
| Frequency of use for examination, frames, lenses, or contact lenses unlimited | |
| ¹Frame, lens, and lens option discounts apply only when purchasing a complete pair of eyeglasses. If purchased separately, members receive 20% off the retail price. | |
Contact Us
New Enrollments
Phone: (312) 726-6565
Email: [email protected]
Mailing Address
PO Box 11625
Green Bay, WI 54307-1625