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.
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.
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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: help[email protected]

 

Mailing Address

PO Box 11625
Green Bay, WI 54307-1625

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