Scott & White Health Plans Wisconsin

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Plan Overviews

Scott & White Health Plan offers a bronze HMO and bronze PPO plan for individuals and families. Contact an agent at 312-726-6565 for enrollment assistance. Scott & White Health Plan does not offer health plans through the health insurance Marketplace and is not available everywhere in Wisconsin.
Scott and White Health Plan will not be offering indvidual plans after Dec 31, 2017. Check out other options here.

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Health Maintenance Organizations (HMO) An HMO gives you a range of benefits for a prepaid monthly fee. The plan focuses on wellness, prevention, and treatment within a network of providers. Out-of-network providers are usually not covered, unless in an emergency. Preferred Provider Organizations (PPO) PPOs often have a larger network of providers. This option can offer the greatest flexibility for members seeking care in and out of network. If a member visits an in-network doctor, they’re only responsible for their annual deductible and copay. If a member gets care outside the network, benefits may be reduced and their copay may be higher. Often, annual deductibles for PPO plans are higher than deductibles for HMO plans.

Bronze HMO 6400/50v Bronze PPO 7150
Benefit HMO Plan In Network (No Out of Network) PPO In Network PPO Out of Network
Plan Coinsurance 80% 100% 50%
Member Coinsurance 20% 0% 50%
Individual Deductible 1 Family Deductible $6,400 $12,800 $7,150 $14,300 $14,300 $28,600
Individual Max Out Of Pocket 2 Family Max Out Of Pocket $7,150 $14,300 $7,150 $14,300 $14,300 $28,600
Primary Care Office Visit $50 copay (first visit) $60 copay (first 2 visits) Deductible then 50%
Specialist Office Visit Deductible then 20% $100 copay (first 2 visits) Deductible then 50%
Urgent Care $50 copay (first visit) Deductible then 0% Deductible then 0%
Emergency Room Deductible then 20% Deductible then 0% Deductible then 0%
Imaging (PET, CT, MRI) Deductible then 20% Deductible then 0% Deductible then 50%
Outpatient Lab and X-Ray Deductible then 20% Deductible then 0% Deductible then 50%
Inpatient Hospitalization Deductible then 20% Deductible then 0% Deductible then 50%
Pharmacy Deductible None None None
Preferred Generic Drugs $17 copay $40 copay Deductible then 50%
Preferred Brand Drugs Deductible then 50% $100 copay Deductible then 50%
Non-Preferred Brand Deductible then 50% Deductible then 50% Deductible then 50%
Specialty Drugs Deductible then 50% Deductible then 50% Deductible then 50%
(1 ) Deductibles and out-of-pocket responsibility apply per calendar year.
(2) All member responsibility for copays, deductibles, and coinsurance apply to the out-of-pocket maximum. Preventive medications are covered in full – deductible and coinsurance do not apply.
The PPO plan includes coverage when out-of-network providers are used; however, you will be responsible for any amounts above the allowed charges. These amounts can be billed to you by the provider and do not apply to your annual out-of-pocket maximum under the plan.
SCOTT AND WHITE HEALTH PLAN and the INSURANCE COMPANY OF SCOTT AND WHITE ARE QUALIFIED HEALTH PLAN ISSUERS.
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.

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