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 Account	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 Plan	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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Copay Plus & Classic Plan Overview

	Gold Copay Plus 1500X	Silver Copay Plus 2750X	Silver Copay Plus 3500X	Silver Classic 2500X	Silver Classic 3750X
Individual Deductible	$1,500	$2,750	$3,500	$2,500	$3,750
Individual Out-of-Pocket Max	$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
Coinsurance	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 Deductible	$2,650	$5,000	$7,150
Individual Out-of-Pocket Max	$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
Coinsurance	0%	20%	0%
Preventative Exam*	No Charge
Urgent Care	No charge after deductible	20% after deductible	No charge after deductible
Emergency Room
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 Deductible	$3,000	$6,550	$7,150
Individual Out-of-Pocket Max	$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
Coinsurance	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 Deductible	$2,750	$2,500	$400	$100
Individual Out-of-Pocket Max	$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 Deductible	$3,500	$3,000	$400	$100
Individual Out-of-Pocket Max	$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 Deductible*	$2,500	$2,000	$500	$100
Individual Out-of-Pocket Max*	$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 Deductible*	$3,750	$3,450	$800	$250
Individual Out-of-Pocket Max*	$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 Deductible*	$5,000	$3,250	$850	$125
Individual Out-of-Pocket Max*	$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 Deductible	$3,000	$2,000	$1,000	$300
Individual Out-of-Pocket Max	$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