University of Wisconsin–Milwaukee


State Group Health Insurances Breakdown

30 day enrollment or change deadline
  The State Group Health Insurances provide comprehensive hospital, surgical, and medical benefits. All of the health plans offer a uniform benefit package with more detail available in the Reference Guide and the Decision Guide.

Benefits Uniform Benefits for Eligible Participants Excluding Retirees
Annual Deductible No deductible
Annual Coinsurance & Out-of-Pocket Maximum (OOPM) 90%/10% to annual OOPM $500 individual/$1,000 family except as described
Routine Preventive 100% (As required by federal law)
Hospital Days 90%/10% coinsurance to OOPM as medically necessary, plan providers only. No day limit
Emergency Room $75 copay per visit, 90% coinsurance thereafter to OOPM
Ambulance 90%/10% coinsurance to OOPM
Pharmaceutical (Navitus for all Plans)
Three levels of copayments:
  1. $5.00 (Generic)
  2. $15.00 (Some Generic and Name Brand)
  3. $35.00 (Drugs Not Included in the Formulary)
Current Formulary Available at Navitus or call (866)333-2757

Uniform Dental Benefits:

Key Plan Providers
Covered Services (Examples)
  In-Network Provider
Out-of-Network

Deductible: $0 $0
Annual Benefit Max (per person):
$1,000 $1,000
Diagnostic/Preventative:
100% 75% Routine Evaluations, X-Rays, Flouride, etc.
Restorative: 100% 50% Fillings
Periodontic: 80% 50% Limited to Periodontal Maintenance
Adjunctive Services:
80% 50% Local Anesthesia
Ortho: 50% (children only)
50% (children only)

Ortho Lifetime Max:
$1,500 $1,500

Diagnostic/Preventative:

Routine Oral Evaluation - exams limited to two per year. Note that comprehensive exams are not done multiple times in a year.

Please review the provider summaries carefully in the It's your choice 2014 Decision Guide and if necessary use the Wisconsin county map to select a health plan based on your health care providers county.