University of Wisconsin–Milwaukee

Contact UsContact Benefits

Phone: 414 - 229 - 5353
Email: benefits@uwm.edu

 Work/Life BalanceETF
Employee Assistance Program: Lifematters  

 
   

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.