State Group Health Insurances Breakdown
|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:
Uniform Dental Benefits:
|Key Plan Providers
||Covered Services (Examples)
|Annual Benefit Max (per person):
||100%||75%||Routine Evaluations, X-Rays, Flouride, etc.
|Periodontic:||80%||50%||Limited to Periodontal Maintenance
|Ortho:||50% (children only)
||50% (children only)
|Ortho Lifetime Max:
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.