Dean Focus Silver Share - 38345WI0080075 Health Insurance Plan

Dean Health Plan health insurance plan with the Plan ID 38345WI0080075. The plan is called Dean Focus Silver Share.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 94.02% (we converted the output of AV Calculator to percentage to compare with data provided by Issuer, it shows the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 5.98% of the costs of all covered benefits (according to the AV Calculator by CMS.gov). More information about AV Calculator methodology.

Health Insurance Plan ID 38345WI0080075
Health Insurance Plan Year 2025
State Wisconsin
Health Insurance Issuer Dean Health Plan
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 38345WI0080075-06
Provider Network(s) DEANHEALTHPLANFOCUS
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 03 Dec 2024 06:24 GMT).

Providers Wisconsin All US States
All 4643 66976
PCP 277 460
Allergy 2 2
OB/GYN 6 10
Dentists 23 28
Available Variants of the Health Plan

Standard Off Exchange Plan - 38345WI0080075-00

Standard On Exchange Plan - 38345WI0080075-01

Open to Indians below 300% FPL - 38345WI0080075-02

Open to Indians above 300% FPL - 38345WI0080075-03

73% AV Silver Plan - 38345WI0080075-04

87% AV Silver Plan - 38345WI0080075-05

94% AV Silver Plan - 38345WI0080075-06

Last Plan Update Date Fri, 20 Sep 2024 00:00 GMT
Last Import Date Tue, 03 Dec 2024 06:24 GMT

Benefits of Dean Focus Silver Share Health Insurance Plan, 38345WI0080075-06

Benefit Covered In Network Out Of Network
Abortion for Which Public Funding is Prohibited
NO
Accidental Dental

Exclusions: See policy or plan document for additional benefit exclusions.

See policy or plan document for additional benefit explanation.

YES

10.00%

100.00%
Acupuncture
NO
Allergy Testing

Exclusions: See policy or plan document for additional benefit exclusions.

YES

10.00%

100.00%
Bariatric Surgery
NO
Basic Dental Care - Adult
NO
Basic Dental Care - Child
NO
Chemotherapy

See policy or plan document for additional benefit explanation.

YES

$35.00

100.00%
Chiropractic Care

Exclusions: See policy or plan document for additional benefit exclusions.

YES

$5.00

100.00%
Cosmetic Surgery
NO
Delivery and All Inpatient Services for Maternity Care

Exclusions: See policy or plan document for additional benefit exclusions.

YES

10.00%

100.00%
Dental Check-Up for Children
NO
Diabetes Education

Exclusions: See policy or plan document for additional benefit exclusions.

See policy or plan document for additional benefit explanation.

YES

No Charge

100.00%
Dialysis
YES

10.00%

100.00%
Durable Medical Equipment

Exclusions: See policy or plan document for additional benefit exclusions.

See policy or plan document for additional benefit explanation.

YES

10.00%

100.00%
Emergency Room Services
YES

10.00%

10.00%
Emergency Transportation/Ambulance

Exclusions: See policy or plan document for additional benefit exclusions.

YES

10.00%

10.00%
Eye Glasses for Children

Limit: 1.0 Item(s) per Year

Exclusions: See policy or plan document for additional benefit exclusions.

See policy or plan document for additional benefit explanation.

YES

10.00%

100.00%
Gender Affirming Care
NO
Generic Drugs
YES

$5.00

100.00%
Habilitation Services

Limit: 60.0 Visit(s) per Year

Exclusions: See policy or plan document for additional benefit exclusions.

See policy or plan document for additional benefit explanation.

YES

10.00%

100.00%
Hearing Aids

Limit: 2.0 Item(s) per 3 Years

Exclusions: See policy or plan document for additional benefit exclusions.

See policy or plan document for additional benefit explanation.

YES

10.00%

100.00%
Home Health Care Services

Limit: 60.0 Visit(s) per Year

Exclusions: See policy or plan document for additional benefit exclusions.

YES

10.00%

100.00%
Hospice Services

Exclusions: See policy or plan document for additional benefit exclusions.

YES

10.00%

100.00%
Imaging (CT/PET Scans, MRIs)
YES

10.00%

100.00%
Infertility Treatment
NO
Infusion Therapy

Exclusions: See policy or plan document for additional benefit exclusions.

YES

10.00%

100.00%
Inpatient Hospital Services (e.g., Hospital Stay)

Exclusions: See policy or plan document for additional benefit exclusions.

YES

10.00%

100.00%
Inpatient Physician and Surgical Services
YES

10.00%

100.00%
Laboratory Outpatient and Professional Services
YES

10.00%

100.00%
Long-Term/Custodial Nursing Home Care
NO
Major Dental Care - Adult
NO
Major Dental Care - Child
NO
Mental/Behavioral Health Inpatient Services
YES

10.00%

100.00%
Mental/Behavioral Health Outpatient Services

Exclusions: See policy or plan document for additional benefit exclusions.

YES

$5.00

100.00%
Non-Preferred Brand Drugs
YES

60.00%

100.00%
Nutritional Counseling

See policy or plan document for additional benefit explanation.

YES

10.00%

100.00%
Orthodontia - Adult
NO
Orthodontia - Child
NO
Other Practitioner Office Visit (Nurse, Physician Assistant)
YES

$5.00

100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
YES

10.00%

100.00%
Outpatient Rehabilitation Services

Limit: 60.0 Visit(s) per Year

Exclusions: See policy or plan document for additional benefit exclusions.

See policy or plan document for additional benefit explanation.

YES

10.00%

100.00%
Outpatient Surgery Physician/Surgical Services
YES

10.00%

100.00%
Preferred Brand Drugs
YES

$125.00

100.00%
Prenatal and Postnatal Care

Exclusions: See policy or plan document for additional benefit exclusions.

YES

10.00%

100.00%
Preventive Care/Screening/Immunization
YES

No Charge

100.00%
Primary Care Visit to Treat an Injury or Illness

Virtual visits are unlimited with a $0 copayment when provided by a designated in-network virtual care provider for non-urgent medical symptoms for common illnesses.

YES

$5.00

100.00%
Private-Duty Nursing
NO
Prosthetic Devices

Exclusions: See policy or plan document for additional benefit exclusions.

YES

10.00%

100.00%
Radiation
YES

10.00%

100.00%
Reconstructive Surgery

Exclusions: See policy or plan document for additional benefit exclusions.

YES

10.00%

100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy

Limit: 20.0 Visit(s) per Year

Exclusions: See policy or plan document for additional benefit exclusions.

See policy or plan document for additional benefit explanation.

YES

10.00%

100.00%
Rehabilitative Speech Therapy

Limit: 20.0 Visit(s) per Year

Exclusions: See policy or plan document for additional benefit exclusions.

See policy or plan document for additional benefit explanation.

YES

10.00%

100.00%
Routine Dental Services (Adult)
NO
Routine Eye Exam (Adult)
NO
Routine Eye Exam for Children

Limit: 1.0 Exam(s) per Benefit Period

Exclusions: See policy or plan document for additional benefit exclusions.

YES

$5.00

100.00%
Routine Foot Care
NO
Skilled Nursing Facility

Limit: 30.0 Days per Stay

Exclusions: See policy or plan document for additional benefit exclusions.

YES

10.00%

100.00%
Specialist Visit
YES

$35.00

100.00%
Specialty Drugs
YES

$700.00

100.00%
Substance Abuse Disorder Inpatient Services
YES

10.00%

100.00%
Substance Abuse Disorder Outpatient Services

Exclusions: See policy or plan document for additional benefit exclusions.

YES

$5.00

100.00%
Transplant

Exclusions: See policy or plan document for additional benefit exclusions.

YES

10.00%

100.00%
Treatment for Temporomandibular Joint Disorders

See policy or plan document for additional benefit explanation.

YES

10.00%

100.00%
Urgent Care Centers or Facilities
YES

10.00%

10.00%
Weight Loss Programs
NO
Well Baby Visits and Care
YES

No Charge

100.00%
X-rays and Diagnostic Imaging
YES

10.00%

100.00%

Dean Focus Silver Share Health Insurance Plan Variant 38345WI0080075-06 Attributes

Plan Attribute Value
AV Calculator Output Number 0.9402335515831021
Begin Primary Care Cost-Sharing After Number Of Visits 0
Begin Primary Care Deductible Coinsurance After Number Of Copays 0
Business Year 2025
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type 94% AV Level Silver Plan
Dental Only Plan No
Design Type Not Applicable
Disease Management Programs Offered Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy
EHB Percent of Total Premium 1.0
First Tier Utilization 100%
Formulary ID WIF008
Formulary URL URL
HIOS Product ID 38345WI008
Import Date 2024-09-20 01:02:54
Limited Cost Sharing Plan Variation - Estimated Advanced Payment $0.00
Inpatient Copayment Maximum Days 0
HSA Eligible No
New/Existing Plan New
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer ID 38345
Issuer Marketplace Marketing Name Dean Health Plan
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Silver
Multiple In Network Tiers No
National Network No
Network ID WIN002
Out of Country Coverage Yes
Out of Country Coverage Description Emergency Services
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Emergency Services
Plan Brochure URL
Plan Effective Date 2025-01-01
Plan Expiration Date 2025-12-31
Plan ID (Standard Component ID with Variant) 38345WI0080075-06
Plan Marketing Name Dean Focus Silver Share
Plan Type EPO
Plan Variant Marketing Name Dean Focus Silver Share
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $1,200
SBC Scenario, Having a Baby, Copayment $10
SBC Scenario, Having a Baby, Deductible $0
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $70
SBC Scenario, Having Diabetes, Copayment $1,500
SBC Scenario, Having Diabetes, Deductible $0
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $200
SBC Scenario, Treatment of a Simple Fracture, Copayment $100
SBC Scenario, Treatment of a Simple Fracture, Deductible $0
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID WIS004
Source Name HIOS
Plan ID 38345WI0080075
State Code WI
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person per person not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual Not Applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group per group not applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person per person not applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual Not Applicable
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 10.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $0 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $0 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $0
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group per group not applicable
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person per person not applicable
Combined Medical and Drug EHB Deductible, Out of Network, Individual Not Applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $3050 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $1525 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $1,525
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person per person not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual Not Applicable
Unique Plan Design No
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered No

Copay & Coinsurance of Dean Focus Silver Share Health Insurance Plan, 38345WI0080075

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about Dean Focus Silver Share, 38345WI0080075 Health Insurance Plan, 38345WI0080075

  • Does Dean Focus Silver Share Health Insurance Plan, 38345WI0080075 support Mail Ordering?

    Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.

  • Does (38345WI0080075) Health Insurance Plan, Variant (38345WI0080075-06) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy

    Does (38345WI0080075) Health Insurance Plan, Variant (38345WI0080075-06) have Out Of Country Coverage?

    Yes. Details: Emergency Services

    Does (38345WI0080075) Health Insurance Plan, Variant (38345WI0080075-06) have Out of Service Area Coverage?

    Yes. Details: Emergency Services

    Does (38345WI0080075) Health Insurance Plan, Variant (38345WI0080075-06) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy

    Does Dean Focus Silver Share Health Insurance Plan, Variant (38345WI0080075-06) offer Disease Management Programs for Asthma?

    Yes, the Dean Focus Silver Share Health Insurance Plan Variant 38345WI0080075-06 offers Disease Management Program for Asthma.

    Does Dean Focus Silver Share Health Insurance Plan, Variant (38345WI0080075-06) offer Disease Management Programs for Heart disease?

    Yes, the Dean Focus Silver Share Health Insurance Plan Variant 38345WI0080075-06 offers Disease Management Program for Heart disease.

    Does Dean Focus Silver Share Health Insurance Plan, Variant (38345WI0080075-06) offer Disease Management Programs for Depression?

    Yes, the Dean Focus Silver Share Health Insurance Plan Variant 38345WI0080075-06 offers Disease Management Program for Depression.

    Does Dean Focus Silver Share Health Insurance Plan, Variant (38345WI0080075-06) offer Disease Management Programs for Diabetes?

    Yes, the Dean Focus Silver Share Health Insurance Plan Variant 38345WI0080075-06 offers Disease Management Program for Diabetes.

    Does Dean Focus Silver Share Health Insurance Plan, Variant (38345WI0080075-06) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Dean Focus Silver Share Health Insurance Plan Variant 38345WI0080075-06 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Dean Focus Silver Share Health Insurance Plan, Variant (38345WI0080075-06) offer Disease Management Programs for Low back pain?

    Yes, the Dean Focus Silver Share Health Insurance Plan Variant 38345WI0080075-06 offers Disease Management Program for Low back pain.

    Does Dean Focus Silver Share Health Insurance Plan, Variant (38345WI0080075-06) offer Disease Management Programs for Pregnancy?

    Yes, the Dean Focus Silver Share Health Insurance Plan Variant 38345WI0080075-06 offers Disease Management Program for Pregnancy.

 

Disclaimer: This is based on the import(Date: Tue, 03 Dec 2024 06:24 GMT) of the data from Healthcare Issuers listed by CMS. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: CMS.gov, HealthPorta HEALTHCARE MRF API