1899-1 wps small group all-in-one brochure

WPS Small Group Insurance

70 yearsWPS Health Insurance has been serving the people of Wisconsin—and beyond—since 1946.

LOCAL. HONEST. INDEPENDENT.

Today WPS, a leading not-for-profit health insurer based in Wisconsin, offers high-quality coverage and networks, affordable plans, and a wide range of benefit choices, so you can protect your employees’ health.

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EComprehensive provider access. Freedom of choice.WPS Statewide NetworkWide range of providers, clinics, and specialty care centers across Wisconsin.

25,000health care professional service locations

165hospitals

More than

Ideal for:Small businesses with employees throughout the state » Agnesian Healthcare

» Ascension Health » Aspirus Network, Inc. » Aurora Health Care » Bellin Health » Children’s Health System » Dean Clinics/SSM Healthcare » Froedtert » Gundersen Health System » Holy Family Memorial » Hospital Sisters Health

System/Prevea Health

Find a complete list of in-network providers

Online: wpsic.com—click Find a Doctor

Phone: 1-800-332-6451


» Marshfield Clinic » Mayo Clinic Health

System » Medical College of

Wisconsin » OakLeaf Medical

Network, Inc. » ProHealth » ThedaCare » UnityPoint Health

Meriter » UW Health/UW Medical

Foundation


69%small business owners who consider health benefits very important for recruiting and retaining good employees.1

¹National Small Business Association’s (NSBA) Small Business Health Care Survey, 2015


Comprehensive provider access. Freedom of choice.First Health/SelectCare WrapIn-network benefits—even outside Wisconsin—for members covered under WPS Statewide Network.

Find a complete list of in-network providers

Online: wpsic.com—click Find a Doctor

Phone: 1-800-332-6451

1 millionhealth care service locations

5,000hospitals

More than

Ideal for: » Members who travel » Members whose children attend school out of state » Out-of-state employees receiving in-network care

90,000ancillary facilities

First Health SelectCare

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55%Wisconsin residents covered by employer-sponsored insurance.2

2Kaiser Family Foundation estimates based on the Census Bureau’s March 2014, March 2015, and March 2016 Current Population Survey (CPS: Annual Social and Economic Supplements).


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WPS Small Group Copay Plan Summary » Copays help reduce out-of-pocket costs » Affordable plan designs » No referral needed: Choose providers in-network and out-of-network » Plan covers greater share of costs when care provided in-network

See your local agent

Request a

Quote Call 1-800-332-6451 Visit wpsic.com

You Pay

Metal TierIndividual

deductible*Coinsurance

Individual Annual Max

Out of Pocket*At Preferred Providers**

In Network Out of Network

In Network

Out of Network

In Network

Out of Network

Teladoc Visit

Retail Clinic Visit

PCP Visit

Specialty Visit

Emergency Room

Outpatient Lab/X-ray

Outpatient Surgery Hospitalization

Platinum $500 $1,000 20% 50% $1,650 $11,000 No charge $10 $25 $50 $250 20% after deductible

Gold $1,000 $2,000 20% 50% $4,500 $12,000 No charge $10 $25 $50 $250 20% after deductible


Gold $2,000 $4,000 0% 30% $3,000 $10,000 No charge $10 $25 $50 $250 No charge after deductible


Gold $2,500 $5,000 0% 30% $3,500 $11,000 No charge $10 $25 $50 $250 No charge after deductible

Silver $2,500 $5,000 20% 50% $7,150 $15,000 No charge $10 $35 $70 $300 20% after deductible

Silver $3,000 $6,000 0% 30% $6,500 $12,000 No charge $10 $35 $70 $300 No charge after deductible




Platinum and Gold Prescription Drugs: Preventive and Preferred Generics: $0—Non-Preferred Generics: $15—Preferred Brand: $40— Non-Preferred Brand: $65—Specialty Drugs: 25% to $500

Silver Prescription Drugs: Preventive and Preferred Generics: $0—Non-Preferred Generics: $20—Preferred Brand: $50— Non-Preferred Brand: $80—Specialty Drugs: 30% to $500

*Family deductibles and out-of-pocket limits are 2x the individual amounts.**Preferred providers are in this plan’s network. All other providers are out of network. Services performed out of network are subject to the out-of-network deductible and coinsurance. See policy for details.

³National Small Business Association Small Business Health Care Survey, 2015


26%offer a Health Savings Account to their employees.3

Health Savings Account (HSA) Use a Health Savings Account (HSA) to:

» Pay for qualified health expenses (e.g., dental and vision)

» Save for future qualified medical expenses

» Save for retiree health expenses

You must be covered by an HSA-qualified high-deductible health

plan (HDHP) and not covered by any other health insurance.

WPS Group HSA-Qualified High-Deductible Health Plan (HDHP) Summary » Gives employees more control over their medical expenses

» Significantly lower premiums

» Wide range of plan options and benefits

» Health Savings Account (HSA) helps pay for qualified medical expenses tax-free

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You Pay

Metal Tier Individual deductible* Coinsurance

Individual Annual Max

Out of Pocket*At Preferred Providers**

In Network

Out of Network

In Network

Out of Network

In Network

Out of Network

Teladoc Visit

Retail Clinic Visit

PCP Visit

Specialty Visit

Emergency Room

Outpatient Lab/X-ray

Outpatient Surgery Hospitalization

Gold+ $2,000 $4,000 0% 30% $2,000 $10,000 No charge after deductible

Silver++ $1,500 $3,000 30% 50% $6,550 $13,000 30% after deductible

Silver++ $2,200 $4,400 20% 50% $5,000 $14,400 20% after deductible

Silver $2,600 $5,200 20% 50% $6,550 $15,200 20% after deductible

Silver $3,600 $7,200 0% 30% $3,600 $13,200 No charge after deductible

Bronze $5,050 $10,100 30% 50% $6,550 $20,100 30% after deductible

Bronze $6,550 $13,100 0% 30% $6,550 $19,100 No charge after deductible

Prescription Drugs: Preventive: $0—All others: deductible and coinsurance

*Family deductibles and out-of-pocket limits are 2x the individual amounts.**Preferred providers are in this plan’s network. All other providers are out of network. Services performed out of network are subject to the out-of-network deductible and coinsurance. See policy for details.+ Non-Embedded Deductible and Out-of-Pocket Limit: This plan features a non-embedded deductible and out-of-pocket limit. If an employee has family coverage, the family deductible must be satisfied before this plan will pay benefits. One person can satisfy the family deductible. If an employee has family coverage, the family out-of-pocket limit must be satisfied before this plan will pay 100% of covered benefits. One person can satisfy the family out-of-pocket limit. Deductibles and out-of-pocket maximums apply annually. ++ Non-Embedded Deductible and Embedded Out-of-Pocket Limit: This plan features a non-embedded deductible. If an employee has family coverage, the family deductible must be satisfied before this plan will pay benefits. One person can satisfy the family deductible. This plan features an embedded out-of-pocket limit. The individual out-of-pocket limit must be satisfied before this plan will pay 100% of covered benefits. Deductibles and out-of-pocket maximums apply annually.

3.2%average decrease in monthly drug costs in 2015 for members using Express Scripts.4


4Express Scripts 2015 Drug Trend Report Executive Summary.

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Preventive Care 100% covered by WPS when care given by preferred provider: » Routine immunizations » Routine medical exams » Well-baby care » Mammograms » Preventive screenings » Preventive drugs » … and more

The preventive services listed are covered subject to the terms and conditions set forth in your WPS certificate. Age-appropriate screenings are set by the United States Preventive Services Task Force and are subject to change.

Teladoc® Telehealth Services » The care you need, when you need it » Connect with a licensed physician over the phone or via

video consult » Cost: FREE for a copay plan or $45 fee for the HDHP plan

EyeMed Vision Care Discount » FREE access for WPS members » Save on eye care and eyewear » Thousands of locations nationwide

Member ResourcesConvenient access to tools and resources for your best health. » Access health and wellness information » Locate in-network doctors and facilities » Order prescriptions through Express Scripts » Manage your account » Learn about your benefits

Visit wpsic.com and click Members to get started.

Prescription Drug Coverage

» $0 copay on select preventive drugs for common conditions (e.g., high blood pressure, cholesterol, heart conditions, and asthma)

» Keep costs down: Lower-cost generic drugs and monitoring of specialty drug use

» Home delivery service available

Delta Dental InsuranceThe most in-network providers in the state and nation: » Delta Dental PPO Network: Lowest agreed-upon

fees; more locations offer care than any other PPO network

» Delta Dental Premier: More than 90% of Wisconsin dentists belong to the state’s largest dentist network

Plan features and add-ons: » Save on preventive care options and medical

management for selected diseases and conditions » Additional options available: orthodontic services;

coverage and treatment for endodontic and non-surgical periodontic services; and maximum allowable charge reimbursement plan

Fitness Reimbursement*Encourage employees to stay active: » $30 reward each month for visiting a fitness club

10 or more times that month » Includes large fitness chains, independently owned

clubs, and YMCA/YWCA » Three ways to track: Automated reporting via 5,700

partner centers, smartphone app, or paper log

$0 Copay Drugs

Amlodipine besylateAtenololAtenolol/chlorthalidoneAtorvastatin calciumBenazepril hclBisoprolol fumarate/hctzCarvedilolChlorthalidoneClonidine hclDiltiazem 24hr cdEnalapril maleateEnalapril/hydrochlorothiazideGemfibrozilGlimepirideGlipizideGlyburideGlyburide, micronizedHydrochlorothiazideIndapamideIrbesartanLisinoprilLisinopril/hydrochlorothiazideLosartan potassiumLosartan/hydrochlorothiazideLovastatinMetformin hclMetolazoneMetoprolol tartrateMontelukast sodiumPravastatin sodiumPropranolol hclQuinapril hclRamiprilSimvastatinSpironolactoneTriamterene/hydrochlorothiazideVerapamil hclWarfarin sodium

*If you think an employee might be unable to meet a standard for a reward under this wellness program, the employee might qualify for an opportunity to earn the same reward by different means.

In Wisconsin:Professionally Active Physicians: 16,0195 Professionally Active Nurses: 31,4616

5Special data request for information on active state licensed physicians from Redi-Data, Inc, April 2016. 6Special data request on State Licensing Information from Redi-Data Inc, April 2016



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CEChoose the Right Plan to Support the Best Health of

Your Employees

Searching for the right fit?Comprehensive plans give you options with affordable, high-quality coverage across Wisconsin.

Ready to choose?You can apply online or over the phone in just a few minutes.

About WPSWisconsin Physicians Service Insurance Corporation, doing business as WPS Health Solutions, has a strong legacy of serving the people of Wisconsin. Founded in 1946, WPS is Wisconsin’s leading not-for-profit health insurer, offering affordable individual health insurance, family health insurance, and high-deductible health plans, as well as flexible and affordable group health plans and cost-effective benefit plan administration for businesses.See your local agent Call 1-800-332-6451 Visit wpsic.com

Contact us today!WPS Health Insurance is ready to help you find the plan that meet your needs!

7National Small Business Association’s (NSBA) Small Business Health Care Survey, 2015


In Wisconsin7...440,763 small businesses1.2 million small business employees

©2016 Wisconsin Physicians Service Insurance Corporation. All rights reserved. 29985-021-1609

1717 W. BroadwayP.O. Box 8190Madison, WI 53708-8190

See your local agent

Request a

Quote Call 1-800-332-6451 Visit wpsic.com

LOCAL. Based in Wisconsin. Covering all of Wisconsin.

HONEST. In 2016, WPS was named one of the World’s Most Ethical Companies® for the seventh straight year.

INDEPENDENT. Independent for more than 70 years.

1899-1 wps small group all-in-one brochure

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