It's Your Choice 2016
State of Wisconsin
Group Health Insurance Program
(State Employees, Retirees, Continuants and Graduate Assistants)
State Maintenance Plan (SMP)Administered by WPS Health Insurance
What is SMP?
The State Maintenace Plan, or SMP, is a self-insured health plan that offers Uniform Benefits. SMP is designed to provide a health plan option for members who live or work in areas without adequate access to in-network providers or hospitals. Additional in-network providers are available in some Michigan and Minnesota counties to expand access to in-network care.
What’s New for 2016
Visit the Health Center at wpsic.com/healthcenter, a continually updated online resource designed to help you make good health decisions, whether you’re looking for advice on treating a chronic condition or for tips on leading a healthy lifestyle.
Go to www.wpsic.com/state and click “Find a Doctor.” Choose your plan to search for a provider in your network. To request a printed directory be mailed to you, call 1-800-634-6448.
Referrals, Prior Authorizations, Out-of- Network Care
You must get a referral approved by WPS before getting care outside the WPS SMP network. Your provider must request the referral. Retroactive referrals are not allowed. It is ultimately the member’s responsibility to make sure the referral is submitted and approved prior to receiving services.
Members or providers may request prior authorization for services when concerned if WPS will pay and at what rate. Without an approved prior authorization, WPS may deny payment.
Visit wpsic.com/state and follow the “Member Materials” link to obtain a copy of a Medical Preauthorization Request Form or call member services. You will receive written notification of the approval or denial for the prior authorization.
Prior authorization is required for low back surgery and high-tech radiology services.
Bayfield, Buffalo, Florence, Forest, Iron, Menominee, Pepin and Vilas counties.
Emergency and Urgent Care Outside Service Area
For emergency and urgent care, in-network hospital emergency rooms or urgent care facilities should be used if possible. If you are unable to reach an in-network provider, go to the nearest appropriate medical facility.
Contact 1-800-634-6448 or your primary care physician if assistance is needed to determine the appropriate level of care.
Follow-up care must be received by an in-network provider unless otherwise approved by WPS.
Mental, Behavioral Health and Substance Abuse
Medically necessary services are available when performed by licensed mental health professionals practicing within the scope of their licenses and processed based on the provider’s network status.
This page was last modified on: 9/23/2015 5:02:41 PM