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Publications

It's Your Choice 2007

State of Wisconsin Employees
Graduate Assistants - University of Wisconsin


Plan Descriptions

This section includes information provided by each health plan to assist you in selecting your plan for the coming year. Plans may provide you with additional information through mailings during Dual-Choice and as a participant with a specific plan. Read this section carefully and contact the plan for more information.

While we believe that most of the categories on the following pages are self-explanatory, participants may not be familiar with all of them. For example:

  • the number of PCPs (primary care physicians) indicated are the total contracted PCPs. It does not reflect PCPs who may be less than full-time with that plan or are affiliated with more than one alternate plan.
  • the number of board certified speciality care physicians refers to those who have passed a specialty board examination under the American Board of Medical Specialties.
  • the 24-hour nurse line refers to a service whereby you can contact nurses to discuss health concerns and receive advice about obtaining emergency or urgent care services.
  • the PCP restrictions refer to such issues as whether all family members must select PCPs in the same clinic or IPA or if women may select an OB/GYN as their PCP.

Hospitals who are participating with the Leapfrog survey are recognized on the following pages. Please review Section C, questions 34 and 36, and see the survey results at www.leapfroggroup.org for more information.

One Frog is awarded when a hospital has recently submitted data to Leapfrog.

A second Frog is awarded to the hospital based on the results they achieved in the fourth ‘leap’. The fourth leap is focused on patient safety, uses the National Quality Forum (NQF) endorsed measures and applies to ALL hospitals (rural/urban). A hospital receives a second frog when their results on this leap are either a full pie or 3/4 pie, meaning full implementation on the measure or good progress in implementing measure respectively. When you visit the Leapfrog website and click on the pie for this fourth measure for a hospital, you are able to see the progress of that hospital for each of the individual 27 NQF safety measures.

One checkmark is awarded to a hospital that has provided data for last year’s error prevention measures and 2 of the three clinical measures from last year. (The clinical measure on surgical infection prevention was recently implemented and hospitals are beginning to report on their progress.)

A second checkmark is awarded to a hospital providing data on the new error prevention measure-Medication Reconciliation. This measure indicates a hospital’s progress toward identifying the most complete and accurate list of medications a patient is taking when admitted to the hospital and using that list to provide correct medications for the patient anywhere within the health care system.

Plans Offering Routine Dental Care

The Uniform Benefits package provides health insurance coverage to eligible employees, annuitants, and dependents. The Uniform Benefits package does not include coverage for routine dental care. The Group Insurance Board permits participating health plans the option to offer dental coverage to its members. The plans listed below have elected to provide some level of dental benefits. The benefits vary from plan to plan. There are no requirements regarding the minimum levels of coverage offered.

Please refer to Plan Description pages found in this Section for a more detailed explanation of dental benefits offered by the health plan you are interested in. Contact the plan directly if you have specific questions regarding the dental coverage or dental providers.

Remember that there will be restrictions on dental providers that you may use, just as there are restrictions on providers you may access for medical care under the plan you select. It is possible that the plan does not have a participating dentist in your county. In that case, the plan will not be "qualified" in that county and you may have to travel to see a plan dentist.

Plans Offering Dental Benefits:

CompcareBlue - Northwest
CompcareBlue - Southeast
Dean Health Plan
Group Health Cooperative – Eau Claire
Group Health Cooperative – South Central
Gundersen Lutheran Health Plan
Health Tradition Health Plan
Humana - Eastern
Humana - Western
Medical Associates Health Plan
MercyCare Health Plan
Network Health Plan
Physicians Plus Insurance Corporation
Security Health Plan
UnitedHealthCare NE
UnitedHealthCare SE
Unity-Community
Unity-UW Health
WPS Patient Choice Plan 1
WPS Patient Choice Plan 2

Health Plan Features Comparison and Descriptions

Comparison of State Plan Types

Plans With Uniform Benefits

CompcareBlue - Northwest Network
CompcareBlue - Southeast Network
Dean Health Plan
Group Health Cooperative of Eau Claire
Group Health Cooperative - Southcentral
Gundersen Lutheran Health Plan
Health Tradition
Humana - Eastern Region
Humana - Western Region
Medical Associates Health Plans
MercyCare Health Plan
Network Health Plan
Physicians Plus - Meriter & UW
Security Health Plan of Wisconsin, Inc.
State Maintenance Plan
UnitedHealthcare of Wisconsin - Northeast
UnitedHealthcare of Wisconsin - Southeast
Unity - Community
Unity - UW Health
WPS - Patient Choice Plan 1
WPS - Patient Choice Plan 2
WPS - Prevea Health Plan

The PBM & Plans Without Uniform Benefits

Navitus Health Solutions
Standard Plan