Description
The State Maintenance Plan, or SMP, is a 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.
What’s New for 2023
Dean Health Plan is the new SMP vendor effective January 1, 2023.
SMP will be offered in Florence, Marquette, Waupaca, and Waushara counties.
SMP will no longer be available in the following counties: Forest, Pierce, Polk, Rusk, St. Croix, and Wood.
Provider Directory
Go to deancare.com/wi-employees to access the SMP provider directory. To request a printed directory be mailed to you, call 800-279-1301.
Referrals, Authorizations, Out-of-Network
Your health care provider must get prior authorization from us before we will cover certain procedures or services. Examples of procedures and services that need prior authorization can be viewed on-line. This is NOT a complete list. You should contact our Customer Care Center at 800-279-1301 to verify whether a procedure or service needs prior authorization.
If your health care provider recommends that you have a service or procedure that needs prior authorization, your health care provider should submit a prior authorization request form to us. It is the member’s responsibility to make sure your health care provider requests prior authorization. We must receive the prior authorization request at least 15 business days before the date of your service or procedure. We will notify you in writing of our decision.
If you fail to get prior authorization for any medically necessary covered service which requires an authorization, a penalty of 50% of the allowed amount, up to a $500 maximum per occurrence, is applied or the service may be denied for failure to obtain an authorization. All copays, deductibles, and coinsurance for covered expenses still apply. This penalty will not count toward your out-of-pocket expense maximum. You, the member, must ensure that your health care provider has gotten prior authorization for all services.
Out-of-Network Care
You can choose to seek care from health care providers that are not in our network. However, if you choose to seek care from an out-of-network provider you will be responsible for paying higher out-of-pocket costs.
If you choose to see an out-of-network provider, we will pay charges up to our maximum allowable fee. If there is a difference between the maximum allowable fee and what the out-of-network provider bills, you may have to pay the difference. Please call our Customer Care Center if you have questions about the maximum allowable fee.
If a network provider cannot provide care that you need, we may cover care you receive from an out-of-network provider as if that provider is in our network with an approved referral.
Emergency and Urgent Care
If you receive Urgent Care or Emergency Care at an out-of-network facility and need further care, we may request that you be transferred to a network facility after you are stabilized. If you do not wish to be transferred to a network facility, continued coverage at an in-plan benefit level may not be available.
If you have a question regarding when to seek Urgent Care or Emergency Services, contact the 24-hour Nurse Advice Line (available to Wisconsin residents only) by calling 800-576-8773.
No prior authorization is needed for emergency and urgent care, however, if you need to be admitted to a facility we must be notified within 48 hours or the next business day (whichever is longer) at 800-279-1301.
Mental, Behavioral Health and Substance Abuse
A prior authorization is required for the following mental health and substance use services:
- Detox
- Inpatient
- Residential
- Partial hospitalization/day treatment
- Intensive outpatient
- In-home therapy
For members with mental health and substance use disorders, Dean Health Plan's behavioral health and substance use case management provides an individualized approach. The goal is to help you manage your health and live your best life. Learn more by visiting Behavioral health.
More Ways to Access Mental Health
If you or someone you know is struggling, you are not alone. Dean Health Plan offers many supports, services, and treatment options within our network. Visit deancare.com/wellness/behavioral-health for additional information.
Telemedicine continues to grow every day and more specialties are finding ways to provide virtual options for patients. Find out what telepsychiatry means and how it works. You can find an in-network provider at deancare.com/doctors.
Learn more about Dean Health Plan telepsychiatry at deancare.com/news/what-is-telepsychiatry.
24-Hour Nurseline
Nurse Advice Line: deancare.com/members/dean-on-call
Our 24-Hour Nurse Advice Line is a free telephone service for Dean Health Plan members and/or Dean Medical Group patients. It's available 24 hours a day, 365 days a year. If you're not sure you need to see a doctor—or you're wondering if you have a problem—give us a call at 800-576-8773.
Experienced registered nurses on our 24-hour Nurse Advise Line are always available to answer your questions and concerns. When responding to your call, they draw on years of clinical experience in many medical specialties.
NOTE: Due to licensing restrictions, the 24-Hour Nurse Advice Line's triage services are only available to residents of Wisconsin. .
Virtual Visits
E-visit - $ the lowest-cost option
SSM Health Express Virtual Care – Health Care that Fits your Life
SSM Health Express Virtual Care is available to anyone – whether you're an established SSM Health patient or seeing us for the first time, we've got you covered. Choose the option that’s right for you.
SSM Health Express Virtual Care now offers two convenient virtual options to access care on your time. SSM Health Express Virtual Care offers online assessment and treatment for a wide range of conditions, from minor illnesses and injuries to urgent needs. Common conditions treated:
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Video Visit – For urgent needs, use video visits to be quickly connected with an expert SSM Health Provider (PCP copay applies).
e-Visit – Connect with an e-visit for minor medical needs. Complete a simple online form and an SSM Health provider will follow up electronically with a treatment plan ($0 copay for non-High Deductible Health Plan (HDHP) members).
Visit ssmhealth.com/access/express-virtual-care or deancare.com/virtualvisit for more information and/or to get started with care.
Care Outside the Service Area
The SMP, offered by Dean Health Plan, will reimburse for covered services at 50% of our maximum allowable fee, subject to a $5,000 individual, $10,000 family deductible.
Major Health Systems
Available in select counties. See provider directory.