Description
The 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. The SMP is available in counties where there are no qualified Tier 1 health plans.
The SMP provider network is a combination of Dean Health Plan HMO providers and First Health PPO network providers located within the designated SMP counties. The SMP network also includes access to the First Health PPO providers in the following Michigan and Minnesota counties:
Michigan Counties
- Gogebic
- Iron
- Dickinson
- Menominee
Minnesota Counties
- Cook
- Lake
- St. Louis
If no in-network providers are available within your SMP county, you may seek services with a First Health in-network provider located within a neighboring county. You should start with your primary care provider for recommendations to a First Health in-network specialist. You may also contact Dean Health Plan's Member Services by calling 1-800-279-1301 for assistance in locating a nearby in-network provider.
What’s New for 2025
Thirteen new counties have been designated as SMP counties for 2025, designated with an “*” below. Two counties have been removed as SMP counties - Waupaca and Waushara counties.
SMP is available in the following counties:
| Adams County | Dunn County* | Lafayette County* | Polk County | Taylor County |
| Ashland County | Florence County | Langlade County | Portage County | Vilas County |
| Barron County* | Forest County | Lincoln County | Price County | Walworth County* |
| Bayfield County | Grant County* | Marathon County | Richland County | Washburn County |
| Buffalo County* | Green County | Marquette County | Rock County* | Wood County |
| Burnett County | Iowa County* | Menominee County | Rusk County* | |
| Clark County | Iron County | Oneida County | Sauk County | |
| Columbia County | Jefferson County* | Pepin County* | Sawyer County | |
| Douglas County | Juneau County | Pierce County* | St. Croix County* |
Provider Directory
SMP providers are a combination of Dean Health Plan HMO providers and First Health PPO providers located within the designated SMP counties.
To find a provider:
- Go to Dean Health Plan's Group Health Insurance webpage.
- Go to the Providers and information section.
- Under Printable provider directory, you can view two directories:
- State Maintenance Plan (SMP): Lists First Health Providers within the designated SMP counties
- Supplemental HMO SMP: Lists Dean Health Plan HMO providers within the designated SMP counties located within the HMO network
To request a printed directory by mail, call 1-800-279-1301.
You may also use an interactive search tool to find First Health PPO providers:
- Go to Dean Health Plan's Group Health Insurance webpage.
- Go to the Providers and information section.
- Click "Find a First Health provider."
- Click "Start Now."
- Under Type of Provider: select "All providers."
- Under Search By: select "Search by state."
- Select Wisconsin from the State dropdown.
- Select a county name from the County dropdown or a city name from the City dropdown. You can select up to seven counties or cities at a time.
- Click "Search Now."
- You can further refine your results using the “Refine Location” and/or “Refine Your Results” tool options to the left.
Limited Provider Availability
When non-emergency medical services, such as specialty care, are not available from an SMP provider in the directory, contact Dean Health Plan to find the nearest available provider.
If no in-network providers are available within your SMP county, you may seek services with a First Health in-network provider located within a neighboring county. You should start with your primary care provider for recommendations to a First Health in-network specialist. You may also contact Dean Health Plan's Member Services by calling 1-800-279-1301 for assistance in locating a nearby in-network provider. You can also search for other provider alternatives following the provider search instructions listed above.
Please note your benefit plan provides for services with both in and out-of-network providers. Services with non-plan providers will apply to the out-of-network benefit, except for emergency services.
Referrals, Authorizations, Out-of-Network
Prior authorizations are required for certain procedures or services before you receive care. A Prior Authorization is a written request that is completed by your Primary Care Provider (PCP) and/or network specialist provider requesting authorization of a specific service(s) or procedure that is to be performed. Review our prior authorization list for examples of procedures and services requiring prior authorization. This is not a complete list. Contact Member Services at 1-800-279-1301 to verify whether a procedure or service needs prior authorization.
If your healthcare provider recommends a service or procedure that needs prior authorization, they should submit a prior authorization request form to us. It’s your responsibility to make sure your provider requests prior authorization at least 15 business days before the date of your service or procedure. We will notify you in writing of our decision.
If you receive services without an approved prior authorization request, the claim may be denied if it’s found ineligible for coverage.
Out-of-Network Care
You can choose to seek care from healthcare providers that are not in our network. However, if you get care from an out-of-network provider you’ll be responsible for paying higher out-of-pocket costs.
There is an out-of-network annual deductible of $5,000 individual / $10,000 family. Once the annual deductible is met, you pay 50% for allowable services, with no out-of-pocket maximum.
We’ll pay charges up to our maximum allowable fee. If there’s a difference between the maximum allowable fee and the amount billed by your out-of-network provider, we’ll review the appropriateness of fees that exceed the maximum allowable fee, holding you harmless. Please call Member Services 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 prior authorization.
Emergency and Urgent Care
If you require emergency or urgent care when outside of the network, seek care at the nearest medical facility. Contact Member Services at 1-800-279-1301, if possible, when you receive emergency care from an out-of-network provider.
No prior authorization is needed for emergency and urgent care. However, you should notify us as soon as possible if you are admitted as an inpatient.
Mental, Behavioral Health and Substance Abuse
More Ways to Access Mental Health
If you or someone you know is struggling, you are not alone. We offer many supports, services, and treatment options within our network.
For members with mental health and substance use disorders, our behavioral health and substance use disorder case management provides an individualized approach. The goal is to help you manage your health and live your best life. Learn more about our behavioral health services.
Telemedicine continues to grow every day and more specialties are finding ways to provide virtual options for patients. Find an in-network provider to get started.
A prior authorization is required for the following mental health and substance use disorder services:
- Detox
- Inpatient
- Residential
- Partial Hospitalization/Day Treatment
- Intensive Outpatient
- In-home Therapy
24-Hour Nurseline
Nurse Advice Line is there whenever you have a health question. You can connect with an experienced registered nurse by calling 1-800-576-8773 (TTY: 711). The Nurse Advice Line is available after-clinic hours from 5 p.m. - 8 p.m. and 24/7 on weekends and holidays to serve patient triage needs. Go online for additional information.
NOTE: Due to licensing restrictions Nurse Advice Line's triage services are only available to residents of Wisconsin.
Virtual Visits
E-visits: the lowest-cost option
SSM Express Virtual Care is there when you can’t meet with your regular physician or need after-hours care in the comfort of your home.
E-visits are used for minor medical concerns. By filling out a simple online form an SSM Health provider will respond to your care needs electronically. There’s no need to schedule an appointment and costs can vary by plan.*
Virtual visits connect you with an SSM Health provider through a video conference when you want to talk with a physician about an urgent health need. A conference usually happens in a few minutes during operating hours and cost can vary by plan.*
Learn more about choosing the right care.
*Reference your schedule of benefits for cost-sharing.
Schedule of Benefits
Review your Schedule of Benefits for an explanation of what medical services the Group Health Insurance Program (GHIP) covers and what you pay for covered services. See your Certificate of Coverage for complete coverage details.
Major Health Systems
- Aspirus Health
- Ascension Wisconsin
- Aurora Health Care
- Essentia Health
- Marshfield Clinic
- Northlakes Community Clinics
- St. Luke's (Aspirus Health)