Description
The Access Plan network option is a preferred provider organization (PPO) that provides you access to thousands of preferred providers across Wisconsin and nationwide through the First Health PPO network of providers. This also includes the Dean Health Plan HMO provider network, making it a great network option for anyone who lives out-of-state, travels frequently, or has children away at school. Out-of-network providers are available worldwide.
What's New for 2026
Enrollment, ID cards, and member tools
- New ID cards: Cards with new member IDs and group numbers will be issued. All current medical authorizations that exist will carry over to your new member ID. Please be sure to present your new ID card to your providers for claim submissions.
- Member Portal: The member portal will have a new look and feel but your credentials remain the same.
- If you have not created a portal account, please create an account once you receive your new ID cards to view your benefit information, claims information, and more.
- Primary Care Provider (PCP)/Primary Care Clinic (PCC) changes will need to go through Member Services.
- New member services phone number and hours:
- Phone: 877-371-6762
- Hours:
- Monday – Friday: 7 am – 8 pm CST (closed on Thursdays between 8 am - 9 am)
- Saturday: 9 am – 3 pm CST
Network
- Notable additions
- Milwaukee Rehabilitation Hospital, Milwaukee, WI
- Aspirus Lake View Hospital, Two Harbors, MN
- Notable terminations
- Cleveland Clinic, OH
Provider Directory
The Access Plan and Access High Deductible Health Plan (HDHP) use the First Health provider network throughout Wisconsin and nationwide. In Southern Wisconsin, members also have access to the Dean Health Plan HMO provider network. To search for providers, see the instructions below. If you choose to seek care from an out-of-network provider, you will be responsible for paying higher out-of-pocket costs.
To search online for First Health nationwide providers visit our First Health Locate a Provider webpage, or go to the Providers and information section of Dean's Group Health Insurance webpage and follow the instructions below.
- Under Online provider search: Next to Access PPO Network click "Find a First Health provider."
- Click "Start Now."
- Under Type of provider: select "All providers."
- Under Search by: select "Search by state."
- Select desired state 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 Search results using the “Refine location” and/or “Refine Your results” tool options to the left.
Before seeking medical care with First Health providers, we suggest confirming your provider's network participation by calling your provider's office and asking if they participate in the First Health Network.
To search online for Dean Health Plan HMO providers in Southern Wisconsin visit our Dean Health Plan HMO Find a Doctor webpage, or go to the Providers and Information section of Dean's Group Health Insurance webpage and follow the instructions below.
- Under Online provider search, click on Dean Health Plan HMO network.
- Under “My Location” enter a city, county, state or zip.
- Under “Select Plan Type”, choose “Commercial HMO/POS Insurance (Group or Individual Coverage)."
- From here you can scroll down and click on “Search” or enter additional search criteria.
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 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 877-371-6762 to verify whether a procedure or service needs prior authorization.
If your health care 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’ll notify you in writing of our decision.
If you receive services without an approved prior authorization request, the claim may be paid at the out-of-network benefit or denied if it’s found ineligible for coverage.
Out-of-Network Care
You can choose to seek care from health care 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. Deductibles and out-of-pocket limits vary between plan design options. Refer to your schedule of benefits for complete details.
Services received outside of the United States will apply to your out-of-network benefit. The Foreign Claim Submission form should be completed for manual reimbursement.
If you see an out-of-network provider, 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 an in-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-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 877-371-6762, 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 Health, Behavioral Health and Substance Abuse
More ways to access mental health services
If you or someone you know is struggling, you’re 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 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 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 800-576-8773 (TTY: 711).
The Nurse Advice Line is available after-clinic hours from 5 pm - 8 pm and 24/7 on weekends and holidays to serve patient triage needs.
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
You have access to any licensed provider in the First Health PPO network (see Provider Directory).