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.

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 and limited counties in Michigan. You should start with your primary care provider for recommendations to a First Health in-network specialist. You may also contact Dean Health Plan Member Services by calling 877-371-6762 for assistance in locating a nearby in-network provider.

The SMP is available in Florence County and the following Michigan counties:

  • Gogebic
  • Iron
  • Dickinson
  • Menominee

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 (closed on Thursdays between 8 am - 9 am)
      • Saturday: 9 am – 3 pm

Provider Directory

To find a provider:

  1. Go to Dean Health Plan's Group Health Insurance webpage.
  2. Go to the Providers and information section.
  3. Under Printable provider directory, you can view the SMP provider directory:
  • State Maintenance Plan (SMP): First Health network providers within the designated SMP counties.

To request a printed directory by mail, call 877-371-6762.

You may also use an interactive search tool to find First Health network providers:

  1. Go to Dean Health Plan's Group Health Insurance webpage.
  2. Go to the Providers and information section.
  3. Under the Online provider search section, click "Find a First Health provider" next to Access PPO network.
  4. Click "Start Now."
  5. Type of Provider: select "All Providers."
  6. Search By: select "Search by State."
  7. Select Wisconsin from the State dropdown.
  8. Select an SMP 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.
  9. Click "Search Now."
  10. You can further refine your results using the “Refine location” and/or “Refine your results” tool options to the left.

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  877-371-6762 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.

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.

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

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

For care guidance 24/7, our Nurse Advice Line (800-576-8773) has nurses to assist with questions or guide you to the appropriate location for care.

Schedule of Benefits

The Schedule of Benefits explains 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.

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.

Major Health Systems

  • Marshfield Medical Center
  • St. Vincent Hospital-Hospital Sisters-Third Order of St. Francis
  • Dickinson County Healthcare System

Full Service Areas

Florence County

Limited Service Areas

Michigan