Call 866.631.4611 for questions or to speak to someone about a plan.
An HMO gives you access to doctors and hospitals within its network. A primary care practitioner (PCP) can help coordinate your overall medical care. No matter which HMO plan you choose you will receive:
Aspirus offers 13 regional hospitals in Wisconsin and 4 more in the Upper Peninsula of Michigan, over 75 clinics and more than 400 physicians.
With an HMO plan, there is no referral necessary to see an in-network specialist, but some services will require review and prior authorization. If you receive care from an out-of-network provider, the HMO will not pay for that care unless the condition was deemed an emergency or approved prior authorization is received from Aspirus Health Plan.
2025 Plan Details – Contracts, Plan Summaries and Summary of Benefits and Coverage (SBCs).
Individual deductible
$1,500 or $2,400
Individual out-of-pocket maximum
$7,800 or $6,250
Family deductible
$3,000 or $4,800
Family out-of-pocket maximum
$15,600 or $12,500
Coinsurance
25%-30%
Office visits
$0 - $30, $60 Speciality
Individual deductible
$5,000 or $6,600
Individual out-of-pocket maximum
$8,000 or $7,500
Family deductible
$10,000 or $13,200
Family out-of-pocket maximum
$16,000 or $15,000
Coinsurance
40% or 30%
Office visits
$0 - $40, $80 Speciality
Individual deductible
$0 or $7,500
Individual out-of-pocket maximum
$9,200 or $9,200
Family deductible
$0 or $15,000
Family out-of-pocket maximum
$18,400 or $18,400
Coinsurance
50% or 50%
Office visits
$35-50 or $200 Speciality
Individual deductible
$9,200
Individual out-of-pocket maximum
$9,200
Family deductible
$18,400
Family out-of-pocket maximum
$18,400
Coinsurance
0%
Office visits
0% after deductible
Individual deductible
$5,400
Individual out-of-pocket maximum
$5,400
Family deductible
$10,800
Family out-of-pocket maximum
$10,800
Coinsurance
0%
Office visits
0% after deductible
Individual deductible
$7,200
Individual out-of-pocket maximum
$7,200
Family deductible
$14,400
Family out-of-pocket maximum
$14,400
Coinsurance
0%
Office visits
$0 after deductible