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.
2023 Plan Details – Contracts, Plan Summaries and Summary of Benefits and Coverage (SBCs).
Individual deductible
$2,000 or $2,800
Individual out-of-pocket maximum
$8,700 or $6,500
Family deductible
$4,000 or $5,600
Family out-of-pocket maximum
$17,400 or $13,000
Coinsurance
25%-30%
Office visits
$0 - $30, $60 Speciality
Individual deductible
$5,800 or $7,500
Individual out-of-pocket maximum
$8,900 or $8,400
Family deductible
$11,600 or $15,000
Family out-of-pocket maximum
$17,800 or $16,800
Coinsurance
40% or 30%
Office visits
$0 - $40, $80 Speciality
Individual deductible
$6,500 or $7,500 or $9,100
Individual out-of-pocket maximum
$8,550 or $9,000 or $9,100
Family deductible
$13,000 or $15,000 or $18,200
Family out-of-pocket maximum
$17,100 or $18,000 or $18,200
Coinsurance
20% or 50% or 0%
Office visits
20% after deductible or $0 after deductible
or $50, $100 Speciality
Individual deductible
$9,100
Individual out-of-pocket maximum
$9,100
Family deductible
$18,200
Family out-of-pocket maximum
$18,200
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
$6,000 or $6,900
Individual out-of-pocket maximum
$6,950 or $6,900
Family deductible
$12,000 or $13,800
Family out-of-pocket maximum
$13,900 or $13,800
Coinsurance
30% after deductible or 0% after deductible
Office visits
$0 after deductible