2024 Plan Information

Small Group Health Maintenance Organization (HMO)

Aspirus Health Plan believes in giving you all the information you need to make a sound decision. Whether you are choosing a plan and need to see the fine details, requesting information on behalf of a family member, or filing a claim, we are your resource. The plan options below will connect to your insurance plan documents.

What you will find in the charts

Certificate/Contract – This is the legal contract between you and Aspirus Health Plan. It includes the details about your insurance plan.

Plan Summary – High level chart that shows the deductible, coinsurance, out-of-pocket and much more for all plan offerings.

Summary of Benefits (SBC) – An easy-to-read version of your plan that can be used to compare plans. The Certificate/Contract and Plan Summary will give a “detailed version” of same information.

Questions? Contact member services at 866.631.5404

2024 Small Group HMO Plans

Health Maintenance Organization (HMO) plans

Plan Name Summary of Benefits (SBC) Plan Summary Contract
HMO Platinum 400 86584WI0040001-00.pdf 29989 AHP SG Plan Summary.pdf 86584WI0040001 2024 SG HMO Platinum 400.pdf
HMO Gold 1150 86584WI0040002-00.pdf 29989 AHP SG Plan Summary.pdf 86584WI0040002 2024 SG HMO Gold 1150.pdf
HMO Gold 1700 86584WI0040003-00.pdf 29989 AHP SG Plan Summary.pdf 86584WI0040003 2024 SG HMO Gold 1700.pdf
HMO Gold 2100 86584WI0040005-00.pdf 29989 AHP SG Plan Summary.pdf 86584WI0040005 2024 SG HMO Gold 2100.pdf
HMO Gold 2600 86584WI0040006-00.pdf 29989 AHP SG Plan Summary.pdf 86584WI0040006 2024 SG HMO Gold 2600.pdf
HMO Silver 3700 86584WI0040009-00.pdf 29989 AHP SG Plan Summary.pdf 86584WI0040009 2024 SG HMO Silver 3700.pdf
HMO Silver 4500 86584WI0040010-00.pdf 29989 AHP SG Plan Summary.pdf 86584WI0040010 2024 SG HMO Silver 4500.pdf
HMO Silver 5000 86584WI0040011-00.pdf 29989 AHP SG Plan Summary.pdf 86584WI0040011 2024 SG HMO Silver 5000.pdf
HMO HDHP-HSA Gold 2800 86584WI0040012-00.pdf 29989 AHP SG Plan Summary.pdf 86584WI0040012 2024 SG HMO HDHP Gold 2800.pdf
HMO HDHP-HSA Silver 2400 86584WI0040013-00.pdf 29989 AHP SG Plan Summary.pdf 86584WI0040013 2024 SG HMO HDHP Silver 2400.pdf
HMO HDHP-HSA Silver 3250 86584WI0040015-00.pdf 29989 AHP SG Plan Summary.pdf 86584WI0040015 2024 SG HMO HDHP Silver 3250.pdf
HMO HDHP-HSA Silver 5200 86584WI0040016-00.pdf 29989 AHP SG Plan Summary.pdf 86584WI0040016 2024 SG HMO HDHP Silver 5200.pdf
HMO HDHP-HSA Bronze 6200 86584WI0040017-00.pdf 29989 AHP SG Plan Summary.pdf 86584WI0040017 2024 SG HMO HDHP Bronze 6200.pdf
HMO HDHP-HSA Bronze 7200 86584WI0040018-00.pdf 29989 AHP SG Plan Summary.pdf 86584WI0040018 2024 SG HMO HDHP Bronze 7200.pdf
HMO Silver 7000 86584WI0040020-00.pdf 29989 AHP SG Plan Summary.pdf 86584WI0040020 2024 SG HMO Silver 7000.pdf
HMO HDHP-HSA Gold 3150 86584WI0040021-00.pdf 29989 AHP SG Plan Summary.pdf 86584WI0040021 2024 SG HMO HDHP Gold 3150.pdf
HMO HDHP-HSA Silver 4300 86584WI0040022-00.pdf 29989 AHP SG Plan Summary.pdf 86584WI0040022 2024 SG HMO HDHP Silver 4300.pdf
HMO HDHP Bronze 8050 86584WI0040024-00.pdf 29989 AHP SG Plan Summary.pdf 86584WI0040024 2024 SG HMO HDHP Bronze 8050.pdf