WPS Illinois Small Group Insurance –2019
Illinois employers
HONEST. INDEPENDENT. MIDWESTERN.
WPS Health Insurance offers high-quality coverage, local and national networks, affordable plans, and a wide range of benefit choices that you and your employees need. WPS, a leading not-for-profit health insurer based in Wisconsin, has been serving the people of the Midwest since 1946.
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Comprehensive provider access. Freedom of choice.The Alliance NetworkAccess to major hospitals, health systems, and physicians in northern Illinois and southern Wisconsin.
90 hospitals
18,000service providers
More than
» Ascension Health System » Beloit Health System » Centegra Health » Cadence Health » CGH Medical Center » Dean Clinics/SSM Healthcare » Finley Hospital » Freeport Health Network » Illinois Valley Community Hospital » KishHealth » KSB Hospital
Find a complete list of providers in The Alliance Network online at wpshealth.com; click on Find a Doctor. Providers can leave or enter the network at any time. It is recommended that you check the network status of your provider on a regular basis.
9,500medical doctors, including:
» Mercy Health System » Mercy Medical Center-Dubuque » Midwest Medical Center » Monroe Clinic » OSF Healthcare » Rochelle Community Hospital » Rockford Health System » Swedish American Health System » University of Wisconsin Hospital
and Clinics
Clinton
IAMN
ILWI
MI
WI
PeoriaKnox
McLean
Warren
Livingston
Henry
Milwaukee
Kane
DuPage
Gogebic
Cook
Bureau
Ozaukee
LincolnLanglade
ShawanoMarathon
Clark
Taylor
Wood Portage Waupaca Outagamie
Waushara
MarquetteGreenLake Fond du Lac
Washing
ton
Waukesha
DeKalb
McHenry
LaSalle
Clayton
Chippewa
Eau Claire
PepinBuffalo
Houston
Winona
Trem
peal
eau
La CrosseMonroe
Jackson
Fayette
Winn
eshie
k
Allamakee
Adams
Juneau
SaukRichland ColumbiaDodge
JeffersonDaneIowa
Grant
LafayetteGreen
RockWalworth
DubuqueWinnebago BooneStephenson
Jo Daviess
OgleCarroll
Whiteside
Lee
Vernon
Crawford
Winnebago
Vilas
Sawyer
Rusk
Racine
Price
Ontonagon
Oneida
IronIron
Houghton
Dunn
Barron
Jackson
Scott
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Specialty Hospital LocationsOffer specialty care for children, rehabilitation, surgery, or other services
S
Hospital LocationsH
Primary Service Area
1WPS Customer Service data, 2017.
HONEST. INDEPENDENT. MIDWESTERN.
99%of customer calls are connected to a live Customer Service Representative right here in the Midwest.1
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HONEST. INDEPENDENT. MIDWESTERN.
Comprehensive provider access. Freedom of choice.First Health Network In-network benefits—in all 50 states outside specific counties in Illinois and Wisconsin—for customers covered under The Alliance Network.
Visit wpshealth.com and click on the Find a Doctor tool.or for First Health, visit myfirsthealth.comProviders can leave or enter the network at any time. It is recommended that you check the network status of your provider on a regular basis.
1 millionhealth care service locations
More than
Ideal for: » Customers who travel » Customers whose children attend school out of state » Out-of-state employees receiving in-network care
90,000ancillary facilities
5,000hospitals
Find a complete list of in-network providers
Call: 800-332-1398
Online: wpshealth.com—click Find a Doctor
First Health
51%of Illinois residents are covered by employer-sponsored insurance.2
2Kaiser Family Foundation estimate based on Census Bureau, 2017. Retrieved from kff.org/other/state-indicator/total-population/ on Aug. 3, 2018.
HONEST. INDEPENDENT. MIDWESTERN.
You Pay
Metal TierIndividual
Deductible1Coinsurance
Individual Annual Max
Out of Pocket1
At Preferred Providers2
In NetworkOut of
NetworkIn
NetworkOut of
NetworkIn
NetworkOut of
NetworkTeladoc
Visit
Retail Clinic Visit
PCP Visit
Specialty Visit
Emergency Room
Outpatient Lab/X-ray
Outpatient Surgery
Hospitalization
Platinum $500 $1,000 20% 50% $1,650 $11,000 No charge $10 $35 $55 $375 20% after deductible*
Gold $1,000 $2,000 20% 50% $5,000 $12,000 No charge $10 $35 $55 $375 20% after deductible*
Gold $1,500 $3,000 10% 40% $6,000 $11,000 No charge $10 $35 $55 $375 10% after deductible*
Gold $2,000 $4,000 20% 50% $7,900 $14,000 No charge $10 $35 $55 $375 20% after deductible*
Gold $2,500 $5,000 20% 50% $7,900 $15,000 No charge $10 $35 $55 $375 20% after deductible*
Silver $3,000 $6,000 20% 50% $7,900 $16,000 No charge $10 $45 $90 $500 20% after deductible*
Silver $3,500 $7,000 10% 40% $7,900 $15,000 No charge $10 $45 $90 $500 10% after deductible*
Silver $4,500 $9,000 0% 30% $7,900 $15,000 No charge $10 $45 $90 $500 No charge after deductible*
Silver $4,500 $9,000 20% 50% $7,900 $19,000 No charge $10 $45 $90 $500 20% after deductible*
Silver $5,500 $11,000 20% 50% $7,900 $21,000 No charge $10 $45 $90 $500 20% after deductible*
Silver $6,500 $13,000 20% 50% $7,900 $23,000 No charge $10 $45 $90 $500 20% after deductible*
Platinum and Gold Prescription Drugs: Preventive and Preferred Generics: $0; Non-Preferred Generics: $15; Preferred Brand: $40; Non-Preferred Brand: $70; Specialty Drugs: 30% coinsurance
Silver Prescription Drugs: Preventive and Preferred Generics: $0; Non-Preferred Generics: $25; Preferred Brand: $60; Non-Preferred Brand: $100; Specialty Drugs: $500 deductible, then 40% coinsurance
*Until maximum out-of-pocket is met
HONEST. INDEPENDENT. MIDWESTERN.
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AYWPS Small Group Copay Plan Summary
» Copays help reduce out-of-pocket costs » Affordable plan designs » No referral needed: Choose providers in-network and out-of-network » Plan covers greater share of costs when care provided is in-network
1Family deductibles and out-of-pocket limits are 2x the individual amounts.
²Preferred providers are in this plan’s network. All other providers are out of network. Ser-vices performed out of network are subject to the out-of-network deductible and coinsur-ance. See policy for details.
All plans feature embedded deductibles and out-of-pocket maximums unless otherwise noted.Preventive drugs include specific supplements, contraceptives, immunizations, and other preventive drugs ranked A or B by the U.S. Preventive Services Task Force.
84%of both employers and employees agree that health care benefits are important for attracting and retaining employees.3
3Transamerica Center for Health Studies® Survey: Employer Attitudes Toward the Employer Mandate and the ACA, December 2016
HONEST. INDEPENDENT. MIDWESTERN.
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WPS Group High-Deductible Health Plan (HDHP) Summary
» Gives employees more control over their medical expenses » Significantly lower premiums » Wide range of plan options and benefits
» Offer employees up to four benefit plan design options
¹Family deductibles and out-of-pocket limits are 2x the individual amounts.
²Preferred providers are in this plan’s network. All other providers are out of network. Services performed out of network are subject to the out-of-network deductible and coinsurance. See policy for details.³Non-Embedded Deductible and Out-of-Pocket Limit: This plan features a non-embedded deductible and out-of-pocket limit. If an employee has family coverage, the family deductible must be satisfied before this plan will pay benefits. One person can satisfy the family deductible. If an employee has family coverage, the family out-of-pocket limit must be satisfied before this plan will pay 100% of covered benefits. One person can satisfy the family out-of-pocket limit. Deductibles and out-of-pocket maximums apply annually.
4Non-Embedded Deductible and Embedded Out-of-Pocket Limit: This plan features a non-em-bedded deductible. If an employee has family coverage, the family deductible must be satisfied before this plan will pay benefits. One person can satisfy the family deductible. This plan features an embedded out-of-pocket limit. The individual out-of-pocket limit must be satisfied before this plan will pay 100% of covered benefits. Deductibles and out-of-pocket maximums apply annually.Unless otherwise noted, plans have an Embedded Deductible and Embedded Out-of-Pocket Limit: These plans feature an embedded deductible where an individual deductible must be satisfied before this plan will pay benefits. These plans feature an embedded out-of-pocket limit where the out-of-pocket limit must be satisfied before this plan will pay 100% of covered benefits. Deductibles and out-of-pocket maximums apply annually.Preventive drugs include specific supplements, contraceptives, immunizations, and other preventive drugs ranked A or B by the U.S. Preventive Services Task Force.
HSA-Qualified HDHPOur HSA-qualified HDHPs combine the cost savings of a HDHP with the ability to add a Health Savings Account (HSA) that you own and control. Employee-owned, tax-favored personal savings accounts help your employees pay for current medical expenses sand save for future medical needs.
You Pay
Metal Tier Individual Deductible1 Coinsurance
Individual Annual Max
Out of Pocket1At Preferred Providers2
In Network
Out of Network
In Network
Out of Network
In Network
Out of Network
Teladoc Visit
Retail Clinic Visit
PCP Visit
Specialty Visit
Emergency Room
Outpatient Lab/X-ray
Outpatient Surgery
Hospitalization
Gold3 $2,000 $4,000 0% 30% $2,000 $10,000 No charge after deductible
Gold $2,800 $5,600 0% 30% $2,800 $11,600 No charge after deductible
Silver4 $1,550 $3,100 30% 50% $6,750 $13,100 30% after deductible*
Silver4 $2,500 $5,000 30% 50% $6,750 $15,000 30% after deductible*
Silver $2,700 $5,400 20% 50% $6,750 $15,400 20% after deductible*
Silver $3,500 $7,000 20% 50% $6,750 $17,000 20% after deductible*
Silver $3,850 $7,700 0% 30% $3,850 $13,700 No charge after deductible
Bronze $5,500 $11,000 30% 50% $6,750 $21,000 30% after deductible*
Bronze $6,750 $13,500 0% 30% $6,750 $19,500 No charge after deductible
Prescription Drugs: Preventive: $0; All others: deductible and coinsurance
*Until maximum out-of-pocket is met
HONEST. INDEPENDENT. MIDWESTERN.
of health plans using Express Scripts spent less per person on prescription drugs in 2017 compared to 2016.4
44%
4Express Scripts 2017 Drug Trend Report.
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HPreventive Care 100% covered by WPS when care given by preferred provider:
» Routine immunizations » Routine medical exams » Well-child care » Mammograms
The preventive services listed are covered subject to the terms and conditions set forth in your WPS certificate. Age-appropriate screenings are set by the United States Preventive Services Task Force and are subject to change.
EyeMed Vision Care Discount » No-cost access for WPS customers » Save on eye care and eyewear with discount No. 9238049 » Thousands of locations nationwide
Hear in America Hearing Program » Includes an annual hearing screening at no cost » Discounts on nine top hearing aid brands » Three-year warranties covering repairs, loss, and damage are
included with all purchases » Three years of office service included (clean, check, adjust) » Three years of hearing aid batteries included » To take advantage of this offer, call 800-286-6149 and tell
them you are a WPS customer
Prescription Drug Coverage » $0 copay on select preventive drugs for common
conditions (e.g., high blood pressure, cholesterol, heart conditions, and asthma)
» Keep costs down: Lower-cost generic drugs and monitoring of specialty drug use
» Home delivery service available
$0 Copay Drugs
Amlodipine besylate
Atenolol
Atenolol/chlorthalidone
Atorvastatin calcium
Benazepril hcl
Bisoprolol fumarate/hctz
Carvedilol
Chlorthalidone
Clonidine hcl
Diltiazem 24hr cd
Enalapril maleate
Enalapril/hydrochlorothiazide
Gemfibrozil
Glimepiride
Glipizide
Glyburide
Glyburide, micronized
Hydrochlorothiazide
Indapamide
$0 Copay Drugs
Irbesartan
Lisinopril
Lisinopril/hydrochlorothiazide
Losartan potassium
Losartan/hydrochlorothiazide
Lovastatin
Metformin hcl
Metolazone
Metoprolol tartrate
Montelukast sodium
Pravastatin sodium
Propranolol hcl
Quinapril hcl
Ramipril
Simvastatin
Spironolactone
Triamterene/ hydrochlorothiazide
Verapamil hclWarfarin sodium
» Preventive screenings » Preventive drugs » And more
Preventive drugs include specific supplements, contraceptives, immunizations, and other preventive drugs ranked A or B by the U.S. Preventive Services Task Force.
5Kaiser Family Foundation 2017 Employer Health Benefits Survey. Retrieved from kff.org/report-section/ehbs-2017-section-12-health-and-wellness-programs/ on Aug. 1, 2018.
Small firms that offer wellness and health promotion programs.5
58%
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1The Active&Fit Direct and ExerciseRewards programs are provided by American Specialty Health Fitness, Inc., a subsidiary of American Specialty Incorporated (ASH). Active&Fit Direct and ExerciseRewards are trademarks of ASH and used with permission herein. If you think an employee might be unable to meet a standard for a reward under this wellness program, the employee might qualify for an opportunity to earn the same reward by different means.
Teladoc® Telehealth Services » Connect with a licensed physician over the phone or via video consult
» Cost: No added cost for a copay plan or $45 fee for an HDHP plan
ExerciseRewards™ Program1
» Encourages employees to stay active
» $30 reward each month for visiting a fitness club 10 or more times that month
» Includes large fitness chains, independently owned clubs, and YMCA/YWCA
» Three ways to track: Automated reporting via 5,700 partner centers, smartphone app, or paper log
Active&Fit™ Direct Program1
» Choose from 9,000+ participating fitness centers nationwide for only $25 a month (plus a $25 enrollment fee and applicable taxes)
» A guest pass to try out a fitness center before enrolling (where available)
» The option to switch fitness centers to make sure you find the right fit
Delta Dental InsuranceThe most in-network providers:
» Delta Dental PPO Network: Lowest agreed-upon fees; more locations than any other PPO network
» Delta Dental Premier: More than 80% of the country’s dentists are in this network
» More options available: orthodontic services; coverage and treatment for endodontic and nonsurgical periodontic services; and maximum allowable charge reimbursement plan
Visit wpshealth.com and click Customers to get started.
Customer ResourcesConvenient access to tools and resources for your best health.
» Access health and wellness information » Locate in-network doctors and facilities » Order prescriptions through Express Scripts » Manage your account » Learn about your benefits
6U.S. Small Business Administration Office of Advocacy, Illinois 2018 Small Business Profile
In Illinois:6
1.2 million small businesses2.5 million small business employees
HONEST. INDEPENDENT. MIDWESTERN.
Choose the Right Plan to Support the Best Health of Your Employees
About WPSWisconsin Physicians Service Insurance Corporation, doing business as WPS Health Solutions, has a strong legacy of serving the people of the Midwest since 1946. WPS, a leading not-for-profit health insurer based in Wisconsin, offers flexible and affordable group health plans and cost-effective benefit plan administration for businesses.
Searching for the right fit?Comprehensive plans give you options with affordable, high-quality coverage across Illinois.
Ready to choose?You can apply online or over the phone in just a few minutes.
See your local agent
CALL 800-332-1398
Visit wpshealth.com
Contact us today!WPS Health Insurance is ready to help you find the plan that meet your needs!HONEST. INDEPENDENT. MIDWESTERN.
In accordance with 215 ILCS 97/35 Sec.35. Disclosure of Information. Upon request, Small employers have the right
to information concerning WPS’: (a) right to change premium rates and the factors that may affect changes in premium
rates; (b) renewability of coverage provisions; (c) pre-existing conditions exclusion, if any; and (d) the benefits and
premiums available under all health insurance cover for which the employer is qualified.
©2018 Wisconsin Physicians Service Insurance Corporation. All rights reserved. JO9483 31179-100-1808
1717 W. BroadwayP.O. Box 8190Madison, WI 53708-8190
See your local agent
Request a
Quote Call 800-332-1398 Visit wpshealth.com
HONEST. In 2018, WPS was named one of the World’s Most Ethical Companies® for the ninth straight year.*
INDEPENDENT. Independent for more than 70 years.
MIDWESTERN. Covering northern Illinois and all of Wisconsin.
* 2010–2018 World’s Most Ethical Companies, Ethisphere® Institute, worldsmostethicalcompanies.ethisphere.com/honorees/.