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1570 Midway Pl.Menasha, WI 54952
844-635-1322networkhealth.com/individual
HMO plans underwritten by Network Health Plan. Nondiscrimination - Network Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Multi-language Interpreter Services - If you, or someone you’re helping, has questions about Network Health, you have the right to get help and information in your language at no cost. To talk to an interpreter, call 855-275-1400. Spanish: Si usted, o alguien a quien usted está ayudando, tiene preguntas acerca de Network Health, tiene derecho a obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al 855-275-1400. Hmong: Yog koj, los yog tej tus neeg uas koj pab ntawd, muaj lus nug txog Network Health, koj muaj cai kom lawv muab cov ntshiab lus qhia uas tau muab sau ua koj hom lus pub dawb rau koj. Yog koj xav nrog ib tug neeg txhais lus tham, hu rau 855-275-1400.1788-02-0919
2020 Prestige Individual and Family Plans
Wisconsin-Based Health Plan844-635-1322 networkhealth.com/individual
Meet Network HealthWe’re a local, Wisconsin-based health insurance company that puts customers first. Co-owned by Froedtert Health and Ministry Health Care, part of Ascension Wisconsin, we understand the importance of quality health care and believe it should be convenient.
Great Coverage Close to HomeWith a Network Health Prestige plan, you have access to a network of high-quality doctors, hospitals, clinics and specialists, so you can get the care you need close to home.
For the most up-to-date provider list or to find a doctor or facility, visit networkhealth.com/find-a-doctor/prestige and type in the Help Me Find field.
The Hometown Advantage
We Speak Your LanguageWhen you call Network Health, we don’t bombard you with health insurance language. We talk like people, not insurance dictionaries. Our plain-language approach—paired with high-rated customer service—provides the ultimate customer experience.
We Live in Your CommunityBeing local allows us to focus on our mission to create healthy and strong Wisconsin communities. At Network Health, our employees strive to provide exceptional service because we know we are helping our neighbors, friends and family.
We Cut Costs, Not CornersOur plans give you access to health care professionals who can answer your questions and connect you with programs to manage your health. If you have a health condition, our nurse care managers or condition managers can help you develop a customized care plan to improve your health and prevent costly complications.
OUTAGAMIE
WINNEBAGOCALUMET
WAUKESHA
RACINE
WASHINGTONWASHINGTON
OZAUKEEOZAUKEE
MILWAUKEEMILWAUKEE
KENOSHA
That’s why we offer a variety of plan options to ensure you have the quality coverage you need and want at an affordable cost. As you compare plans, remember you may qualify for a subsidy from the government, if you purchase your Network Health Prestige plan through the Health Insurance Exchange, also known as the Marketplace, at HealthCare.gov.
All our plans are Health Maintenance Organization (HMO) plans, which means you’ll need to use our high-quality network of doctors, hospitals, clinics and specialists for services to be covered—this includes labs and services your doctor may refer—so you’ll want to ensure all providers are in-network before receiving services.
Check out the chart on the right to learn about Network Health’s Prestige plans, which are all available on the Health Insurance Exchange.
What’s that?Subsidy—Financial help provided by the government to help people afford health insurance. There are two types of subsidies—premium tax credits and cost-sharing reductions. A premium tax credit helps make your monthly premium payments lower. A cost-sharing reduction lowers the amount you pay for health insurance deductibles, copayments and coinsurance. If you qualify for a subsidy, you must obtain coverage through the Marketplace to receive the benefit.
PLAN COMPARISONPrestige Bronze Essential + Dental + Vision + Fitness + 3 Free PCP Visits
Prestige Bronze 20 HDHP + Dental + Vision
Prestige Bronze 0 + Dental + Vision
Prestige Bronze 50 HDHP + Dental + Vision
Prestige Silver Essential + Dental + Vision + Fitness + 3 Free PCP Visits
Prestige Silver 20 HDHP + Dental + Vision
Prestige Gold Essential + Dental + Vision + Fitness + 3 Free PCP Visits
Prestige Gold 50 + Dental + Vision
Prestige Gold 0 HDHP + Dental + Vision
Monthly Premium $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
DEDUCTIBLEIndividual $7,200 $6,000 $6,700 $3,500 $4,000 $3,500 $1,750 $1,000 $2,800
Family $14,400 $12,000 $13,400 $7,000 $8,000 $7,000 $3,500 $2,000 $5,600
Coinsurance 50% 20% $0 after deductible 50% 40% 20% 20% 50% $0 after deductible
OUT-OF-POCKET LIMIT
Individual $8,150 $6,900 $8,150 $6,900 $8,150 $6,900 $8,150 $4,300 $5,000
Family $16,300 $13,800 $16,300 $13,800 $16,300 $13,800 $16,300 $8,600 $10,000
BENEFITS
Preventive Care $0 $0 $0 $0 $0 $0 $0 $0 $0
Routine Vision Exam $0 $0 $0 $0 $0 $0 $0 $0 $0
Annual Dental Exam $0 $0 $0 $0 $0 $0 $0 $0 $0
Primary Care Doctor Visit
$0 for first three visits, then $40 per visit 20% after deductible $0 after deductible 50% after deductible $0 for first three visits,
then $25 per visit 20% after deductible $0 for first three visits, then $20 per visit 50% after deductible $0 after deductible
Virtual Visit $0 per visit 0% after deductible $0 after deductible 0% after deductible $0 per visit 0% after deductible $0 per visit 0% after deductible $0 after deductible
Specialist Visit $100 per visit 20% after deductible $0 after deductible 50% after deductible $80 per visit 20% after deductible $60 per visit 50% after deductible $0 after deductible
Chiropractic 50% after deductible 20% after deductible $0 after deductible 50% after deductible 40% after deductible 20% after deductible 20% after deductible 50% after deductible $0 after deductible
Hospital Stay 50% after deductible 20% after deductible $0 after deductible 50% after deductible 40% after deductible 20% after deductible 20% after deductible 50% after deductible $0 after deductible
Emergency Room $500 after deductible per visit 20% after deductible $0 after deductible 50% after deductible $500 after deductible
per visit 20% after deductible $350 per visit 50% after deductible $0 after deductible
X-ray and Diagnostic Imaging
$60 after deductibleper visit 20% after deductible $0 after deductible 50% after deductible $60 per visit 20% after deductible $50 per visit 50% after deductible $0 after deductible
PHARMACY BENEFIT COMPARISON
RETAIL30-DAY SUPPLYCost per prescription or refill
Preventive Drugs $0 $0 $0 $0 $0 $0 $0 $0 $0
Tier 1Adherence Generics (limited only to categories of antidiabetics, statins, and RAS antagonists)
$0 $0 after deductible $0 $0 after deductible $0 $0 after deductible $0 $0 $0 after deductible
Tier 2 Generics $20 20% after deductible $20 30% after deductible $20 20% after deductible $15 $15 $0 after deductible
Tier 3 Preferred Brand Drugs $80 after deductible 20% after deductible $70 after deductible 40% after deductible $80 20% after deductible $60 $50 $0 after deductible
Tier 4 Non-Preferred Brand Drugs 35% after deductible 35% after deductible 35% after deductible 50% after deductible 35% after deductible 35% after deductible 35% after deductible 35% after deductible 35% after deductible
Tier 5 Preferred Specialty Drugs 35% after deductible 35% after deductible 35% after deductible 35% after deductible 35% after deductible 35% after deductible 35% after deductible 35% after deductible 35% after deductible
Tier 6 Non-Preferred Specialty Drugs 50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible
New for 2020 – Lower Rates, Extra Benefits
Your health insurance needs are unique.
$Typically, as plans go up in metal level (bronze, silver, gold) you’ll get more coverage and pay more for your monthly premium. Your exact monthly premium depends on the financial assistance you may be eligible for through the government. To find out what your premium will be, get a quote at networkhealth.com/individual.
A fitness benefit with a free Fitbit®—upon request— and access to over 350 fitness locations in Wisconsin with Prestige Essential plans
A dental exam, bite-wing x-ray and dental cleaning
$25 per month program for preferred insulin
$0 Virtual doctor visits (for some plans, deductible must be met first)
A Momentum healthy rewards program offers the opportunity to earn $100 in gift cards for completing four tasks essential to your health and wellness
An annual vision exam and discounts on prescription eyewear
Lower rates for all Network Health Prestige plans
$
$0 adherence generic drugs (for some plans, deductible must be met first)
That’s why we offer a variety of plan options to ensure you have the quality coverage you need and want at an affordable cost. As you compare plans, remember you may qualify for a subsidy from the government, if you purchase your Network Health Prestige plan through the Health Insurance Exchange, also known as the Marketplace, at HealthCare.gov.
All our plans are Health Maintenance Organization (HMO) plans, which means you’ll need to use our high-quality network of doctors, hospitals, clinics and specialists for services to be covered—this includes labs and services your doctor may refer—so you’ll want to ensure all providers are in-network before receiving services.
Check out the chart on the right to learn about Network Health’s Prestige plans, which are all available on the Health Insurance Exchange.
What’s that?Subsidy—Financial help provided by the government to help people afford health insurance. There are two types of subsidies—premium tax credits and cost-sharing reductions. A premium tax credit helps make your monthly premium payments lower. A cost-sharing reduction lowers the amount you pay for health insurance deductibles, copayments and coinsurance. If you qualify for a subsidy, you must obtain coverage through the Marketplace to receive the benefit.
PLAN COMPARISONPrestige Bronze Essential + Dental + Vision + Fitness + 3 Free PCP Visits
Prestige Bronze 20 HDHP + Dental + Vision
Prestige Bronze 0 + Dental + Vision
Prestige Bronze 50 HDHP + Dental + Vision
Prestige Silver Essential + Dental + Vision + Fitness + 3 Free PCP Visits
Prestige Silver 20 HDHP + Dental + Vision
Prestige Gold Essential + Dental + Vision + Fitness + 3 Free PCP Visits
Prestige Gold 50 + Dental + Vision
Prestige Gold 0 HDHP + Dental + Vision
Monthly Premium $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
DEDUCTIBLEIndividual $7,200 $6,000 $6,700 $3,500 $4,000 $3,500 $1,750 $1,000 $2,800
Family $14,400 $12,000 $13,400 $7,000 $8,000 $7,000 $3,500 $2,000 $5,600
Coinsurance 50% 20% $0 after deductible 50% 40% 20% 20% 50% $0 after deductible
OUT-OF-POCKET LIMIT
Individual $8,150 $6,900 $8,150 $6,900 $8,150 $6,900 $8,150 $4,300 $5,000
Family $16,300 $13,800 $16,300 $13,800 $16,300 $13,800 $16,300 $8,600 $10,000
BENEFITS
Preventive Care $0 $0 $0 $0 $0 $0 $0 $0 $0
Routine Vision Exam $0 $0 $0 $0 $0 $0 $0 $0 $0
Annual Dental Exam $0 $0 $0 $0 $0 $0 $0 $0 $0
Primary Care Doctor Visit
$0 for first three visits, then $40 per visit 20% after deductible $0 after deductible 50% after deductible $0 for first three visits,
then $25 per visit 20% after deductible $0 for first three visits, then $20 per visit 50% after deductible $0 after deductible
Virtual Visit $0 per visit 0% after deductible $0 after deductible 0% after deductible $0 per visit 0% after deductible $0 per visit 0% after deductible $0 after deductible
Specialist Visit $100 per visit 20% after deductible $0 after deductible 50% after deductible $80 per visit 20% after deductible $60 per visit 50% after deductible $0 after deductible
Chiropractic 50% after deductible 20% after deductible $0 after deductible 50% after deductible 40% after deductible 20% after deductible 20% after deductible 50% after deductible $0 after deductible
Hospital Stay 50% after deductible 20% after deductible $0 after deductible 50% after deductible 40% after deductible 20% after deductible 20% after deductible 50% after deductible $0 after deductible
Emergency Room $500 after deductible per visit 20% after deductible $0 after deductible 50% after deductible $500 after deductible
per visit 20% after deductible $350 per visit 50% after deductible $0 after deductible
X-ray and Diagnostic Imaging
$60 after deductibleper visit 20% after deductible $0 after deductible 50% after deductible $60 per visit 20% after deductible $50 per visit 50% after deductible $0 after deductible
PHARMACY BENEFIT COMPARISON
RETAIL30-DAY SUPPLYCost per prescription or refill
Preventive Drugs $0 $0 $0 $0 $0 $0 $0 $0 $0
Tier 1Adherence Generics (limited only to categories of antidiabetics, statins, and RAS antagonists)
$0 $0 after deductible $0 $0 after deductible $0 $0 after deductible $0 $0 $0 after deductible
Tier 2 Generics $20 20% after deductible $20 30% after deductible $20 20% after deductible $15 $15 $0 after deductible
Tier 3 Preferred Brand Drugs $80 after deductible 20% after deductible $70 after deductible 40% after deductible $80 20% after deductible $60 $50 $0 after deductible
Tier 4 Non-Preferred Brand Drugs 35% after deductible 35% after deductible 35% after deductible 50% after deductible 35% after deductible 35% after deductible 35% after deductible 35% after deductible 35% after deductible
Tier 5 Preferred Specialty Drugs 35% after deductible 35% after deductible 35% after deductible 35% after deductible 35% after deductible 35% after deductible 35% after deductible 35% after deductible 35% after deductible
Tier 6 Non-Preferred Specialty Drugs 50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible
New for 2020 – Lower Rates, Extra Benefits
Your health insurance needs are unique.
$Typically, as plans go up in metal level (bronze, silver, gold) you’ll get more coverage and pay more for your monthly premium. Your exact monthly premium depends on the financial assistance you may be eligible for through the government. To find out what your premium will be, get a quote at networkhealth.com/individual.
A fitness benefit with a free Fitbit®—upon request— and access to over 350 fitness locations in Wisconsin with Prestige Essential plans
A dental exam, bite-wing x-ray and dental cleaning
$25 per month program for preferred insulin
$0 Virtual doctor visits (for some plans, deductible must be met first)
A Momentum healthy rewards program offers the opportunity to earn $100 in gift cards for completing four tasks essential to your health and wellness
An annual vision exam and discounts on prescription eyewear
Lower rates for all Network Health Prestige plans
$
$0 adherence generic drugs (for some plans, deductible must be met first)
1570 Midway Pl.Menasha, WI 54952
844-635-1322networkhealth.com/individual
HMO plans underwritten by Network Health Plan. Nondiscrimination - Network Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Multi-language Interpreter Services - If you, or someone you’re helping, has questions about Network Health, you have the right to get help and information in your language at no cost. To talk to an interpreter, call 855-275-1400. Spanish: Si usted, o alguien a quien usted está ayudando, tiene preguntas acerca de Network Health, tiene derecho a obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al 855-275-1400. Hmong: Yog koj, los yog tej tus neeg uas koj pab ntawd, muaj lus nug txog Network Health, koj muaj cai kom lawv muab cov ntshiab lus qhia uas tau muab sau ua koj hom lus pub dawb rau koj. Yog koj xav nrog ib tug neeg txhais lus tham, hu rau 855-275-1400.1788-02-0919
2020 Prestige Individual and Family Plans
Wisconsin-Based Health Plan844-635-1322 networkhealth.com/individual
Meet Network HealthWe’re a local, Wisconsin-based health insurance company that puts customers first. Co-owned by Froedtert Health and Ministry Health Care, part of Ascension Wisconsin, we understand the importance of quality health care and believe it should be convenient.
Great Coverage Close to HomeWith a Network Health Prestige plan, you have access to a network of high-quality doctors, hospitals, clinics and specialists, so you can get the care you need close to home.
For the most up-to-date provider list or to find a doctor or facility, visit networkhealth.com/find-a-doctor/prestige and type in the Help Me Find field.
The Hometown Advantage
We Speak Your LanguageWhen you call Network Health, we don’t bombard you with health insurance language. We talk like people, not insurance dictionaries. Our plain-language approach—paired with high-rated customer service—provides the ultimate customer experience.
We Live in Your CommunityBeing local allows us to focus on our mission to create healthy and strong Wisconsin communities. At Network Health, our employees strive to provide exceptional service because we know we are helping our neighbors, friends and family.
We Cut Costs, Not CornersOur plans give you access to health care professionals who can answer your questions and connect you with programs to manage your health. If you have a health condition, our nurse care managers or condition managers can help you develop a customized care plan to improve your health and prevent costly complications.
OUTAGAMIE
WINNEBAGOCALUMET
WAUKESHA
RACINE
WASHINGTONWASHINGTON
OZAUKEEOZAUKEE
MILWAUKEEMILWAUKEE
KENOSHA
1570 Midway Pl.Menasha, WI 54952
844-635-1322networkhealth.com/individual
HMO plans underwritten by Network Health Plan. Nondiscrimination - Network Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Multi-language Interpreter Services - If you, or someone you’re helping, has questions about Network Health, you have the right to get help and information in your language at no cost. To talk to an interpreter, call 855-275-1400. Spanish: Si usted, o alguien a quien usted está ayudando, tiene preguntas acerca de Network Health, tiene derecho a obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al 855-275-1400. Hmong: Yog koj, los yog tej tus neeg uas koj pab ntawd, muaj lus nug txog Network Health, koj muaj cai kom lawv muab cov ntshiab lus qhia uas tau muab sau ua koj hom lus pub dawb rau koj. Yog koj xav nrog ib tug neeg txhais lus tham, hu rau 855-275-1400.1788-02-0919
2020 Prestige Individual and Family Plans
Wisconsin-Based Health Plan844-635-1322 networkhealth.com/individual
Meet Network HealthWe’re a local, Wisconsin-based health insurance company that puts customers first. Co-owned by Froedtert Health and Ministry Health Care, part of Ascension Wisconsin, we understand the importance of quality health care and believe it should be convenient.
Great Coverage Close to HomeWith a Network Health Prestige plan, you have access to a network of high-quality doctors, hospitals, clinics and specialists, so you can get the care you need close to home.
For the most up-to-date provider list or to find a doctor or facility, visit networkhealth.com/find-a-doctor/prestige and type in the Help Me Find field.
The Hometown Advantage
We Speak Your LanguageWhen you call Network Health, we don’t bombard you with health insurance language. We talk like people, not insurance dictionaries. Our plain-language approach—paired with high-rated customer service—provides the ultimate customer experience.
We Live in Your CommunityBeing local allows us to focus on our mission to create healthy and strong Wisconsin communities. At Network Health, our employees strive to provide exceptional service because we know we are helping our neighbors, friends and family.
We Cut Costs, Not CornersOur plans give you access to health care professionals who can answer your questions and connect you with programs to manage your health. If you have a health condition, our nurse care managers or condition managers can help you develop a customized care plan to improve your health and prevent costly complications.
OUTAGAMIE
WINNEBAGOCALUMET
WAUKESHA
RACINE
WASHINGTONWASHINGTON
OZAUKEEOZAUKEE
MILWAUKEEMILWAUKEE
KENOSHA