Dean Health Dean Classic 3000X WI

Plan Information
Company Dean Health Plan
State WI
Metal Tier Silver
Plan Type HMO

Cost Sharing Benefits

These details are for the standard Silver plan. For reduced Cost Sharing versions scroll down below

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $3,000 Data Not Available
Deductible (Family) $6,000 Data Not Available
Coinsurance 10% Data Not Available
Out of Pocket Maximum (Individual) $6,250 Data Not Available
Out of Pocket Maximum (Family) $12,500 Data Not Available
Services In Network Out of Network
Primary Care Visit 10% Coinsurance after deductible Data Not Available
Specialist Visit 10% Coinsurance after deductible Data Not Available
In Patient Hospital Services 10% Coinsurance after deductible Data Not Available
Emergency Room Services $200 Copay before deductible and $200 copay
Mental / Behavioral Health 10% coinsurance Data Not Available
Imaging (CT/PET Scans, MRIs) 10% coinsurance Data Not Available
Rehabilitative Speech Therapy 10% coinsurance Data Not Available
Rehabilitative Occupational & Physical Therapy 10% coinsurance Data Not Available
Preventative Care Data Not Available Data Not Available
Laboratory Outpatient and Professional Services 10% coinsurance Data Not Available
X-ray and Diagnostic Imaging 10% coinsurance Data Not Available
Prescription Drugs In Network Out of Network
Generic Rx $10
Preferred Brand Rx 30%
Non Preferred Brand Rx 50%
Specialty Drugs 50%

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $1,750.00
Deductible (Family) $3,500.00
Out of Pocket Maximum (Individual) $5,000.00
Out of Pocket Maximum (Family) $10,000.00
Services In Network Out of Network
Primary Care Physician 10% Coinsurance after deductible
Specialists 10% Coinsurance after deductible
Emergency Room $200 Copay before deductible and
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible
Prescription Drugs In Network Out of Network
Generic Rx $10.00
Preferred Brand Rx 30%
Non Preferred Brand Rx 50%
Specialty Drugs 50%

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $250.00
Deductible (Family) $500.00
Out of Pocket Maximum (Individual) $2,000.00
Out of Pocket Maximum (Family) $4,000.00
Services In Network Out of Network
Primary Care Physician 10% Coinsurance after deductible
Specialists 10% Coinsurance after deductible
Emergency Room $200 Copay before deductible and
Inpatient Facility 10% Coinsurance after deductible
Inpatient Physician 10% Coinsurance after deductible
Prescription Drugs In Network Out of Network
Generic Rx $10.00
Preferred Brand Rx 30%
Non Preferred Brand Rx 50%
Specialty Drugs 50%

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $150.00
Deductible (Family) $300.00
Out of Pocket Maximum (Individual) $500.00
Out of Pocket Maximum (Family) $1,000.00
Services In Network Out of Network
Primary Care Physician 5% Coinsurance after deductible
Specialists 5% Coinsurance after deductible
Emergency Room $200 Copay before deductible and
Inpatient Facility 5% Coinsurance after deductible
Inpatient Physician 5% Coinsurance after deductible
Prescription Drugs In Network Out of Network
Generic Rx $10.00
Preferred Brand Rx 30%
Non Preferred Brand Rx 50%
Specialty Drugs 50%

Other Plans

Other plans that are available in the state.

Plan Name
Dean Classic 3000X
Dean Classic 4500X
Dean Copay Plus 1000X
Dean Copay Plus 2000X
Dean Copay Plus 3500X
Dean HSA 5000X
Dean HSA 6250X
Dean HSA Focus 5000X
Dean HSA Focus 6250X
Dean Safety Net
Dean Value 4000X
Dean Value 6000X
Dean Value Focus 4000X
Dean Value Focus 6000X
Prevea360 Classic 3000X
Prevea360 Classic 4500X
Prevea360 Copay Plus 1000X
Prevea360 Copay Plus 2000X
Prevea360 Copay Plus 3500X
Prevea360 HSA 5000X
Prevea360 HSA 6250X
Prevea360 Safety Net
Prevea360 Value 4000X
Prevea360 Value 6000X
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This tool is for research purposes only. The numbers shown are estimates based on the information you have provided and our best efforts to provide accurate data. We try to keep the information up to date however we cannot make warranties about the accuracy of our information. We advise that users confirm any research with the respective health insurance companies and health exchanges.