HSHS

Skip to Content

Hospital Sisters Healthy Plan provider options

Administered by Dean Health Plan

How to determine your network service area

In general, you need to receive care inside your designated network to have coverage for your medical care through the HSHS Healthy Plan for 2018. Your network is determined by your home ZIP code.

If you live inside the service area

You are inside the HSHS/Prevea360 network service area if your listed residence is in one of the designated ZIP codes.

If your address is in the HSHS/Prevea360 network service area, for 2018 you'll see providers in the Exclusive Provider Organization (EPO). In most cases, this covers service received only from HSHS/Prevea 360 network providers (including PCIN providers). This means if you receive care outside the network, you will most likely be responsible for the full cost of care.

You can see any PCIN designated providers as well as any Prevea360 providers, just select the appropriate link to find a provider.

On your insurance member identification card you will see the Prevea360 provider logo on the front right side of the card.

Find a PCIN provider

Find a Prevea360 provider - select ASO Network

If you live outside the service area

If your ZIP code is not listed—and you live in Wisconsin—your network providers for 2018 is also the Exclusive Provider Organization (EPO). Since you live outside of the service area,  you can also use the HealthEOS network. In most cases, the plan covers services received from only HSHS/Prevea 360 network providers (including PCIN providers) and the HealthEOS network, with the exception of Marshfield or Mayo providers. Care received from Marshfield or Mayo providers without an approved prior authorization from Dean will most likely result in you being responsible for the full cost of care.

If you receive care outside these networks, you will most likely be responsible for the full cost of care.

You and your dependents are still able to receive care from an HSHS/Prevea 360 network provider as well as a PCIN provider.

Your insurance member identification card will include both Prevea360 and Health EOS logos on the front.

Find a PCIN provider

Find a Prevea360 provider - select ASO Network

Find a HealthEOS provide - select Health EOS

Traveling out of the area

If you are out of the area and need emergency services, an extended network option helps protect you from possible additional out-of-pocket expenses.

Your coverage

You don't need a referral or prior authorization for emergency services — no matter where you travel. We will cover emergency services while you're out of the network service area, subject to policy copays, co-insurance, deductibles and usual and customary fees.

The amount charged for these services received from an out-of-network provider may exceed the usual and customary fees, in which case you will be responsible for paying the difference between the amount charged and the usual and customary fees.

For emergencies

If you need emergency care outside the service area and are unable to get to a plan provider, go to the nearest urgent care or emergency center. It is important to notify Dean as soon as possible by calling the Customer Care Center at 1-888-895-1188.

All follow-up care should be done by a plan provider. If you are out of the area and unable to see a plan provider, call your primary care practitioner for a referral to an out-of-area provider. These services require approval by Dean Health Plan.

To reduce the chance of being billed for maximum allowable fee charges, you can use our complementary network provider network by accessing MultiPlan.


Out-of-area-dependents

HSHS is committed to helping your dependent get the health care coverage they need when they need it. Students who attend college outside of the area and children living in communities outside the Dean Health Plan service area are common examples of out-of-area dependents.

Designated out-of-area dependents have additional providers available to them.

Notify us

While a referral isn't needed for your out-of-area dependent to access MultiPlan providers, remember that there may be services that require a prior authorization.

To receive this benefit, you or your Out of Area dependent must contact Customer Service before receiving any services:

  • Call Customer Service at 1-888-895-1188
  • Explain that your dependent is residing Out of Area
  • Customer Service will then set up your dependent's information indicating that they reside outside of the service area.

For more information on those services, see your Summary Plan Description at deancare.com/aso, visit the HSHS benefits website or call Customer Service at 1-888-895-1188.

In an emergency

If your dependent needs urgent or emergency care outside the service area and is unable to get to a plan provider or MultiPlan, he or she should go to the nearest urgent care or emergency center for treatment.

It is important to notify Dean as soon as possible by calling the Customer Care Center at 1-888-895-1188.

Find a MultiPlan provider - select MultiPlan logo.

Questions?

If you are having a medical emergency, call 911 or go to a nearby urgent care or emergency department.

Benefit representatives are available to answer your questions.

For questions about your medical benefits or providers, contact Dean Health Plan’s Customer Care Center by email (link) or at 1-888-895-1188, 7:30 a.m. to 5:00 p.m. CST, Monday through Thursday and 8:00 a.m. to 4:30 p.m. CST, Friday.

For pharmacy-related questions, contact Navitus’s Customer Service at 1-866-333-2757, 24 hours a day, 7 days a week (Closed Thanksgiving and Christmas Day).

Dean On Call

Dean On Call logoIf you're not sure you need to see a doctor, give us a call 24 hours a day, 365 days a year.

Experienced registered nurses at Dean on Call are always available to answer your health questions and concerns.

(608) 250-1393
(800) 57-NURSE
(1-800-576-8773)
* NOTE: Due to licensing regulations, Dean on Call's triage services are only available to residents of Wisconsin.

  • Connect with us on Facebook
  • See us on YouTube
  • Connect with us on LinkedIn

© 2017 Dean Health Plan, Inc. | All rights reserved.

A Member of SSM Health

SSM Health and the infinity symbol are trademarks of SSM Health and its affiliates.