Covered Services under BadgerCare Plus, Dean Health Plan

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Covered Services under BadgerCare Plus by Dean Health Plan

Dean Health Plan is responsible to provide all medically necessary covered services under BadgerCare Plus. Some services may require a doctor’s order or a prior authorization. These benefits may be subject to change, please contact the Customer Care Center to confirm. BadgerCare Plus covers the following services:

Chiropractic Services – this benefit is covered by the State of Wisconsin

  • Full coverage
  • $.50 to $3 copayment per service

Dental Services – this benefit is covered by the State of Wisconsin

  • Full coverage
  • $.50 to $3 copayment per service

Disposable Medical Supplies (DMS)

  • Full coverage
  • $.50 to $3 copayment per service

Drugs – this benefit is covered by the State of Wisconsin

  • Comprehensive drug benefit with coverage of generic and brand name prescription drugs, and some over-the-counter (OTC) drugs
  • Members limited to five prescriptions per month for opiod drugs.
  • Copayments:
    • $0.50 for OTC drugs
    • $1 for generic drugs
    • $3 for brand
  • Copayments are limited to $12.00 per member, per provider, per month. OTCs are excluded from this $12.00 maximum.

Durable Medical Equipment (DME)

  • Full coverage
  • $0.50 to $3 copayment per item
  • Rental items are not subject to copayment

Health Screenings for Children

  • Full coverage of HealthCheck screenings and other services for individuals under age 21 years
  • $1 copayment per screening for 18, 19, and 20 year olds only

Hearing Services

  • Full coverage
  • $.50 to $3 per procedure
  • No copayment for hearing aid batteries

Home Care Services (Home Health, Private Duty Nursing and Personal Care)

  • Full coverage of private duty nursing, home health services, and personal care
  • No copayment

Hospice Services

  • Full coverage
  • No copayment

Inpatient Hospital Services

  • Full coverage
  • $3 copayment per day with a $75 cap per stay

Mental Health and Substance Abuse Treatment*

  • Full coverage (not including room and board)
  • $.50 to $3 copayment per service, limited to the first 15 hours or $825 of services, whichever comes first, provided per calendar year.
  • Copayment not required when services provided in hospital setting

Nursing Home Services

  • Full coverage
  • No copayment

Outpatient Hospital - Emergency Room

  • Full coverage
  • No copayment

Outpatient Hospital Services

  • Full coverage
  • $3 copayment per visit

Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy (ST)

  • Full coverage
  • $.50 to $3 copayment per service
  • Copayment obligation limited to the first 30 hours or $1,500, whichever occurs first, during one calendar year (copayment limits calculated separately for each discipline)

Physician Services

    • Full coverage, including laboratory and radiology
    • $.50 to $3 copayment per service limited to $30 per provider per calendar year.
    • No copayment for emergency services, anesthesia or clozapine management

Prenatal /Maternity Care

      • Full coverage, including prenatal care coordination, and preventive mental health and substance abuse screening and counseling for women at risk of mental health or substance abuse problems
      • No copayment

Reproductive Health Services

      • Full coverage, excluding infertility treatments, surrogate parenting and the reversal of voluntary sterilization
      • No copayment for family planning services

Routine Vision

      • Full coverage including coverage of eyeglasses
      • $0.50 to $3 copayment per service

Smoking Cessation Services

      • Coverage includes prescription and OTC tobacco cessation products
      • Refer to the drug benefit for information on copayments

Transportation – Ambulance, Specialized Medical Vehicle (SMV), Common Carrier

      • Full coverage of emergency and non-emergency transportation to and from a certified provider for a BadgerCare Plus covered service
        • $2 copayment for non-emergency ambulance trips
        • $1 copayment per trip for transportation by SMV
        • No copayment for transportation by common carrier or emergency ambulance

 

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