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Wisconsin Health Insurance

Enrollment and Eligibility

 

Dependant Eligibility

To cover any dependents under a family policy, you will need to know who qualifies as a dependent under your Dean Health Plan policy.

Dependent children are covered until the end of the month in which they turn 27 unless otherwise specified in your Member Certificate. Dependents are only covered beyond the limiting age under special circumstances which are outlined in the Member Certificate.

After to your 2012 renewal, qualified dependents include a biological child, adopted child, child placed for adoption, stepchild or legal ward (regardless of marital status). Dependent children are covered until the end of the month in which they turn 26 unless otherwise specified in your Member Certificate. Dependents are only covered beyond the limiting age under special circumstances which are outlined in the Member Certificate.

Out-of-Area Coverage for Students

Please note, this section does not apply to members covered on a Point of Service, Point of Enrollment, Triple Option, State of Wisconsin or Wisconsin Public Employer plan.

If your dependent attends school out of our service area, your policy may have a special provision for out-of-area coverage. This provision provides students with coverage for emergency and urgent care covered up to our maximum allowable fee.

Most policies cover non-emergency, non-urgent, and any follow-up care at 50 percent of our maximum allowable fee if the care is prior authorized by Dean Health Plan. Your primary care provider must submit a written referral to our Managed Care Department for prior authorization.

If you would like an extra ID card for your dependent or have any questions about his or her coverage, please call our Customer Care Center.

 

Special Enrollment Periods

Adding Dependents to Your Policy
This section only applies to members of an employer group plan. The Federal Employee Health Benefits Plan may have different criteria for special enrollment periods. Please contact your payroll office for more information if you are covered under the State of Wisconsin or Wisconsin Public Employer plans.

There may be times when you need to add a dependent to your policy after your coverage is already in effect. These situations may qualify for special enrollment periods. The following are examples of some special enrollment periods:

  1. Marriage - If you get married, you can add your spouse and any newly acquired eligible dependents to your policy. An application must be received within 30 days of the event. Your spouse's coverage will become effective on the date of marriage.
  2. Birth or adoption of a child - An application should be received within 60 days of the birth or placement of the adopted child. If you are changing from a single to a family policy you can also add your spouse to your policy. If you are adding your spouse, the application must be submitted within 30 days of the birth or adoption.
  3. Loss of other insurance coverage - If your spouse has coverage through their employer and they lose that coverage due to a change in their employment status, you can add your spouse and dependents to your policy. Also, if you are covered under your spouse's health plan and you lose that coverage due to a change in employment status, you can apply through your employer for coverage under Dean Health Plan. An application, and proof of the loss of coverage must be received within 30 days of the loss of coverage.

For more detailed information on special enrollment periods, please refer to your Member Certificate.

Please check with your employer to find out which special enrollment periods are recognized and offered through your group plan.

 

Your ID Cards

As a member of Dean Health Plan you have received a membership ID card. This card serves many important roles for your health care. Your card identifies you as a Dean Health Plan member. It is important to present your ID card every time you visit your doctor or pharmacist.

Your card not only identifies you, it also lists important information relating to your covered benefits. Information on your card includes: your primary care physician/clinic, the members covered on your policy, your benefit renewal month, and whether you have covered drug benefits or office co-payments.

This card will not expire unless your coverage terminates. New cards will be issued to you only when significant changes in your coverage occur. For example, you will receive a new card if you change your status from single to family, or if you change your primary care provider. When you receive your card, it is important to review the information carefully to ensure that everything is correct.

Please keep in mind that your card is not a guarantee of coverage. Members are covered only for services listed in their Schedule of Benefits and Member Certificate. If, for any reason, you need a new card or additional cards you may request them via DeanConnect or through our Customer Care Center.

 

Canceling Your Coverage

At some point, you may need to cancel coverage under your Dean Health Plan policy for yourself or a dependent for one of many reasons, such as divorce, termination of employment, dependents reaching the limiting age of your contract or for moving out of the service area.

If you have any questions regarding canceling your policy, please contact our Customer Care Center.

Group Plans
If your policy is through your employer, contact your employer's personnel or payroll office. They will assist you with any necessary procedures. Be sure to check with your employer to determine if you or your dependents would qualify for state or federal continuation benefits.

If a dependent's cancellation of coverage will change the type of policy you have (for example, switching from a family policy to a single policy), you will have to complete a new application to request this policy change. Please check with your employer for the applicable cancellation date. Some employer groups request that coverage end on the date of an event rather than at the end of that month.

Non-Group Plans
If you are covered under the Individual or Conversion plans, you will need to contact Customer Care Center to cancel your coverage. Farm plan members should contact Greater Insurance Service to cancel coverage.

If a subscriber cancels coverage and qualified dependents wish to continue coverage, a new application must be completed. If the request is received by the end of the month, the coverage will be canceled at the end of that month and any prepaid premiums will be refunded back to the cancellation date. If the notification is received after the requested cancellation date, an explanation for the backdated cancellation is necessary for review and approval.

Address Changes

On the move? Please don't forget to let us know if your address changes. We mail updated benefit information, ID cards, and our newsletter to the address that you have provided to us. Eventually, the forwarding addresses expire and you may not receive important information.

If you have moved, please take a moment to contact our Customer Care Center and advise us of your new address. If it is more convenient, you may drop us a note. Please be sure to include the following information: name, subscriber number, new address, phone number (if changed), and moving date. You can also change your address using this online form.

Please remember to also change your address at your health care providers' offices.

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Contact Dean Health Plan

If you have any questions please contact our Customer Care Center by email, or at (800) 279-1301.