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Covered BadgerCare Plus Services

As a BadgerCare Plus member, you have special insurance coverage. Dean Health Plan works with the State of Wisconsin to provide that coverage to you and your family. That means you should receive health care services from doctors and hospitals in the Dean Health Plan network. There might come a time when you need extra or special health care services. If so, you will need to get a doctor's referral (sometimes called a prior authorization) before you get those services.  

These benefits could change, call the Customer Care Center at 800-279-1301 to be sure of coverage.

Services covered by the State of Wisconsin

Use any provider that will accept your ForwardHealth ID card:


Chiropractic

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

Dental

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

Drugs

  • 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.
  • Copays:
    • $0.50 for OTC drugs
    • $1 for generic drugs
    • $3 for brand
  • Copays are limited to $12 per member, per provider, per month. OTCs are excluded from this $12 maximum.
  • You can go to any pharmacy that accepts your ForwardHealth ID card. See our online directory to find a pharmacy.

Services covered by Dean Health Plan

Click on any health care service listed below to see your coverage details.

YOU MUST USE DEAN PROVIDERS:

  • Full coverage
  • $.50 to $3 copay per service
  • Full coverage
  • $0.50 to $3 copay per item
  • Rental items are not subject to copay
  • 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
  • Full coverage
  • $.50 to $3 per procedure
  • No copay for hearing aid batteries
Home health, private-duty nursing and personal care
  • Full coverage of private-duty nursing, home health services and personal care
  • No copay
  • Full coverage
  • No copay
  • Full coverage
  • $3 copay per day with a $75 cap per stay
  • Full coverage (not including room and board)
  • $.50 to $3 copay per service, limited to the first 15 hours or $825 of services, whichever comes first, provided per calendar year.
  • Copay not required when services provided in hospital setting
  • Full coverage
  • No copay
  • Full coverage
  • No copay
  • Full coverage
  • $.50 to $3 copay per service
  • Copay limited to the first 30 hours or $1,500, whichever occurs first, during one calendar year (copay limits are calculated separately for each discipline)
  • Full coverage, including laboratory and radiology
  • $.50 to $3 copay per service limited to $30 per provider per calendar year.
  • No copay for emergency services, anesthesia or clozapine management
  • 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 copay
  • Full coverage, excluding infertility treatments, surrogate parenting and the reversal of voluntary sterilization
  • No copay for family planning services
  • Full coverage including coverage of eyeglasses
  • $0.50 to $3 copay per service
  • Coverage includes prescription and OTC tobacco cessation products
  • Refer to the drug benefit for information on copayments
  • Full coverage of emergency and non-emergency transportation to and from a certified provider for a BadgerCare Plus covered service 
  • $2 copay for non-emergency ambulance trips
  • $1 copay per trip for transportation by SMV
  • No copay for transportation by common carrier or emergency ambulance

If you receive a bill in the mail:

If you get a bill, contact the provider who is billing you. It may only be a request for more information about your BadgerCare Plus status or it could be a bill for copays.

Dean Health Plan pays your provider for the services you receive. A provider cannot require you, your relatives, or others to pay additional charges for these covered services. Providers know the limits placed on their services and are required to explain if Dean Health Plan does not cover any of the services before the service is provided.