Small group health insurance plans in Wisconsin

In Wisconsin, we offer fully insured and self-insured plans.

• Fully insured plans – Fully insured plans are available for businesses with two to 50 employees. With these plans, you pay an insurance carrier fixed premiums based on the number of your employees, while your carrier administers your company’s plan and pays out all claims.
• Self-insured Balance level funded plans – If you’re looking for a self-insured plan with the cash flow certainty of a fully insured plan, our level funded Balance plans (available for businesses with five to 50 employees) may be a great fit. Each month, you pay a “level amount,” including an administrative fee, stop-loss premium and an estimated amount for claims based on a maximum or worst-case scenario. If claims come in above the estimated amount, you don’t owe anything additional. If claims come in below the estimated amount, you’ll receive 50% of the surplus at settlement time once you renew.

Does your business have more than 50 employees? See our large group plan options instead.

Based on your funding model and business location, choose from up to two provider networks to fit your company’s budget and your employees’ needs. All our networks are designed to put high-quality care first.

In addition, most of our networks include national, 50-state coverage through our alliance with Cigna. That means straightforward, seamless access to over 1 million providers and 6,300 hospitals, with no referrals or separate insurance card needed.

Our networks serving most of Wisconsin include:

Perform – This network includes all HealthPartners-contracted providers excluding Mayo Clinic and Mayo Clinic Health System, plus nationwide access to over 1 million providers and 6,300 hospitals. It’s available for self-insured Balance level funded plans statewide.

Our networks serving northeast Wisconsin include:

All our fully insured and self-insured group plans for small businesses offer high-quality health insurance options that have comprehensive benefits and coverage. We’ll be there every step of the way to make sure you get the most out of your plan.

Specific benefits and coverage levels vary by plan, but all plans include:

• 100% preventive care coverage, including routine checkups, immunizations, screening and counseling
• Prescription drug coverage with an actively managed, cost-effective formulary (drug list)
  • Formulary insulin covered with no member cost-sharing after a $25 benefit cap per fill
• Coverage for telemedicine services such as Teladoc and Doctor on Demand, with many plans offering access to Virtuwell , our online clinic where members can get care anywhere
• Out-of-network coverage, with urgent care and emergency care covered at in-network levels
• Compliance with the Affordable Care Act (ACA)

Choose from a variety of plans and health account options for your employees, including:

• Traditional copay and coinsurance plans – These plans charge a set fee for a specific service, like a clinic visit. These fees are usually listed on a member’s insurance card and can help members decide whether to make a doctor appointment or head to urgent care. Some plans also include a deductible.
• “Three for Free” plans – With these plans, the first three office or urgent care visits each year are at no extra cost. Employees also have access to a wide range of care and benefits through coinsurance with varying deductible amounts.
• High-deductible health plans (HDHPs) – These plans usually have lower premiums and higher deductibles, meaning your employees pay less each month for insurance and more out of pocket when they receive care. They also typically cost less for employers.
  • Employees with an HDHP are also eligible to open a Health Savings Account (HSA), a special pretax bank account for eligible health care expenses which both the employee and the employer can contribute to.
• Health Reimbursement Account (HRA) plans – In these plans, an employer offers a predetermined amount of money to its employees, which is then used for eligible health care expenses.
• Flexible Spending Accounts (FSAs) – With an FSA, employees and employers can put pretax money into a special account for eligible employee medical expenses. An FSA can typically be offered alongside any other group medical plan.

Depending on the size of your group, you may have the option to select multiple plan designs. No matter which plan you choose, you’ll have access to everyday health support, programs and resources to support physical and mental health, and more.

Our teams are dedicated to collaborating closely with you to understand your company and your employees’ unique needs. Many of our plans include value-added services such as virtual health support, well-being resources, pharmacy navigation and more, available at no extra cost to you or your employees.

We’ll work together to discover which services and resources may be a good fit, and we’ll help your employees take charge of their plan so they can work to stay healthy and happy. Some of our services and resources include:

• Award-winning, locally based member and employer support teams
• Employee Assistance Programs (EAP) to help employees manage stress, be more productive at work and live healthier every day
• Omada Mind digital program for stress, anxiety and depression
• Living Well comprehensive well-being resources, including digital assessments, personalized action plans and discounts
• Comprehensive disease and case management support
• Medication Therapy Management (MTM) that helps ensure medications are working together correctly
• Assist America 24/7 coverage, helping your employees find a doctor, fill a prescription and more when traveling
• Digital and in-person decision support tools, making managing care easy anytime, anywhere
• Communications toolkits to drive employee engagement and help your employees get the most out of their plan
• Easy-to-use plan administration tools that save you time and money so you can focus on growing your business