Individual and Family
Health Maintenance Organization (HMO) Plans

Call 877.588.5462 to speak to a representative about selecting a plan option.

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HMO plans that fit your lifestyle

An HMO gives you access to doctors and hospitals within its network. A primary care practitioner (PCP) can help coordinate your overall medical care. No matter which HMO plan you choose you will receive:

  • 100% coverage for preventive services completed by an in-network provider
  • $0 copay on preventive drugs that target common medical conditions
  • 24/7/365 video visits for general medical, dermatology and behavioral health through MDLive
  • Access to our RN Comprehensive Care Coordination team
  • FREE Nurseline 24/7/365
  • Access to Hearing Aides and supplies
  • Tobacco Cessation coverage

Is my doctor in the network?

Aspirus Health is one of the region's leading nonprofit health systems, serving Wisconsin, Minnesota, and Michigan through 19 hospitals, more than 80 clinics, and over 1,300 providers.

With an Aspirus HMO plan, no referral is required to see an in-network specialist; however, some services require review and prior authorization. If you receive care from an out-of-network provider, Aspirus HMO will not cover those services unless the condition is deemed an emergency or prior authorization has been approved by Aspirus Health Plan.

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2027 HMO health plans at a glance

2027 Plan Details – Contracts, Plan Summaries and Summary of Benefits and Coverage (SBCs).

HMO Gold (two options)

Individual deductible
$2,000 or $2,700

Individual out-of-pocket maximum
$7,000 or $8,200

Family deductible
$4,000 or $5,400

Family out-of-pocket maximum
$14,000 or $17,200

Coinsurance
25%-30%

Office visits
$30. $60 Specialty

HMO Silver (two options)

Individual deductible
$6,600 or $7,000

Individual out-of-pocket maximum
$9,000 or $10,000

Family deductible
$12,200 or $14,000

Family out-of-pocket maximum
$18,000 or $20,000

Coinsurance
30% or 40%

Office visits
$40. $80 Specialty

HMO Bronze (two options) Now HSA eligible

Individual deductible
$0 or $7,500

Individual out-of-pocket maximum
$10,800 or $12,000

Family deductible
$0 or $15,000

Family out-of-pocket maximum
$21,600 or $24,000

Coinsurance
50% or 50%

Office visits
$35-50 or $100-$200 Specialty

HMO Catastrophic Now HSA eligible

Individual deductible
$12,000

Individual out-of-pocket maximum
$12,000

Family deductible
$24,000

Family out-of-pocket maximum
$24,000

Coinsurance
0%

Office visits
0% after deductible

HMO HSA Silver

Individual deductible
$5,900

Individual out-of-pocket maximum
$5,900

Family deductible
$11,800

Family out-of-pocket maximum
$11,800

Coinsurance
0%

Office visits
0% after deductible

HMO HSA Bronze

Individual deductible
$11,750

Individual out-of-pocket maximum
$11,750

Family deductible
$23,500

Family out-of-pocket maximum
$23,500

Coinsurance
0%

Office visits
$0 after deductible