2023 Plan Information

Individual & Family Health Maintenance Organization (HMO)

Aspirus Health Plan believes in giving you all the information you need to make a sound decision. Whether you are choosing a plan and need to see the fine details, requesting information on behalf of a family member, or filing a claim, we are your resource. The plan options below will connect to your insurance plan documents.

What you will find in the charts

Certificate/Contract – This is the legal contract between you and Aspirus Health Plan. It includes the details about your insurance plan.

Plan Summary – High level chart that shows the deductible, coinsurance, out-of-pocket and much more for all plan offerings.

Summary of Benefits (SBC) – An easy-to-read version of your plan that can be used to compare plans. The Certificate/Contract and Plan Summary will give a “detailed version” of same information.

Questions? Contact member services at 866.631.5404

2023 Off-Marketplace

Health Maintenance Organization (HMO) plans

Plan Name Summary of Benefits (SBC) Plan Summary Contract
HMO Silver 7500 86584WI0010001-00.pdf 29986 AHP Individual Plan Summary HMO POS.pdf 86584WI0010001-00, -01 HMO Silver 7500 2023.pdf
HMO Bronze 9100 86584WI0010005-00.pdf 29986 AHP Individual Plan Summary HMO POS.pdf 86584WI0010005-00, -01 HMO Bronze 9100 2023.pdf
HMO Bronze 6500 with 3 free PCP 86584WI0010006-00.pdf 29986 AHP Individual Plan Summary HMO POS.pdf 86584WI0010006-00, -01 HMO Bronze 6500 with 3 for Free 2023.pdf
HMO Gold 2800 86584WI0010007-00.pdf 29986 AHP Individual Plan Summary HMO POS.pdf 86584WI0010007-00, -01 HMO Gold 2800 2023.pdf
HMO Bronze 7500 86584WI0010011-00.pdf 29986 AHP Individual Plan Summary HMO POS.pdf 86584WI0010011-00, -01 HMO Bronze 7500 2023.pdf
HMO Silver 5800 86584WI0010012-00.pdf 29986 AHP Individual Plan Summary HMO POS.pdf 86584WI0010012-00, -01 HMO Silver 5800 2023.pdf
HMO Gold 2000 86584WI0010015-01.pdf 29986 AHP Individual Plan Summary HMO POS.pdf 86584WI0010015-00, -01 HMO Gold 2000 2023.pdf
HMO HDHP Bronze 6000 86584WI0010003-00.pdf 29986 AHP Individual Plan Summary HMO POS.pdf 86584WI0010003-00, -01 HMO HDHP Bronze 6000 2023.pdf
HMO HDHP Bronze 6900 86584WI0010009-00.pdf 29986 AHP Individual Plan Summary HMO POS.pdf 86584WI0010009-00, -01 HMO HDHP Bronze 6900 2023.pdf
HMO HDHP Silver 5400 86584WI0010013-00.pdf 29986 AHP Individual Plan Summary HMO POS.pdf 86584WI0010013-00, -01 HMO HDHP Silver 5400 2023.pdf
HMO Catastrophic 9100 with 3 fee PCP visits 86584WI0010008-00.pdf 29986 AHP Individual Plan Summary HMO POS.pdf 86584WI0010008-00, -01 HMO Catastrophic 9100 with 3 for Free 2023.pdf

2023 On-Marketplace

Health Maintenance Organization (HMO) plans

Plan Name Summary of Benefits (SBC) Plan Summary Contract
HMO Bronze 9100 86584WI0010005-01.pdf 29987 AHP Individual Plan Summary Gold and Bronze.pdf 86584WI0010005-00, -01 HMO Bronze 9100 2023.pdf
HMO Bronze 0 CSR Zero 86584WI0010005-02.pdf 29987 AHP Individual Plan Summary Gold and Bronze.pdf 86584WI0010005-02 HMO Bronze 0 CSR Zero 2023.pdf
HMO Bronze 9100 CSR Ltd 86584WI0010005-03.pdf 29987 AHP Individual Plan Summary Gold and Bronze.pdf 86584WI0010005-03 HMO Bronze 9100 CSR Ltd 2023.pdf
HMO Bronze 6500 with 3 free PCP 86584WI0010006-01.pdf 29987 AHP Individual Plan Summary Gold and Bronze.pdf 86584WI0010006-00, -01 HMO Bronze 6500 with 3 for Free 2023.pdf
HMO Bronze 0 CSR Zero 3 Free PCP 86584WI0010006-02.pdf 29987 AHP Individual Plan Summary Gold and Bronze.pdf 86584WI0010006-02 HMO Bronze 0 CSR Zero 3 Free PCP 2023.pdf
HMO Bronze 6500 CSR Ltd 3 Free PCP 86584WI0010006-03.pdf 29987 AHP Individual Plan Summary Gold and Bronze.pdf 86584WI0010006-03 HMO Bronze 6500 CSR Ltd 3 Free PCP 2023.pdf
HMO Gold 2800 86584WI0010007-01.pdf 29987 AHP Individual Plan Summary Gold and Bronze.pdf 86584WI0010007-00, -01 HMO Gold 2800 2023.pdf
HMO Gold 0 CSR Zero 86584WI0010007-02.pdf 29987 AHP Individual Plan Summary Gold and Bronze.pdf 86584WI0010007-02 HMO Gold 0 CSR Zero 2023.pdf
HMO Gold 2800 CSR Ltd 86584WI0010007-03.pdf 29987 AHP Individual Plan Summary Gold and Bronze.pdf 86584WI0010007-03 HMO Gold 2800 CSR Ltd 2023.pdf
HMO Bronze 7500 86584WI0010011-01.pdf 29987 AHP Individual Plan Summary Gold and Bronze.pdf 86584WI0010011-00, -01 HMO Bronze 7500 2023.pdf
HMO Bronze 0 CSR Zero 86584WI0010011-02.pdf 29987 AHP Individual Plan Summary Gold and Bronze.pdf 86584WI0010011-02 HMO Bronze 0 CSR Zero 2023.pdf
HMO Bronze 7500 CSR Ltd 86584WI0010011-03.pdf 29987 AHP Individual Plan Summary Gold and Bronze.pdf 86584WI0010011-03 HMO Bronze 7500 CSR Ltd 2023.pdf
HMO Gold 2000 86584WI0010015-01.pdf 29987 AHP Individual Plan Summary Gold and Bronze.pdf 86584WI0010015-00, -01 HMO Gold 2000 2023.pdf
HMO Gold 0 CSR Zero 86584WI0010015-02.pdf 29987 AHP Individual Plan Summary Gold and Bronze.pdf 86584WI0010015-02 HMO Gold 0 CSR Zero 2023.pdf
HMO Gold 2000 CSR Ltd 86584WI0010015-03.pdf 29987 AHP Individual Plan Summary Gold and Bronze.pdf 86584WI0010015-03 HMO Gold 2000 CSR Ltd 2023.pdf
HMO HDHP Bronze 6000 86584WI0010003-01.pdf 29987 AHP Individual Plan Summary Gold and Bronze.pdf 86584WI0010003-00, -01 HMO HDHP Bronze 6000 2023.pdf
HMO HDHP Bronze 0 CSR Zero 86584WI0010003-02.pdf 29987 AHP Individual Plan Summary Gold and Bronze.pdf 86584WI0010003-02 HMO HDHP Bronze 0 CSR Zero.pdf
HMO HDHP Bronze 6000 CSR Ltd 86584WI0010003-03.pdf 29987 AHP Individual Plan Summary Gold and Bronze.pdf 86584WI0010003-03 HMO HDHP Bronze 6000 CSR Ltd 2023.pdf
HMO HDHP Bronze 6900 86584WI0010009-01.pdf 29987 AHP Individual Plan Summary Gold and Bronze.pdf 86584WI0010009-00, -01 HMO HDHP Bronze 6900 2023.pdf
HMO HDHP Bronze 0 CSR Zero 86584WI0010009-02.pdf 29987 AHP Individual Plan Summary Gold and Bronze.pdf 86584WI0010009-02 HMO HDHP Bronze 0 CSR Zero 2023.pdf
HMO HDHP Bronze 6900 CSR Ltd 86584WI0010009-03.pdf 29987 AHP Individual Plan Summary Gold and Bronze.pdf 86584WI0010009-03 HMO HDHP Bronze 6900 CSR Ltd 2023.pdf
HMO Catastrophic 9100 with 3 free PCP 86584WI0010008-01.pdf 29987 AHP Individual Plan Summary Gold and Bronze.pdf 86584WI0010008-00, -01 HMO Catastrophic 9100 with 3 for Free 2023.pdf

(Eligibility for plans -02 through -06 are determined by the Marketplace)

Health Maintenance Organization (HMO) plans - Cost Sharing

Plan Name Summary of Benefits (SBC) Plan Summary Contract
HMO Silver 7500 86584WI0010001-01.pdf 29988 AHP Individual Plan Summary Silver.pdf 86584WI0010001-00, -01 HMO Silver 7500 2023.pdf
HMO Silver 0 CSR Zero 86584WI0010001-02.pdf 29988 AHP Individual Plan Summary Silver.pdf 86584WI0010001-02 HMO Silver 0 CSR Zero 2023.pdf
HMO Silver 7500 CSR Ltd 86584WI0010001-03.pdf 29988 AHP Individual Plan Summary Silver.pdf 86584WI0010001-03 HMO Silver 7500 CSR Ltd 2023.pdf
HMO Silver 6900 CSR 73 86584WI0010001-04.pdf 29988 AHP Individual Plan Summary Silver.pdf 86584WI0010001-04 HMO Silver 6900 CSR 73 2023.pdf
HMO Silver 1850 CSR 87 86584WI0010001-05.pdf 29988 AHP Individual Plan Summary Silver.pdf 86584WI0010001-05 HMO Silver 1850 CSR 87 2023.pdf
HMO Silver 750 CSR 94 86584WI0010001-06.pdf 29988 AHP Individual Plan Summary Silver.pdf 86584WI0010001-06 HMO Silver 750 CSR 94 2023.pdf
HMO Silver 5800 86584WI0010012-01.pdf 29988 AHP Individual Plan Summary Silver.pdf 86584WI0010012-00, -01 HMO Silver 5800 2023.pdf
HMO Silver 0 CSR Zero 86584WI0010012-02.pdf 29988 AHP Individual Plan Summary Silver.pdf 86584WI0010012-02 HMO Silver 0 CSR Zero 2023.pdf
HMO Silver 5800 CSR Ltd 86584WI0010012-03.pdf 29988 AHP Individual Plan Summary Silver.pdf 86584WI0010012-03 HMO Silver 5800 CSR Ltd 2023.pdf
HMO Silver 5700 CSR 73 86584WI0010012-04.pdf 29988 AHP Individual Plan Summary Silver.pdf 86584WI0010012-04 HMO Silver 5700 CSR 73 2023.pdf
HMO Silver 800 CSR 87 86584WI0010012-05.pdf 29988 AHP Individual Plan Summary Silver.pdf 86584WI0010012-05 HMO Silver 800 CSR 87 2023.pdf
HMO Silver 0 CSR 94 86584WI0010012-06.pdf 29988 AHP Individual Plan Summary Silver.pdf 86584WI0010012-06 HMO Silver 0 CSR 94 2023.pdf
HMO HDHP Silver 5400 86584WI0010013-01.pdf 29988 AHP Individual Plan Summary Silver.pdf 86584WI0010013-00, -01 HMO HDHP Silver 5400 2023.pdf
HMO HDHP Silver 0 CSR Zero 86584WI0010013-02.pdf 29988 AHP Individual Plan Summary Silver.pdf 86584WI0010013-02 HMO HDHP Silver 0 CSR Zero 2023.pdf
HMO HDHP Silver 5400 CSR Ltd 86584WI0010013-03.pdf 29988 AHP Individual Plan Summary Silver.pdf 86584WI0010013-03 HMO HDHP Silver 5400 CSR Ltd 2023.pdf
HMO HDHP Silver 4400 CSR 73 86584WI0010013-04.pdf 29988 AHP Individual Plan Summary Silver.pdf 86584WI0010013-04 HMO HDHP Silver 4400 CSR 73 2023.pdf
HMO HDHP Silver 1600 CSR 87 86584WI0010013-05.pdf 29988 AHP Individual Plan Summary Silver.pdf 86584WI0010013-05 HMO HDHP Silver 1600 CSR 87 2023.pdf
HMO HDHP Silver 550 CSR 94 86584WI0010013-06.pdf 29988 AHP Individual Plan Summary Silver.pdf 86584WI0010013-06 HMO HDHP Silver 550 CSR 94 2023.pdf

(Eligibility for plans -02 through -06 are determined by the Marketplace)