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5-Star Employee Trust Fund's Quality Rating for 2018!
©2017 Dean Health Plan, Inc. • 4910_1708
Dean Health Plan, Inc. | 1277 Deming Way | Madison, WI 53717
800-279-1301 | TTY: 711 | deancare.com
2018 State of WisconsinGroup Health Insurance Program
Vernon
Richland
Sauk
Grant
Iowa
LafayetteGreen Rock
Walworth
Jefferson
Waukesha
Juneau
Adams
MarquetteGreenLake
Fond du Lac
ColumbiaDodge
Dane
Friendship
Elroy
WonewocHillsboroMarkesan
Brandon
Ripon
Waupun
Mt. CalvaryFond du Lac
CampbellsportCampbellsportBrownsvilleFox Lake
MayvilleBeaver Dam
RandolphPardeevillePortage
Rio
ColumbusLodi
Baraboo
Lake Delton
Wisconsin Dells
Reedsburg
Plain
Sauk City
Prairie du Sac
Spring Green
Richland Center
Boscobel Muscoda
FennimoreMontfort
Highland
Dodgeville
Barneveld
Mineral Point
Lancaster
Platteville
Cuba City
Dubuque, IAGalena, IL Lena, IL
Freeport, ILDurand, IL
Roscoe, IL
Shullsburg
DarlingtonArgyle
BlanchardvilleNew Glarus
Monroe
Albany
Brodhead
Beloit
EdgertonMilton
Janesville
Clinton
Whitewater
DelavanDarien
Juneau
Watertown
Jefferson
Fort Atkinson
Johnson Creek
Lake Mills
Waterloo Ixonia OconomowocSussex
HartlandDelafield
Waukesha
Eagle Mukwonago
MuskegoNew Berlin
Brookfield
PewaukeeBlack Earth
Madison
Verona
BellevilleOregon Stoughton
Cambridge
Cottage Grove
Deerfield
Sun PrairieWaunakee
Evansville
Westfield
Oxford
Wauwatosa
Hospital only
Hospital and Primary Care Provider location
Primary Care Provider location only
ProviderNetwork
Dean Health Plan offers a current and complete listing of physicians, clinics, pharmacies and more at
deancare.com/doctors.
Important contact information such as phone numbers and locations are listed on our website. If you would like a
printed copy of the provider directory, please call our Customer Care Center at 800-279-1301. Please keep in
mind that the online directory has the most up-to-date listing of providers.
We’re Hereto Help
ClickVisit deancare.com/contact-us
and click the Dean Health Plan button.
CallCall the Customer Care Center 800-279-1301 (TTY: 711)
Monday through Thursday: 7:30 am to 6 pm
Friday: 7:30 am to 5 pm
Come inOur Insurance Desk is open Monday through Friday,
7:30 am to 5 pm. Come in to our Health Plan Office or
one of the following SSM Health Dean Medical Group locations:
Business Office: 1277 Deming Way, Madison
East: 1821 S. Stoughton Road, Madison
West: 752 N. High Point Road, Madison
Fish Hatchery: 1313 Fish Hatchery Road, Madison
Janesville East: 3200 E. Racine Street, Janesville
deancare.com | 3
Table ofContents
page(s)
4-5 Introduction to Dean Health Plan
6 Convenient Tools and Resources
7 New Member Checklist
8 The Dean Provider Network
9 Understanding Your Benefits ClaimsandPayment
ExplanationofBenefits
10-11 Getting the Right Care UrgentandEmergencyCare
Out-of-AreaCare
Authorizations
12 Common Insurance Terms
13 Member Rights and Responsibilities
14 Plan Details
15-16 Privacy and Confidentiality
17-18 Your Notes
4 | 2018StateofWisconsinGroupHealthInsuranceProgram
Serving Youfor More than 30 YearsDean Health Plan is proud to serve the State of Wisconsin Group Health Insurance Program! Over three
decades ago, we responded to the needs of the state by creating managed care plans and effectively
managing the cost and quality of that care. That long history has helped Dean Health Plan become a
market leader in health insurance in southern Wisconsin. Here are some exceptional reasons why so many
choose Dean Health Plan:
Access to ProvidersDean Health Plan has been providing award-winning health care
coverage since 1983. Our network is staffed with health care
professionals who are dedicated to helping you and your loved ones
remain as healthy as possible, even when you’re on the road.
Dean On CallAnswers to your health-related questions are available 24/7/365.
If you’re not sure where to go for care or you have a health concern,
experienced registered nurses at Dean On Call are here to help.
Call 800-57-NURSE (800-576-8773).*
* Due to licensing regulations, Dean On Call’s triage services are only available to Wisconsin residents. For any life-threatening emergencies, always dial 911.
5
deancare.com | 5
5-Star Quality Rating from Employee Trust Fund!Dean Health Plan is proud to have earned Employee Trust Fund’s 5-Star
quality rating. We are always striving to find better ways of serving you.
Care ManagementWhile you should always start with your primary care provider for non-
emergency care, sometimes you might need additional help navigating
through the health care system. That’s where the Dean Health Plan
Care Management team comes in. If you’re diagnosed with a chronic
health condition or have a complex health care need, we can help guide
you to the most appropriate method of care and ensure your needs are
met and your questions and concerns are addressed. Learn more about
Care Management at deancare.com/caremanagement.
Prevention FocusedIt’s easy to get well and stay well with Dean Health Plan. We
emphasize a proactive, preventive approach to care — one in which
a primary care provider (PCP) oversees all aspects of your health
care needs and keeps you well through regular visits. These visits
are a good time to receive needed immunizations or health and
cancer screenings.
Accredited by National Committee for Quality AssuranceAccreditation is by the National Committee for Quality Assurance
(NCQA). NCQA is an independent, not-for-profit organization that
evaluates health plans based on more than 50 standards of care and
service to determine health plan accreditation.
6 | 2018StateofWisconsinGroupHealthInsuranceProgram
ConvenientTools and ResourcesGet the information you need, when you need it. Find it within member tools that easily connect you
to health information, benefit details and much more.
View details of your insurance plan benefits
Change your primary care provider
Request ID cards or download a digital ID card
Review and print claims history and information
Check the status of prior authorizations for services
Find your Explanations of Benefits (EOB)
Your online member portal
Tip: You’ll need your member number from your ID card to activate your account.
Send and receive secure messages with your primary care provider and/or Care Management team
Get real-time lab and test results
Schedule appointments or review past visit details
Request prescription refills
View current medical records
Pay medical bills online
Your online health record
Want information on the go? Activate MyChart then download the mobile app onto your smartphone.
❯❯ Activate these accounts today! deancare.com/newmember
Online Answers ● Visit deancare.com/wi-employees for links to important member
documents with details of your benefits and coverage. There you’ll also find a link for our online directory so you can search for a provider, clinic or pharmacy near you.
deancare.com | 7
New MemberChecklistBegin your experience with Dean Health Plan by taking a few simple steps. Complete this checklist
to unlock resources and take important actions so you can get the most out of being a member. This
checklist is helpful even if you are continuing your coverage with Dean Health Plan.
Activate Your AccountsGet access anytime to your personal health information with your MyChart account. Have your health
insurance and member information available at your fingertips with your DeanConnect account.
Seepage6tolearnmore.
Review Your Health Care BenefitsTogether, the “It’s Your Choice” materials from the Wisconsin Department of Employee Trust Funds (ETF)
and the “Summary of Benefits and Coverage” documents from Dean Health Plan specifically outline the
benefits, services, exclusions and limitations under your policy. The same Guide is issued for each of the
many State of Wisconsin Group Health Insurance Program plans, but the Summary reflects Dean Health
Plan’s specific benefits, so be sure to read both. Visit deancare.com/wi-employees to access them online.
Please also see etf.wi.gov for more information.
Choose a Primary Care ProviderChoose a primary care provider (PCP) who is right for you. Go online or call our Customer Care Center
at 800-279-1301. Fostering an open and honest relationship with a primary care provider whom you can
trust is an important part of Dean’s integrated care model.
Transfer Your Medical RecordsOnce you’ve chosen a primary care provider and made an initial appointment, have your medical
records sent over from your previous clinic. Simply fill out an “Authorization to Release Protected Health
Information” form, available at deancare.com/members under Member Forms, and give it to your previous
provider. He or she will transfer the records to your new Dean provider.
Let Us Know if You Have Health ConcernsIf you have a chronic health condition or have a complex health care need, we encourage you to take
advantage of our Care Management services. Visit deancare.com or call the Customer Care Center at
800-279-1301 for more information.
Visit our State of Wisconsin Group Health Insurance Program website to access your policy’s specific benefits and coverage details: deancare.com/wi-employees
8 | 2018StateofWisconsinGroupHealthInsuranceProgram
The DeanProvider NetworkAs a Dean Health Plan member, you have access to more than 2,000 in-network providers
throughout our 20-county service area. Visit our State of Wisconsin Group Health Insurance Program
website at deancare.com/wi-employees for the online provider directory to easily find excellent doctors
available in our network. Please see the back inside cover of this book for a detailed service area map.
• To search the directory, select Online Provider Directory.
• To download an electronic copy of the directory, select Printable Provider Directory.
• You may also call our Customer Care Center at 800-279-1301 to request a copy to be mailed to you.
Providers in the NetworkMadison and Beyond
SSM Health Dean Medical Group is a major provider of health care to Madison and its surrounding
communities. Our reach goes beyond the Capital City with more than two dozen clinic locations, all
owned by SSM Health.
To complement our clinics, more than 2,000 other doctors across southern Wisconsin have joined the
Dean Health Plan network. In addition to unsurpassed access, patients enjoy consistent, high-quality care
that’s been recognized in a variety of independent measures. Our health plan, clinics and hospitals have
a long tradition of collaborating to provide you with the care you need, where and when you need it. We
work together – for you.
SSM Health Dean Medical GroupWhere Quality Soars
We lead the pack in a variety of key measures linked to prevention and
management of chronic conditions, as compiled by the Wisconsin Collaborative
for Healthcare Quality in 2016.
Hospitals You Can Trust
SSM Health St. Mary’s Hospital – Madison, SSM Health St. Mary’s Hospital – Janesville
and SSM Health St. Clare Hospital – Baraboo offer high-quality care and an
exceptional patient experience. SSM Health St. Mary’s Hospital – Madison is
recognized as one of the best hospitals for 2017–18 in Wisconsin by U.S.News&
WorldReport; it was also named a Best Regional Hospital, a status earned by just
10 percent of the nearly 5,000 hospitals evaluated. SSM Health St. Mary’s Hospital –
Janesville achieved the most improved door-to-imaging time for stroke patients in
the first quarter of 2017 among all 46 state hospitals participating in the Wisconsin
Coverdell Stroke Program. SSM Health St. Clare Hospital – Baraboo was one of only
six hospitals nationally to receive the Premier QUEST award for high-value health
care in all six categories.
deancare.com | 9
UnderstandingYour BenefitsThe State of Wisconsin Group Health Insurance Program is a network-based plan. That means your
primary care provider from our Dean Health Plan network oversees all aspects of your health care needs
and emphasizes preventive care to keep you as healthy as possible. Please refer to the State of Wisconsin
Group Health Insurance Program’s “It’s Your Choice” materials and your “Summary of Benefits and
Coverage” from Dean for details.
Claims and PaymentFiling ClaimsTime is valuable to all of us; that’s why Dean Health Plan minimizes the amount of paperwork required
for our members. In most cases, claims are submitted directly to Dean Health Plan by providers or clinic
staff. On occasion, if you’re traveling out of the area or have a college-age dependent, for example, it may
be necessary for you to submit a claim for reimbursement. When submitting the claim, please be sure to
follow these guidelines:
1. Send an itemized bill from the provider of services. If services were received outside of the
United States, you will need to submit the original bill along with an itemized bill that has been
translated into English and indicate the appropriate currency exchange rate at the time the
services were received.
2. Send the bill within 60 days of receiving the services to:
Dean Health Plan
Attn: Claims Department
P.O. Box 56099
Madison, WI 53705
If you have another insurance company that is the primary payer, you will need to send the Explanation of
Benefits (described below) to Dean Health Plan or to your health care provider.
Explanation of Benefits (EOB)The EOB contains important information including the total amount charged, the amount paid by Dean
Health Plan, and the amount that is your (the member’s) responsibility. You may access all of your EOBs
online at any time through your DeanConnect account, accessible at deancare.com/wi-employees.
Remember, an EOB is not a bill.
deancare.com/wi-employees or etf.wi.govYour place to go for policy information, including:
• Provider listings
• Plan information and details
• Dean Health Plan Communication – copies of letters and other
correspondence sent to members
10 | 2018StateofWisconsinGroupHealthInsuranceProgram
Getting theRight Care
You may be wondering why we stress the importance of selecting a primary care provider (or location)
within the Dean Health Plan network as you enroll. It’s because we emphasize a proactive, preventive
approach to care—one in which a primary care provider oversees all aspects your health care needs. This
keeps you and your family well and decreases the duplication of services. Your primary care provider
should be your first choice for care whenever possible. But know that when a more immediate need arises,
you do have other options.
If you’re unsure where to get care, call Dean On Call, our 24-hour nurse hotline for help. See page 3 for
more information about Dean On Call. Making the right choice when it comes to the care you need ensures
you receive the right care in the right place without unnecessary costs.
Urgent and Emergency CareIf immediate care is needed, visit urgent care. Urgent care is designed to treat medical problems that
require attention sooner than a regular office visit, but are not serious enough to warrant a visit to an
emergency department. Urgent care sites are also generally open on evenings and weekends.
For critical illness or injury, seek emergency care. Though urgent care centers are convenient and a
good option for some illnesses and injuries, more serious symptoms need immediate care at an emergency
department. Dial 911 if you think a health problem is life threatening or could worsen on the way to the hospital.
Out-of-Area CareWith Dean Health Plan, there’s no need to worry about health insurance while on vacation. Both urgent
and emergency care are covered by Dean Health Plan if you or your covered family member are unable
to return to the service area for immediate treatment. It’s also a good idea to familiarize yourself with the
types of ailments that can be treated as urgent care vs. emergency care. Visit deancare.com/rightcare
for details.
PRIMARYCARE
URGENTCARE EMERGENCY
CARE
deancare.com | 11
Behind the Scenes at DeanWays we’re helping you get the right care
Prior AuthorizationAs you navigate your health care, it’s important to note that there are certain medical services or provider
visits that will require prior authorization by Dean Health Plan. These authorizations are required so our
Medical Affairs team can make sure you are getting the appropriate care. A good rule to remember
is that any time you seek services with an out-of-network provider, you will need to obtain a prior
authorization.
Utilization ManagementWhen you need to discuss issues or have questions related to the requirement of an authorization for a
particular service, Dean Health Plan is here to help. Contact the Customer Care Center at 800-279-1301 (TTY: 711), and you will be connected to the Utilization Management department. This department ensures
you receive the appropriate and necessary care for your condition.
Utilization Management staff members are available Monday through Friday, 8 am to 4:30 pm. If you have an
urgent need outside of those hours, please leave a message with the Customer Care Center and your call will
be returned within one business day.
New Medical TechnologyEvery year Dean Health Plan evaluates new medical technology and reviews existing technology to
determine if any changes or updates are needed to guidelines outlining appropriate use. During this
process, we review requests for ongoing care or treatment recommendations for all utilization management
decisions, including medical, behavioral health care, pharmaceuticals and medical devices. Dean Health Plan
follows the review process set by the National Commission for Quality Assurance (NCQA). Based upon the
results of the technology assessment, we will draft or revise medical policies if necessary.
For help to translate or understand this information, please call 800-279-1301 (TTY: 711).
12 | 2018StateofWisconsinGroupHealthInsuranceProgram
CommonInsurance TermsAllowed amount: The maximum amount on which payment is based for a health plan’s covered health care services.
Annual maximum out-of-pocket: The maximum amount a member could pay out-of-pocket for covered health care services in a plan year before the plan would pay 100 percent of the cost of covered services. The maximum does not include premium payments.
Benefit maximum: A benefit maximum is a limit on a covered service. A service may be limited by duration or number of visits – and if not an Essential Health Benefit, by dollar limit. To review your benefit maximums please refer to your member policy document.
Coinsurance: Your share of the costs of a covered health care service, calculated as a percent of the allowed amount for the service. You pay coinsurance plus any deductibles you owe first. For example, if Dean Health Plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your coinsurance payment of 20% would be $20. Dean Health Plan pays the rest of the allowed amount.
Copay: A fixed amount that you pay for a covered health care service, usually when you get the service. The amount can vary by the type of covered health care service.
Deductible: The amount you owe for covered services before the plan begins to pay. For example, if your deductible is $1,000, Dean Health Plan won’t pay anything for covered services subject to the deductible until you’ve met your $1,000. Not all services are subject to the deductible, such as preventive services.
Essential Health Benefits (EHB): Essential Health Benefits consist of 10 health care benefit categories. Plans that cover EHB may put an annual or lifetime dollar limit on the amount of EHB.
Formulary: A list of prescription drugs covered by an insurance plan offering prescription drug benefits. Also called a drug list. Normally a formulary will also tell you what tier (or cost-sharing level) a particular drug will be in.
Guaranteed issue: A requirement that health plans must allow you to enroll for coverage regardless of health status, age, gender or any other factors that might predict the future use of health services.
Health Savings Account (HSA): A medical savings account available to taxpayers who are enrolled in a High Deductible Health Plan. The funds contributed to the account aren’t subject to federal income tax at the time of deposit. Funds must be used to pay for qualified medical expenses. Unlike a Flexible Spending Account (FSA), funds roll over year to year if you don’t spend them.
Individual mandate: All individuals, with certain exceptions, are required to maintain minimum essential health coverage under the Affordable Care Act provisions.
In-network providers: Refers to physicians, hospitals or other health care providers who are contracted with Dean Health Plan.
Out-of-network providers: Refers to physicians, hospitals or other health care providers who are not contracted with Dean Health Plan, which could result in a greater cost for services for you.
Pre-existing condition: A health problem you had before the date that new health coverage starts. Under the Affordable Care Act, insurers may no longer impose benefit limitations or exclusions due to a pre-existing condition.
Preventive care: Routine health care that includes screenings, check-ups and patient counseling to prevent illnesses, disease or other health problems.
Prior authorization: Approval from a health plan that may be required before you receive services or fill a prescription in order for the service or prescription to be covered by your plan.
deancare.com | 13
MemberRights & ResponsibilitiesYou deserve the best service and health care possible. Rights and responsibilities help foster cooperation
among members, practitioners and Dean Health Plan.
Members have the right to: • Be treated with respect and recognition of their dignity and right to privacy.
• Receive a listing of Dean Health Plan participating practitioners in order to choose a Primary Care Physician.
• Present a question or complaint or grievance to Dean Health Plan, about the organization or the care it
provides, without fear of discrimination or repercussion.
• Receive information on procedures and policies regarding their health care benefits.
• Timely responses to requests regarding their health care plan.
• Request information regarding Advance Directives.
• Participate with practitioners in making decisions about their health care.
• A candid discussion of appropriate or medically necessary treatment options for their conditions,
regardless of cost or benefit coverage.
• Receive information about the organization, its services, its practitioners and providers, and members’
rights and responsibilities.
• Make recommendations regarding the organization’s members’ rights and responsibilities policies.
• Receive a copy of the Dean Health Plan Notice of Privacy Practices, which describes how medical
information about you may be used or disclosed and how you can get access to this information.
The notice is available at deancare.com/privacy.
Members have the responsibility to: • Read and understand the materials provided by Dean Health Plan concerning their health care benefits.
Dean Health Plan encourages members to contact Dean Health Plan if they have any questions.
• Present their ID card in order to identify themselves as Dean Health Plan members before receiving
health care services.
• Notify Dean Health Plan of any enrollment status changes such as family size or address You must also
communicate enrollment status changes to your employer so that your system of record can be updated.
• Supply information (to the extent possible) that the organization and its practitioners and providers
need in order to provide care.
• Follow plans and instructions for care that they have agreed on with their practitioners.
• Understand their health problems and participate in developing mutually agreed upon treatment goals
to the degree possible.
• Fulfill financial obligations as they relate to any copays, deductibles and/or premiums as outlined
in your policy.
• Provide information about any other health insurance coverage you have so that Dean Health Plan can
coordinate benefits with the other insurance plan(s).
14 | 2018StateofWisconsinGroupHealthInsuranceProgram
PlanDetailsLimitations & ExclusionsFor a list of services, treatments, equipment or supplies that are excluded (meaning no benefits are
payable under the Plan Benefits); or have some limitations on the benefit provide, please refer to the
State of Wisconsin Group Health Insurance Program’s “Its Your Choice” materials, under Uniform Benefits
Exclusions and Limitations.
Complaints, Grievances and Appeals ProcessWe know that at times you may have questions and concerns about benefits, claims or services you have
received from Dean Health Plan. Sharing your concerns will help us to identify areas of improvement or
clarification needed in our processes or documents as well as help clear up areas of confusion with your
benefits or coverage. When a question or concern arises, we encourage you to reach out to our Customer
Care Center at 800-279-1301. Our Customer Care Specialists will make every effort to resolve your
concern promptly and completely. Your input matters, and we encourage you to call with any concerns
you may have regarding your health care.
If after contacting us, you continue to feel
a decision has adversely affected your
coverage, benefits or relationship with
Dean Health Plan, you may file a grievance
(sometimes called an appeal). For details
on how to file or for more information
about these procedures, please visit the
online Member Handbook accessible on
deancare.com/members under Member Benefits. Or feel free to contact the
Customer Care Center at 800-279-1301 with
any questions about the process.
As a member of the State of Wisconsin
Group Health Insurance Program, you also
have the right to request an administrative
review through ETF if an independent review
organization has not rendered a decision on
your grievance that is final and binding. Refer
to your “It’s Your Choice” materials for details
on this process.
deancare.com | 15
Privacy andConfidentiality
Privacy and ConfidentialityThis notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Protecting the Privacy of Your Personal Health InformationDean is required by law to maintain the privacy of your personal health and financial information (collectively referred to as “non-public personal information”) and provide you with written notification of our legal duties and privacy practices concerning that information. This Notice describes how we protect the confidentiality of our members’ (and former members’) nonpublic personal information. It includes brief explanations on how we obtain, use, and protect your nonpublic personal information.
Types of Nonpublic Personal Information Dean Collects About YouWe collect a variety of nonpublic personal information needed to administer health insurance coverage and benefits. We collect nonpublic personal information about you from some of the following sources:
• Information we receive directly or indirectly from you or your employer or benefits plan sponsor through applications, surveys or other forms. The information may be received in writing, in person, by telephone or electronically. Examples include name, address, social security number, date of birth, marital status and medical history.
• Information about your transactions with us, our affiliates, our providers, our agents and others. This includes information from health care claims, medical history, eligibility information, payment information, service request, and appeal and grievance information.
• Information you authorize us to collect from others.
Choices about Your Health InformationWe will not use or disclose your health information without your written authorization, except as described in this Notice. You generally have the right and choice to tell us to:
• Share information with your family, close friends or others involved in payment for your care.
• Share information in a disaster relief situation.
In the following cases we never share your information unless you give us written permission:
• Most uses and disclosures of psychotherapy notes
• Marketing purposes
• Sale of your information
If you do give us written authorization to use or disclose your health information for a particular purpose, you may change your mind at any time. You must let us know in writing if you change your mind.
How Dean May Use or Disclose Your Health InformationWe will not disclose your nonpublic personal information unless we are allowed or required by law to do so. The following categories describe the ways that Dean may use and disclose your nonpublic personal information. For each category of uses and disclosures, we will explain what we mean and present some examples. Not every use or disclosure we might make will be listed. However, all the ways we are permitted to use and disclose information will fall within one of the categories.
Note: Some of the uses and disclosures described in this notice may be limited in certain cases by applicable State laws that are more stringent than Federal laws, including disclosures related to mental health and substance abuse, developmental disability, alcohol and other drug abuse (AODA), and HIV testing.
We are allowed to use and disclose information that falls within one of the following categories:
1. Payment. We may use and disclose your health information to make and collect payment for treatment and services you receive, such as: determining your eligibility for plan benefits, obtaining premiums, determining your health plan’s responsibility for benefits, and collecting payment for your health services.
2. Health Care Operations. We may use and disclose your health information to support our business activities and improve our coverage and services. However, we are not allowed to use genetic information to decide whether we will give you coverage or the price of that coverage. Health care operations include such activities as:
• Underwriting
• Premium rating
• Other functions related to plan coverage
• Quality assessment and improvement activities
• Activities designed to improve health and reduce health care cost
• Case management and care coordination
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
16 | 2018StateofWisconsinGroupHealthInsuranceProgram
Notice: We are part of an Organized Health Care Arrangement (OHCA) with SSM Health and Dean Health System. As part of the OHCA, we may from time to time share your information with other members of the OHCA in order to perform joint health care operations. These uses and disclosures allow the OHCA to run efficiently. For example, we may share your information in order to: improve population health management; conduct quality assessment and improvement activities; conduct or arrange for medical review, legal services, audit services, and fraud and abuse detection programs; business planning and development such as cost management; and business management and general OHCA administrative activities.
1. Treatment. We may disclose your health information to a physician or other health care provider that is treating you. We may contact you with information on treatment alternatives and other related functions that may be of interest to you.
2. Distributing Health-related Benefits and Services. We may use and disclose your health information to provide information on health-related benefits and services that may be of interest to you.
3. Disclosure to Plan Sponsors. If applicable, we may disclose your health information to the sponsor of your group health plan for purposes of administering benefits under the plan. If you have a group health plan, your employer is the plan sponsor.
4. Public Safety. We can share health information about you for certain situations such as: preventing disease; helping with product recalls; reporting adverse reactions to medications; reporting suspected abuse, neglect, or domestic violence; and preventing or reducing a serious and imminent threat to the health or safety of a particular person or the public.
5. Research. Under certain circumstances, and only after a special approval process, we may use and disclose your health information to help conduct research.
6. Required by Law. We will share information about you if laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.
7. Workers’ Compensation, Law Enforcement, and Other Government Requests. We can use and share health information about you: for workers’ compensation claims; for law enforcement purposes or with a law enforcement official; with health oversight agencies for activities authorized by law; and for special government functions such as military, national security, and presidential protective services.
8. Legal Actions. We may disclose your health information in the course of any administrative or judicial proceeding.
How Dean Protects This InformationWe limit the collection of nonpublic personal information to that which is necessary to administer our business, provide quality service, and meet regulatory requirements. We maintain physical, electronic, and procedural safeguards that comply with federal regulations to safeguard your nonpublic personal information. We limit the internal use of oral, written, and electronic nonpublic personal information about you and ensure that only authorized staff and business associates with the need to know have access to it. We maintain safeguards for your nonpublic personal information and review them regularly to protect your privacy.
Your Health Information Rights1. Right to Request Restrictions. You have the right to request
restrictions on certain uses and disclosures of your health information.
2. Right to Request Confidential Communications. You have the right to receive your health information through a reasonable alternative means or at an alternative location.
3. Right to See and Copy. You have the right to see and copy certain health information about you.
4. Right to Correct Records. You have a right to request that Dean correct certain health information held by Dean if you think it is incorrect or incomplete.
5. Right to Accounting of Disclosures. You have the right to receive a list “accounting of disclosures” of your health information made by us in the past six years. The list will not include disclosures made for purposes of treatment, payment, health care operations, or certain other disclosures (such as those you asked us to make).
6. Right to Copy of Notice. You have a right to receive a paper copy of this Notice at any time.
7. Right to be Notified of a Breach. You will be notified in the event of a breach of your unsecured protected health information.
8. Right to a Representative. You have the right to appoint a medical power of attorney, of if someone is your legal guardian, that person can exercise your rights and makes choices about your health information.
Changes to this Notice of Privacy PracticesDean may change this Notice from time to time and make the new provisions effective for all nonpublic personal information we maintain, including information we created or received before the change.
Dean will always comply with the current version of this Notice.
ComplaintsPlease submit complaints about this Notice or how we handle your health information, in writing, to our Privacy Officer. Dean will not hold any complaint you submit against you in any way. In addition, if you believe your privacy rights have been violated, you may file a complaint with the Secretary of the U.S. Department of Health and Human Services.
If you have questions, complaints, or want to exercise any of your health information rights, call the Customer Care Center at 800-279-1301 (TTY: 711) or contact us at the following address:
Privacy OfficerPO Box 56099Madison, Wisconsin 53705
The effective date of this notice is 8/1/2017.
deancare.com | 17
YourNotes
18 | 2018StateofWisconsinGroupHealthInsuranceProgram
YourNotes
Vernon
Richland
Sauk
Grant
Iowa
LafayetteGreen Rock
Walworth
Jefferson
Waukesha
Juneau
Adams
MarquetteGreenLake
Fond du Lac
ColumbiaDodge
Dane
Friendship
Elroy
WonewocHillsboroMarkesan
Brandon
Ripon
Waupun
Mt. CalvaryFond du Lac
CampbellsportCampbellsportBrownsvilleFox Lake
MayvilleBeaver Dam
RandolphPardeevillePortage
Rio
ColumbusLodi
Baraboo
Lake Delton
Wisconsin Dells
Reedsburg
Plain
Sauk City
Prairie du Sac
Spring Green
Richland Center
Boscobel Muscoda
FennimoreMontfort
Highland
Dodgeville
Barneveld
Mineral Point
Lancaster
Platteville
Cuba City
Dubuque, IAGalena, IL Lena, IL
Freeport, ILDurand, IL
Roscoe, IL
Shullsburg
DarlingtonArgyle
BlanchardvilleNew Glarus
Monroe
Albany
Brodhead
Beloit
EdgertonMilton
Janesville
Clinton
Whitewater
DelavanDarien
Juneau
Watertown
Jefferson
Fort Atkinson
Johnson Creek
Lake Mills
Waterloo Ixonia OconomowocSussex
HartlandDelafield
Waukesha
Eagle Mukwonago
MuskegoNew Berlin
Brookfield
PewaukeeBlack Earth
Madison
Verona
BellevilleOregon Stoughton
Cambridge
Cottage Grove
Deerfield
Sun PrairieWaunakee
Evansville
Westfield
Oxford
Wauwatosa
Hospital only
Hospital and Primary Care Provider location
Primary Care Provider location only
ProviderNetwork
Dean Health Plan offers a current and complete listing of physicians, clinics, pharmacies and more at
deancare.com/doctors.
Important contact information such as phone numbers and locations are listed on our website. If you would like a
printed copy of the provider directory, please call our Customer Care Center at 800-279-1301. Please keep in
mind that the online directory has the most up-to-date listing of providers.
We’re Hereto Help
ClickVisit deancare.com/contact-us
and click the Dean Health Plan button.
CallCall the Customer Care Center 800-279-1301 (TTY: 711)
Monday through Thursday: 7:30 am to 6 pm
Friday: 7:30 am to 5 pm
Come inOur Insurance Desk is open Monday through Friday,
7:30 am to 5 pm. Come in to our Health Plan Office or
one of the following SSM Health Dean Medical Group locations:
Business Office: 1277 Deming Way, Madison
East: 1821 S. Stoughton Road, Madison
West: 752 N. High Point Road, Madison
Fish Hatchery: 1313 Fish Hatchery Road, Madison
Janesville East: 3200 E. Racine Street, Janesville
5-Star Employee Trust Fund's Quality Rating for 2018!
©2017 Dean Health Plan, Inc. • 4910_1708
Dean Health Plan, Inc. | 1277 Deming Way | Madison, WI 53717
800-279-1301 | TTY: 711 | deancare.com
2018 State of WisconsinGroup Health Insurance Program
