Individual & Family

Medical Certificate & Policy Materials for Individual & Family Plans
To view your specific benefit and copay information, you will need to log into MyChart.

Member Handbook

Your member handbook provides information on benefits, eligibility, choosing and changing your PCP, specialty care, where to go for emergency care, and more.

Medical Certificate of Coverage
General Exclusions & Limitations
Appeal Process 
Privacy Policy


Enrollment Forms

Application Form
Plan Choice Form
Release of Information Authorization
Electronic Funds Transfer (EFT) Authorization & Change Form
Change Form for Non-Group Members ** For Changes Only. Please use the application (above) for new enrollment.


Send the Change Form to:
Physicians Plus Insurance Corporation
2650 Novation Parkway
Madison, WI 53713


Individual & Family Plan Base Rates Effective 1/1/17

Dane County Resident, Non-Tobacco User
Dane County Resident, Tobacco User

Outside Dane County, Non-Tobacco User
Outside Dane County, Tobacco User

 


2017 Individual Health Plans 

 
Gold
Gold-1: $35 Office Visits with $2,000 deductible and 20% Coinsurance
Gold-2: $35 Office Visits with $3,300 deductible
Gold-3: $2,500 deductible - Member only
Gold-4: $5,000 deductible - Family only

Silver
Silver-1: $40 Office Visits with $2,500 deductible and 30% Coinsurance
Silver-2: $40 Office Visits with $3,000 deductible and 20% Coinsurance
Silver-3: $25 Primary Care Physicians (PCP) Visits with $5,500 deductible
Silver-4: $25 PCP Visits with $6,000 deductible
Silver-5: $25 PCP Visits with $6,600 deductible
Silver-6: $25 PCP Visits with $6,850 deductible

Bronze
Bronze-1: $75 PCP Visits (limit of three visits) with $6,600 deductible and 50% coinsurance
Bronze-2: $75 PCP Visits (limit of three visits) with $6,750 deductible and 30% coinsurance
Bronze-3: $6,850 deductible 

Catastrophic
Basic Catastrophic: $7,150 deductible (with three PCP visits included at no additional cost)