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 1/1/18

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

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

 


2018 Individual Health Plans 


Gold
Copay Standard Gold $1,500
Copay Standard Gold $2,000
Copay Simple Gold $3,300
H.S.A. Gold $2,500 - Member Only
H.S.A. Gold $5,000 - Family Only
H.S.A. Gold $2,700 Embedded

Silver
Copay Value Silver $3,000
H.S.A. Silver $4,000
Copay Primary Silver $5,500
Copay Primary Silver $6,850

Bronze
H.S.A. Bronze $6,550 Embedded
Deductible Plus Bronze $7,000
Deductible Standard Bronze $7,350

Basic Catastrophic
Deductible Plus Catastrophic $7,350