Wisconsin HSA Plans

There are 3 HSA eligible plans in Wisconsin, available state-wide through Blue Cross Blue Shield.

Health Savings Accounts can reduce your out of pocket costs as well as your tax burden. Learn more at our HSA Guide.

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Advantage Bronze HMO 006, Advantage Bronze 104, Advantage Silver 103
Plan Name Blue Advantage Bronze HMO 006 Blue Advantage Plus Bronze 104 Blue Advantage Silver HMO 103
Plan Brochure Plan Details Plan Details Plan Details
Deductiblea specified amount of money that the insured must pay before an insurance company will pay a claim. $6,500 $5,000 $3,750
CoinsuranceWhat % you pay after your deductible has been met and before your out of pocket max None (Member pays 0% after deductible) 40% 0%
Out-of-Pocket MaximumAn out-of-pocket maximum is the most you'll have to pay during a policy period (usually a year) for health care services (includes deductible) $6,500 $6,550 $3,750
Primary Care Office Visit 0% after deductible 40% $30
Specialist Office Visit 0% after deductible 40% $0 after deductible
Mental Illness Treatment and Substance Abuse Rehab Office Visit 0% after deductible 40% 40%
Emergency Room 0% after deductible 40% 40%
Urgent Care 0% after deductible $20 $0 after deductible
Inpatient Hospital Service 0% after deductible 40% $0 after deductible
Outpatient Surgery 0% after deductible 50% $0 after deductible
Outpatient X-Rays and Diagnostic Imaging 0% after deductible 50% $100
Outpatient Imaging (CT/PET Scans/MRIs) 0% after deductible 50% $0 after deductible
Network Blue Advantage HMO
HSA Eligible Yes Yes Yes
Outpatient Prescription Drugs – Preferred Pharmacy 0% after deductible 30%/30%/40%/50%/50% $0 after deductible
Outpatient Prescription Drugs – Non-Preferred Pharmacy 0% after deductible 35%/35%/50%/50%/50% $0 after deductible
Prescription Drug Utilization Benefit Management Programs Specialty Pharmacy Program: To be eligible for maximum benefits, specialty medications must be obtained through the preferred Specialty Pharmacy provider. Member Pay the Difference: When choosing a brand name drug over an available generic equivalent, you pay your usual share plus the difference in cost. Prior Authorization/Step Therapy Requirements: Before receiving coverage for some medications, your doctor will need to receive authorization from BCBSWI and you may first need to try more clinically appropriate or cost-effective drugs. Mail-Order Program: You may receive up to a 90-day supply for prescription drugs through the mail-order program or at select retail pharmacies depending on your prescription drug benefit.