Wisconsin health plan · 2026

Premier POS $5,500 - 40% Copay · 38166WI0150036

Security Health Plan of Wisconsin, Inc. offers this marketplace health insurance plan (Plan ID 38166WI0150036) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Silver Plan type: POS CSR: Standard Silver On Exchange Plan Issuer: Security Health Plan of Wisconsin, Inc.
Telehealth Data pending HSA eligible No Dental Not listed Vision Adult/Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 71.53% (28.47% member share on average). Learn about AV methodology.

2026 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$499 – $2442

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

$10,000

$20000 per group

Review MOOP rules

Office visits

Primary care $40.00
Specialist $80.00
HSA Not eligible

Drug tiers

Generic $5.00
Preferred brand $60.00

View formulary tiers

$731 / mo before subsidies

≈ $8776 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$2449 / mo before subsidies

≈ $29390 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$2905 / mo before subsidies

≈ $34857 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1945 / mo before subsidies

≈ $23339 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge, No Charge

Emergency Room Services

No Charge after deductible, 40.00% Coinsurance after deductible

Durable Medical Equipment

No Charge after deductible, 40.00% Coinsurance after deductible

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Enrollment guidance

Stay on top of 2026 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2026 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Wisconsin). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Standard Silver On Exchange Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge, No Charge

Emergency Room Services

No Charge after deductible, 40.00% Coinsurance after deductible

Durable Medical Equipment

No Charge after deductible, 40.00% Coinsurance after deductible

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 38166WI0150036
Coverage year 2026
State Wisconsin
Issuer Security Health Plan of Wisconsin, Inc.
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 38166WI0150036-01
Available variants

Standard Off Exchange Plan · 38166WI0150036-00

Standard On Exchange Plan · 38166WI0150036-01
Last plan update Thu, 30 Oct 2025 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Wisconsin 12119
PCPs in Wisconsin 1412
Telehealth support Data pending
Nationwide providers 16596
12,119 doctors statewide 1,412 PCPs 47 OB/GYN

Provider network(s)

Providers Wisconsin All US states
All 12119 16596
PCP 1412 2289
Allergy 10 12
OB/GYN 47 73
Dentists 113 126

Drug coverage overview

7,563 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
NON-PREFERRED-GENERIC-AND-NON-PREFERRED-BRAND 4,068
SPECIALTY-DRUGS 2,055
ZERO-COST-SHARE-PREVENTIVE-DRUGS 1,440
Prior authorization Drugs
Required 1,438
Not Required 6,125
Step therapy Drugs
Required 451
Not Required 7,112
Quantity limits Drugs
Has Limit 2,126
No Limit 5,437

Customer highlights

What stands out for members

  • Issuer: Security Health Plan of Wisconsin, Inc. · Plan ID 38166WI0150036 · 2026 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, Pregnancy, Weight Loss Programs.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 38166WI0150036-01 (Standard On Exchange Plan) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Diabetes Care Management

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Diabetes Education

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Home Health Care Services

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 60.0 Visit(s) per Year

Services must be provided fewer than seven days each week and fewer than eight hours each day for periods of 21 days or less.

Laboratory Outpatient and Professional Services

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Other Practitioner Office Visit (Nurse, Physician Assistant)

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Preventive Care/Screening/Immunization

No Charge, No Charge
Tier 1 in-network No Charge, No Charge
Out-of-network 100.00%

Primary Care Visit to Treat an Injury or Illness

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Rehabilitative Occupational and Rehabilitative Physical Therapy

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Limit: 20.0 Visit(s) per Year

Exclusions: Limitations include: services that are not for or related to the treatment of an illness or injury, services that continue after the member reaches the expected state of improvement, resolution or stabilization of a health condition as determined by Security Health Plan, treatment provided by athletic trainers, physical therapy, speech therapy, occupational therapy and/or complementary therapy for the following conditions: learning disabilities, developmental delay (regardless of cause), perceptual disorders, intellectual disabilities or related conditions, behavior disorders, multiple handicaps, sensory deficit, motor dysfunction, communication or articulation disorders including apraxia, dyspraxia and pervasive development disorders.

Rehabilitative Speech Therapy

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Limit: 20.0 Visit(s) per Year

Rehabilitative services must be short term.

Exclusions: Limitations include: services that are not for or related to the treatment of an illness or injury, services that continue after the member reaches the expected state of improvement, resolution or stabilization of a health condition as determined by Security Health Plan, treatment provided by athletic trainers, physical therapy, speech therapy, occupational therapy and/or complementary therapy for the following conditions: learning disabilities, developmental delay (regardless of cause), perceptual disorders, intellectual disabilities or related conditions, behavior disorders, multiple handicaps, sensory deficit, motor dysfunction, communication or articulation disorders including apraxia, dyspraxia and pervasive development disorders.

Specialist Visit

$80.00
Tier 1 in-network $80.00
Out-of-network 100.00%

Urgent Care Centers or Facilities

$80.00
Tier 1 in-network $80.00
Out-of-network $80.00

Exclusions: Limitations include: care that can safely be postponed until the member returns to the service area, follow-up care received from a non-network provider unless prior authorized by Security Health Plan and take-home drugs and supplies dispensed by a hospital at the time of hospital discharge for use at home.

X-rays and Diagnostic Imaging

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Intravenous chemotherapy is covered.

Delivery and All Inpatient Services for Maternity Care

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Exclusions: Limitations include: prenatal cradle (maternity belt), home delivery and home visits, services performed by a licensed midwife or certified professional midwife, services to determine gender, abortion procedures to end a pregnancy except as specifically stated above.

Dialysis

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Durable Medical Equipment

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Exclusions: Limitations include: routine maintenance and replacement of equipment because of abuse and neglect and urable medical equipment and medical supplies for your comfort, personal hygiene, convenience or athletics-related conditions including, but not limited to, air conditioners, air cleaners, humidifiers, physical fitness equipment, disposable supplies, self-help devices not medical in nature, duplicate pieces of equipment, deluxe/nonstandard equipment and back-up equipment.

Emergency Room Services

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network No Charge after deductible, 40.00% Coinsurance after deductible

Exclusions: Limitations include: care that can safely be postponed until the member returns to the service area, follow-up care received from a non-network provider unless prior authorized by Security Health Plan and take-home drugs and supplies dispensed by a hospital at the time of hospital discharge for use at home.

Emergency Transportation/Ambulance

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network No Charge after deductible, 40.00% Coinsurance after deductible

Exclusions: Limitations include: Ambulance transport to a home or outpatient setting, medical van transportation, non-emergency licensed professional ambulance services (unless authorized by Security Health Plan), first responders and rescue services and transportation from an acute facility to a sub-acute setting.

Hospice Services

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Exclusions: Limitations include: financial or legal counseling, including estate planning or drafting of a will, homemaker or caretaker services that are not solely related to the member’s care including, but not limited to, sitter or companion services for the member or the member’s family, transportation, house cleaning, or physical maintenance of the house and pastoral counseling or funeral arrangements.

Inpatient Hospital Services (e.g., Hospital Stay)

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Inpatient Physician and Surgical Services

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Mental/Behavioral Health Inpatient Services

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Mental/Behavioral Health Outpatient Services

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Outpatient Rehabilitation Services

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Limit: 20.0 Visit(s) per Year

Rehabilitative services must be short term.

Exclusions: Limitations include: services that are not for or related to the treatment of an illness or injury, services that continue after the member reaches the expected state of improvement, resolution or stabilization of a health condition as determined by Security Health Plan, treatment provided by athletic trainers, physical therapy, speech therapy, occupational therapy and/or complementary therapy for the following conditions: learning disabilities, developmental delay (regardless of cause), perceptual disorders, intellectual disabilities or related conditions, behavior disorders, multiple handicaps, sensory deficit, motor dysfunction, communication or articulation disorders including apraxia, dyspraxia and pervasive development disorders.

Outpatient Surgery Physician/Surgical Services

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Radiation

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Skilled Nursing Facility

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 30.0 Days per Stay

Exclusions: Limitations include: skilled nursing care and/or skilled therapy not prior approved by Security Health Plan and leave-of-absence days, respite care, custodial care, care exceeding the number of days shown in the member’s Schedule of Benefits.

Substance Abuse Disorder Inpatient Services

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Substance Abuse Disorder Outpatient Services

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Transplant

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Exclusions: Limitations include: lodging expenses including meals, expenses related to the recipient’s transportation except for medically necessary professionally licensed ambulance services, the purchase price of any bone marrow, organ or tissue that is sold rather than donated, services not ordered by a physician or surgeon, transplants involving non-human or artificial organs or

Mental health & substance use

Behavioral health visits and substance use treatment.

Autism Spectrum Disorders

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Mental Health Other

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Hearing Aids

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 1.0 Item(s) per 3 Years

Major Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Prenatal and Postnatal Care

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Routine Eye Exam for Children

No Charge, No Charge
Tier 1 in-network No Charge, No Charge
Out-of-network 100.00%

Limit: 1.0 Visit(s) per Year

Well Baby Visits and Care

No Charge, No Charge
Tier 1 in-network No Charge, No Charge
Out-of-network 100.00%

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$5.00
Tier 1 in-network $5.00
Out-of-network 100.00%

Exclusions: Limitations include: prescription drugs dispensed by non-network pharmacies, prescription drugs not found on the current version of the formulary, medications administered in a physician office (and/or associated fees) that could be safely self-administered or have oral or other alternatives that could be safely self-administered, prescription drugs as a replacement for a previously dispensed prescription drug that was lost, stolen, broken or destroyed, prescription drugs dispensed for an amount that exceeds the supply limit (daily supply or quantity limit), prescription drugs dispensed outside the United States, except as required for emergency treatment, prescription drugs packaged with an over-the-counter medication in a kit, unless the kit is specifically included on the current formulary.

Non-Preferred Brand Drugs

$120.00
Tier 1 in-network $120.00
Out-of-network 100.00%

Exclusions: Limitations include: prescription drugs dispensed by non-network pharmacies, prescription drugs not found on the current version of the formulary, medications administered in a physician office (and/or associated fees) that could be safely self-administered or have oral or other alternatives that could be safely self-administered, prescription drugs as a replacement for a previously dispensed prescription drug that was lost, stolen, broken or destroyed, prescription drugs dispensed for an amount that exceeds the supply limit (daily supply or quantity limit), prescription drugs dispensed outside the United States, except as required for emergency treatment, prescription drugs packaged with an over-the-counter medication in a kit, unless the kit is specifically included on the current formulary.

Preferred Brand Drugs

$60.00
Tier 1 in-network $60.00
Out-of-network 100.00%

Exclusions: Limitations include: prescription drugs dispensed by non-network pharmacies, prescription drugs not found on the current version of the formulary, medications administered in a physician office (and/or associated fees) that could be safely self-administered or have oral or other alternatives that could be safely self-administered, prescription drugs as a replacement for a previously dispensed prescription drug that was lost, stolen, broken or destroyed, prescription drugs dispensed for an amount that exceeds the supply limit (daily supply or quantity limit), prescription drugs dispensed outside the United States, except as required for emergency treatment, prescription drugs packaged with an over-the-counter medication in a kit, unless the kit is specifically included on the current formulary.

Prescription Drugs Other

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Specialty Drugs

45.00%
Tier 1 in-network 45.00%
Out-of-network 100.00%

Exclusions: Limitations include: prescription drugs dispensed by non-network pharmacies, prescription drugs not found on the current version of the formulary, medications administered in a physician office (and/or associated fees) that could be safely self-administered or have oral or other alternatives that could be safely self-administered, prescription drugs as a replacement for a previously dispensed prescription drug that was lost, stolen, broken or destroyed, prescription drugs dispensed for an amount that exceeds the supply limit (daily supply or quantity limit), prescription drugs dispensed outside the United States, except as required for emergency treatment, prescription drugs packaged with an over-the-counter medication in a kit, unless the kit is specifically included on the current formulary.

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Basic Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Dental Anesthesia

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Dental Check-Up for Children

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Infusion Therapy

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Major Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Nutritional Counseling

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Exclusions: Covered only when both of the following are true: nutritional education is required for a disease in which patient self-management is an important component of the treatment and there exists a knowledge deficit regarding the disease which requires the intervention of a trained health professional

Orthodontia - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Orthodontia - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Prosthetic Devices

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Routine Dental Services (Adult)

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Weight Loss Programs

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Acupuncture

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Allergy Testing

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Bariatric Surgery

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Cardiac Rehabilitation

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 36.0 Visit(s) per Year

Clinical Trials

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Cosmetic Surgery

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Eye Glasses for Children

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 1.0 Visit(s) per Year

Exclusions: Limited to a selection of glasses approved by Security Health Plan

Habilitation Services

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Limit: 20.0 Visit(s) per Year

Supplementing with the federal definition of habilitative services: Health care services that help a person keep, learn, or improve skills and functioning for daily living. Examples include therapy for a child who is not walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology and other services for people with disabilities in a variety of inpatient and/or outpatient settings.

Exclusions: Limitations include: services that are not for or related to the treatment of an illness or injury, services that continue after the member reaches the expected state of improvement, resolution or stabilization of a health condition as determined by Security Health Plan, treatment provided by athletic trainers, physical therapy, speech therapy, occupational therapy and/or complementary therapy for the following conditions: learning disabilities, developmental delay (regardless of cause), perceptual disorders, intellectual disabilities or related conditions, behavior disorders, multiple handicaps, sensory deficit, motor dysfunction, communication or articulation disorders including apraxia, dyspraxia and pervasive development disorders.

Imaging (CT/PET Scans, MRIs)

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Infertility Treatment

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Long-Term/Custodial Nursing Home Care

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Newborn Services Other

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Private-Duty Nursing

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Reconstructive Surgery

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Routine Eye Exam (Adult)

No Charge, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Routine Foot Care

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Treatment for Temporomandibular Joint Disorders

No Charge after deductible, 40.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 40.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 4.0 Visit(s) per Year

Exclusions: Limitations include: cosmetic or elective orthodontic care, periodontal care, general dental care, upper and lower jawbone surgery except as required for direct treatment of acute traumatic injury, dislocation, cancer or temporomandibular joint disorder and orthognathic surgery jaw alignment, except as a treatment of obstructive sleep apnea.

Variant attributes

Premier POS $5,500 - 40% Copay · Variant 38166WI0150036-01

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2026

CSR Variation Type

Standard Silver On Exchange Plan

HIOS Product ID

38166WI015

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

38166WI0150036-01

Plan Marketing Name

Premier POS $5,500 - 40% Copay

Plan Variant Marketing Name

Premier POS $5,500 - 40% Copay

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

38166

Issuer Marketplace Marketing Name

Security Health Plan

Market Coverage

SHOP (Small Group)

Multiple In Network Tiers

No

National Network

No

Network ID

WIN005

Out of Country Coverage

Yes

Out of Country Coverage Description

Urgent and Emergent Care

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

Urgent and Emergent Care

Service Area ID

WIS005

State Code

WI

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.715266675

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

40.00%

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

No

Medical Drug Maximum Out of Pocket Integrated

Yes

Medical EHB Deductible, In Network (Tier 1), Default Coinsurance

40.00%

SBC Scenario, Having a Baby, Coinsurance

$2,700

SBC Scenario, Having a Baby, Copayment

$30

SBC Scenario, Having a Baby, Deductible

$5,500

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$1,700

SBC Scenario, Having Diabetes, Deductible

$500

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$0

SBC Scenario, Treatment of a Simple Fracture, Copayment

$90

SBC Scenario, Treatment of a Simple Fracture, Deductible

$2,600

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

$60000 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

$30000 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

$30,000

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$20000 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$10000 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$10,000

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

$40000 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

$20000 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

$20,000

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

WIF041

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$0

SBC Scenario, Having Diabetes, Limit

$0

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

1

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Drug EHB Deductible, Combined In/Out of Network, Family Per Group

$0 per group

Drug EHB Deductible, Combined In/Out of Network, Family Per Person

$0 per person

Drug EHB Deductible, Combined In/Out of Network, Individual

$0

Drug EHB Deductible, In Network (Tier 1), Family Per Group

$0 per group

Drug EHB Deductible, In Network (Tier 1), Family Per Person

$0 per person

Drug EHB Deductible, In Network (Tier 1), Individual

$0

Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Drug EHB Deductible, Out of Network, Individual

Not Applicable

Dental Only Plan

No

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, Pregnancy, Weight Loss Programs

First Tier Utilization

100%

HSA/HRA Employer Contribution

No

Import Date

10/30/2025

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

Yes

Is a Referral Required for Specialist?

No

Medical EHB Deductible, Combined In/Out of Network, Family Per Group

$33000 per group

Medical EHB Deductible, Combined In/Out of Network, Family Per Person

$16500 per person

Medical EHB Deductible, Combined In/Out of Network, Individual

$16,500

Medical EHB Deductible, In Network (Tier 1), Family Per Group

$11000 per group

Medical EHB Deductible, In Network (Tier 1), Family Per Person

$5500 per person

Medical EHB Deductible, In Network (Tier 1), Individual

$5,500

Medical EHB Deductible, Out of Network, Family Per Group

$22000 per group

Medical EHB Deductible, Out of Network, Family Per Person

$11000 per person

Medical EHB Deductible, Out of Network, Individual

$11,000

Plan Effective Date

1/1/2026

Plan Expiration Date

12/31/2026

Plan Type

POS

QHP/Non QHP

Both

Source Name

HIOS

Plan ID

38166WI0150036

Unique Plan Design

No

Wellness Program Offered

Yes

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Wisconsin?

Premier POS $5,500 - 40% Copay (38166WI0150036) is a Silver POS from Security Health Plan of Wisconsin, Inc. in Wisconsin for the 2026 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Premier POS $5,500 - 40% Copay support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Premier POS $5,500 - 40% Copay HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Adult, Child.

Does Premier POS $5,500 - 40% Copay support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with Premier POS $5,500 - 40% Copay?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, Pregnancy, Weight Loss Programs.

Is there out-of-country coverage for Premier POS $5,500 - 40% Copay?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Urgent and Emergent Care

Does Premier POS $5,500 - 40% Copay cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Urgent and Emergent Care

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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