Wisconsin health plan · 2026

QUARTZ GUNDERSEN PERFORMANCE SILVER (DENTAL & VISION) $9,000 DED · 37833WI0380344

Quartz Health Benefit Plans Corporation offers this marketplace health insurance plan (Plan ID 37833WI0380344) 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: HMO CSR: 73% AV Level Silver Plan Issuer: Quartz Health Benefit Plans Corporation
Telehealth Data pending HSA eligible No Dental Adult/Child Vision Adult/Child

Issuer actuarial value: 73.05%. Expect to pay roughly 26.95% of covered costs out of pocket, based on issuer reporting.

CMS AV Calculator output: 71.62% (28.38% 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

$395 – $1549

Before subsidies

Estimate after subsidies

Deductible

$5,500

$11000 per group

See deductible details

Max out-of-pocket

$8,400

$16800 per group

Review MOOP rules

Office visits

Primary care $30.00
Specialist $90.00
HSA Not eligible

Drug tiers

Generic $10.00
Preferred brand $100.00

View formulary tiers

$541 / mo before subsidies

≈ $6494 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.

$1715 / mo before subsidies

≈ $20578 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.

$2077 / mo before subsidies

≈ $24922 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.

$1320 / mo before subsidies

≈ $15838 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

Emergency Room Services

40.00% Coinsurance after deductible

Durable Medical Equipment

40.00%

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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.
  • 73% AV Level Silver 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

Emergency Room Services

40.00% Coinsurance after deductible

Durable Medical Equipment

40.00%

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.

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 3
PCPs in Wisconsin N/A
Telehealth support Data pending
Nationwide providers 3
3 doctors statewide
Providers Wisconsin All US states
All 3 3
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A

Drug coverage overview

3,848 drugs tracked

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

Tier Covered drugs
GENERIC 1,552
NON-PREFERRED 1,301
SPECIALTY 609
PREFERRED-BRAND 386
Prior authorization Drugs
Required 751
Not Required 3,097
Step therapy Drugs
Required 55
Not Required 3,793
Quantity limits Drugs
Has Limit 908
No Limit 2,940

Customer highlights

What stands out for members

  • Issuer: Quartz Health Benefit Plans Corporation · Plan ID 37833WI0380344 · 2026 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 37833WI0380344-04 (73% AV Silver Plan) currently displayed.
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Benefits

Covered services & limitations

Everyday care

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

Chiropractic Care

$30.00

Diabetes Care Management

$30.00

Diabetes Education

40.00% Coinsurance after deductible

Home Health Care Services

40.00% Coinsurance after deductible

Laboratory Outpatient and Professional Services

40.00% Coinsurance after deductible

Other Practitioner Office Visit (Nurse, Physician Assistant)

$30.00

Preventive Care/Screening/Immunization

No Charge

Primary Care Visit to Treat an Injury or Illness

$30.00

Rehabilitative Occupational and Rehabilitative Physical Therapy

40.00% Coinsurance after deductible

Rehabilitative Speech Therapy

40.00% Coinsurance after deductible

Specialist Visit

$90.00

Urgent Care Centers or Facilities

$90.00

X-rays and Diagnostic Imaging

40.00% Coinsurance after deductible

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

40.00% Coinsurance after deductible

Delivery and All Inpatient Services for Maternity Care

40.00% Coinsurance after deductible

Dialysis

40.00% Coinsurance after deductible

Durable Medical Equipment

40.00%

Emergency Room Services

40.00% Coinsurance after deductible

Emergency Transportation/Ambulance

40.00% Coinsurance after deductible

Hospice Services

40.00% Coinsurance after deductible

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

40.00% Coinsurance after deductible

Inpatient Physician and Surgical Services

40.00% Coinsurance after deductible

Mental/Behavioral Health Inpatient Services

40.00% Coinsurance after deductible

Mental/Behavioral Health Outpatient Services

$30.00

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

40.00% Coinsurance after deductible

Outpatient Rehabilitation Services

40.00% Coinsurance after deductible

Outpatient Surgery Physician/Surgical Services

40.00% Coinsurance after deductible

Radiation

40.00% Coinsurance after deductible

Skilled Nursing Facility

40.00% Coinsurance after deductible

Substance Abuse Disorder Inpatient Services

40.00% Coinsurance after deductible

Substance Abuse Disorder Outpatient Services

$30.00

Transplant

40.00% Coinsurance after deductible

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

30.00%

Hearing Aids

40.00%

Major Dental Care - Child

50.00%

Prenatal and Postnatal Care

$30.00

Routine Eye Exam for Children

$30.00

Well Baby Visits and Care

No Charge

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$10.00

Non-Preferred Brand Drugs

50.00%

Preferred Brand Drugs

$100.00

Specialty Drugs

60.00% Coinsurance after deductible

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

40.00% Coinsurance after deductible

Basic Dental Care - Adult

20.00%

Dental Anesthesia

40.00% Coinsurance after deductible

Dental Check-Up for Children

$0.00

Infusion Therapy

40.00% Coinsurance after deductible

Major Dental Care - Adult

50.00%

Nutritional Counseling

$30.00

Orthodontia - Adult

Coverage details pending

Orthodontia - Child

50.00%

Prosthetic Devices

40.00%

Routine Dental Services (Adult)

$0.00

Weight Loss Programs

Coverage details pending

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

Acupuncture

Coverage details pending

Allergy Testing

Coverage details pending

Bariatric Surgery

Coverage details pending

Clinical Trials

40.00% Coinsurance after deductible

Cosmetic Surgery

Coverage details pending

Eye Glasses for Children

40.00%

Gender Affirming Care

40.00% Coinsurance after deductible

Habilitation Services

40.00% Coinsurance after deductible

Imaging (CT/PET Scans, MRIs)

40.00% Coinsurance after deductible

Infertility Treatment

Coverage details pending

Long-Term/Custodial Nursing Home Care

Coverage details pending

Private-Duty Nursing

Coverage details pending

Reconstructive Surgery

40.00% Coinsurance after deductible

Routine Eye Exam (Adult)

$30.00

Routine Foot Care

40.00% Coinsurance after deductible

Treatment for Temporomandibular Joint Disorders

40.00% Coinsurance after deductible

Virtual Visit

No Charge

Variant attributes

QUARTZ GUNDERSEN PERFORMANCE SILVER (DENTAL & VISION) $9,000 DED · Variant 37833WI0380344-04

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2026

CSR Variation Type

73% AV Level Silver Plan

HIOS Product ID

37833WI038

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

37833WI0380344-04

Plan Marketing Name

QUARTZ GUNDERSEN PERFORMANCE SILVER (DENTAL & VISION) $9,000 DED

Plan Variant Marketing Name

QUARTZ GUNDERSEN PERFORMANCE SILVER (DENTAL & VISION) $5,500 DED CSR 73

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

73.05%

Issuer ID

37833

Issuer Marketplace Marketing Name

Quartz

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

WIN002

Out of Country Coverage

Yes

Out of Country Coverage Description

Foreign claims for emergency care are subject to a maximum benefit of $20,000 per benefit year.

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization

Service Area ID

WIS003

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

0.716150028

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$1,800

SBC Scenario, Having a Baby, Copayment

$100

SBC Scenario, Having a Baby, Deductible

$5,500

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$800

SBC Scenario, Having Diabetes, Deductible

$100

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$100

SBC Scenario, Treatment of a Simple Fracture, Copayment

$100

SBC Scenario, Treatment of a Simple Fracture, Deductible

$2,200

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

per group not applicable

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

per person not applicable

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

Not Applicable

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

40.00%

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

$16800 per group

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

$8400 per person

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

$8,400

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

per group not applicable

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

per person not applicable

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

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

WIF004

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

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy

EHB Percent of Total Premium

0.9646

First Tier Utilization

100%

Import Date

10/15/2025

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

New

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Plan Effective Date

1/1/2026

Plan Expiration Date

12/31/2026

Plan Type

HMO

QHP/Non QHP

Both

Source Name

HIOS

Plan ID

37833WI0380344

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

per group not applicable

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

per person not applicable

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

Not Applicable

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

$11000 per group

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

$5500 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$5,500

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Individual

Not Applicable

Unique Plan Design

Yes

Wellness Program Offered

No

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?

QUARTZ GUNDERSEN PERFORMANCE SILVER (DENTAL & VISION) $9,000 DED (37833WI0380344) is a Silver HMO from Quartz Health Benefit Plans Corporation 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 QUARTZ GUNDERSEN PERFORMANCE SILVER (DENTAL & VISION) $9,000 DED 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 QUARTZ GUNDERSEN PERFORMANCE SILVER (DENTAL & VISION) $9,000 DED 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 add-ons: Adult, Child.

Vision add-ons: Adult, Child.

Does QUARTZ GUNDERSEN PERFORMANCE SILVER (DENTAL & VISION) $9,000 DED 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 QUARTZ GUNDERSEN PERFORMANCE SILVER (DENTAL & VISION) $9,000 DED?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy.

Is there out-of-country coverage for QUARTZ GUNDERSEN PERFORMANCE SILVER (DENTAL & VISION) $9,000 DED?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Foreign claims for emergency care are subject to a maximum benefit of $20,000 per benefit year.

Does QUARTZ GUNDERSEN PERFORMANCE SILVER (DENTAL & VISION) $9,000 DED 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: Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization

How do I enroll in or manage payments for QUARTZ GUNDERSEN PERFORMANCE SILVER (DENTAL & VISION) $9,000 DED?

Use the issuer portal https://hixenroll.quartzbenefits.com to pay premiums or start enrollment, then return to HealthPorta for benefit comparisons.

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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