HSHS Medical Plans

UMR is the medical claims administrator for colleagues who reside in Illinois or outside of Wisconsin.

You have three medical options through HSHS:

• Value option (formerly Basic option)
• Premier option (formerly High option)
• High Deductible Health Plan (HDHP) with Health Savings Account (HSA) - see below for more HSA information
• Waive Coverage
   

Coverage Options

When you enroll in medical (including prescription drug coverage),you can choose from these coverage levels:

• Colleague only
• Colleague + Spouse/LDA
• Colleague + Child(ren)
• Colleague + Spouse and Child(ren)
   

Network

Each medical plan option (Value, Premier, HDHP) has three network tiers which determine the benefit paid by the plan based on the tier your provider falls in. These tiers apply based on the providers you use. You do not have to elect a tier during enrollment. To confirm which tier your providers fall in, use the Find a Provider information below.

• HSHS Select Tier (Tier 1) – HSHS, PCC and Prevea providers and facilities. 
• HSHS Extended Tier (Tier 2) – local partners such as Springfield Clinic, SIU, PCIN network, SSM, SLU, Mercy and others.  *Springfield Clinic Ambulatory Surgical Center is covered under the UMR Choice Plus network.
• UCH Choice Plus Tier (Tier 3) – nationwide United Healthcare network 

 

Find a Provider

Before determining which tier a provider is in, you need to determine if you live inside the HSHS Service Area. Colleagues that live outside of the service area will receive the HSHS Extended Tier benefit level for services received from any UHC Choice Plus provider.

Click here to determine if you are in the HSHS Service Area.

Find a Provider

 

Out-of-area Dependents

If you have a dependent who lives outside of the HSHS service area, such as a child attending college, you can register your dependent with UMR after you receive your ID card. Call UMR to get started.

Once your dependent is registered, they will receive the HSHS Extended benefit level for all in-network services.
 

Health Savings Account (HSA)

Colleagues enrolled in the High Deductible Health Plan are eligible to utilize a health savings account (HSA) offered through HealthEquity. Money in your HSA is yours to use on qualified medical, dental and vision expenses or save for retirement. After signing up for your HSA you will receive a debit card in the mail from HealthEquity.

Advantages of HSAs include:

• No "use it or lose it". The money is yours and the HSA rolls over year after year for use in the future or in retirement.
• HSAs are triple-tax advantaged - contributions are deducted before taxes, investments and interest earned are tax-free, and money is never taxed if you use it to pay qualified medical, dental and vision expenses.
• HSAs are individually owned accounts that you keep regardless of employer or insurance changes.

HSHS will make a $25 per-pay-period employer contribution to your HSA regardless of whether you are able to contribute anything to the account yourself. You are able to make additional pre-tax contributions up to the 2025 IRS limits ($4,300 for self-coverage and $8,550 if you cover any dependents). Those 55 and older can contribute an additional $1,000. HSHS employer contributions count towards the IRS limits.

Colleagues who have other non-HDHP coverage are not eligible to contribute to an HSA. This includes those covered by Medicare, Medicaid, TRICARE, or a FSA or HRA that reimburses expenses before the HDHP deductible is met.

Visit learn.healthequity.com/hshs/hsa to learn more about HSAs and review a list of qualifying expenses.

 

Additional Resources

• 2025 HSHS Annual Benefit Guide
• UMR Access Guide - access URM to view claims, find providers, order new ID cards and more.
• Transparency in Coverage - transparency-in-coverage.uhc.com

Dean Health Plan is the medical claims administrator for colleagues who reside in Wisconsin.

You have three Exclusive Provider Organization (EPO) medical options through HSHS:

• Value option (formerly Basic option)
• Premier option (formerly High option)
• High Deductible Health Plan (HDHP) with Health Savings Account (HSA) - see below for more HSA information
• Waive Coverage

 

Coverage Options

When you enroll in medical (including prescription drug coverage), you can choose from these coverage levels:

• Colleague only
• Colleague + Spouse/LDA
• Colleague + Child(ren)
• Colleague + Spouse and Child(ren)

Network

Depending on the zip code of your primary home residence, your provider network is: 

• HSHS/Prevea 360
• HSHS/Prevea 360/First Health

Prior Authorization

Out-of-network services will not be covered unless you first obtain a referral from your network provider and prior authorization from Dean Health Plan. Your network provider will need to submit a referral request to Dean Health Plan. If you have questions regarding the referral process, please contact Dean Health Plan at 1-888-895-1188. 

 

Find a Provider

To locate network providers, follow these steps:
1. Go to deancare.com/HSHS
2. Determine your network service area. Your network is determined by your home ZIP code.
3. Based on your network service area, select Find a Prevea360 provider or First Health provider.

 

Excluded Providers

The HSHS medical plan will not pay benefits for services received from particular providers. HSHS is proud of our facilities and physicians, and we want to encourage colleagues to use HSHS facilities and physicians for their care. The utilization of our own providers invests in our people and our organization, helping to build a stronger system of care in the communities we serve. See the list of excluded providers and facilities.

 

Traveling Outside Network Service Area

A referral is not required for urgent care when you are traveling outside your network service area and emergency care. For care required to treat an urgent situation while you are traveling outside your network service area or an emergency medical condition, the HSHS medical plan provides the same benefit level regardless of the provider who provides your care. 

 

Out-of-area Dependents

If you have a dependent that does not live in the Prevea360 service area, such as a child attending college, you can register your dependent with Dean Health Plan after you receive your Dean Health Plan ID card. Call Dean Health Plan to get started. Once your dependent is registered, the First Health network will apply for your dependent’s medical plan coverage.  

 

Health Savings Account (HSA)

Colleagues enrolled in the High Deductible Health Plan are eligible to utilize a health savings account (HSA) offered through HealthEquity. Money in your HSA is yours to use on qualified medical, dental and vision expenses or save for retirement. After signing up for your HSA you will receive a debit card in the mail from HealthEquity.

Advantages of HSAs include:

• No "use it or lose it". The money is yours and the HSA rolls over year after year for use in the future or in retirement.
• HSAs are triple-tax advantaged - contributions are deducted before taxes, investments and interest earned are tax-free, and money is never taxed if you use it to pay qualified medical, dental and vision expenses.
• HSAs are individually owned accounts that you keep regardless of employer or insurance changes.

HSHS will make a $25 per-pay-period employer contribution to your HSA regardless of whether you are able to contribute anything to the account yourself. You are able to make additional pre-tax contributions up to the 2025 IRS limits ($4,300 for self-coverage and $8,550 if you cover any dependents). Those 55 and older can contribute an additional $1,000. HSHS employer contributions count towards the IRS limits.

Colleagues who have other non-HDHP coverage are not eligible to contribute to an HSA. This includes those covered by Medicare, Medicaid, TRICARE, or a FSA or HRA that reimburses expenses before the HDHP deductible is met.

Visit learn.healthequity.com/hshs/hsa to learn more about HSAs and review a list of qualifying expenses.

 

Additional Resources

2025 HSHS Annual Benefit Guide