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(Illinois/outside of Wisconsin)

Using Network Providers

Using HSHS providers and facilities will always provide you the highest level of benefit. With the UMR medical plan colleagues will have access to a three-tiered network listed below.

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.

• HSHS Select - HSHS, PCC and Prevea providers and facilities.
• HSHS Extended - local partners such as Springfield Clinic, PCIN network providers, SSM, SLU, Mercy and others.
  *Springfield Clinic Ambulatory Surgical Center is covered under the UMR Choice Plus network.
• UHC Choice Plus - nationwide United Healthcare network.

Find a Provider

When you need care from a non-network provider

• Out-of-network services will not be covered unless you first obtain a referral from your network provider and prior authorization from UMR.
• Your network provider will need to submit a referral request to UMR.
• In order for services to be covered, the referral needs to be reviewed and approved prior to services being received.

To learn more, contact UMR Customer Service at 1-800-221-6346.

(Wisconsin)

Using Network Providers

Your medical options will be Exclusive Provider Organization (EPO) options that, in most cases, only cover services received from HSHS/Prevea360 network providers. This means if you receive care outside the network you will most likely be responsible for the full cost of care.

To determine if you live in the HSHS/Prevea360 network service area, click HERE to access a list of designated counties or zip codes. If your address is in the HSHS/Prevea360 network service area, you'll see providers in the Exclusive Provider Organization (EPO). In most cases, this covers service received only from HSHS/Prevea 360 network providers. This means if you receive care outside the network, you will most likely be responsible for the full cost of care.

If your zip code is not listed and you live in Wisconsin, your network providers is also the Exclusive Provider Organization (EPO). For 2022, since you live outside of the service area, you can also use the First Health network. In most cases, the plan covers services received from only HSHS/Prevea360 network providers, and the First Health network, with the exception of Marshfield or Mayo providers. Care received from Marshfield or Mayo providers without an approved prior authorization from Dean will most likely result in you being responsible for the full cost of care. If you receive care outside these networks, you will most likely be responsible for the full cost of care.

When you need care from a non-network provider

• 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.
• If HealthEOS is your primary network, you need a referral if the provider required for your care is not in either the HSHS/Prevea360 or the HealthEOS network.
• In order for services to be covered, the referral needs to be reviewed and approved prior to services being received.

To learn more, contact the Dean Customer Service Center at 1-888-895-1188.