Q. What are the changes to the Marquette medical and pharmacy plans?
A. Marquette will offer the same PPO and HDHP medical plans in 2027 with the following changes:
- Coinsurance increase: Under both plans within the NexusACO network, the employee portion of coinsurance will increase to 15% for Tier 1 providers (formerly 10%) and to 35% for Tier 2 providers (formerly 30%).
- Focused retail pharmacy network: CVS stores, including those inside Target, are no longer in-network with Navitus.
Q. What is the difference betweeen the two Marquette medical plans?
A. The two plans offer the same benefits at a different cost to you. With the PPO plan, you’ll pay a higher monthly premium, but the plan will pay benefits sooner. With the HDHP plan, the premium will be lower, but you’ll need to meet a higher deductible before the plan will pay for your care. To decide which plan to elect, it will be important for you to:
- Understand what type of health care services you may expect in the coming year.
- Evaluate the deductibles and your out-of-pocket costs including premiums or the cost as you seek care.
- Determine funding a Flexible Spending Account (FSA) or a Health Savings Account (HSA) based on the plan you choose.
See the 2027 Annual Benefits Enrollment Guide for help selecting a plan.
The two plans encourage you to work with your Primary Care Provider (PCP) whenever you need care. Although you won’t need to formally request a referral from your PCP to see a specialist, it’s in your best interest to do so. Having one central person to care for you ensures you will receive the right care, at the right time, from the right provider.
Q. What is the NexusACO provider network?
A. UMR created a new provider network called NexusACO. ACO stands for Accountable Care Organization. This new network of high-efficiency providers is a subset of the UnitedHealthcare Choice Plus Network you’ve been familiar with for the last several years. In Southeastern Wisconsin, the NexusACO Tier 1 providers include those contracted with Advocate Aurora, Children’s Wisconsin, Froedtert (excludes Froedtert South) and the Medical College of Wisconsin. If receiving care outside of Southeastern Wisconsin, look for a Tier 1 provider in the national NexusACO network in your area to receive the Tier 1 benefit.
Q. Why did medical plan premiums increase overall?
A. Our goal continues to be ensuring that employees have access to quality care and choice of plans andproviders. Like most employers across the country, Marquette is experiencing rising health care andprescription drug costs. Human Resources, together with the Health Care Task Force, evaluated manyoptions to reduce the renewal increase. Ultimately, Marquette is making the following changes for 2027:
- An increase in medical plan coinsurance
- A move to a focused pharmacy network
Q. What am I required to do during the 2027 annual enrollment period (Oct. 26 – Nov. 9)?
A. To be covered under a Marquette medical plan in 2027, you do not need to make an active election if you are currently enrolled, unless you want to change your medical plan or the family members you cover. If you do nothing, your 2027 benefits will default to your 2026 medical plan election and the family members you cover.
If you are covering a spouse and enrolled that spouse in coverage for 2027, you must complete the spousal surcharge certification to re-certify your spouse’s access to other coverage through their employer or the spousal surcharge for 2027 will apply.
Similarly, as in past years, if you want to fund a Flexible Spending Account (FSA) or a Health Savings Account (HSA) you will need to make an active election also, indicating the annual amount you want to contribute.
If you want your dental and vision elections to stay the same for 2027 (as they were in 2026), there is nothing you need to do. Those elections are passive and will carry over into the new year. The same passive elections apply to any voluntary benefits you have elected.
Q. How does the Specialty Access Program work for specialty medications?
A. The Specialty Access Program provides assistance to the member by evaluating alternative methods to help pay for these medications while ensuring the member is adhering to their recommended course of treatment. In its simplest form, it works as follows:
- Member seeks to fill a specialty medication.
- Navitus ensures drug is medically necessary.
- Member’s medication qualifies for the Specialty Access Program.
- Member works with a specialist to enroll.
- Member receives medication from the program and continues to have access to Lumicera’s clinical expertise and support.
*Enrolling in this program will be mandatory for all members using specialty medications. If a medication does not qualify for funding assistance, the member, once enrolled, will pay their share of the cost as usual. If they do not enroll in the program and adhere to its guidelines, they will pay the full cost of the medication.
Q. How can benefits be received from the Marquette University Physical Therapy Clinic?
A. If you are enrolled in the PPO or HDHP plan, you can receive care through the Marquette University Physical Therapy clinic at a fee of $35 per visit. This fee will not count toward your deductible or out-of-pocket maximum.
Q. What is the Samaritan Fund?
A. Marquette University is excited to announce its new partnership with the Samaritan Fund Program. This program supports those who have serious medical conditions or high-cost medications that may be financially difficult, even with insurance in place.
All employees and family members who participate in the university’s medical plan are eligible to apply for assistance. If accepted, you would get an individual health insurance plan combined with financial assistance that will leave you with little to no out-of-pocket costs for insurance premiums or care. If not accepted, you remain on the university’s medical plan you enrolled in.
Please direct any questions on this program to the Samaritan Fund Program team via phone at (866) 764-9290 or via email at service@samaritanfundprogram.com. Additional information can be found here.
Contact Samaritan Fund to apply prior to the close of open enrollment.
Q. Will I receive new ID cards at the start of the new year?
A. For 2027, you can expect the following:
- Medical: You will only receive a new UMR ID card if you are newly enrolling in the plan or if you changed covered family members for 2027.
- Dental: You will only receive a new Delta Dental ID card if you are newly enrolling in the plan or if you changed covered family members for 2027.
- Vision: VSP does not send ID cards to members. VSP will continue using your 9-digit MU Employee ID number as your unique identifier and as the means to determine your eligibility.