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Wisconsin Department of Employee Trust Funds header image It's Your Choice 2016 State of Wisconsin Group Health Insurance Program
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Wisconsin Department Of Employee Trust Funds

It's Your Choice 2016


State of Wisconsin
Group Health Insurance Program
(State Employees, Retirees, Continuants and Graduate Assistants)

Health Plan 2016 Premium Rates

Form Number: et-2107pr

Active Employees

When you select medical coverage, you are automatically enrolled in dental, but you may choose to opt out of dental for 2016. Learn more about how to opt out of Uniform Dental Benefits or medical benefits for the plan year.

Employee contribution rates for the 2016 plan year are provided below.

2016 Employee Monthly Contribution Rates

plustooth
It's Your Choice Health Plan
Medical with Dental
Single Rate Family Rate
$86.00 $217.00
UW Graduate Assistants**
Single Rate Family Rate
$44.50 $112.50
plus It's Your Choice Health Plan
Medical without Dental
Single Rate Family Rate
$83.00 $209.00
UW Graduate Assistants**
Single Rate Family Rate
$41.50 $104.50
piggytooth It's Your Choice HDHP
Medical with Dental
Lower premium; higher deductible & OOPL
Single Rate Family Rate
$32.00 $81.00
piggy It's Your Choice HDHP
Medical without Dental
Lower premium; higher deductible & OOPL
Single Rate Family Rate
$29.00 $73.00
globetooth It's Your Choice Access Health Plan
Medical with Dental
Higher premium, increased provider flexibility
Single Rate Family Rate
$253.00 $632.00
UW Graduate Assistant**
Single Rate Family Rate
$128.00 $320.00
globe It's Your Choice Access Health Plan
Medical without Dental
Higher premium, increased provider flexibility
Single Rate Family Rate
$250.00 $624.00
UW Graduate Assistant**
Single Rate Family Rate
$125.00 $312.00
briefcasetooth It's Your Choice Access HDHP
Medical with Dental
Increased provider flexibility, lower premium, higher deductible & OOPL
Single Rate Family Rate
$199.00 $496.00
briefcase It's Your Choice Access HDHP
Medical without Dental
Increased provider flexibility, lower premium, higher deductible & OOPL
Single Rate Family Rate
$196.00 $488.00

You can find the full premium rates online, with dental and without dental.

IYC Health Plan and IYC HDHP contribution rates are provided at the Tier 1 level. IYC Access Health Plan and IYC Access HDHP contribution rates are provided at the Tier 3 level. See more information about tiering.

Note: Employees appointed to work fewer than 1,044 hours (50% of full time) pay 50% of the total monthly premium.

**Not eligible for the HDHP.




Out-of-State Residents Assigned to Work Out of State

globetooth It's Your Choice Access Health Plan
Medical with Dental
Higher premium, increased provider flexibility
Single Rate Family Rate
$136.00 $341.00
UW Graduate Assistant**
Single Rate Family Rate
$69.50 $174.50
globe It's Your Choice Access Health Plan
Medical without Dental
Higher premium, increased provider flexibility
Single Rate Family Rate
$133.00 $333.00
UW Graduate Assistant**
Single Rate Family Rate
$66.50 $166.50
briefcasetooth It's Your Choice Access HDHP
Medical with Dental
Increased provider flexibility, lower premium, higher deductible & OOPL
Single Rate Family Rate
$82.00 $205.00
briefcase It's Your Choice Access HDHP
Medical without Dental
Increased provider flexibility, lower premium, higher deductible & OOPL
Single Rate Family Rate
$79.00 $197.00
Out-of-state residents assigned to work out-of-state receive the IYC Access Plan at a Tier 2 level.
See more information about tiering
.

Disclaimer:
Every effort has been made to ensure that this information is accurate, but may be subject to change. Please note revision dates located at the bottom of each page. In the event of conflicting information, federal law, state statute, state health contracts and/or policies and provisions established by the State of Wisconsin Group Insurance Board shall be followed.

This page was last modified on: 10/13/2015 2:44:33 PM