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Wisconsin Department of Employee Trust Funds header image It's Your Choice 2016 State of Wisconsin Group Health Insurance Program
members retirees employers governing boards careers at etf
Wisconsin Department Of Employee Trust Funds It's Your Choice 2016


Local Deductible Plan
Insurance for Employees
and Retirees
(PO4)


Health Plan 2016 Premium Rates

Form Number: et-2158pr

Employee and Non-Medicare Retiree Rates

The employee and non-Medicare Retiree1 health plan rates reflect total monthly premium rates for each health plan.

  Medical with Dental Medical without Dental
Health Plan Name Single Family Single Family
Anthem Blue Preferred Northeast 691.90 1,720.90 665.60 1,655.20
Anthem Blue Preferred Southeast 769.00 1,913.60 742.70 1,847.90
Arise Health Plan 1,011.80 2,520.60 985.50 2,454.90
Arise Health Plan - Aspirus Arise 968.60 2,412.60 942.30 2,346.90
Dean Health Insurance 713.30 1,774.40 687.00 1,708.70
Dean Health Insurance-Prevea360 691.20 1,719.10 664.90 1,653.40
GHC of Eau Claire 980.60 2,442.60 954.30 2,376.90
GHC of South Central Wisconsin 640.30 1,591.90 614.00 1,526.20
Gundersen Health Plan 775.00 1,928.60 748.70 1,862.90
Health Tradition Health Plan 681.90 1,695.90 655.60 1,630.20
HealthPartners Health Plan 873.90 2,175.90 847.60 2,110.20
Humana-Eastern 1,131.50 2,819.90 1,105.20 2,754.20
Humana-Western 1,182.00 2,946.10 1,155.70 2,880.40
IYC Access Health Plan - Balance of State5 1,178.30 2,939.50 1,152.00 2,873.80
IYC Access Health Plan- Dane6 1,096.10 2,734.00 1,069.80 2,668.30
IYC Access Health Plan- Milwaukee7 1,270.60 3,170.20 1,244.30 3,104.50
IYC Access Health Plan- Waukesha8 1,178.30 2,939.50 1,152.00 2,873.80
IYC Medicare Plus4 NA4 NA4 NA4 NA4
Medical Associates Health Plans 644.30 1,601.90 618.00 1,536.20
MercyCare Health Plans 674.60 1,677.60 648.30 1,611.90
Network Health - Northeast 734.30 1,826.90 708.00 1,761.20
Network Health - Southeast 781.50 1,944.90 755.20 1,879.20
Physicians Plus 693.20 1,724.10 666.90 1,658.40
Security Health Plan 1,013.50 2,524.90 987.20 2,459.20
State Maintenance Plan (SMP) 792.50 1,974.30 766.20 1,908.60
UnitedHealthcare of Wisconsin 870.00 2,166.10 843.70 2,100.40
Unity Health Insurance-Community 659.30 1,639.40 633.00 1,573.70
Unity Health Insurance-UW Health 605.60 1,505.10 579.30 1,439.40
WEA Trust-East 787.50 1,959.90 761.20 1,894.20
WEA Trust-Northwest Chippewa Valley 994.70 2,477.90 968.40 2,412.20
WEA Trust-Northwest Mayo Clinic Hlth. Sys. 994.70 2,477.90 968.40 2,412.20
WEA Trust-South Central 608.60 1,512.60 582.30 1,446.90

NA = not applicable
1 Members of new participating employers may have a surcharge added to their rates. Your employer will inform you. Contact your payroll office with questions.
2 Medicare 1 = Family coverage with at least one insured family member enrolled in Medicare Parts A, B and D.
3 Medicare 2 = Family coverage with all insured family members enrolled in Medicare Parts A, B and D.
4 Members with IYC Access Health Plan or SMP coverage who become enrolled in Medicare Parts A and B will automatically be moved to the IYC Medicare Plus plan. All other non-Medicare family members remain covered under the IYC Access Health Plan or SMP. IYC Access Health Plan rates are determined by the employer county or the retiree county of residence. Counties are divided into the following rate categories:
5 Balance of State: All other Wisconsin counties not listed below. (Code A4)
6 Dane: Dane, Grant, Jefferson, La Crosse, Polk and St. Croix. (A1)
7 Milwaukee: Milwaukee County. Also applies to retirees and continuants living out of state. (A2)
8 Waukesha: Kenosha, Ozaukee, Racine, Washington and Waukesha. (A3)

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 2:44:35 PM