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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


Local Deductible Plan
Insurance for Employees
and Retirees
(PO4)


Health Plan 2016 Premium Rates

Form Number: et-2158prm

Medicare Retiree Rates

The Medicare Retiree health plan rates reflect total monthly premium rates for each health plan.

  Medical with Dental Medical without Dental
Health Plan Name Single Medicare 12 Medicare 23 Single Medicare 12 Medicare 23
Anthem Blue Preferred Northeast 566.50 1,252.50 1,140.20 540.20 1,199.90 1,074.50
Anthem Blue Preferred Southeast 605.10 1,368.20 1,217.40 578.80 1,315.60 1,151.70
Arise Health Plan 726.50 1,732.40 1,460.20 700.20 1,679.80 1,394.50
Arise Health Plan - Aspirus Arise 704.90 1,667.60 1,417.00 678.60 1,615.00 1,351.30
Dean Health Insurance 570.30 1,277.70 1,147.80 544.00 1,225.10 1,082.10
Dean Health Insurance-Prevea360 559.80 1,245.10 1,126.80 533.50 1,192.50 1,061.10
GHC of Eau Claire 609.50 1,584.20 1,226.20 583.20 1,531.60 1,160.50
GHC of South Central Wisconsin 540.70 1,175.10 1,088.60 514.40 1,122.50 1,022.90
Gundersen Health Plan 498.70 1,267.80 1,004.60 472.40 1,215.20 938.90
Health Tradition Health Plan 545.10 1,221.10 1,097.40 518.80 1,168.50 1,031.70
HealthPartners Health Plan 641.80 1,509.80 1,290.80 615.50 1,457.20 1,225.10
Humana-Eastern 434.10 1,559.70 875.40 407.80 1,507.10 809.70
Humana-Western 434.10 1,610.20 875.40 407.80 1,557.60 809.70
IYC Access Health Plan - Balance of State5 NA4 1,659.10 NA4 NA4 1,606.50 NA4
IYC Access Health Plan- Dane6 NA4 1,576.90 NA4 NA4 1,524.30 NA4
IYC Access Health Plan- Milwaukee7 NA4 1,751.40 NA4 NA4 1,698.80 NA4
IYC Access Health Plan- Waukesha8 NA4 1,659.10 NA4 NA4 1,606.50 NA4
IYC Medicare Plus4 480.80 NA4 970.20 454.50 NA4 904.50
Medical Associates Health Plans 454.90 1,093.30 917.00 428.60 1,040.70 851.30
MercyCare Health Plans 536.30 1,205.00 1,079.80 510.00 1,152.40 1,014.10
Network Health - Northeast 587.70 1,316.10 1,182.60 561.40 1,263.50 1,116.90
Network Health - Southeast 611.30 1,386.90 1,229.80 585.00 1,334.30 1,164.10
Physicians Plus 567.20 1,254.50 1,141.60 540.90 1,201.90 1,075.90
Security Health Plan 616.80 1,624.40 1,240.80 590.50 1,571.80 1,175.10
State Maintenance Plan (SMP) NA4 1,273.30 NA4 NA4 1,220.70 NA4
UnitedHealthcare of Wisconsin 634.60 1,498.70 1,276.40 608.30 1,446.10 1,210.70
Unity Health Insurance-Community 524.10 1,177.50 1,055.40 497.80 1,124.90 989.70
Unity Health Insurance-UW Health 499.90 1,099.60 1,007.00 473.60 1,047.00 941.30
WEA Trust-East 516.50 1,298.10 1,040.20 490.20 1,245.50 974.50
WEA Trust-Northwest Chippewa Valley 589.10 1,577.90 1,185.40 562.80 1,525.30 1,119.70
WEA Trust-Northwest Mayo Clinic Hlth. Sys. 589.10 1,577.90 1,185.40 562.80 1,525.30 1,119.70
WEA Trust-South Central 453.90 1,056.60 915.00 427.60 1,004.00 849.30

NA = not applicable
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: 10/15/2015 9:37:59 AM