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Wisconsin Department of Employee Trust Funds header image It's Your Choice 2017 Local Traditional Health Plan Insurance Program
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2017 It's Your Choice - Local Traditional Health Plan Insurance for Employees and Retirees
Wisconsin Department Of Employee Trust Funds It's Your Choice 2017


Local Traditional Plan
Insurance for Employees
and Retirees
(PO2, PO12)


Health Plan 2017 Premium Rates

Form Number: et-2128prm

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 Individual Medicare 12 Medicare 23 Individual Medicare 12 Medicare 23
Anthem Blue Preferred Northeast 595.08 1,341.36 1,187.94 567.24 1,285.68 1,118.32
Arise Health Plan 777.68 1,889.26 1,553.14 749.84 1,833.58 1,483.52
Dean Health Insurance 604.68 1,385.66 1,207.14 576.84 1,329.98 1,137.52
Dean Health Insurance-Prevea360 592.38 1,348.16 1,182.54 564.54 1,292.48 1,112.92
GHC of Eau Claire 599.58 1,551.06 1,196.94 571.74 1,495.38 1,127.32
GHC of South Central Wisconsin 566.08 1,254.46 1,129.94 538.24 1,198.78 1,060.32
Gundersen Health Plan 537.28 1,225.56 1,072.34 509.44 1,169.88 1,002.72
Health Tradition Health Plan 555.58 1,254.96 1,108.94 527.74 1,199.28 1,039.32
HealthPartners Health Plan 645.58 1,532.66 1,288.94 617.74 1,476.98 1,219.32
Humana-Eastern  472.68 1,603.86 943.14 444.84 1,548.18 873.52
Humana-Western 472.68 1,776.06 943.14 444.84 1,720.38 873.52
IYC Access Health Plan - Balance of State5 and IYC Medicare Plus4 444.94 1,756.14 898.64 417.10 1,700.46 829.02
IYC Access Health Plan- Dane6 and IYC Medicare Plus4 444.94 1,659.16 898.64 417.10 1,603.48 829.02
IYC Access Health Plan- Milwaukee7 and IYC Medicare Plus4 444.94 1,865.20 898.64 417.10 1,809.52 829.02
IYC Access Health Plan- Waukesha8 and IYC Medicare Plus4 444.94 1,756.14 898.64 417.10 1,700.46 829.02
Medical Associates Health Plans 472.88 1,113.76 943.54 445.04 1,058.08 873.92
MercyCare Health Plans 540.98 1,267.86 1,079.74 513.14 1,212.18 1,010.12
Network Health - Northeast 611.28 1,390.06 1,220.34 583.44 1,334.38 1,150.72
Network Health - Southeast 617.28 1,407.96 1,232.34 589.44 1,352.28 1,162.72
Physicians Plus 598.28 1,350.96 1,194.34 570.44 1,295.28 1,124.72
Security Health Plan - Central 643.78 1,757.16 1,285.34 615.94 1,701.48 1,215.72
Security Health Plan - Valley 643.78 1,757.16 1,285.34 615.94 1,701.48 1,215.72
State Maintenance Plan (SMP) 444.94 1,311.56 898.64 417.10 1,255.88 829.02
UnitedHealthcare of Wisconsin 682.08 1,631.86 1,361.94 654.24 1,576.18 1,292.32
Unity Health Insurance-Community 517.38 1,208.46 1,032.54 489.54 1,152.78 962.92
Unity Health Insurance-UW Health 488.08 1,107.66 973.94 460.24 1,051.98 904.32
WEA Trust-East 547.38 1,419.56 1,092.54 519.54 1,363.88 1,022.92
WEA Trust-Northwest Chippewa Valley 629.98 1,738.36 1,257.74 602.14 1,682.68 1,188.12
WEA Trust-Northwest Mayo Clinic Hlth. Sys. 629.98 1,738.36 1,257.74 602.14 1,682.68 1,188.12

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: 11/1/2016 1:08:20 PM