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


Local Deductible Plan
Insurance for Employees
and Retirees
(PO4, PO14)


Health Plan 2017 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 Individual Family Individual Family
Anthem Blue Preferred Northeast          713.44      1,759.38          685.60      1,689.76
Arise Health Plan      1,049.54      2,599.68      1,021.70      2,530.06
Dean Health Insurance          745.34      1,839.18          717.50      1,769.56
Dean Health Insurance-Prevea360          722.24      1,781.38          694.40      1,711.76
GHC of Eau Claire          902.24      2,231.38          874.40      2,161.76
GHC of South Central Wisconsin          660.24      1,626.38          632.40      1,556.76
Gundersen Health Plan          660.14      1,626.18          632.30      1,556.56
Health Tradition Health Plan          670.34      1,651.68          642.50      1,582.06
HealthPartners Health Plan          843.04      2,083.38          815.20      2,013.76
Humana-Eastern      1,067.54      2,644.68      1,039.70      2,575.06
Humana-Western      1,226.04      3,040.88      1,198.20      2,971.26
IYC Access Health Plan - Balance of State5 and IYC Medicare Plus4      1,238.10      3,087.94      1,210.26      3,018.32
IYC Access Health Plan- Dane6 and IYC Medicare Plus4      1,148.84      2,864.74      1,121.00      2,795.12
IYC Access Health Plan- Milwaukee7 and IYC Medicare Plus4      1,338.36      3,338.48      1,310.52      3,268.86
IYC Access Health Plan- Waukesha8 and IYC Medicare Plus4      1,238.10      3,087.94      1,210.26      3,018.32
Medical Associates Health Plans          616.54      1,517.18          588.70      1,447.56
MercyCare Health Plans          695.64      1,714.88          667.80      1,645.26
Network Health - Northeast          743.34      1,834.18          715.50      1,764.56
Network Health - Southeast          754.34      1,861.68          726.50      1,792.06
Physicians Plus          719.34      1,774.18          691.50      1,704.56
Security Health Plan - Central      1,051.24      2,603.88      1,023.40      2,534.26
Security Health Plan - Valley      1,051.24      2,603.88      1,023.40      2,534.26
State Maintenance Plan (SMP)          818.18      2,037.20          790.34      1,967.58
UnitedHealthcare of Wisconsin          900.64      2,227.38          872.80      2,157.76
Unity Health Insurance-Community          662.64      1,632.38          634.80      1,562.76
Unity Health Insurance-UW Health          596.94      1,468.18          569.10      1,398.56
WEA Trust-East          829.34      2,049.18          801.50      1,979.56
WEA Trust-Northwest Chippewa Valley      1,046.64      2,592.38      1,018.80      2,522.76
WEA Trust-Northwest Mayo Clinic Hlth. Sys.      1,046.64      2,592.38      1,018.80      2,522.76

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: 11/1/2016 1:08:12 PM