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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-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 Individual Medicare 12 Medicare 23 Individual Medicare 12 Medicare 23
Anthem Blue Preferred Northeast 570.58 1,267.86 1,138.94 542.74 1,212.18 1,069.32
Arise Health Plan 738.58 1,771.96 1,474.94 710.74 1,716.28 1,405.32
Dean Health Insurance 579.38 1,308.56 1,156.54 551.54 1,252.88 1,086.92
Dean Health Insurance-Prevea360 568.38 1,274.46 1,134.54 540.54 1,218.78 1,064.92
GHC of Eau Claire 574.78 1,460.86 1,147.34 546.94 1,405.18 1,077.72
GHC of South Central Wisconsin 543.98 1,188.06 1,085.74 516.14 1,132.38 1,016.12
Gundersen Health Plan 517.38 1,161.36 1,032.54 489.54 1,105.68 962.92
Health Tradition Health Plan 532.98 1,187.16 1,063.74 505.14 1,131.48 994.12
HealthPartners Health Plan 620.58 1,447.46 1,238.94 592.74 1,391.78 1,169.32
Humana-Eastern 428.58 1,479.96 854.94 400.74 1,424.28 785.32
Humana-Western 428.58 1,638.46 854.94 400.74 1,582.78 785.32
IYC Access Health Plan - Balance of State5 and IYC Medicare Plus4 444.94 1,683.04 898.64 417.10 1,627.36 829.02
IYC Access Health Plan- Dane6 and IYC Medicare Plus4 444.94 1,593.78 898.64 417.10 1,538.10 829.02
IYC Access Health Plan- Milwaukee7 and IYC Medicare Plus4 444.94 1,783.30 898.64 417.10 1,727.62 829.02
IYC Access Health Plan- Waukesha8 and IYC Medicare Plus4 444.94 1,683.04 898.64 417.10 1,627.36 829.02
Medical Associates Health Plans 441.68 1,042.06 881.14 413.84 986.38 811.52
MercyCare Health Plans 539.98 1,219.46 1,077.74 512.14 1,163.78 1,008.12
Network Health - Northeast 585.48 1,312.66 1,168.74 557.64 1,256.98 1,099.12
Network Health - Southeast 590.98 1,329.16 1,179.74 563.14 1,273.48 1,110.12
Physicians Plus 573.48 1,276.66 1,144.74 545.64 1,220.98 1,075.12
Security Health Plan - Central 625.98 1,661.06 1,249.74 598.14 1,605.38 1,180.12
Security Health Plan - Valley 625.98 1,661.06 1,249.74 598.14 1,605.38 1,180.12
State Maintenance Plan (SMP) 444.94 1,263.12 898.64 417.10 1,207.44 829.02
UnitedHealthcare of Wisconsin 642.78 1,527.26 1,283.34 614.94 1,471.58 1,213.72
Unity Health Insurance-Community 499.08 1,145.56 995.94 471.24 1,089.88 926.32
Unity Health Insurance-UW Health 472.08 1,052.86 941.94 444.24 997.18 872.32
WEA Trust-East 526.58 1,339.76 1,050.94 498.74 1,284.08 981.32
WEA Trust-Northwest Chippewa Valley 602.78 1,633.26 1,203.34 574.94 1,577.58 1,133.72
WEA Trust-Northwest Mayo Clinic Hlth. Sys. 602.78 1,633.26 1,203.34 574.94 1,577.58 1,133.72

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 2:08:20 PM