Form Number: et-2107prta

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IYC Health Plan & Access Plan

Health Plan With Dental
Individual / Family
Without Dental
Individual / Family
Access Plan1 by WEA Trust $1,536.32  /  $3,809.98 $1,506.12  /  $3,734.48
Dean Health Insurance $673.96  /  $1,654.06 $643.76  /  $1,578.56
Dean Health Insurance-Prevea360 $729.86  /  $1,793.82 $699.66  /  $1,718.32
Group Health Cooperative of Eau Claire $833.96  /  $2,054.06 $803.76  /  $1,978.56
Group Health Cooperative of South Central Wisconsin $653.36  /  $1,602.56 $623.16  /  $1,527.06
HealthPartners Health Plan $795.76  /  $1,958.56 $765.56  /  $1,883.06
Medical Associates Health Plan $697.76  /  $1,713.56 $667.56  /  $1,638.06
MercyCare Health Plan $693.34  /  $1,702.52 $663.14  /  $1,627.02
Network Health $793.66  /  $1,953.32 $763.46  /  $1,877.82
Quartz - Community $802.28  /  $1,974.86 $772.08  /  $1,899.36
Quartz - UW Health $679.90  /  $1,668.92 $649.70  /  $1,593.42
Robin with HealthPartners Health Plan $795.76  /  $1,958.56 $765.56  /  $1,883.06
Security Health Plan - Central $846.54  /  $2,085.52 $816.34  /  $2,010.02
Security Health Plan - Valley $866.96  /  $2,136.56 $836.76  /  $2,061.06
State Maintenance Plan (SMP)1 by WEA Trust $993.22  /  $2,452.22 $963.02  /  $2,376.72
WEA Trust - East $826.46  /  $2,035.32 $796.26  /  $1,959.82
WEA Trust West - Chippewa Valley $825.36  /  $2,032.56 $795.16  /  $1,957.06
 WEA Trust West - Mayo Clinic Health System $825.36  /  $2,032.56 $795.16  /  $1,957.06

1Members with Access Plan or SMP coverage who enroll in Medicare Parts A and B will automatically be moved to the IYC Medicare Plus plan. All other non-Medicare family members will remain covered under the Access HDHP or SMP.

High Deductible Health Plan (HDHP) & Access HDHP

Health Plan With Dental
Individual / Family
Without Dental
Individual / Family
Access Plan1 by WEA Trust $1,297.28  /  $3,212.38 $1,267.08  /  $3,136.88
Dean Health Insurance $584.46  /  $1,430.30 $554.26  /  $1,354.80
Dean Health Insurance-Prevea360 $632.54  /  $1,550.50 $602.34  /  $1,475.00
Group Health Cooperative of Eau Claire $722.06  /  $1,774.30 $691.86  /  $1,698.80
Group Health Cooperative of South Central Wisconsin $566.74  /  $1,386.00 $536.54  /  $1,310.50
HealthPartners Health Plan $689.20  /  $1,692.16 $659.00  /  $1,616.66
Medical Associates Health Plan $604.92  /  $1,481.46 $574.72  /  $1,405.96
MercyCare Health Plan $601.12  /  $1,471.96 $570.92  /  $1,396.46
Network Health $687.40  /  $1,687.66 $657.20  /  $1,612.16
Quartz - Community $694.82  /  $1,706.20 $664.62  /  $1,630.70
Quartz - UW Health $589.56  /  $1,443.06 $559.36  /  $1,367.56
Robin with HealthPartners Health Plan $689.20  /  $1,692.16 $659.00  /  $1,616.66
Security Health Plan - Central $732.88  /  $1,801.36 $702.68  /  $1,725.86
Security Health Plan - Valley $750.44  /  $1,845.26 $720.24  /  $1,769.76
State Maintenance Plan (SMP)1 by WEA Trust $841.56  /  $2,073.08 $811.36  /  $1,997.58
WEA Trust - East $715.60  /  $1,758.16 $685.40  /  $1,682.66
WEA Trust West - Chippewa Valley $714.66  /  $1,755.80 $684.46  /  $1,680.30
 WEA Trust West - Mayo Clinic Health System $714.66  /  $1,755.80 $684.46  /  $1,680.30

1Members with Access HDHP or SMP coverage who enroll in Medicare Parts A and B will automatically be moved to the IYC Medicare Plus plan. All other non-Medicare family members will remain covered under the Access HDHP or SMP.

Non-Medicare Retiree with HDHP Family Coverage and a Medicare Dependent

These rates are for HDHP family coverage with at least one dependent enrolled in Medicare Parts A, B and D. (A subscriber who is enrolled in Medicare Parts A, B and D is not eligible for the HDHP).

Health Plan With Dental Without Dental
Access Plan1 by WEA Trust $1,678.42 $1,618.02
Dean Health Insurance $1,015.50 $955.10
Dean Health Insurance-Prevea360 $1,114.18 $1,053.78
Group Health Cooperative of Eau Claire $1,215.00 $1,154.60
Group Health Cooperative of South Central Wisconsin $1,017.38 $956.98
HealthPartners Health Plan $1,092.84 $1,032.44
Medical Associates Health Plan $971.76 $911.36
MercyCare Health Plan $1,017.24 $956.84
Network Health $1,138.14 $1,077.74
Quartz - Community $1,158.58 $1,098.18
Quartz - UW Health $1,003.16 $942.76
Robin with HealthPartners Health Plan $1,092.84 $1,032.44
Security Health Plan - Central $1,178.48 $1,118.08
Security Health Plan - Valley $1,203.40 $1,143.00
State Maintenance Plan (SMP)1 by WEA Trust $1,222.70 $1,162.30
WEA Trust - East $1,147.04 $1,086.64
WEA Trust West - Chippewa Valley $1,145.60 $1,085.20
 WEA Trust West - Mayo Clinic Health System $1,145.60 $1,085.20

1Members with Access HDHP or SMP coverage who enroll in Medicare Parts A and B will automatically be moved to the IYC Medicare Plus plan. All other non-Medicare family members will remain covered under the Access HDHP or SMP.

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