Form Number: et-2128pr
The employee and non-Medicare Retiree health plan rates reflect total monthly premium rates for each health plan. Total monthly premiums are shown without Uniform Dental.
Members of new participating employers may have a surcharge added to their rates. Your employer will inform you. Contact your payroll office with questions.
| Health Plan | Individual | Family |
|---|---|---|
| Access Plan1 by Dean Health Plan | $1,257.02 | $3,105.28 |
| Aspirus Health Plan | $1,246.96 | $3,080.12 |
| Common Ground Healthcare Cooperative | $1,173.70 | $2,896.96 |
| Dean Health Plan | $1,011.62 | $2,491.76 |
| Dean Health Plan - Prevea360 East | $972.74 | $2,394.56 |
| Dean Health Plan - Prevea360 West and Mayo Clinic Health System | $1,113.58 | $2,746.66 |
| GHC of Eau Claire Greater WI | $1,116.48 | $2,753.92 |
| GHC of Eau Claire River Region | $1,193.74 | $2,947.06 |
| GHC-SCW Dane Choice | $830.22 | $2,038.26 |
| GHC-SCW Neighbors | $915.96 | $2,252.62 |
| HealthPartners Health Plan Southeast | $1,319.86 | $3,262.36 |
| HealthPartners Health Plan West | $1,330.94 | $3,290.06 |
| Medical Associates Health Plan | $811.04 | $1,990.32 |
| MercyCare Health Plan | $865.28 | $2,125.92 |
| Network Health | $1,024.26 | $2,523.36 |
| Quartz Central | $1,323.14 | $3,270.56 |
| Quartz - UW Health | $902.42 | $2,218.76 |
| Quartz West | $878.98 | $2,160.16 |
| Robin with HealthPartners Health Plan | $1,381.10 | $3,415.46 |
| Security Health Plan | $1,310.96 | $3,240.12 |
| State Maintenance Plan (SMP)1 by Dean Health Plan | $1,001.02 | $2,465.28 |
1Members with Local 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 remain covered under the Local Access Plan or SMP.