Form Number: et-2169pr
The employee and non-Medicare retiree health plan rates reflect the total monthly premium rates for each health plan.
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 | $1,022.94 | $2,520.08 |
| Aspirus Health Plan | $1,014.76 | $2,499.62 |
| Common Ground Healthcare Cooperative | $955.42 | $2,351.26 |
| Dean Health Plan | $824.12 | $2,023.02 |
| Dean Health Plan - Prevea360 East | $792.64 | $1,944.32 |
| Dean Health Plan - Prevea360 West and Mayo Clinic Health System | $906.72 | $2,229.52 |
| GHC of Eau Claire Greater WI | $909.06 | $2,235.36 |
| GHC of Eau Claire River Region | $971.64 | $2,391.82 |
| GHC-SCW Dane Choice | $677.20 | $1,655.72 |
| GHC-SCW Neighbors | $746.64 | $1,829.32 |
| HealthPartners Health Plan Southeast | $1,073.80 | $2,647.22 |
| HealthPartners Health Plan West | $1,082.78 | $2,669.66 |
| Medical Associates Health Plan | $661.66 | $1,616.86 |
| MercyCare Health Plan | $705.60 | $1,726.72 |
| Network Health | $834.36 | $2,048.62 |
| Quartz Central | $1,076.46 | $2,653.86 |
| Quartz - UW Health | $735.68 | $1,801.92 |
| Quartz West | $716.70 | $1,754.46 |
| Robin with HealthPartners Health Plan | $1,123.40 | $2,771.22 |
| Security Health Plan | $1,066.60 | $2,629.22 |
| State Maintenance Plan (SMP)1 by Dean Health Plan | $815.58 | $2,001.68 |
1 Members with the Access Plan or SMP coverage who enroll in Medicare Parts A and B will automatically be moved to the Medicare Plus plan. All other non-Medicare family members will remain covered under the Access Plan or SMP.