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 | $1,375.40 | $3,396.26 |
| Aspirus Health Plan | $1,337.30 | $3,300.98 |
| Common Ground Healthcare Cooperative | $1,313.36 | $3,241.14 |
| Dean Health Plan | $1,139.24 | $2,805.84 |
| Dean Health Plan - Medica West and Mayo Clinic Health System | $1,329.70 | $3,281.98 |
| Dean Health Plan - Prevea360 East | $1,060.74 | $2,609.58 |
| GHC of Eau Claire Greater WI | $1,419.24 | $3,505.84 |
| GHC of Eau Claire River Region | $1,536.80 | $3,799.74 |
| GHC-SCW Dane Choice | $906.94 | $2,225.08 |
| GHC-SCW Neighbors | $1,055.68 | $2,596.94 |
| HealthPartners Health Plan Southeast | $1,404.38 | $3,468.68 |
| HealthPartners Health Plan West | $1,410.88 | $3,484.94 |
| Medical Associates Health Plan | $964.36 | $2,368.64 |
| MercyCare Health Plan | $996.54 | $2,449.08 |
| Network Health | $1,115.30 | $2,745.98 |
| Quartz Central | $1,423.02 | $3,515.28 |
| Quartz - UW Health | $973.02 | $2,390.28 |
| Quartz West | $962.02 | $2,362.78 |
| Robin with HealthPartners Health Plan | $1,427.22 | $3,525.78 |
| Security Health Plan | $1,375.12 | $3,395.54 |
| State Maintenance Plan (SMP)1 by Dean Health Plan | $1,097.92 | $2,702.54 |
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.