Form Number: ET-2158pr
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 | $1,280.18 | $3,158.20 |
| Aspirus Health Plan | $1,245.12 | $3,070.54 |
| Common Ground Healthcare Cooperative | $1,223.10 | $3,015.48 |
| Dean Health Plan | $1,062.90 | $2,614.98 |
| Dean Health Plan - Medica West and Mayo Clinic Health System | $1,238.12 | $3,053.04 |
| Dean Health Plan - Prevea360 East | $990.68 | $2,434.44 |
| GHC of Eau Claire Greater WI | $1,320.50 | $3,258.98 |
| GHC of Eau Claire River Region | $1,428.66 | $3,529.38 |
| GHC-SCW Dane Choice | $849.18 | $2,080.68 |
| GHC-SCW Neighbors | $986.04 | $2,422.84 |
| HealthPartners Health Plan Southeast | $1,306.84 | $3,224.84 |
| HealthPartners Health Plan West | $1,312.82 | $3,239.78 |
| Medical Associates Health Plan | $902.02 | $2,212.78 |
| MercyCare Health Plan | $931.62 | $2,286.78 |
| Network Health | $1,040.88 | $2,559.94 |
| Quartz Central | $1,323.98 | $3,267.68 |
| Quartz - UW Health | $909.98 | $2,232.68 |
| Quartz West | $899.86 | $2,207.38 |
| Robin with HealthPartners Health Plan | $1,327.84 | $3,277.34 |
| Security Health Plan | $1,279.92 | $3,157.54 |
| State Maintenance Plan (SMP)1 by Dean Health Plan | $1,043.18 | $2,565.72 |
1Members with Local 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 remain covered under the Local Access Plan or SMP.