Form Number: ET-2168pr
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 | $1,303.98 | $3,217.70 |
| Aspirus Health Plan | $1,268.16 | $3,128.14 |
| Common Ground Healthcare Cooperative | $1,245.66 | $3,071.88 |
| Dean Health Plan | $1,081.98 | $2,662.68 |
| Dean Health Plan - Medica West and Mayo Clinic Health System | $1,261.02 | $3,110.28 |
| Dean Health Plan - Prevea360 East | $1,008.20 | $2,478.24 |
| GHC of Eau Claire Greater WI | $1,345.18 | $3,320.68 |
| GHC of Eau Claire River Region | $1,455.70 | $3,596.98 |
| GHC-SCW Dane Choice | $863.62 | $2,116.78 |
| GHC-SCW Neighbors | $1,003.44 | $2,466.34 |
| HealthPartners Health Plan Southeast | $1,331.22 | $3,285.78 |
| HealthPartners Health Plan West | $1,337.32 | $3,301.04 |
| Medical Associates Health Plan | $917.60 | $2,251.74 |
| MercyCare Health Plan | $947.84 | $2,327.34 |
| Network Health | $1,059.48 | $2,606.44 |
| Quartz Central | $1,348.74 | $3,329.58 |
| Quartz - UW Health | $925.74 | $2,272.08 |
| Quartz West | $915.40 | $2,246.24 |
| Robin with HealthPartners Health Plan | $1,352.68 | $3,339.44 |
| Security Health Plan | $1,303.72 | $3,217.04 |
| State Maintenance Plan (SMP)1 by Dean Health Plan | $1,024.92 | $2,520.04 |
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.