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 | $1,119.46 | $2,756.40 |
| Aspirus Health Plan | $1,088.56 | $2,679.12 |
| Common Ground Healthcare Cooperative | $1,069.16 | $2,630.62 |
| Dean Health Plan | $928.14 | $2,278.08 |
| Dean Health Plan - Medica West and Mayo Clinic Health System | $1,082.40 | $2,663.72 |
| Dean Health Plan - Prevea360 East | $864.54 | $2,119.08 |
| GHC of Eau Claire Greater WI | $1,154.94 | $2,845.08 |
| GHC of Eau Claire River Region | $1,250.16 | $3,083.12 |
| GHC-SCW Dane Choice | $739.96 | $1,807.62 |
| GHC-SCW Neighbors | $860.44 | $2,108.82 |
| HealthPartners Health Plan Southeast | $1,142.90 | $2,814.98 |
| HealthPartners Health Plan West | $1,148.16 | $2,828.12 |
| Medical Associates Health Plan | $786.48 | $1,923.92 |
| MercyCare Health Plan | $812.54 | $1,989.08 |
| Network Health | $908.74 | $2,229.58 |
| Quartz Central | $1,158.00 | $2,852.72 |
| Quartz - UW Health | $793.50 | $1,941.48 |
| Quartz West | $784.58 | $1,919.18 |
| Robin with HealthPartners Health Plan | $1,161.40 | $2,861.22 |
| Security Health Plan | $1,119.20 | $2,755.72 |
| State Maintenance Plan (SMP)1 by Dean Health Plan | $894.70 | $2,194.50 |
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.