Form Number: ET-2107prtg

Health PlanIndividual 
with / without dental		Family
with / without dental
Access Plan by Dean$1,246.26 / $1,213.54$3,073.40 / $2,991.60
Aspirus Health Plan$798.12 / $765.40$1,953.04 / $1,871.24
Common Ground Healthcare Cooperative$775.76 / $743.04$1,897.14 / $1,815.34
Dean Health Plan$680.42 / $647.70$1,658.78 / $1,576.98
Dean Health Plan - Prevea360 East$789.04 / $756.32$1,930.34 / $1,848.54
Dean Health Plan - Medica West and Mayo Clinic Health System$905.36 / $872.64$2,221.14 / $2,139.34
GHC of Eau Claire Greater WI$839.56 / $806.84$2,056.64 / $1,974.84
GHC of Eau Claire River Region$858.16 / $825.44$2,103.14 / $2,021.34
GHC-SCW Dane Choice$677.86 / $645.14$1,652.38 / $1,570.58
GHC-SCW Neighbors$716.36 / $683.64$1,748.64 / $1,666.84
HealthPartners Health Plan Southeast$790.04 / $757.32$1,932.84 / $1,851.04
HealthPartners Health Plan West$805.54 / $772.82$1,971.58 / $1,889.78
Medical Associates Health Plan$685.50 / $652.78$1,671.48 / $1,589.68
MercyCare Health Plan$585.94 / $553.22$1,422.58 / $1,340.78
Network Health$781.32 / $748.60$1,911.04 / $1,829.24
Quartz Central$800.08 / $767.36$1,957.94 / $1,876.14
Quartz - UW Health$693.52 / $660.80$1,691.54 / $1,609.74
Quartz West$786.64 / $753.92$1,924.34 / $1,842.54
Robin with HealthPartners Health Plan$815.30 / $782.58$1,995.98 / $1,914.18
Security Health Plan$823.06 / $790.34$2,015.38 / $1,933.58
State Maintenance Plan (SMP) by Dean Health Plan$968.84 / $936.12$2,379.86 / $2,298.06