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 | $1,448.58 | $3,578.10 |
| Aspirus Health Plan | $1,375.00 | $3,394.12 |
| CareSource Wisconsin | $1,364.56 | $3,368.02 |
| Dean Health Plan | $1,269.20 | $3,129.62 |
| GHC of Eau Claire Greater WI | $1,528.46 | $3,777.78 |
| GHC of Eau Claire River Region | $1,518.28 | $3,752.32 |
| GHC-SCW Dane Choice | $943.02 | $2,314.18 |
| GHC-SCW Neighbors | $1,211.20 | $2,984.62 |
| HealthPartners Health Plan Southeast | $1,395.02 | $3,444.18 |
| HealthPartners Health Plan West | $1,484.02 | $3,666.68 |
| Medica West and Mayo Clinic Health System | $1,472.62 | $3,638.18 |
| Medical Associates Health Plan | $1,012.98 | $2,489.08 |
| MercyCare Health Plan | $1,007.54 | $2,475.48 |
| Network Health | $1,065.26 | $2,619.78 |
| Prevea360 East | $1,020.64 | $2,508.22 |
| Quartz Central | $1,435.46 | $3,545.28 |
| Quartz UW Health | $978.10 | $2,401.88 |
| Quartz West | $1,053.46 | $2,590.28 |
| Robin with HealthPartners Health Plan | $1,447.56 | $3,575.52 |
| Security Health Plan | $1,304.86 | $3,218.78 |
| State Maintenance Plan (SMP)1 | $1,159.86 | $2,856.32 |
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.