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 | $1,475.54 | $3,645.50 |
| Aspirus Health Plan | $1,400.32 | $3,457.42 |
| CareSource Wisconsin | $1,389.66 | $3,430.78 |
| Dean Health Plan | $1,292.22 | $3,187.18 |
| GHC of Eau Claire Greater WI | $1,557.12 | $3,849.42 |
| GHC of Eau Claire River Region | $1,546.72 | $3,823.42 |
| GHC-SCW Dane Choice | $958.96 | $2,354.02 |
| GHC-SCW Neighbors | $1,232.96 | $3,039.02 |
| HealthPartners Health Plan Southeast | $1,420.78 | $3,508.58 |
| HealthPartners Health Plan West | $1,511.72 | $3,735.92 |
| Medica West and Mayo Clinic Health System | $1,500.08 | $3,706.82 |
| Medical Associates Health Plan | $1,030.44 | $2,532.72 |
| MercyCare Health Plan | $1,024.88 | $2,518.82 |
| Network Health | $1,083.84 | $2,666.22 |
| Prevea360 East | $1,038.26 | $2,552.28 |
| Quartz Central | $1,462.10 | $3,611.88 |
| Quartz UW Health | $994.80 | $2,443.62 |
| Quartz West | $1,071.80 | $2,636.12 |
| Robin with HealthPartners Health Plan | $1,474.46 | $3,642.78 |
| Security Health Plan | $1,328.66 | $3,278.28 |
| State Maintenance Plan (SMP)1 | $1,180.54 | $2,907.98 |
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.