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 | $1,266.10 | $3,121.90 |
| Aspirus Health Plan | $1,201.28 | $2,959.82 |
| CareSource Wisconsin | $1,192.10 | $2,936.86 |
| Dean Health Plan | $1,108.14 | $2,726.96 |
| GHC of Eau Claire Greater WI | $1,336.40 | $3,297.62 |
| GHC of Eau Claire River Region | $1,327.44 | $3,275.22 |
| GHC-SCW Dane Choice | $820.96 | $2,009.02 |
| GHC-SCW Neighbors | $1,057.08 | $2,599.32 |
| HealthPartners Health Plan Southeast | $1,218.92 | $3,003.92 |
| HealthPartners Health Plan West | $1,297.28 | $3,199.82 |
| Medica West and Mayo Clinic Health System | $1,287.24 | $3,174.72 |
| Medical Associates Health Plan | $882.56 | $2,163.02 |
| MercyCare Health Plan | $877.78 | $2,151.06 |
| Network Health | $928.58 | $2,278.06 |
| Prevea360 East | $889.30 | $2,179.86 |
| Quartz Central | $1,254.52 | $3,092.92 |
| Quartz UW Health | $851.86 | $2,086.26 |
| Quartz West | $918.20 | $2,252.12 |
| Robin with HealthPartners Health Plan | $1,265.18 | $3,119.56 |
| Security Health Plan | $1,139.54 | $2,805.46 |
| State Maintenance Plan (SMP)1 | $1,011.90 | $2,486.40 |
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.