Form Number: ET-2128pr
The employee and non-Medicare Retiree health plan rates reflect total monthly premium rates for each health plan. Total monthly premiums are shown without Uniform Dental.
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 | $1,556.26 | $3,847.30 |
| Aspirus Health Plan | $1,476.30 | $3,647.38 |
| CareSource Wisconsin | $1,464.96 | $3,619.02 |
| Dean Health Plan | $1,361.30 | $3,359.88 |
| GHC of Eau Claire Greater WI | $1,643.10 | $4,064.38 |
| GHC of Eau Claire River Region | $1,632.04 | $4,036.72 |
| GHC-SCW Dane Choice | $1,006.76 | $2,473.52 |
| GHC-SCW Neighbors | $1,298.26 | $3,202.28 |
| HealthPartners Health Plan Southeast | $1,498.06 | $3,701.78 |
| HealthPartners Health Plan West | $1,594.80 | $3,943.62 |
| Medica West and Mayo Clinic Health System | $1,582.42 | $3,912.68 |
| Medical Associates Health Plan | $1,082.80 | $2,663.62 |
| MercyCare Health Plan | $1,076.90 | $2,648.88 |
| Network Health | $1,139.62 | $2,805.68 |
| Prevea360 East | $1,091.12 | $2,684.42 |
| Quartz Central | $1,542.02 | $3,811.68 |
| Quartz UW Health | $1,044.90 | $2,568.88 |
| Quartz West | $1,126.80 | $2,773.62 |
| Robin with HealthPartners Health Plan | $1,555.18 | $3,844.58 |
| Security Health Plan | $1,400.06 | $3,456.78 |
| State Maintenance Plan (SMP)1 | $1,242.44 | $3,062.74 |
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.