Form Number: ET-2107prtg

Health PlanIndividual 
with / without dental		Family
with / without dental
Access Plan$1,402.78 / $1,368.90$3,463.60 / $3,378.90
Aspirus Health Plan$860.44 / $826.56$2,107.72 / $2,023.02
CareSource Wisconsin  $819.96 / $786.08$2,006.52 / $1,921.82
Dean Health Plan$723.54 / $689.66$1,765.48 / $1,680.78
GHC of Eau Claire Greater WI$915.38 / $881.50$2,245.08 / $2,160.38
GHC of Eau Claire River Region$953.56 / $919.68$2,340.52 / $2,255.82
GHC-SCW Dane Choice$714.14 / $680.26$1,741.98 / $1,657.28
GHC-SCW Neighbors$950.64 / $916.76$2,333.22 / $2,248.52
HealthPartners Health Plan Southeast$837.68 / $803.80$2,050.82 / $1,966.12
HealthPartners Health Plan West$889.46 / $855.58$2,180.28 / $2,095.58
Medica West and Mayo Clinic Health System$960.00 / $926.12$2,356.62 / $2,271.92
Medical Associates Health Plan$746.04 / $712.16$1,821.72 / $1,737.02
MercyCare Health Plan$622.28 / $588.40$1,512.32 / $1,427.62
Network Health$827.06 / $793.18$2,024.28 / $1,939.58
Prevea360 East$828.88 / $795.00$2,028.82 / $1,944.12
Quartz Central$861.18 / $827.30$2,109.58 / $2,024.88
Quartz UW Health$722.28 / $688.40$1,762.32 / $1,677.62
Quartz West$851.08 / $817.20$2,084.32 / $1,999.62
Robin with HealthPartners Health Plan$868.28 / $834.40$2,127.32 / $2,042.62
Security Health Plan$834.20 / $800.32$2,042.12 / $1,957.42
State Maintenance Plan (SMP)$1,089.02 / $1,055.14$2,679.20 / $2,594.50