Non-Represented Dental Insurance Premiums

2008 DentalBlue (Dentacare)

Monthly Premiums Effective for Coverage 1/1/08

UW Deduction Codes

Plan

Employee

Employee
+ 1

Employee
+2

467
Group Nos.
00166271 and 00166260

Anthem BCBS HMO — Region 1

(Kenosha, Milwaukee, Ozaukee, Racine, Washington & Waukesha Counties

$23.27

$46.55

$74.47

Anthem BCBS HMO — Region 2

(All other Wisconsin Counties)

$28.78

$57.56

$92.10

478
Group Nos.
00166270 and 00166212

Anthem BCBS PPO

$21.70

$43.38

$71.58

479
Group Nos.
00166272 and 00166261

Anthem BCBS Supplemental

$14.28

$28.56

$42.86

Premiums are deducted one month in advance of the month of coverage

 

2007 DentalBlue (Dentacare)
(Group #83445-7)

Monthly Premiums

OSER Deduction Codes

UW Deduction Codes

Plan

Employee

Employee
+ 1

Employee
+2

484

467

Dentacare HMO—Region 1

(Kenosha, Milwaukee, Ozaukee, Racine, Washington & Waukesha Counties

$19.12

$38.25

$61.19

Dentacare HMO—Region 2

(All other Wisconsin Counties)

$23.65

$47.30

$75.68
485

478

Preferred PPO

$19.38

$38.75

$63.94
486

479

Supplemental Plan

$11.48

$22.96

$34.45

Premiums are deducted one month in advance of the month of coverage

 

2006 DentalBlue (Dentacare)
(Group #83445-7)

Monthly Premiums

UW Deduction Codes

Plan

Employee

Employee
+ 1

Employee
+2

467

Dentacare HMO—Region 1

(Kenosha, Milwaukee, Ozaukee, Racine, Washington & Waukesha Counties

$19.12

$38.25

$61.19

Dentacare HMO—Region 2

(All other Wisconsin Counties)

$23.65

$47.30

$75.68

478

Preferred PPO

$19.38

$38.75

$63.94

479

Supplemental Plan

$11.48

$22.96

$34.45

Premiums are deducted one month in advance of the month of coverage

2005 DentalBlue (Dentacare)
(Group #83445-7)
Monthly Premiums
Deduction Code
Plan
Employee
Employee
& 1
Employee
& 2+
467
Dentacare HMO
$17.40*
$21.52**
$34.80*
$43.04**
$55.68*
$68.86**
478
Preferred PPO
$17.94
$35.88
$59.20
479
Supplemental Plan
$9.95
$19.90
$29.85
*Region 1: Kenosha, Milwaukee, Ozaukee, Racine, Washington and Waukesha Counties
**Region 2: All Other Wisconsin Counties

Premiums are deducted one month in advance of the month of coverage.

File last updated: September 12, 2008
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