University of Wisconsin Represented &
Non-Represented Dental Premiums

2010 DentalBlue (Dentacare)

Monthly Premiums Effective for Coverage 1/1/2010

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

(Region 1 and Region 2)

$23.51

$47.01

$77.56

479
Group Nos.
00166272 and 00166261

Anthem BCBS Supplemental

(Region 1 and Region 2)

$16.59

$33.19

$49.80

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

 

2009 DentalBlue (Dentacare)

Monthly Premiums Effective for Coverage 1/1/2009

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

(Region 1 and Region 2)

$23.51

$47.01

$77.56

479
Group Nos.
00166272 and 00166261

Anthem BCBS Supplemental

(Region 1 and Region 2)

$16.59

$33.19

$49.80

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

 

File last updated: September 29, 2009
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