The premiums in this chart apply to part-time employees in these appointment types: 1) Unclassified employees; 2) Classified employees represented by a Bargaining Unit with a settled contract—see chart below; 3) Non-represented Classified employees which include project employees, LTEs and Craftworker LTEs.
Bargaining Units With Settled Contracts
IMPORTANT: The 3-Tier model and actual contributions are subject to collective bargaining,
non-represented pay plans and unclassified pay plans.
| HEALTH PLAN | TIER | SINGLE | FAMILY | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| STATE SHARE | REG CODE | EMPLOYEE SHARE | EC CODE | TOTAL PREMIUM | STATE SHARE | REG CODE | EMPLOYEE SHARE | EC CODE | TOTAL PREMIUM | |||
| STANDARD PLAN | 3 | 404.25 | 4AO | 404.25 | 4AE | 808.50 | 1008.85 | >4AO | 1008.85 | 4AE | 2017.70 | |
| STANDARD PLAN OUT-OF-STATE | 2 | 404.25 | 4AO | 404.25 | 4AE | 808.50 | 1008.85 | 4AO | 1008.85 | 4AE | 2017.70 | |
| STATE MAINTENANCE PLAN* | 1 | 255.65 | 4AR | 255.65 | 4AA | 511.30 | 637.50 | 4AR | 637.50 | 4AA | 1275.00 | |
| COMPCAREBLUE - AURORA/FAMILY | 1 | 247.80 | 4HK | 247.80 | 4HJ | 495.60 | 617.80 | 4HK | 617.80 | 4HJ | 1235.60 | |
| COMPCAREBLUE NORTHWEST | 2 | 280.55 | 4DE | 280.55 | 4DD | 561.10 | 699.70 | 4DE | 699.70 | 4DD | 1399.40 | |
| COMPCAREBLUE SOUTHEAST | 2 | 293.20 | 4EN | 293.20 | 4EM | 586.40 | 731.30 | 4EN | 731.30 | 4EM | 1462.60 | |
| DEAN HEALTH PLAN | 1 | 218.80 | 4CP | 218.80 | 4CO | 437.60 | 545.30 | 4CP | 545.30 | 4CO | 1090.60 | |
| GHC-EAU CLAIRE | 1 | 262.50 | 4DN | 262.50 | 4DM | 525.00 | 654.55 | 4DN | 654.55 | 4DM | 1309.10 | |
| GHC-SOUTH CENTRAL | 1 | 215.10 | 4DB | 215.10 | 4DA | 430.20 | 536.05 | 4DB | 536.05 | 4DA | 1072.10 | |
| GUNDERSEN LUTHERAN | 1 | 266.20 | 4BN | 266.20 | 4BM | 532.40 | 663.80 | 4BN | 663.80 | 4BM | 1327.60 | |
| HEALTH TRADITION | 1 | 267.60 | 4CW | 267.60 | 4CV | 535.20 | 667.30 | 4CW | 667.30 | 4CV | 1334.60 | |
| HUMANA-EASTERN | 1 | 285.80 | 4EQ | 285.80 | 4EP | 571.60 | 712.80 | 4EQ | 712.80 | 4EP | 1425.60 | |
| HUMANA-WESTERN | 2 | 285.75 | 4BW | 285.75 | 4BV | 571.50 | 712.70 | 4BW | 712.70 | 1425.40 | ||
| MEDICAL ASSOCIATES HMO | 1 | 221.70 | 4DP | 221.70 | 4DQ | 443.40 | 552.55 | 4DP | 552.55 | 4DQ | 1105.10 | |
| MERCYCARE HEALTH PLAN | 1 | 201.40 | 4GN | 201.40 | 4GM | 402.80 | 501.80 | 4GN | 501.80 | 4GM | 1003.60 | |
| NETWORK HEALTH PLAN | 1 | 232.70 | 4GB | 232.70 | 4GA | 465.40 | 580.05 | 4GB | 580.05 | 4GA | 1160.10 | |
| PHYSICIANS PLUS | 1 | 219.65 | 4CM | 219.65 | 4CL | 439.30 | 547.45 | 4CM | 547.45 | 4CL | 1094.90 | |
| UNITED HEALTHCARE NE | 1 | 224.30 | 4DH | 224.30 | 4DG | 448.60 | 559.05 | 4DH | 559.05 | 4DG | 1118.10 | |
| UNITED HEALTHCARE SE | 1 | 265.60 | 4HX | 265.60 | 4HW | 531.20 | 662.30 | 4HX | 662.30 | 4HW | 1324.60 | |
| UNITY-COMMUNITY | 1 | 273.20 | 4CH | 273.20 | 4CG | 546.40 | 681.30 | 4CH | 681.30 | 4CG | 1362.60 | |
| UNITY-UW HEALTH | 1 | 217.65 | 4BE | 217.65 | 4BD | 435.30 | 542.45 | 4BE | 542.45 | 4BD | 1084.90 | |
| WPS PATIENT CHOICE 1 | 1 | 277.50 | 4HR | 277.50 | 4HQ | 555.00 | 692.05 | 4HR | 692.05 | 4HQ | 1384.10 | |
| WPS PATIENT CHOICE 2 | 2 | 300.75 | 4HU | 300.75 | 4HT | 601.50 | 750.20 | 4HU | 750.20 | 4HT | 1500.40 | |
| WPS PREVEA HEALTH PLAN | 1 | 256.30 | 4BH | 256.30 | 4BG | 512.60 | 639.05 | 4BH | 639.05 | 4BG | 1278.10 | |
*Only available to employees living in SMP counties
File last updated: March 19, 2007
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© 2006 Board of Regents of the University of Wisconsin System
10/05