At Least 50% Time or Greater The premiums in this chart apply to full-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.
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 | 662.60 | 4AO | 100.00 | 4AE | 762.60 | 1612.40 | 4AO | 250.00 | 4AE | 1862.40 | |
| STANDARD PLAN OUT-OF-STATE | 2 | 712.60 | 4AO | 50.00 | 4AE | 762.60 | 1737.40 | 4AO | 125.00 | 4AE | 1862.40 | |
| STATE MAINTENANCE PLAN* | 1 | 459.70 | 4AR | 22.00 | 4AA | 481.70 | 1110.30 | 4AR | 55.00 | 4AA | 1165.30 | |
| ATRIUM HEALTH PLAN | 1 | 430.20 | 4CE | 22.00 | 4CD | 452.20 | 1072.00 | 4CE | 55.00 | 4CD | 1127.00 | |
| COMPCAREBLUE - AURORA/FAMILY | 1 | 357.20 | 4HK | 22.00 | 4HJ | 379.20 | 889.50 | 4HK | 55.00 | 4HJ | 944.50 | |
| COMPCAREBLUE NORTHEAST | 2 | 435.90 | 4HN | 50.00 | 4HM | 485.90 | 1086.30 | 4HN | 125.00 | 4HM | 1211.30 | |
| COMPCAREBLUE NORTHWEST | 1 | 462.70 | 4DE | 22.00 | 4DD | 484.70 | 1153.30 | 4DE | 55.00 | 4DD | 1208.30 | |
| COMPCAREBLUE SOUTHEAST | 1 | 452.50 | 4EN | 22.00 | 4EM | 474.50 | 1127.80 | 4EN | 55.00 | 4EM | 1182.80 | |
| DEAN HEALTH PLAN | 1 | 384.70 | 4CP | 22.00 | 4CO | 406.70 | 958.30 | 4CP | 55.00 | 4CO | 1013.30 | |
| GHC-EAU CLAIRE | 1 | 485.50 | 4DN | 22.00 | 4DM | 507.50 | 1210.30 | 4DN | 55.00 | 4DM | 1265.30 | |
| GHC-SOUTH CENTRAL | 1 | 369.00 | 4DB | 22.00 | 4DA | 391.00 | 919.10 | 4DB | 55.00 | 4DA | 974.10 | |
| GUNDERSEN LUTHERAN | 1 | 451.20 | 4BN | 22.00 | 4BM | 473.20 | 1124.60 | 4BN | 55.00 | 4BM | 1179.60 | |
| HEALTH TRADITION | 1 | 474.30 | 4CW | 22.00 | 4CV | 496.30 | 1182.30 | 4CW | 55.00 | 4CV | 1237.30 | |
| HUMANA-EASTERN | 2 | 480.60 | 4EQ | 50.00 | 4EP | 530.60 | 1198.10 | 4EQ | 125.00 | 4EP | 1323.10 | |
| HUMANA-WESTERN | 1 | 476.20 | 4BW | 22.00 | 4BV | 498.20 | 1187.10 | 4BW | 55.00 | 4BV | 1242.10 | |
| MEDICAL ASSOCIATES HMO | 1 | 402.40 | 4DP | 22.00 | 4DQ | 424.40 | 1002.50 | 4DP | 55.00 | 4DQ | 1057.50 | |
| MERCYCARE HEALTH PLAN | 1 | 350.30 | 4GN | 22.00 | 4GM | 372.30 | 872.30 | 4GN | 55.00 | 4GM | 927.30 | |
| NETWORK-FOX VALLEY | 1 | 417.30 | 4GB | 22.00 | 4GA | 439.30 | 1039.80 | 4GB | 55.00 | 4GA | 1094.80 | |
| PHYSICIANS PLUS | 1 | 389.00 | 4CM | 22.00 | 4CL | 411.00 | 969.10 | 4CM | 55.00 | 4CL | 1024.10 | |
| PREVEA HEALTH PLAN | 1 | 449.50 | 4BH | 22.00 | 4BG | 471.50 | 1120.30 | 4BH | 55.00 | 4BG | 1175.30 | |
| UNITED HEALTHCARE (formerly TOUCHPOINT) | 1 | 390.00 | 4DH | 22.00 | 4DG | 412.00 | 971.50 | 4DH | 55.00 | 4DG | 1026.50 | |
| UNITY-COMMUNITY | 1 | 459.30 | 4CH | 22.00 | 4CG | 481.30 | 1144.80 | 4CH | 55.00 | 4CG | 1199.80 | |
| UNITY-UW HEALTH | 1 | 369.10 | 4BE | 22.00 | 4BD | 391.10 | 919.30 | 4BE | 55.00 | 4BD | 974.30 | |
*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
UW1332-1 09/05