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 | 381.30 | 4AO | 381.30 | 4AE | 762.60 | 931.20 | 4AO | 931.20 | 4AE | 1862.40 | |
| STANDARD PLAN OUT-OF-STATE | 2 | 381.30 | 4AO | 381.30 | 4AE | 762.60 | 931.20 | 4AO | 931.20 | 4AE | 1862.40 | |
| STATE MAINTENANCE PLAN* | 1 | 240.85 | 4AR | 240.85 | 4AA | 481.70 | 582.65 | 4AR | 582.65 | 4AA | 1165.30 | |
| ATRIUM HEALTH PLAN | 1 | 226.10 | 4CE | 226.10 | 4CD | 452.20 | 563.50 | 4CE | 563.50 | 4CD | 1127.00 | |
| COMPCAREBLUE - AURORA/FAMILY | 1 | 189.60 | 4HK | 189.60 | 4HJ | 379.20 | 472.25 | 4HK | 472.25 | 4HJ | 944.50 | |
| COMPCAREBLUE NORTHEAST | 2 | 242.95 | 4HN | 242.95 | 4HM | 485.90 | 605.65 | 4HN | 605.65 | 4HM | 1211.30 | |
| COMPCAREBLUE NORTHWEST | 1 | 242.35 | 4DE | 242.35 | 4DD | 484.70 | 604.15 | 4DE | 604.15 | 4DD | 1208.30 | |
| COMPCAREBLUE SOUTHEAST | 1 | 237.25 | 4EN | 237.25 | 4EM | 474.50 | 591.40 | 4EN | 591.40 | 4EM | 1182.80 | |
| DEAN HEALTH PLAN | 1 | 203.35 | 4CP | 203.35 | 4CO | 406.70 | 506.65 | 4CP | 506.65 | 4CO | 1013.30 | |
| GHC-EAU CLAIRE | 1 | 253.75 | 4DN | 253.75 | 4DM | 507.50 | 632.65 | 4DN | 632.65 | 4DM | 1265.30 | |
| GHC-SOUTH CENTRAL | 1 | 195.50 | 4DB | 195.50 | 4DA | 391.00 | 487.05 | 4DB | 487.05 | 4DA | 974.10 | |
| GUNDERSEN LUTHERAN | 1 | 236.60 | 4BN | 236.60 | 4BM | 473.20 | 589.80 | 4BN | 589.80 | 4BM | 1179.60 | |
| HEALTH TRADITION | 1 | 248.15 | 4CW | 248.15 | 4CV | 496.30 | 618.65 | 4CW | 618.65 | 4CV | 1237.30 | |
| HUMANA-EASTERN | 2 | 265.30 | 4EQ | 265.30 | 4EP | 530.60 | 661.55 | 4EQ | 661.55 | 4EP | 1323.10 | |
| HUMANA-WESTERN | 1 | 249.10 | 4BW | 249.10 | 4BV | 498.20 | 621.05 | 4BW | 621.05 | 4BV | 1242.10 | |
| MEDICAL ASSOCIATES HMO | 1 | 212.20 | 4DP | 212.20 | 4DQ | 424.40 | 528.75 | 4DP | 528.75 | 4DQ | 1057.50 | |
| MERCYCARE HEALTH PLAN | 1 | 186.15 | 4GN | 186.15 | 4GM | 372.30 | 463.65 | 4GN | 463.65 | 4GM | 927.30 | |
| NETWORK-FOX VALLEY | 1 | 219.65 | 4GB | 219.65 | 4GA | 439.30 | 547.40 | 4GB | 547.40 | 4GA | 1094.80 | |
| PHYSICIANS PLUS | 1 | 205.50 | 4CM | 205.50 | 4CL | 411.00 | 512.05 | 4CM | 512.05 | 4CL | 1024.10 | |
| PREVEA HEALTH PLAN | 1 | 235.75 | 4BH | 235.75 | 4BG | 471.50 | 587.65 | 4BH | 587.65 | 4BG | 1175.30 | |
| UNITEDHEALTHCARE (formerly TOUCHPOINT) | 1 | 206.00 | 4DH | 206.00 | 4DG | 412.00 | 513.25 | 4DH | 513.25 | 4DG | 1026.50 | |
| UNITY-COMMUNITY | 1 | 240.65 | 4CH | 240.65 | 4CG | 481.30 | 599.90 | 4CH | 599.90 | 4CG | 1199.80 | |
| UNITY-UW HEALTH | 1 | 195.55 | 4BE | 195.55 | 4BD | 391.10 | 487.15 | 4BE | 487.15 | 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
UW1333-1 10/05