State Group Health

State Group Health

UW System State Group Health  Monthly Employee Premium – 2016
Premium Tier Employees Covered by the WRS

-IYC Health Plan-

Employees Covered by the WRS

– IYC HDHP-

Employees Covered by Grad Assistant/ Short-Term AS

-IYC Health Plan Only-

Single Family Single Family Single Family
Tier 1 With Dental $86.00 $217.00 $32.00 $81.00 $44.50 $112.50
Without Dental $83.00 $209.00 $29.00 $73.00 $41.50 $104..50
Tier 2 (Access Plan – required to work out of state) With Dental $136.00 $341.00 $82.00 $205.00 $69.50 $174.50
Without Dental $133.00 $333.00 $79.00 $197.00 $66.50 $166.50
Tier 3 (Access Plan) With Dental $253.00 $632.00 $199.00 $496.00 $128.00 $320.00
Without Dental $250.00 $624.00 $196.00 $488.00 $125.00 $312.00

*WRS covered employees who are working less than 50% and University Staff Temporary employees with one appointment pay 50% of the total premium.

Additional Premium Information

Dental & Vision

EPIC Benefits+

Monthly Premiums
 Employee
Only
Employee
+ Spouse/DP
Employee
+ Child
Family
Without Vision
Insurance
$19.77$39.54$39.54$59.31
With Vision
Insurance
$24.02$47.04$47.04$70.34

The University does not contribute toward the premium.

Dental Wisconsin

Monthly Premiums
 Employee OnlyEmployee
+ Spouse/DP
Employee
+ Child(ren)
Family
Select Plan$20.52$42.19$48.68$71.59
PPO$25.49$53.96$60.34$91.21

The University does not contribute toward the premium.

VSP Vision Insurance

Monthly Premiums
Employee OnlyEmployee
+ Spouse/DP
Employee
+ Child(ren)
Family
$6.54$13.08$14.73$23.54

The University does not contribute toward the premium.

Life Insurance

 
Monthly Premiums and Coverage Levels
Age as of April 1Basic and Supplemental
Rate per $1,000
Additional
Rate per $1,000
Spouse/Domestic Partner
& Dependent Coverage
Under age 40$0.04$0.06One Unit of Coverage:
$2.50 for $10,000 Spouse/DP
and $5,000 for each child.
40-44$0.06$0.09
45-49$0.10$0.15
50-54$0.16$0.24Two Units of Coverage:
$5.00 for $20,000 Spouse/DP
and $10,000 for each child.
55-59$0.22$0.33
60-64$0.30$0.45
65-69$0.39$0.59
Over Age 70 Additional Coverage
Age as of April 1Rate per $1,000
70$1.00
71

1.15

721.25
731.45
741.60
751.80
761.95
77-892.06
90+Available upon request

Basic coverage – first unit of coverage
Supplemental coverage – second unit of coverage
Additional coverage – may choose one to three Additional units of coverage
Each unit of coverage is equal to your annual salary

Use the Premium Calculator or see the rate chart below to determine your monthly premium.

Monthly Premiums and Coverage Levels
Age as January 1EmployeeSpouse / Domestic Partner*
$5,000$10,000$15,000$20,000$5,000$10,000
27 or less$0.12$0.23$0.35$0.46$0.18$0.36
28-300.130.250.380.500.200.40
31-330.160.320.480.640.250.50
34-360.190.370.560.740.300.59
37-390.230.450.680.900.360.72
40-420.340.681.021.360.541.08
43-450.541.081.622.160.861.71
46-480.651.301.952.601.042.07
49-510.911.812.723.621.442.88
52-541.162.323.484.641.853.69
55-571.623.234.856.462.575.13
58-602.024.036.058.063.116.21
61-632.785.568.3411.123.877.74
64-664.007.9911.9915.985.4010.80
67-695.5911.1716.7622.347.5215.03
70-728.6217.2425.8634.4811.6623.31
73+12.3324.6636.9949.3216.6533.30
Child Coverage
Benefit AmountMonthly Premium
$2,500$0.18
$5,000$0.35
$7,500$0.53
$10,000$0.70
$12,500$0.88
$15,000$1.05
$17,500$1.23
$20,000$1.40
$22,500$1.58
$25,000$1.75

*Spouse/domestic partner coverage is determined by the employee’s age.

The University does not contribute towards the premium.

Active Employee Rates

(effective 11/1/2016)

*For coverage prior to 11/1/2016, see Annuitant Rates below*

Monthly Premiums and Coverage Levels
Benefit Amount$25,000$50,000$100,000$150,000$200,000$250,000
Employee Only$0.65$1.30$2.60$3.90$5.20$6.50
Family$0.98$1.95$3.90$5.85$7.80$9.75
Monthly Premiums and Coverage Levels (cont'd)
Benefit Amount$300,000$350,000$400,000$450,000$500,000
Employee Only$7.80$9.10$10.40$11.70$13.00
Family$11.70$13.65$15.60$17.55$19.50

The University does not contribute towards the premium.


Annuitant Rates

(effective 11/1/2016)

**These rates currently apply to Active Employees prior to 11/1/2016**

Monthly Premiums and Coverage Levels
Benefit Amount$25,000$50,000$100,000$150,000$200,000$250,000
Employee Only$0.73$1.45$2.90$4.35$5.80$7.25
Family$1.10$2.20$4.40$6.60$8.80$11.00
Monthly Premiums and Coverage Levels (cont'd)
Benefit Amount$300,000$350,000$400,000$450,000$500,000
Employee Only$8.70$10.15$11.60$13.05$14.50
Family$13.20$15.40$17.60$19.80$22.00

The University does not contribute towards the premium.

The level of Group Term Life insurance coverage you are eligible to elect, and your monthly cost, is determined by your age. Coverage level and premium are based on employee’s age as of January 1st of the current year.

Benefit Amounts effective 10/1/14.

Monthly Premiums
and Coverage Levels
Age as of
January 1
Benefit
Amount
Premium
Under 35 $33,000 $1.00
35 – 39 $28,000 1.25
40 – 44 $25,000 1.60
45 – 49 $18,000 2.00
50 – 54 $15,000 2.40
55 – 59 $13,000 3.80
60 – 64 $12,000 4.35
65 and over $7,000 3.00

The University of Wisconsin does not contribute to the premium.

Benefits are based on your age as of the start of the contract year – October 1st.

The annual premium of $24.00 is deducted from your October earnings. The University of Wisconsin does not contribute toward the premium. If employment starts after October 1st, you must wait until the following year for enrollment.

Eligible employees on a leave of absence will be billed for the annual premium of $24.00 by the UW Service Center. Premium must be remitted through direct payment or payroll deduction by December 1st or coverage will end as of 9/30 with no option of conversion.

Coverage Levels
Age as of
October 1
Benefit
Amount
Age as of
October 1
Benefit
Amount
Under 28$101,00049-51$22,600
28-3098,10052-5417,200
31-3390,90055-5713,100
34-3678,90058-6010,300
37-3965,00061-638,200
40-4250,90064-666,100
43-4539,10067-694,500
46-4830,00070 +3,400