Monthly Premiums
| Plan Option* | Employee | Family | Employee + Spouse | Employee + Child(ren) |
|---|---|---|---|---|
| Plan 1 | $1008 | $3328 | $2017 | $1714 |
| Plan 2 | $870 | $2871 | $1740 | $1479 |
| Plan 3 | $702 | $2316 | $1404 | $1193 |
| Plan 3 (with HRA) | $744 | $2455 | $1488 | $1265 |
| Plan 4 | $692 | $2284 | $1384 | $1177 |
| Plan 4 (with HRA) | $734 | $2421 | $1467 | $1248 |
* To determine the deductible amounts, out-of-pocket maximums, and coinsurance percentages for each plan option, please consult the detailed chart below.
Rates effective for rate region 2.
For organizations in 2026 Rate Region D, the estimated 2027 regional rating factor = +6.8%.
For organizations in 2026 Rate Region E, the estimated 2027 regional rating factor = +3.3%.
For organizations in 2026 Rate Region F, the estimated 2027 regional rating factor = -3.1%.
For organizations in Waupaca, WI, the estimated 2027 regional rating factor = -1.1%.
For organizations in Jefferson, WI, the estimated 2027 regional rating factor = -5.1%.
Please see the 2027 rate announcement page for additional details regarding the 2027 rate changes.
| Plan | Plan 1 | Plan 2 | Plan 3 | Plan 4 |
|---|---|---|---|---|
| Medical Deductible Individual | $1,000 | $2,000 | $3,500 | $4,000 |
| Medical Deductible Family | $2,000 | $4,000 | $7,000 | $8,000 |
| Member Cost Share (Co-Insurance) for Covered Medical Expenses After Deductible | 15% In-Network 30% Non-Network | 20% In-Network 30% Non-Network | 20% In-Network 30% Non-Network | 20% In-Network 50% Non-Network |
| Medical Out-of-Pocket Maximum Individual | $3,000 | $5,000 | $6,000 | $8,000 |
| Medical Out-of-Pocket Maximum Family | $6,000 | $10,000 | $12,000 | $16,000 |
| Rx Out-of-Pocket Maximum Individual | $1,000 | $1,000 | Applied to Medical Deductible; then Plan pays 100% | $1,000 |
| Rx Out-of-Pocket Maximum Family | $2,000 | $2,000 | Applied to Medical Deductible; then Plan pays 100% | $2,000 |
| Total Plan Out-of-Pocket Maximum Individual | $4,000 | $6,000 | $6,000 | $9,000 |
| Total Plan Out-of-Pocket Maximum Family | $8,000 | $12,000 | $12,000 | $18,000 |
Plan design notes
- Plan 3 is a Health Savings Account (HSA)-compliant High Deductible Health Plan (HDHP). Benefits and coverage under Plan 3 may be different from other plan options. Please consult the Plan 3 Summary Plan Description for additional details or contact the Benefit Plans Office.
- Medical Out-of-Pocket Maximum amounts include Medical Deductible amounts.
- Total Plan Out-of-Pocket Maximum amounts for Individual and Family are the total of Medical Out-of-Pocket Maximum amounts and Rx Out-of-Pocket Maximum amounts for Individual and Family, respectively.