Historical Benefit Plan Premiums

Below are the historical premium tables for the various insurance plans offered by the University.

  1. State Group Health
  2. EPIC Benefits+
  3. Dental Insurance
  4. Vision Insurance
  5. Income Continuation Insurance
  6. Life Insurance

Health Insurance

2011 (8/26/2011 - 12/31/2011)

2011 (1/1/2011 - 8/25/2011)

2010

Prior Years

Classified Employees
Non-Represented and Represented with Settled Contracts Represented without Settled Contracts
Full Time Less than Half Time Full Time Less than Half Time
2009 2009    
2008 (1/1 - 7/31) 2008 (1/1 - 7/31)    
2008 (8/1 - 12/31) 2008 (8/1 - 12/31)    
2007 2007    
2006 2006    
2005 2005    
2004 2004    
2003 2003 2003 2003
Graduate Assistants and Short Term Academic Staff
Non-Represented and MGAA TAA
2009 2009
2008 (1/1 - 7/31) 2008 (1/1 - 7/31)
2008 (8/1 - 12/31) 2008 (8/1 - 12/31)
2007 2007
2006 2006
2005  
2004  
2003 2003

EPIC Benefits+

Note: Beginning with the 2011 plan year, EPIC Dental and Excess Medical was renamed to EPIC Benefits+.

2011 EPIC Benefits+ Insurance (Group #3180)
Deduction Code Coverage Type Employee Employee + Spouse or Domestic Partner Employee + Child Employee + 2 or more
404 Active Employee Monthly Premium Without Vision Coverage $16.70 $33.40 $33.40 $50.10
Active Employee Monthly Premium With Vision Coverage $20.70 $40.47 $40.47 $60.49
N/A Retiree Monthly Premium Without Vision Coverage $20.87 $41.64 $48.25 $57.43
Retiree Monthly Premium With Vision Coverage $24.87 $48.71 $55.32 $67.82
2009 Dental and Excess Medical (EPIC) Insurance (Group #3180)
Employee Type Premium
Employee Employee + Child Employee + Spouse Family
Active Employee $16.70 $33.40 $33.40 $50.10
Retiree $20.87 $48.25 $41.64 $57.43
2008 Dental and Excess Medical (EPIC) Insurance (Group #3180)
Employee Type Premium
Employee Employee + Child Employee + Spouse Family
Active Employee $12.90 $25.80 $25.80 $38.70
Retiree $16.85 $33.65 $33.65 $46.40
2006 Dental and Excess Medical (EPIC) Insurance (Group #3180)
Employee Type Premium
Employee Employee + Child Employee + Spouse Family
Active Employee $12.90 $25.80 $25.80 $38.70
Retiree $16.85 $33.65 $33.65 $46.40
2005 Dental and Excess Medical (EPIC) Insurance (Group #3180)
Employee Type Premium
Employee Employee + Child Employee + Spouse Family
Active Employee $11.30 $22.60 $22.60 $33.90
Retiree $13.15 $26.30 $30.45 $36.25

Anthem DentalBlue Insurance | Dental Wisconsin | Union Dental Plans

Anthem DentalBlue Insurance

2010/2011 DentalBlue Insurance — Monthly Premiums Effective for Coverage 1/1/2010
UW Deduction Codes Plan Employee Employee + 1 Employee + 2 or more
467
Group Nos. 00166271 and 00166260

Anthem BCBS Dentacare HMO — Region 1

(Kenosha, Milwaukee, Ozaukee, Racine, Washington & Waukesha Counties

 $23.27 $46.55 $74.47

Anthem BCBS Dentacare HMO — Region 2

(All other Wisconsin Counties)

 $28.78 $57.56 $92.10
478
Group Nos. 00166270 and 00166212

Anthem BCBS PPO

(Region 1 and Region 2)

 $23.51 $47.01 $77.56
479
Group Nos. 00166272 and 00166261

Anthem BCBS Supplemental

(Region 1 and Region 2)

 $16.59 $33.19 $49.80
2009 DentalBlue (Dentacare) — Monthly Premiums Effective for Coverage 01/01/2009
UW Deduction Codes Plan Employee Employee + 1 Employee +2
467
Group Nos. 00166271 and 00166260

Anthem BCBS HMO — Region 1

(Kenosha, Milwaukee, Ozaukee, Racine, Washington & Waukesha Counties

 $23.27 $46.55 $74.47

Anthem BCBS HMO — Region 2

(All other Wisconsin Counties)

 $28.78 $57.56 $92.10
478
Group Nos. 00166270 and 00166212

Anthem BCBS PPO

(Region 1 and Region 2)

 $23.51 $47.01 $77.56
479
Group Nos. 00166272 and 00166261

Anthem BCBS Supplemental

(Region 1 and Region 2)

 $16.59 $33.19 $49.80
2008 DentalBlue (Dentacare) — Monthly Premiums Effective for Coverage 01/01/2008
UW Deduction Codes Plan Employee Employee + 1 Employee +2
467
Group Nos. 00166271 and 00166260

Anthem BCBS HMO — Region 1

(Kenosha, Milwaukee, Ozaukee, Racine, Washington & Waukesha Counties

 $23.27 $46.55 $74.47

Anthem BCBS HMO — Region 2

(All other Wisconsin Counties)

 $28.78 $57.56 $92.10
478
Group Nos. 00166270 and 00166212

Anthem BCBS PPO

(Region 1 and Region 2)

 $21.70 $43.38 $71.58
479
Group Nos. 00166272 and 00166261

Anthem BCBS Supplemental

(Region 1 and Region 2)

 $14.28 $28.56 $42.86
2007 DentalBlue (Dentacare)
(Group #83445-7)
OSER Deduction Code UW Deduction Code Plan Employee Employee + 1 Employee + 2
484 467

Dentacare HMO—Region 1

(Kenosha, Milwaukee, Ozaukee, Racine, Washington & Waukesha Counties

 $19.12 $38.25 $61.19

Dentacare HMO—Region 2

(All other Wisconsin Counties)

 $23.65 $47.30 $75.68
485 478 Preferred PPO $19.38 $38.75 $63.94
486 479 Supplemental Plan $11.48 $22.96 $34.45
2006 DentalBlue (Dentacare)
(Group #83445-7)
UW Deduction Codes Plan Employee Employee + 1 Employee + 2
467

Dentacare HMO—Region 1

(Kenosha, Milwaukee, Ozaukee, Racine, Washington & Waukesha Counties

 $19.12 $38.25 $61.19

Dentacare HMO—Region 2

(All other Wisconsin Counties)

 $23.65 $47.30 $75.68
478 Preferred PPO $19.38 $38.75 $63.94
479 Supplemental Plan $11.48 $22.96 $34.45
2005 DentalBlue (Dentacare)
(Group #83445-7)
UW Deduction Codes Plan Employee Employee + 1 Employee + 2
467

Dentacare HMO—Region 1

(Kenosha, Milwaukee, Ozaukee, Racine, Washington & Waukesha Counties

 $17.40 $34.80 $55.68

Dentacare HMO—Region 2

(All other Wisconsin Counties)

 $21.52 $43.04 $68.86
478 Preferred PPO $17.94 $35.88 $59.20
479 Supplemental Plan $9.95 $19.90 $29.85

Dental Wisconsin

2011 Dental Wisconsin Insurance (Group #31800D) — Monthly Premiums Effective for Coverage 1/1/2011
UW Deduction Codes Plan Employee Employee + Spouse/Domestic Partner Employee + Child(ren) Family
487 Preferred Provider Plan (PPO) $25.54 $54.08 $60.47 $91.41
488 Select Plan $16.99 $34.93 $40.30 $59.28

Union Dental Plans

2011 Union Represented Dental Monthly Rates
Deduction Code Plan Name Bargaining Unit Rate Effective Date Premium
Single 2 Person Family
462 Care Plus Prepaid WSEU 2,3,5,6,12 01/01/2011 $32.99 N/A $81.07
463 DentalBlue WSP 15 09/01/2005 $36.90 N/A $99.62
464 DentaCare Smile Plus UPQHC 11 07/01/2010 $42.05 N/A $113.55
465 Freedom Advance WEAC 13 09/01/2008 $56.21 $105.25 $176.50
466 Delta Exclusive Provider WSEU 2,3,5,6,12 01/01/2010 $27.28 $53.87 $102.98
466 Delta Premier WSEU 2,3,5,6,12 01/01/2010 $29.85 $58.83 $111.09
504 Freedom Basic WPEC 7
PERSA 8
WSP 15		 01/01/2011 $25.53 $52.87 $94.83
505 Freedom Advance WPEC 7
PERSA 8
WSP 15 		01/01/2011 $40.70 $81.23 $133.43
2009 Union Represented Dental Monthly Rates
Deduction Code Plan Name Bargaining Unit Rate Effective Date Premium
Single 2 Person Family
462 Care Plus Prepaid WSEU 2,3,5,6,12 01/01/09 $30.50 N/A $74.96
463 DentalBlue WSP 15 09/01/05 $36.90 N/A $99.62
464 DentaCare Smile Plus UPQHC 11 07/01/09 $38.23 N/A $103.23
465 Freedom Advance WEAC 13 09/01/08 $56.21 $105.25 $176.50
466 Delta Exclusive Provider WSEU 2,3,5,6,12 01/01/08 $27.28 $53.87 $102.98
466 Delta Premier WSEU 2,3,5,6,12 01/01/08 $29.85 $58.83 $111.09
504 Freedom Basic WPEC 7
PERSA 8
WSP 15		 08/01/06 $24.32 $50.36 $90.32
505 Freedom Advance WPEC 7
PERSA 8
WSP 15		 08/01/06 $38.77 $77.37 $127.19
N/A Madison Teachers Assistants Association TAA N/A NONE NONE NONE
2006 Union Represented Dental Premiums
Deduction Code Plan Name Bargaining Unit Rate Effective Date Premium
Single 2 Person Family
462 Care Plus Prepaid WSEU 2,3,5,6,12 01/01/06 $26.65 N/A $65.50
462 Care Plus Prepaid WSEU 2,3,5,6,12 01/01/08 $29.05 N/A $71.39
463 DentalBlue WSP 15 09/01/05 $36.90 N/A $99.62
464 DentaCare Smile Plus UPQHC 11 07/01/08 $36.07 N/A $97.39
07/01/07 $34.03 N/A $91.88
07/01/06 $32.10 N/A $86.68
465 Freedom Advance WEAC 13 08/01/07 $54.31 $101.70 $170.54
466 Delta Exclusive Provider WSEU 2,3,5,6,12 01/01/07 $23.73 $46.85 $89.55
466 Delta Premier WSEU 2,3,5,6,12 01/01/07 $26.67 $52.53 $99.03
504 Freedom Basic WPEC 7
PERSA 8
WSP 15		 08/01/06 $24.32 $50.36 $90.32
505 Freedom Advance WPEC 7
PERSA 8
WSP 15		 08/01/06 $38.77 $77.37 $127.19
N/A Madison Teachers Assistants Association TAA N/A NONE NONE NONE
2005 Union Represented Dental Premiums
Deduction Code Plan Name Bargaining Unit Rate Effective Date Premium
Single 2 Person Family
462 Care Plus Prepaid WSEU 2,3,5,6,12 01/01/05 $26.65 N/A $65.50
463 DentalBlue WSP 15 09/01/03 $25.11 N/A $67.80
464 DentaCare Smile Plus UPQHC 11 07/01/04 $28.57 N/A $77.14
465 Freedom Advance WEAC 13 08/01/04 $36.25 $67.88 $113.83
466 Delta Care WSEU 2,3,5,6,12 02/01/04 $16.87 $33.07 $57.76
466 Delta Preferred WSEU 2,3,5,6,12 02/01/04 $17.22 $33.91 $58.74
466 Delta Premier WSEU 2,3,5,6,12 02/01/04 $26.70 $51.80 $81.56
468

DentalBlue DentaCare HMO — Region 1

(Kenosha, Milwaukee, Ozaukee, Racine, Washington and Waukesha counties)

 WSEU 2,3,5,6,12 01/01/05 $18.14 $35.47 $58.22

DentalBlue DentaCare HMO — Region 2

(All other Wisconsin counties)

 $22.49 $44.98 $71.95
469 DentalBlue Preferred PPO WSEU 2,3,5,6,12 02/01/04 $16.97 $32.89 $57.98
480 DentalBlue Choice WSEU 2,3,5,6,12 02/01/04 $42.50 $85.01 $123.55
481 DentalBlue Supplemental WSEU 2,3,5,6,12 01/01/05 $12.07 $24.14 $37.34
504 Freedom Basic WPEC 7
PERSA 8
WSP 15		 08/01/02 $18.55 $38.41 $68.93
505 Freedom Advance WPEC 7
PERSA 8
WSP 15		 08/01/02 $29.57 $59.01 $97.01
N/A Madison Teachers Assistants Association TAA N/A NONE NONE NONE

Vision Insurance

2010/2011 VSP Vision Plan Monthly Premiums — Coverage Effective 01/01/2010
UW Deduction Code Employee Employee + Spouse/Domestic Partner Employee + Child(ren) Employee + Family
411 $5.24 $10.49 $11.23 $17.93
2009 Vision Plan (OptumHealth)— Monthly Premiums for Coverage Effective 01/01/2009
Group Number F4ZL
UW Deduction Code Employee Employee + Spouse/Domestic Partner Employee + Children Employee + Family
410 $5.83 $11.34 $11.88 $17.82
2008 Vision Plan (OptumHealth)— Monthly Premiums for Coverage Effective 01/01/2008
Group Number F4ZL
UW Deduction Code Employee Employee + Spouse/Domestic Partner Employee + Children Employee + Family
410 $5.83 $11.34 $11.88 $17.82
2007 Vision Plan (OptumHealth)
Group Number F4ZL
UW Deduction Code Employee Employee + Spouse/Domestic Partner Employee + Children Employee + Family
410 $5.40 $10.50 $11.00 $16.50

State Group Life | UW Employees, Inc. Life

Life Insurance

State Group Life Insurance

State Group Life Insurance Premiums Effective through 03/31/2011
Age As of April 1 Basic & Supplemental Per $1,000 Additional Per $1,000 Spouse & Dependent
Under age 30 $.05 $.07

One Unit of Coverage: $2.50 per $10,000 Spouse and $5,000 for each dependent

Two Units of Coverage: $5.00 per $20,000 Spouse and $10,000 for each dependent
30-34 .05 .08
35-39 .05 .08
40-44 .07 .10
45-49 .11 .17
50-54 .18 .27
55-59 .28 .42
60-64 .38 .57
65-69 .50 .75
Over Age 70 Additional Coverage (Deduction Code: 418) — Effective through 03/31/2011
Age as of April 1 Rate per $1,000
70 $1.00
71 1.15
72 1.25
73 1.45
74 1.60
75 1.80
76 1.95
77 2.15
78 2.45
79 2.75
80 3.10
81 3.40
82 3.70
83 4.10
84 4.50
85 4.90
86 5.30
87 5.70
88 6.35
89 7.00
90+ Available upon request

University of Wisconsin Employees, Inc. Life Insurance

UW Employees, Inc. Monthly Premium Table — Premium and Coverage Amounts Effective January 1, 2010
Employee Age Coverage Amount Premium
under 35 $25,000 $1.00
35 - 39 21,000 1.25
40 - 44 18,000 1.60
45 - 49 12,000 2.00
50 - 54 9,000 2.40
55 - 59 7,500 3.80
60 - 64 7,000 4.35
over 64 3,000 3.00