NONREPRESENTED Low Deductible Plan 2015 PLAN NAMES ANTHEM BLUE PREFERRED NORTHEAST ANTHEM BLUE PREFERRED SOUTHEAST ARISE HEALTH PLAN NORTHERN ARISE HEALTH PLAN SOUTHEAST DEAN HEALTH INSURANCE DEAN HEALTH INSURANCE - PREVEA360 GHC OF EAU CLAIRE GHC OF SOUTH CENTRAL WISCONSIN GUNDERSEN HEALTH PLAN HEALTH TRADITION HEALTH PLAN HEALTHPARTNERS HEALTH PLAN HUMANA - EASTERN HUMANA - WESTERN MEDICAL ASSOCIATES HEALTH PLANS MERCYCARE HEALTH PLANS NETWORK HEALTH PHYSICIANS PLUS SECURITY HEALTH PLAN UNITEDHEALTHCARE OF WISCONSIN UNITY HEALTH INSURANCE - COMMUNITY UNITY HEALTH INSURANCE - UW HEALTH WEA TRUST - EAST WEA TRUST - NORTHWEST CHIPPEWA VALLEY WEA TRUST - NORTHWEST MAYO CLINIC HLTH SYS WEA TRUST - SOUTH CENTRAL STATE MAINTENANCE PLAN (SMP) STANDARD PLAN - DANE STANDARD PLAN - MILWAUKEE STANDARD PLAN - WAUKESHA STANDARD PLAN - BALANCE OF STATE Total Premium 647.00 692.80 956.50 986.80 628.30 761.00 1,039.90 576.60 740.80 645.50 831.30 1,107.50 1,107.50 583.80 587.90 707.20 657.40 978.30 825.40 619.80 533.30 764.10 893.10 893.10 726.10 791.20 1,018.00 1,181.70 1,095.40 1,095.40 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ SINGLE County's Contribution 586.38 586.38 586.38 586.38 586.38 586.38 586.38 576.60 586.38 586.38 586.38 586.38 586.38 583.80 586.38 586.38 586.38 586.38 586.38 586.38 533.30 586.38 586.38 586.38 586.38 586.38 586.38 586.38 586.38 586.38 Employee MONTHLY Cost $ 60.62 $ 106.42 $ 370.12 $ 400.42 $ 41.92 $ 174.62 $ 453.52 $ $ 154.42 $ 59.12 $ 244.92 $ 521.12 $ 521.12 $ $ 1.52 $ 120.82 $ 71.02 $ 391.92 $ 239.02 $ 33.42 $ $ 177.72 $ 306.72 $ 306.72 $ 139.72 $ 204.82 $ 431.62 $ 595.32 $ 509.02 $ 509.02 Regular Family 1,610.00 1,724.50 2,383.80 2,459.50 1,563.30 1,895.00 2,592.30 1,434.00 1,844.50 1,606.30 2,070.80 2,761.30 2,761.30 1,452.00 1,462.30 1,760.50 1,636.00 2,438.30 2,056.00 1,542.00 1,325.80 1,902.80 2,225.30 2,225.30 1,807.80 1,972.00 2,537.60 2,946.20 2,732.30 2,732.30 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ FAMILY County's Contribution 1,461.78 1,461.78 1,461.78 1,461.78 1,461.78 1,461.78 1,461.78 1,434.00 1,461.78 1,461.78 1,461.78 1,461.78 1,461.78 1,452.00 1,461.78 1,461.78 1,461.78 1,461.78 1,461.78 1,461.78 1,325.80 1,461.78 1,461.78 1,461.78 1,461.78 1,461.78 1,461.78 1,461.78 1,461.78 1,461.78 Employee MONTHLY Cost $ 148.22 $ 262.72 $ 922.02 $ 997.72 $ 101.52 $ 433.22 $ 1,130.52 $ $ 382.72 $ 144.52 $ 609.02 $ 1,299.52 $ 1,299.52 $ $ 0.52 $ 298.72 $ 174.22 $ 976.52 $ 594.22 $ 80.22 $ $ 441.02 $ 763.52 $ 763.52 $ 346.02 $ 510.22 $ 1,075.82 $ 1,484.42 $ 1,270.52 $ 1,270.52
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