University of Wisconsin Health Insurance Premium Employee Contribution Rates for the 2015 Plan Year



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Tier 3 : Standard Plan, Preferred Provider Plan (PPP) or Classified and Unclassified Employees Tier 1 $92.00 $230.00 Tier 2 $136.00 $341.00 Tier 3 $267.00 $666.00 Classified and Unclassified Employees Tier 1 $32.00 $81.00 Tier 2 $76.00 $192.00 Tier 3 $207.00 $517.00 2015 Monthly Contribution Rates for UW Graduate Assistants Tier 1 $46.00 $115.00 Tier 2 $68.00 $170.50 Tier 3 $133.50 $333.00 UW Graduate Assistants and Teaching Assistants are not eligible for HDHP coverage.

Tier 3 : Standard Plan, Preferred Provider Plan (PPP) or 2015 Monthly Premiums for Crafts Employees -Prevea360 1 $731.90 $1,822.30 1 $814.50 $2,028.80 1 $774.10 $1,927.80 1 $798.30 $1,988.30 1 $676.00 $1,682.60 1 $810.40 $2,018.60 1 $851.80 $2,122.10 1 $648.60 $1,614.10 1 $793.40 $1,976.10 1 $813.80 $2,027.10 1 $725.20 $1,805.60 1 $834.40 $2,078.60 1 $834.40 $2,078.60 1 $675.20 $1,680.60 1 $602.10 $1,497.80 1 $799.30 $1,990.80 1 $683.00 $1,700.10 1 $814.50 $2,028.80 3 $1,392.80 $3,477.80 2 $1,392.80 $3,477.80 1 $862.00 $2,150.20 1 $795.00 $1,980.10 1 $774.80 $1,929.60 1 $694.20 $1,728.10 1 $794.90 $1,979.80 1 $831.20 $2,070.60 1 $831.20 $2,070.60 1 $665.60 $1,656.60 All represented and nonrepresented employees in craft-related classifications pay all of the total monthly premium.

or 2015 Monthly Premiums for Crafts Employees -Prevea360 1 $641.10 $1,595.30 1 $713.30 $1,775.80 1 $678.00 $1,687.50 1 $699.20 $1,740.50 1 $592.10 $1,472.80 1 $709.70 $1,766.80 1 $746.00 $1,857.50 1 $568.20 $1,413.00 1 $694.90 $1,729.80 1 $712.70 $1,774.30 1 $635.20 $1,580.50 1 $730.70 $1,819.30 1 $730.70 $1,819.30 1 $591.40 $1,471.00 1 $527.50 $1,311.30 1 $700.00 $1,742.50 1 $598.30 $1,488.30 1 $713.30 $1,775.80 3 $1,222.40 $3,049.70 2 $1,222.40 $3,049.70 1 $757.40 $1,887.30 1 $696.30 $1,733.30 1 $678.60 $1,689.00 1 $608.10 $1,512.80 1 $696.20 $1,733.00 1 $727.90 $1,812.30 1 $727.90 $1,812.30 1 $583.00 $1,450.00 All represented and nonrepresented employees in craft-related classifications pay 100% of the total monthly HDHP premium and do not receive a State HSA contribution.

or Non-Represented and Represented Employees employed less than half-time -Prevea360 1 $365.95 $911.15 1 $407.25 $1,014.40 1 $387.05 $963.90 1 $399.15 $994.15 1 $338.00 $841.30 1 $405.20 $1,009.30 1 $425.90 $1,061.05 1 $324.30 $807.05 1 $396.70 $988.05 1 $406.90 $1,013.55 1 $362.60 $902.80 1 $417.20 $1,039.30 1 $417.20 $1,039.30 1 $337.60 $840.30 1 $301.05 $748.90 1 $399.65 $995.40 1 $341.50 $850.05 1 $407.25 $1,014.40 3 $696.40 $1,738.90 2 $696.40 $1,738.90 1 $431.00 $1,075.10 1 $397.50 $990.05 1 $387.40 $964.80 1 $347.10 $864.05 1 $397.45 $989.90 1 $415.60 $1,035.30 1 $415.60 $1,035.30 1 $332.80 $828.30 This table shows premium contribution amounts for part time employees with appointments of less than 1044 hours; employees working less than half-time pay 50% of the total monthly premium. These rates apply to represented and non-represented employees. These rates also apply to faculty and academic staff as established by their respective compensation plans.

or Non-Represented and Represented Employees employed less than half-time -Prevea360 1 $320.55 $797.65 1 $356.65 $887.90 1 $339.00 $843.75 1 $349.60 $870.25 1 $296.05 $736.40 1 $354.85 $883.40 1 $373.00 $928.75 1 $284.10 $706.50 1 $347.45 $864.90 1 $356.35 $887.15 1 $317.60 $790.25 1 $365.35 $909.65 1 $365.35 $909.65 1 $295.70 $735.50 1 $263.75 $655.65 1 $350.00 $871.25 1 $299.15 $744.15 1 $356.65 $887.90 3 $611.20 $1,524.85 2 $611.20 $1,524.85 1 $378.70 $943.65 1 $348.15 $866.65 1 $339.30 $844.50 1 $304.05 $756.40 1 $348.10 $866.50 1 $363.95 $906.15 1 $363.95 $906.15 1 $291.50 $725.00 This table shows premium contribution amounts for part time employees with appointments of less than 1044 hours; employees working less than half-time pay 50% of the total monthly HDHP premium and will receive 50% of the State HSA contribution. These rates apply to represented and non-represented employees. These rates also apply to faculty and academic staff as established by their respective compensation plans.