Health Insurance

2015

2014

2013

2012

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+.1

EPIC Benefits+

2016 EPIC Benefits+ Insurance (Group #3180) - Active Employees
Deduction Code Coverage Type Employee Employee + Spouse/Domestic Partner Employee + Child(ren) Family
404 Active Employee Monthly Premium Without Vision Coverage $19.77 $39.54 $39.54 $59.31
Active Employee Monthly Premium With Vision Coverage $24.02 $47.04 $47.04 $70.34
2016 Monthly Rates for Annuitants
Deduction Code Coverage Type Employee Employee +
Spouse/Domestic Partner
Employee + Child(ren) Family
N/A Annuitant Monthly Premium Without Vision Coverage $26.69 $53.27 $61.90 $73.53
Annuitant Monthly Premium With Vision Coverage $31.26 $61.51 $69.68 $85.43
2015 EPIC Benefits+ Insurance (Group #3180) - Active Employees
Deduction Code Coverage Type Employee Employee + Spouse/Domestic Partner Employee + Child(ren) Family
404 Active Employee Monthly Premium Without Vision Coverage $19.77 $39.54 $39.54 $59.31
Active Employee Monthly Premium With Vision Coverage $24.02 $47.04 $47.04 $70.34
2015 Monthly Rates for Annuitants
Deduction Code Coverage Type Employee Employee +
Spouse/Domestic Partner
Employee + Child(ren) Family
N/A Annuitant Monthly Premium Without Vision Coverage $26.69 $53.27 $61.90 $73.53
Annuitant Monthly Premium With Vision Coverage $31.26 $61.51 $69.68 $85.43
2013 and 2014 EPIC Benefits+ Insurance (Group #3180) — Active Employees
Deduction Code Coverage Type Employee Employee + Spouse/Domestic Partner Employee + Child Family
404 Active Employee Monthly Premium Without Vision Coverage $19.77 $39.54 $39.54 $59.31
Active Employee Monthly Premium With Vision Coverage $24.02 $47.04 $47.04 $70.34
2013 and 2014 Monthly Rates for Annuitants
Deduction Code Coverage Type Employee Employee +
Spouse/Domestic Partner
Employee + Child Family
N/A Annuitant Monthly Premium Without Vision Coverage $26.69 $53.27 $61.90 $73.53
Annuitant Monthly Premium With Vision Coverage $31.26 $61.51 $69.68 $85.43
2012 EPIC Benefits+ Insurance (Group #3180) — Active Employees
Deduction Code Coverage Type Employee Employee + Spouse / Domestic Partner Employee + Child Family
404 Active Employee Monthly Premium Without Vision Coverage $18.99 $37.98 $37.98 $56.97
Active Employee Monthly Premium With Vision Coverage $22.99 $45.05 $45.05 $67.36
2012 Monthly Rates for Non-Medicare Primary Annuitants
Deduction Code Coverage Type Annuitant Annuitant + Spouse / Domestic Partner Annuitant + Child Family
N/A Annuitant Monthly Premium Without Vision Coverage $24.32 $48.53 $56.18 $66.90
Annuitant Monthly Premium With Vision Coverage $28.63 $56.30 $63.52 $78.12
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

Note: Effective January 1, 2011, only Classified Represented employees will be eligible to carry Anthem DentalBlue coverage. All other employees wishing to have dental coverage should enroll in the Dental Wisconsin plan. Premiums are deducted one month in advance of the month of coverage.

2012 DentalBlue Insurance — Monthly Premiums Effective for Coverage 1/1/2012
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 Preferred 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)

$18.08 $36.17 $54.28
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

2016 Dental Wisconsin Insurance (Group #31800D) — Active Employees
UW Deduction Codes Plan Employee Employee +
Spouse/Domestic Partner
Employee + Child(ren) Family
487 Preferred Provider Plan (PPO) $25.49 $53.96 $60.34 $91.21
488 Select Plan $20.52 $42.19 $48.68 $71.59
2015 Dental Wisconsin Insurance (Group #31800D) — Active Employees
UW Deduction Codes Plan Employee Employee +
Spouse/Domestic Partner
Employee + Child(ren) Family
487 Preferred Provider Plan (PPO) $25.49 $53.96 $60.34 $91.21
488 Select Plan $20.52 $42.19 $48.68 $71.59
2013 and 2014 Dental Wisconsin Insurance (Group #31800D) — Monthly Premiums Effective for Coverage 1/1/2013
UW Deduction Codes Plan Employee Employee +
Spouse/Domestic Partner
Employee + Child(ren) Family
487 Preferred Provider Plan (PPO) $28.32 $59.96 $67.04 $101.34
488 Select Plan $20.52 $42.19 $48.68 $71.59
2012 Dental Wisconsin Insurance (Group #31800D) — Monthly Premiums Effective for Coverage 1/1/2012
UW Deduction Codes Plan Employee Employee + Spouse/Domestic Partner Employee + Child(ren) Family
487 Preferred Provider Plan (PPO) $26.82 $56.78 $63.49 $95.97
488 Select Plan $17.84 $36.68 $42.32 $62.24
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

2016 VSP Vision Plan Monthly Premiums
UW Deduction Code Employee Employee + Spouse/Domestic Partner Employee + Child(ren) Employee + Family
411 $6.54 $13.08 $14.73 $23.54
2015 VSP Vision Plan Monthly Premiums — Coverage Effective 1/1/2015
UW Deduction Code Employee Employee + Spouse/Domestic Partner Employee + Child(ren) Employee + Family
411 $6.54 $13.08 $14.73 $23.54
2014 VSP Vision Plan Monthly Premiums — Coverage Effective 1/1/2014
UW Deduction Code Employee Employee + Spouse/Domestic Partner Employee + Child(ren) Employee + Family
411 $6.35 $12.70 $14.30 $22.85
2010/2011/2012/2013 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

Income Continuation Insurance (ICI)

For Coverage Effective 2/1/2017

For Coverage Before 2/1/2017

  • Effective Dates 2/1/2016 - 1/31/2017: Excel | PDF
  • Effective Dates 2/1/2015 - 1/31/2016: Excel | PDF
  • Effective Dates 2/1/2014 - 1/31/2015: Excel | PDF
  • Effective Dates 2/1/2013 - 1/31/2014: Excel | PDF
  • Effective Dates 2/1/2012 - 1/31/2013: Excel | PDF
  • Effective Dates 2/1/2010 - 1/31/2012: Excel | PDF
  • Effective Dates 2/1/2007 - 1/31/2010: Excel | PDF

Accidental Death & Dismemberment | Individual and Family Group Life Insurance | State Group Life | University Insurance Association (UIA) Life Insurance | UW Employees, Inc. Life

Accidental Death & Dismemberment

2016 AD&D Monthly Premium per Principal Sum Elected (Group #GTU 83-64-005)
Principal Sum Elected Employee Only Premium Family Plan Premium
$25,000 $0.73 $1.10
$50,000 $1.45 $2.20
$100,000 $2.90 $4.40
$150,000 $4.35 $6.60
$200,000 $5.80 $8.80
$250,000 $7.25 $11.00
$300,000 $8.70 $13.20
$350,000 $10.15 $15.40
$400,000 $11.60 $17.60
$450,000 $13.05 $19.80
$500,000 $22.00 $14.50

Life Insurance

Individual and Family Group Life Insurance

Cost per $1000 of Coverage for Employee and Spouse/Domestic Partner
Employee Attained Age Employee Spouse/Domestic Partner
27 or less $0.023 $0.036
28-30 0.025 0.04
31-33 0.032 0.05
34-36 0.037 0.059
37-39 0.045 0.072
40-42 0.068 0.108
43-45 0.108 0.171
46-48 0.13 0.207
49-51 0.181 0.288
52-54 0.232 0.369
55-57 0.323 0.513
58-60 0.403 0.621
61-63 0.556 0.774
64-66 0.799 1.08
67-69 1.117 1.503
70-72 1.724 2.331
73+ 2.466 3.33
Monthly Premium Table for Employee and Spouse/Domestic Partner Coverage (Deduction Code 428)
Employee Attained Age Employee Spouse/Domestic Partner
$5000 $10,000 $15,000 $20,000 $5000 $10,000
27 or less $0.12 $0.23 $0.35 $0.46 $0.18 $0.36
28-30 0.13 0.25 0.38 0.50 0.20 0.40
31-33 0.16 0.32 0.48 0.64 0.25 0.50
34-36 0.19 0.37 0.56 0.74 0.30 0.59
37-39 0.23 0.45 0.68 0.90 0.36 0.72
40-42 0.34 0.68 1.02 1.36 0.54 1.08
43-45 0.54 1.08 1.62 2.16 0.86 1.71
46-48 0.65 1.30 1.95 2.60 1.04 2.07
49-51 0.91 1.81 2.72 3.62 1.44 2.88
52-54 1.16 2.32 3.48 4.64 1.85 3.69
55-57 1.62 3.23 4.85 6.46 2.57 5.13
58-60 2.02 4.03 6.05 8.06 3.11 6.21
61-63 2.78 5.56 8.34 11.12 3.87 7.74
64-66 4.00 7.99 11.99 15.98 5.40 10.80
67-69 5.59 11.17 16.76 22.34 7.52 15.03
70-72 8.62 17.24 25.86 34.48 11.66 23.31
73+ 12.33 24.66 36.99 49.32 16.65 33.30
Monthly Premium Table for Child Coverage
Amount of Insurance Monthly Premium
$2500 (Code Y) $0.18
$5000 (Code A) 0.35
$7500 (Code B) 0.53
$10,000 (Code C) 0.70

State Group Life Insurance

Basic/Supplemental/Additional Coverage Monthly Premium Rates
(Deduction Codes: Basic=412, Basic Supplemental=414, Additional 1 Unit=419, Additional 2 Units=416, Additional 3 Units=417, Spouse & Dependent=420)
Effective through 3/31/2016
Age As of April 1 Basic and Supplemental Additional Spouse & Dependent
2013/2014/2015
Rate per $1000
2013/2014/2015
Rate per $1000
Under age 30 $.04 $.06

One Unit of Coverage: $2.50 per $10,000 Spouse and $5000 for each dependent

Two Units of Coverage: $5.00 per $20,000 Spouse and $10,000 for each dependent

30-34 .04 .06
35-39 .04 .06
40-44 .06 .09
45-49 .10 .15
50-54 .16 .24
55-59 .22 .33
60-64 .30 .45
65-69 .39 .59
Over Age 70 Additional Coverage (Deduction Code: 418)
Effective through 3/31/2016
Age as of April 1 Rate per $1000
70 $1.00
71 1.15
72 1.25
73 1.45
74 1.60
75 1.80
76 1.95
77–89 2.06
90+ Available upon request
State Group Life Insurance Premiums Effective through 03/31/2013
Age As of April 1 Basic & Supplemental Per $1,000 Additional Per $1,000 Spouse & Dependent
Under age 30 $.04 $.06

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 .04 .06
35-39 .05 .06
40-44 .06 .09
45-49 .10 .15
50-54 .16 .24
55-59 .22 .33
60-64 .30 .45
65-69 .39 .59
Over Age 70 Additional Coverage (Deduction Code: 418) — Effective through 03/31/2013
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+ 2.06
State Group Life Insurance Premiums Effective through 03/31/2012
Age As of April 1 Basic & Supplemental Per $1,000 Additional Per $1,000 Spouse & Dependent
Under age 30 $.04 $.06

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 .04 .07
35-39 .05 .07
40-44 .06 .09
45-49 .10 .15
50-54 .16 .24
55-59 .25 .37
60-64 .33 .50
65-69 .44 .66
Over Age 70 Additional Coverage (Deduction Code: 418) — Effective through 03/31/2012
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+ 2.06
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 Insurance Association (UIA) Life Insurance

University Insurance Association Schedule of Benefits/Coverage Amounts (Group #32872-G)
Age as of Oct 1 Premium Benefit Amount
Under 28 $2.00 $101000
28-30 98100
31-33 90900
34-36 78900
37-39 65000
40-42 50900
43-45 39100
46-48 30000
49-51 22600
52-54 17200
55-57 13100
58-60 10300
61-63 8200
64-66 6100
67-69 4500
70+ 3400

University of Wisconsin Employees, Inc. Life Insurance

UW Employees, Inc. Monthly Premium Table — Premium and Coverage Amounts Effective 2014
Employee Age Coverage 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
UW Employees, Inc. Monthly Premium Table — Premium and Coverage Amounts Effective October 1, 2011
Employee Age Coverage Amount Premium
under 35 $30,000 $1.00
35 - 39 25,000 1.25
40 - 44 22,000 1.60
45 - 49 15,000 2.00
50 - 54 12,000 2.40
55 - 59 10,000 3.80
60 - 64 9000 4.35
65 and over 4000 3.00
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