Historical Benefit Plan Premiums

Health Insurance

2015

• Employee Contribution for the: 2015 Plan Year
• Classified and Unclassified Employees 2015 HDHP | 2015 HMO/PPO
• Employees Employed Less Than Half-Time (classified, unclassified) 2015 HDHP | 2015 HMO/PPO
• Employer Contribution for Less than Full-Time Appointments
• Craftsworkers 2015 HDHP | 2015 HMO/PPO
• Graduate Assistants 2015
• COBRA 2015 HDHP | 2015 HMO/PPO
• Retirees 2015

2014

• Combined Premiums Document
• Classified and Unclassified Employees
• Employees Employed Less Than Half-Time (Classified, Unclassified)
• Craftsworkers
• Graduate Assistants
• COBRA
• Retirees

2013

• Combined Premiums Document
• Classified and Unclassified Employees
• Employees Employed Less Than Half-Time (Classified, Unclassified)
• Craftsworkers
• Graduate Assistants
• COBRA
• Retirees

2012

• Combined Premiums Document
• Classified and Unclassified Employees
• Employees Employed Less Than Half-Time (Classified, Unclassified)
• Craftsworkers
• Graduate Assistants
• COBRA
• Retirees

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

• Classified and Unclassified Employees
• Employees Employed Less Than Half-Time (Classified, Unclassified)
• Craftsworkers
• Graduate Assistants
• COBRA
• Retirees

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

• Non-Represented Employees Covered by WRS (Classified, Unclassified)
• Represented Employees Covered by WRS
• Represented Faculty Covered by WRS (UW-Eau Claire and UW-Superior)
• Graduate Assistants (Including Short-Term Academic Staff - Non Represented)
• Graduate Assistants (Madison, Milwaukee and Extension Represented Graduate Assistants)
• Employees Employed Less Than Half-Time (Classified, Unclassified)
• Craftsworkers
• COBRA

2010

• Non-Represented Employees Covered by WRS (Classified, Unclassified)
• Represented Employees Covered by WRS
• Employees Employed Less Than Half-Time (Classified, Unclassified)
• Craftsworkers
• Graduate Assistants (Including Short-Term Academic Staff - Non Represented)
• Represented Graduate Assistants (Madison)
• Represented Graduate Assistants (Milwaukee)
• COBRA
• Retirees

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

• University Staff Standard Plan
• University Staff Supplemental Plan
• Faculty/Academic Staff/Limited Appointees Standard Plan
• Faculty/Academic Staff/Limited Appointees Supplemental Plan

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