GROUP HEALTH INSURANCE 2003 MONTHLY PREMIUM RATES BY COUNTY FOR GRADUATE ASSISTANTS EMPLOYEE SHARE

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GROUP HEALTH INSURANCE 2003 MONTHLY RATES BY COUNTY FOR GRADUATE ASSISTANTS 01 ADAMS UNITY-COMMUNITY 263.60 0.00 263.60 651.70 0.00 651.70 STANDARD PLAN 263.60 337.00 600.60 651.70 811.60 1,463.30 STANDARD PLAN 2 263.60 113.10 376.70 651.70 251.10 902.80 02 ASHLAND HUMANA-WESTERN 299.10 2.40 301.50 740.40 6.00 746.40 03 BARRON GHC-EAU CLAIRE 260.90 51.50 312.40 644.90 128.80 773.70 VALLEY HEALTH PLAN 260.90 71.40 332.30 644.90 178.50 823.40 04 BAYFIELD MAINTENANCE PLAN 480.48 60.02 540.50 1,170.64 146.26 1,316.90 05 BROWN COMPCAREBLUE NORTHEAST 273.00 0.00 273.00 675.20 0.00 675.20 PREVEA HEALTH PLAN 273.00 56.60 329.60 675.20 141.40 816.60 TOUCHPOINT HEALTH PLAN 273.00 9.40 282.40 675.20 23.50 698.70 STANDARD PLAN 273.00 327.60 600.60 675.20 788.10 1,463.30 STANDARD PLAN 2 273.00 103.70 376.70 675.20 227.60 902.80 06 BUFFALO HUMANA-WESTERN 301.50 0.00 301.50 746.40 0.00 746.40 VALLEY HEALTH PLAN 332.30 0.00 332.30 823.40 0.00 823.40 MAINTENANCE PLAN 480.48 60.02 540.50 1,170.64 146.26 1,316.90 07 BURNETT COMPCAREBLUE NORTH 260.90 38.20 299.10 644.90 95.50 740.40 08 CALUMET HUMANA-EASTERN 232.20 66.90 299.10 573.20 167.20 740.40 09 CHIPPEWA GHC-EAU CLAIRE 260.90 51.50 312.40 644.90 128.80 773.70 VALLEY HEALTH PLAN 260.90 71.40 332.30 644.90 178.50 823.40 Plan's premium not used to calculate the "State Pays" amount due to limited provider availability. Standard Plan 2 and SMP premiums are not used in any

GROUP HEALTH INSURANCE 2003 MONTHLY RATES BY COUNTY FOR GRADUATE ASSISTANTS 10 CLARK GHC-EAU CLAIRE 299.10 13.30 312.40 740.40 33.30 773.70 11 COLUMBIA PHYSICIANS PLUS - SC 243.70 35.20 278.90 601.90 88.00 689.90 UNITY-COMMUNITY 243.70 19.90 263.60 601.90 49.80 651.70 12 CRAWFORD GUNDERSEN LUTHERAN 235.70 71.70 307.40 581.90 179.30 761.20 HEALTH TRADITION 235.70 58.10 293.80 581.90 145.30 727.20 MEDICAL ASSOCIATES HMO 235.70 0.00 235.70 581.90 0.00 581.90 UNITY-COMMUNITY 235.70 27.90 263.60 581.90 69.80 651.70 STANDARD PLAN 235.70 364.90 600.60 581.90 881.40 1,463.30 STANDARD PLAN 2 235.70 141.00 376.70 581.90 320.90 902.80 13 DANE DEAN HEALTH PLAN 238.60 5.10 243.70 589.20 12.70 601.90 GHC-SOUTH CENTRAL 238.60 0.00 238.60 589.20 0.00 589.20 HUMANA-EASTERN 238.60 60.50 299.10 589.20 151.20 740.40 MERCYCARE HEALTH PLAN 209.90 0.00 209.90 517.40 0.00 517.40 PHYSICIANS PLUS - SC 238.60 40.30 278.90 589.20 100.70 689.90 UNITY-UW HEALTH 238.60 7.60 246.20 589.20 19.00 608.20 STANDARD PLAN 238.60 362.00 600.60 589.20 874.10 1,463.30 STANDARD PLAN 2 238.60 138.10 376.70 589.20 313.60 902.80 14 DODGE COMPCAREBLUE NORTHEAST 243.70 29.30 273.00 601.90 73.30 675.20 HUMANA-EASTERN 243.70 55.40 299.10 601.90 138.50 740.40 UNITY-COMMUNITY 243.70 19.90 263.60 601.90 49.80 651.70 15 DOOR PREVEA HEALTH PLAN 282.40 47.20 329.60 698.70 117.90 816.60 TOUCHPOINT HEALTH PLAN 282.40 0.00 282.40 698.70 0.00 698.70 STANDARD PLAN 282.40 318.20 600.60 698.70 764.60 1,463.30 STANDARD PLAN 2 282.40 94.30 376.70 698.70 204.10 902.80 16 DOUGLAS COMPCAREBLUE NORTH 260.90 38.20 299.10 644.90 95.50 740.40 17 DUNN GHC-EAU CLAIRE 301.50 10.90 312.40 746.40 27.30 773.70 HUMANA-WESTERN 301.50 0.00 301.50 746.40 0.00 746.40 VALLEY HEALTH PLAN 301.50 30.80 332.30 746.40 77.00 823.40 STANDARD PLAN 301.50 299.10 600.60 746.40 716.90 1,463.30 STANDARD PLAN 2 301.50 75.20 376.70 746.40 156.40 902.80 Plan's premium not used to calculate the "State Pays" amount due to limited provider availability. Standard Plan 2 and SMP premiums are not used in any

GROUP HEALTH INSURANCE 2003 MONTHLY RATES BY COUNTY FOR GRADUATE ASSISTANTS 18 EAU CLAIRE GHC-EAU CLAIRE 260.90 51.50 312.40 644.90 128.80 773.70 VALLEY HEALTH PLAN 260.90 71.40 332.30 644.90 178.50 823.40 19 FLORENCE HUMANA-WESTERN 301.50 0.00 301.50 746.40 0.00 746.40 MAINTENANCE PLAN 480.48 60.02 540.50 1,170.64 146.26 1,316.90 20 FOND DU LAC COMPCAREBLUE NORTHEAST 232.20 40.80 273.00 573.20 102.00 675.20 DEAN HEALTH PLAN 232.20 11.50 243.70 573.20 28.70 601.90 HUMANA-EASTERN 232.20 66.90 299.10 573.20 167.20 740.40 21 FOREST MAINTENANCE PLAN 480.48 60.02 540.50 1,170.64 146.26 1,316.90 22 GRANT DEAN HEALTH PLAN 235.70 8.00 243.70 581.90 20.00 601.90 GUNDERSEN LUTHERAN 235.70 71.70 307.40 581.90 179.30 761.20 MEDICAL ASSOCIATES HMO 235.70 0.00 235.70 581.90 0.00 581.90 UNITY-COMMUNITY 235.70 27.90 263.60 581.90 69.80 651.70 STANDARD PLAN 235.70 364.90 600.60 581.90 881.40 1,463.30 STANDARD PLAN 2 235.70 141.00 376.70 581.90 320.90 902.80 23 GREEN MERCYCARE HEALTH PLAN 209.90 0.00 209.90 517.40 0.00 517.40 UNITY-COMMUNITY 243.70 19.90 263.60 601.90 49.80 651.70 24 GREEN LAKE DEAN HEALTH PLAN 232.20 11.50 243.70 573.20 28.70 601.90 25 IOWA DEAN HEALTH PLAN 235.70 8.00 243.70 581.90 20.00 601.90 MEDICAL ASSOCIATES HMO 235.70 0.00 235.70 581.90 0.00 581.90 PHYSICIANS PLUS - SC 235.70 43.20 278.90 581.90 108.00 689.90 UNITY-COMMUNITY 235.70 27.90 263.60 581.90 69.80 651.70 STANDARD PLAN 235.70 364.90 600.60 581.90 881.40 1,463.30 STANDARD PLAN 2 235.70 141.00 376.70 581.90 320.90 902.80 Plan's premium not used to calculate the "State Pays" amount due to limited provider availability. Standard Plan 2 and SMP premiums are not used in any

GROUP HEALTH INSURANCE 2003 MONTHLY RATES BY COUNTY FOR GRADUATE ASSISTANTS 26 IRON HUMANA-WESTERN 301.50 0.00 301.50 746.40 0.00 746.40 MAINTENANCE PLAN 480.48 60.02 540.50 1,170.64 146.26 1,316.90 27 JACKSON 28 JEFFERSON DEAN HEALTH PLAN 209.90 33.80 243.70 517.40 84.50 601.90 HUMANA-EASTERN 209.90 89.20 299.10 517.40 223.00 740.40 MERCYCARE HEALTH PLAN 209.90 0.00 209.90 517.40 0.00 517.40 UNITY-COMMUNITY 209.90 53.70 263.60 517.40 134.30 651.70 STANDARD PLAN 209.90 390.70 600.60 517.40 945.90 1,463.30 STANDARD PLAN 2 209.90 166.80 376.70 517.40 385.40 902.80 29 JUNEAU GUNDERSEN LUTHERAN 263.60 43.80 307.40 651.70 109.50 761.20 HEALTH TRADITION 263.60 30.20 293.80 651.70 75.50 727.20 UNITY-COMMUNITY 263.60 0.00 263.60 651.70 0.00 651.70 STANDARD PLAN 263.60 337.00 600.60 651.70 811.60 1,463.30 STANDARD PLAN 2 263.60 113.10 376.70 651.70 251.10 902.80 30 KENOSHA 31 KEWAUNEE PREVEA HEALTH PLAN 329.60 0.00 329.60 816.60 0.00 816.60 TOUCHPOINT HEALTH PLAN 282.40 0.00 282.40 698.70 0.00 698.70 MAINTENANCE PLAN 480.48 60.02 540.50 1,170.64 146.26 1,316.90 32 LA CROSSE 33 LAFAYETTE DEAN HEALTH PLAN 235.70 8.00 243.70 581.90 20.00 601.90 MEDICAL ASSOCIATES HMO 235.70 0.00 235.70 581.90 0.00 581.90 STANDARD PLAN 235.70 364.90 600.60 581.90 881.40 1,463.30 STANDARD PLAN 2 235.70 141.00 376.70 581.90 320.90 902.80 34 LANGLADE 35 LINCOLN MAINTENANCE PLAN 480.48 60.02 540.50 1,170.64 146.26 1,316.90 Plan's premium not used to calculate the "State Pays" amount due to limited provider availability. Standard Plan 2 and SMP premiums are not used in any

GROUP HEALTH INSURANCE 2003 MONTHLY RATES BY COUNTY FOR GRADUATE ASSISTANTS 36 MANITOWOC COMPCAREBLUE NORTHEAST 273.00 0.00 273.00 675.20 0.00 675.20 PREVEA HEALTH PLAN 329.60 0.00 329.60 816.60 0.00 816.60 STANDARD PLAN 329.60 271.00 600.60 816.60 646.70 1,463.30 STANDARD PLAN 2 329.60 47.10 376.70 816.60 86.20 902.80 37 MARATHON 38 MARINETTE HUMANA-WESTERN 301.50 0.00 301.50 746.40 0.00 746.40 PREVEA HEALTH PLAN 329.60 0.00 329.60 816.60 0.00 816.60 TOUCHPOINT HEALTH PLAN 282.40 0.00 282.40 698.70 0.00 698.70 MAINTENANCE PLAN 480.48 60.02 540.50 1,170.64 146.26 1,316.90 39 MARQUETTE UNITY-COMMUNITY 263.60 0.00 263.60 651.70 0.00 651.70 MAINTENANCE PLAN 480.48 60.02 540.50 1,170.64 146.26 1,316.90 72 MENOMINEE MAINTENANCE PLAN 480.48 60.02 540.50 1,170.64 146.26 1,316.90 40 MILWAUKEE COMPCAREBLUE - AURORA/ 252.50 0.00 252.50 623.90 0.00 623.90 HUMANA-EASTERN 252.50 46.60 299.10 623.90 116.50 740.40 STANDARD PLAN 252.50 348.10 600.60 623.90 839.40 1,463.30 STANDARD PLAN 2 252.50 124.20 376.70 623.90 278.90 902.80 41 MONROE 42 OCONTO COMPCAREBLUE NORTHEAST 273.00 0.00 273.00 675.20 0.00 675.20 PREVEA HEALTH PLAN 282.40 47.20 329.60 698.70 117.90 816.60 TOUCHPOINT HEALTH PLAN 282.40 0.00 282.40 698.70 0.00 698.70 STANDARD PLAN 282.40 318.20 600.60 698.70 764.60 1,463.30 STANDARD PLAN 2 282.40 94.30 376.70 698.70 204.10 902.80 43 ONEIDA 44 OUTAGAMIE PREVEA HEALTH PLAN 232.20 97.40 329.60 573.20 243.40 816.60 45 OZAUKEE Plan's premium not used to calculate the "State Pays" amount due to limited provider availability. Standard Plan 2 and SMP premiums are not used in any

GROUP HEALTH INSURANCE 2003 MONTHLY RATES BY COUNTY FOR GRADUATE ASSISTANTS 46 PEPIN HUMANA-WESTERN 301.50 0.00 301.50 746.40 0.00 746.40 VALLEY HEALTH PLAN 332.30 0.00 332.30 823.40 0.00 823.40 MAINTENANCE PLAN 480.48 60.02 540.50 1,170.64 146.26 1,316.90 47 PIERCE HUMANA-WESTERN 301.50 0.00 301.50 746.40 0.00 746.40 VALLEY HEALTH PLAN 332.30 0.00 332.30 823.40 0.00 823.40 MAINTENANCE PLAN 480.48 60.02 540.50 1,170.64 146.26 1,316.90 48 POLK COMPCAREBLUE NORTH 260.90 38.20 299.10 644.90 95.50 740.40 VALLEY HEALTH PLAN 260.90 71.40 332.30 644.90 178.50 823.40 49 PORTAGE 50 PRICE 51 RACINE 52 RICHLAND GUNDERSEN LUTHERAN 243.70 63.70 307.40 601.90 159.30 761.20 PHYSICIANS PLUS - SC 243.70 35.20 278.90 601.90 88.00 689.90 UNITY-COMMUNITY 243.70 19.90 263.60 601.90 49.80 651.70 53 ROCK DEAN HEALTH PLAN 209.90 33.80 243.70 517.40 84.50 601.90 HUMANA-EASTERN 209.90 89.20 299.10 517.40 223.00 740.40 MERCYCARE HEALTH PLAN 209.90 0.00 209.90 517.40 0.00 517.40 PHYSICIANS PLUS - SC 209.90 69.00 278.90 517.40 172.50 689.90 STANDARD PLAN 209.90 390.70 600.60 517.40 945.90 1,463.30 STANDARD PLAN 2 209.90 166.80 376.70 517.40 385.40 902.80 54 RUSK GHC-EAU CLAIRE 312.40 0.00 312.40 773.70 0.00 773.70 VALLEY HEALTH PLAN 332.30 0.00 332.30 823.40 0.00 823.40 MAINTENANCE PLAN 480.48 60.02 540.50 1,170.64 146.26 1,316.90 Plan's premium not used to calculate the "State Pays" amount due to limited provider availability. Standard Plan 2 and SMP premiums are not used in any

GROUP HEALTH INSURANCE 2003 MONTHLY RATES BY COUNTY FOR GRADUATE ASSISTANTS 56 SAUK GUNDERSEN LUTHERAN 243.70 63.70 307.40 601.90 159.30 761.20 PHYSICIANS PLUS - SC 243.70 35.20 278.90 601.90 88.00 689.90 UNITY-COMMUNITY 243.70 19.90 263.60 601.90 49.80 651.70 57 SAWYER COMPCAREBLUE NORTH 260.90 38.20 299.10 644.90 95.50 740.40 GHC-EAU CLAIRE 260.90 51.50 312.40 644.90 128.80 773.70 58 SHAWANO TOUCHPOINT HEALTH PLAN 282.40 0.00 282.40 698.70 0.00 698.70 STANDARD PLAN 282.40 318.20 600.60 698.70 764.60 1,463.30 STANDARD PLAN 2 282.40 94.30 376.70 698.70 204.10 902.80 59 SHEBOYGAN COMPCAREBLUE NORTHEAST 273.00 0.00 273.00 675.20 0.00 675.20 HUMANA-EASTERN 273.00 26.10 299.10 675.20 65.20 740.40 STANDARD PLAN 273.00 327.60 600.60 675.20 788.10 1,463.30 STANDARD PLAN 2 273.00 103.70 376.70 675.20 227.60 902.80 55 ST CROIX COMPCAREBLUE NORTH 260.90 38.20 299.10 644.90 95.50 740.40 VALLEY HEALTH PLAN 260.90 71.40 332.30 644.90 178.50 823.40 60 TAYLOR 61 TREMPEALEAU GHC-EAU CLAIRE 293.80 18.60 312.40 727.20 46.50 773.70 HUMANA-WESTERN 293.80 7.70 301.50 727.20 19.20 746.40 VALLEY HEALTH PLAN 293.80 38.50 332.30 727.20 96.20 823.40 62 VERNON UNITY-COMMUNITY 263.60 0.00 263.60 651.70 0.00 651.70 63 VILAS Plan's premium not used to calculate the "State Pays" amount due to limited provider availability. Standard Plan 2 and SMP premiums are not used in any

GROUP HEALTH INSURANCE 2003 MONTHLY RATES BY COUNTY FOR GRADUATE ASSISTANTS 64 WALWORTH DEAN HEALTH PLAN 209.90 33.80 243.70 517.40 84.50 601.90 HUMANA-EASTERN 209.90 89.20 299.10 517.40 223.00 740.40 MERCYCARE HEALTH PLAN 209.90 0.00 209.90 517.40 0.00 517.40 STANDARD PLAN 209.90 390.70 600.60 517.40 945.90 1,463.30 STANDARD PLAN 2 209.90 166.80 376.70 517.40 385.40 902.80 65 WASHBURN COMPCAREBLUE NORTH 260.90 38.20 299.10 644.90 95.50 740.40 66 WASHINGTON 67 WAUKESHA COMPCAREBLUE - AURORA/ 252.50 0.00 252.50 623.90 0.00 623.90 68 WAUPACA COMPCAREBLUE NORTH 232.20 66.90 299.10 573.20 167.20 740.40 69 WAUSHARA 70 WINNEBAGO 71 WOOD 99 OUT OF GUNDERSEN LUTHERAN 307.40 0.00 307.40 761.20 0.00 761.20 HUMANA-WESTERN 301.50 0.00 301.50 746.40 0.00 746.40 MEDICAL ASSOCIATES HMO 235.70 0.00 235.70 581.90 0.00 581.90 MERCYCARE HEALTH PLAN 209.90 0.00 209.90 517.40 0.00 517.40 PREVEA HEALTH PLAN 329.60 0.00 329.60 816.60 0.00 816.60 MAINTENANCE PLAN 480.48 60.02 540.50 1,170.64 146.26 1,316.90 NOTE: Out of state rates apply for alternate health plans when your designated provider is located outside the state of Wisconsin. Out of state rates apply for State Maintenance Plan, Standard Plan and Standard Plan 2 when the subscriber resides outside the state of Wisconsin. Plan's premium not used to calculate the "State Pays" amount due to limited provider availability. Standard Plan 2 and SMP premiums are not used in any

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