Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management Organizations (HMO) 2005 Total Biweekly Premium
2006 Biweekly Postal Premium rates
Total Premium Govt Pays Empl. Pays Change in empl. payment
Plan - Option - Enrollment Code
AL
Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family 221 222 224 225 221 222 224 225 221 222 224 225 221 222 224 225 WQ1 WQ2 A71 A72 DB1 DB2 136.80 314.65 153.73 353.59 136.80 314.65 153.73 353.59 136.80 314.65 153.73 353.59 136.80 314.65 153.73 353.59 140.84 352.07 151.42 383.69 93.28 214.50 135.55 311.79 150.58 343.31 135.55 311.79 150.58 343.31 135.55 311.79 150.58 343.31 135.55 311.79 150.58 343.31 152.70 381.78 167.89 425.36 97.18 223.51 120.30 276.71 133.64 304.69 120.30 276.71 133.64 304.69 120.30 276.71 133.64 304.69 120.30 276.71 133.64 304.69 135.52 338.83 149.00 373.15 86.25 198.37 15.25 35.08 16.94 38.62 15.25 35.08 16.94 38.62 15.25 35.08 16.94 38.62 15.25 35.08 16.94 38.62 17.18 42.95 18.89 52.21 10.93 25.14 -0.14 -0.32 -0.35 -1.16 -0.14 -0.32 -0.35 -1.16 -0.14 -0.32 -0.35 -1.16 -0.14 -0.32 -0.35 -1.16 1.34 3.34 1.86 9.04 0.44 1.01
AK
Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family
AR
Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family
AZ
Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family
AZ
Aetna Open Access High Self High Family Health Net of Arizona, Inc. High Self High Family Humana CoverageFirst Consumer Driven Self Consumer Driven Family PacifiCare of Arizona
AZ
AZ
AZ
High Self High Family CA Aetna Healthfund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family CA Aetna HMO High Self High Family CA Blue Cross- HMO High Self High Family Blue Shield of CA Access+ High Self High Family Health Net of California High Self High Family Kaiser Foundation Health Plan of California High Self High Family Standard Self Standard Family Kaiser Foundation Health Plan of California High Self High Family Standard Self Standard Family PacifiCare of California High Self High Family Universal Care High Self High Family High Deductible Self High Deductible Family
A31 A32 221 222 224 225 2X1 2X2 M51 M52 SJ1 SJ2 LB1 LB2 591 592 594 595 621 622 624 625 CY1 CY2 6Q1 6Q2 6Q4 6Q5
160.27 399.09 136.80 314.65 153.73 353.59 115.02 283.39 154.52 396.36 159.14 394.76 153.75 363.99 170.39 406.75 131.25 313.30 155.77 360.01 121.92 281.78 140.97 327.06 129.80 342.67 108.95 287.62
175.08 429.44 135.55 311.79 150.58 343.31 120.96 298.01 185.83 476.66 167.25 414.90 171.38 405.71 182.83 436.44 133.56 318.81 164.99 381.33 124.43 287.56 157.70 365.85 133.98 353.68 146.27 369.50
155.38 373.15 120.30 276.71 133.64 304.69 107.35 264.48 164.31 373.15 148.43 368.22 152.10 360.07 162.26 373.15 118.53 282.94 146.43 338.43 110.43 255.21 139.96 324.69 118.91 313.89 129.81 327.93
19.70 56.29 15.25 35.08 16.94 38.62 13.61 33.53 21.52 103.51 18.82 46.68 19.28 45.64 20.57 63.29 15.03 35.87 18.56 42.90 14.00 32.35 17.74 41.16 15.07 39.79 16.46 41.57
1.67 9.28 -0.14 -0.32 -0.35 -1.16 0.67 1.65 4.14 58.92 0.92 2.27 1.98 4.69 1.40 8.62 0.26 0.62 1.04 2.40 0.28 0.65 1.88 4.37 0.47 1.24 4.20 9.21
CA
CA
CA
CA
CA
CA
CO
Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family 221 222 224 225 9E1 9E2 7T1 7T2 FC1 FC2 651 652 654 655 D61 D62 CH1 CH2 221 222 224 225 JC1 JC2 TE1 TE2 TE4 136.80 314.65 153.73 353.59 158.35 407.61 107.98 248.38 New Plan New Plan 160.88 387.69 122.13 294.32 173.50 410.53 New Plan New Plan 136.80 314.65 153.73 353.59 177.65 437.30 168.29 425.79 New Plan 135.55 311.79 150.58 343.31 191.59 449.59 107.97 248.34 113.37 260.76 190.22 448.27 130.40 307.73 187.82 442.48 181.71 427.00 135.55 311.79 150.58 343.31 193.06 475.22 201.41 458.24 167.76 120.30 276.71 133.64 304.69 164.31 373.15 95.82 220.40 100.62 231.42 164.31 373.15 115.73 273.11 164.31 373.15 161.27 373.15 120.30 276.71 133.64 304.69 164.31 373.15 164.31 373.15 148.89 15.25 35.08 16.94 38.62 27.28 76.44 12.15 27.94 12.75 29.34 25.91 75.12 14.67 34.62 23.51 69.33 20.44 53.85 15.25 35.08 16.94 38.62 28.75 102.07 37.10 85.09 18.87 -0.14 -0.32 -0.35 -1.16 9.47 20.91 0.00 0.00 N/A N/A 7.81 31.50 0.93 1.51 3.99 10.88 N/A N/A -0.14 -0.32 -0.35 -1.16 5.84 16.85 18.17 11.38 N/A
CO
Aetna Open Access High Self High Family Humana CoverageFirst Consumer Driven Self Consumer Driven Family Humana CoverageFirst Consumer Driven Self Consumer Driven Family Kaiser Foundation Health Plan of Colorado High Self High Family Standard Self Standard Family PacifiCare of Colorado High Self High Family UnitedHealthcare of Colorado High Self High Family Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family Aetna Open Access High Self High Family ConnectiCare High Self High Family Standard Self
CO
CO
CO
CO
CO
CT
CT
CT
Standard Family DE Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family DE Coventry Health Care High Self High Family Standard Self Standard Family High Deductible Self High Deductible Family DC Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family DC Aetna Open Access High Self High Family Basic Self Basic Family DC CareFirst BlueChoice High Self High Family Kaiser Foundation Health Plan Mid-Atlantic States High Self High Family Standard Self Standard Family M.D. IPA High Self High Family Aetna HealthFund Consumer Driven Self Consumer Driven Family
TE5 221 222 224 225 2J1 2J2 2J4 2J5 LK1 LK2 221 222 224 225 JN1 JN2 JN4 JN5 2G1 2G2 E31 E32 E34 E35 JP1 JP2 221 222
New Plan 136.80 314.65 153.73 353.59 193.32 488.13 159.40 391.87 New Plan New Plan 136.80 314.65 153.73 353.59 176.00 394.23 115.88 271.17 181.64 408.63 159.22 378.96 128.15 305.00 161.10 386.69 136.80 314.65
381.71 135.55 311.79 150.58 343.31 183.97 459.92 147.56 368.88 131.10 317.66 135.55 311.79 150.58 343.31 193.90 434.31 124.28 290.84 194.80 438.26 178.64 425.17 107.15 255.01 175.65 421.63 135.55 311.79
338.77 120.30 276.71 133.64 304.69 163.27 373.15 130.96 327.38 116.35 281.92 120.30 276.71 133.64 304.69 164.31 373.15 110.30 258.12 164.31 373.15 158.54 373.15 95.10 226.32 155.89 373.15 120.30 276.71
42.94 15.25 35.08 16.94 38.62 20.70 86.77 16.60 41.50 14.75 35.74 15.25 35.08 16.94 38.62 29.59 61.16 13.98 32.72 30.49 65.11 20.10 52.02 12.05 28.69 19.76 48.48 15.25 35.08
N/A -0.14 -0.32 -0.35 -1.16 -17.88 -49.28 -1.33 -2.59 N/A N/A -0.14 -0.32 -0.35 -1.16 8.33 16.81 0.94 2.21 3.59 8.56 2.19 9.39 -2.37 -5.62 1.64 4.98 -0.14 -0.32
DC
DC
FL
High Deductible Self High Deductible Family FL Av-Med Health Plan High Self High Family Standard Self Standard Family FL Capital Health Plan High Self High Family FL Humana CoverageFirst Consumer Driven Self Consumer Driven Family FL Humana CoverageFirst Consumer Driven Self Consumer Driven Family FL Humana CoverageFirst Consumer Driven Self Consumer Driven Family FL Humana CoverageFirst Consumer Driven Self Consumer Driven Family FL Humana CoverageFirst Consumer Driven Self Consumer Driven Family FL Humana CoverageFirst Consumer Driven Self Consumer Driven Family FL Humana Medical Plan High Self High Family FL JMH Health Plan High Self High Family FL Vista Healthplan High Self High Family
224 225 ML1 ML2 ML4 ML5 EA1 EA2 BP1 BP2 DL1 DL2 MJ1 MJ2 MQ1 MQ2 QP1 QP2 YG1 YG2 EE1 EE2 J81 J82 3N1 3N2
153.73 353.59 157.08 408.39 125.52 326.33 163.02 432.00 New Plan New Plan New Plan New Plan 103.08 237.09 107.98 248.38 98.18 225.80 112.91 259.67 151.86 349.28 146.92 363.52 179.64 493.88
150.58 343.31 159.64 415.02 133.86 347.99 152.93 405.27 140.37 322.84 129.57 298.00 118.77 273.18 129.57 298.00 107.96 248.34 124.18 285.59 157.33 361.85 164.04 405.91 195.60 537.76
133.64 304.69 141.68 368.33 118.80 308.84 135.73 359.68 124.58 286.52 114.99 264.48 105.41 242.45 114.99 264.48 95.81 220.40 110.21 253.46 139.63 321.14 145.59 360.25 164.31 373.15
16.94 38.62 17.96 46.69 15.06 39.15 17.20 45.59 15.79 36.32 14.58 33.52 13.36 30.73 14.58 33.52 12.15 27.94 13.97 32.13 17.70 40.71 18.45 45.66 31.29 164.61
-0.35 -1.16 0.29 -9.62 0.94 2.44 -1.14 -34.33 N/A N/A N/A N/A 1.76 4.06 2.43 5.58 1.10 2.54 1.27 2.92 0.62 1.42 1.92 4.76 6.39 22.81
FL
Vista Healthplan High Self High Family UL1 UL2 Y91 Y92 5E1 5E2 221 222 224 225 2U1 2U2 L51 L52 AD1 AD2 LM1 LM2 F81 F82 F84 F85 GW1 GW2 JK1 JK2 JK4 157.61 420.83 132.19 353.00 134.08 368.73 136.80 314.65 153.73 353.59 152.77 368.52 112.58 258.95 New Plan New Plan New Plan New Plan 140.97 357.90 106.11 269.39 New Plan New Plan 193.16 461.88 136.85 208.99 557.97 156.52 417.97 138.33 380.43 135.55 311.79 150.58 343.31 169.29 408.38 137.18 317.70 91.78 211.09 113.37 260.76 154.36 391.87 116.19 294.99 132.85 325.42 207.25 516.88 145.91 164.31 373.15 138.91 370.95 122.77 337.63 120.30 276.71 133.64 304.69 150.24 362.44 121.75 281.96 81.45 187.34 100.62 231.42 136.99 347.78 103.12 261.80 117.90 288.81 164.31 373.15 129.50 44.68 184.82 17.61 47.02 15.56 42.80 15.25 35.08 16.94 38.62 19.05 45.94 15.43 35.74 10.33 23.75 12.75 29.34 17.37 44.09 13.07 33.19 14.95 36.61 42.94 143.73 16.41 26.95 116.07 2.74 7.31 0.48 1.32 -0.14 -0.32 -0.35 -1.16 1.86 4.48 2.76 6.61 N/A N/A N/A N/A 1.51 3.83 1.13 2.88 N/A N/A 4.52 33.93 1.01
FL
Vista Healthplan High Self High Family Vista Healthplan of South Florida High Self High Family Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family Aetna Open Access High Self High Family Coventry Health Care of Georgia High Deductible Self High Deductible Family Humana CoverageFirst Consumer Driven Self Consumer Driven Family Humana CoverageFirst Consumer Driven Self Consumer Driven Family Kaiser Foundation Health Plan Of Geogria, Inc. High Self High Family Standard Self Standard Family High Deductible Self High Deductible Family PacifiCare Asia Pacific High Self High Family Standard Self
FL
GA
GA
GA
GA
GA
GA
GU
Standard Family HI HMSA High Self High Family Kaiser Foundation Health Plan of Hawaii High Self High Family Standard Self Standard Family Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family Group Health Cooperative High Self High Family Standard Self Standard Family Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family Aetna Open Access High Self High Family BlueCHOICE High Self High Family Group Health Plan, Inc. High Self High Family High Deductible Self High Deductible Family Health Alliance HMO High Self
JK5 871 872 631 632 634 635 221 222 224 225 VR1 VR2 VR4 VR5 221 222 224 225 IK1 IK2 9G1 9G2 MM1 MM2 MM4 MM5 FX1
361.38 147.75 328.89 170.76 367.13 132.57 285.03 136.80 314.65 153.73 353.59 173.91 424.02 147.12 338.36 136.80 314.65 153.73 353.59 152.11 375.42 177.50 384.30 205.81 444.53 170.30 364.62 181.36
385.32 152.18 338.76 174.29 374.73 122.42 263.19 135.55 311.79 150.58 343.31 196.30 451.48 157.89 363.14 135.55 311.79 150.58 343.31 159.74 405.45 199.24 431.39 230.52 497.90 184.04 394.61 197.67
341.97 135.06 300.65 154.68 332.57 108.65 233.58 120.30 276.71 133.64 304.69 164.31 373.15 140.13 322.29 120.30 276.71 133.64 304.69 141.77 359.84 164.31 373.15 164.31 373.15 163.34 350.22 164.31
43.35 17.12 38.11 19.61 42.16 13.77 29.61 15.25 35.08 16.94 38.62 31.99 78.33 17.76 40.85 15.25 35.08 16.94 38.62 17.97 45.61 34.93 58.24 66.21 124.75 20.70 44.39 33.36
2.69 0.50 1.11 0.40 0.86 -1.14 -2.46 -0.14 -0.32 -0.35 -1.16 12.43 6.39 1.21 2.78 -0.14 -0.32 -0.35 -1.16 0.86 3.38 12.17 15.01 15.14 32.30 1.54 3.37 6.74
HI
ID
ID
IL
IL
IL
IL
IL
High Family IL Humana CoverageFirst Consumer Driven Self Consumer Driven Family Humana Health Plan Inc. High Self High Family Standard Self Standard Family John Deere Health Plan High Self High Family Mercy Health Plans High Self High Family OSF Health Plans, Inc. High Self High Family High Deductible Self High Deductible Family PersonalCares HMO High Self High Family Unicare HMO High Self High Family Standard Self Standard Family High Deductible Self High Deductible Family Union Health Service High Self High Family UnitedHealthcare of the Midwest High Self High Family Advantage Health Solutions, Inc.
FX2 MW1 MW2 751 752 754 755 YH1 YH2 7M1 7M2 9F1 9F2 9F4 9F5 GE1 GE2 171 172 174 175 721 722 761 762 B91 B92
423.25 78.54 180.64 171.78 395.11 121.84 280.22 151.51 371.19 216.77 468.23 164.47 432.52 148.24 368.61 132.38 340.23 167.51 430.02 New Plan New Plan New Plan New Plan 131.19 325.36 New Plan New Plan
461.34 91.78 211.09 179.04 411.78 127.72 293.77 159.71 391.30 242.78 524.42 175.05 460.34 138.31 342.49 164.87 423.74 193.90 430.02 174.90 387.88 224.70 487.45 138.40 343.25 164.70 387.08
373.15 81.45 187.34 158.90 365.45 113.35 260.72 141.74 347.28 164.31 373.15 155.36 373.15 122.75 303.96 146.32 373.15 164.31 373.15 155.22 344.24 164.31 373.15 122.83 304.63 146.17 343.53
88.19 10.33 23.75 20.14 46.33 14.37 33.05 17.97 44.02 78.47 151.27 19.69 87.19 15.56 38.53 18.55 50.59 29.59 56.87 19.68 43.64 60.39 114.30 15.57 38.62 18.53 43.55
17.02 1.49 3.43 0.81 1.88 0.66 1.53 0.93 2.26 16.44 35.12 1.19 6.75 -1.12 -2.94 3.66 12.31 10.75 -21.07 N/A N/A N/A N/A 0.81 2.02 N/A N/A
IL
IL
IL
IL
IL
IL
IL
IL
IN
High Self High Family High Deductible Self High Deductible Family IN Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family IN Aetna Open Access High Self High Family IN Aetna Open Access High Self High Family IN Arnett HMO High Self High Family IN Health Alliance HMO High Self High Family IN Humana CoverageFirst Consumer Driven Self Consumer Driven Family IN Humana CoverageFirst Consumer Driven Self Consumer Driven Family IN Humana CoverageFirst Consumer Driven Self Consumer Driven Family IN Humana CoverageFirst Consumer Driven Self Consumer Driven Family Humana Health Plan Inc. High Self High Family Standard Self
6Y1 6Y2 6Y4 6Y5 221 222 224 225 IK1 IK2 RD1 RD2 G21 G22 FX1 FX2 BM1 BM2 HZ1 HZ2 L81 L82 MW1 MW2 751 752 754
183.68 431.28 174.45 396.49 136.80 314.65 153.73 353.59 152.11 375.42 162.03 393.74 144.38 375.40 181.36 423.25 117.81 270.96 New Plan New Plan 98.18 225.80 78.54 180.64 171.78 395.11 121.84
215.48 505.94 173.98 390.87 135.55 311.79 150.58 343.31 159.74 405.45 162.51 401.79 164.60 427.97 197.67 461.34 129.56 297.99 107.97 248.34 97.18 223.51 91.78 211.09 179.04 411.78 127.72
164.31 373.15 154.41 346.90 120.30 276.71 133.64 304.69 141.77 359.84 144.23 356.59 146.08 373.15 164.31 373.15 114.98 264.47 95.82 220.40 86.25 198.37 81.45 187.34 158.90 365.45 113.35
51.17 132.79 19.57 43.97 15.25 35.08 16.94 38.62 17.97 45.61 18.28 45.20 18.52 54.82 33.36 88.19 14.58 33.52 12.15 27.94 10.93 25.14 10.33 23.75 20.14 46.33 14.37
22.23 53.59 -0.14 -0.64 -0.14 -0.32 -0.35 -1.16 0.86 3.38 0.05 0.90 2.28 12.59 6.74 17.02 1.33 3.04 N/A N/A -0.12 -0.26 1.49 3.43 0.81 1.88 0.66
IN
Standard Family IN M*Plan High Self High Family Physicians Health Plan of Northern Indiana High Self High Family Unicare HMO High Self High Family Standard Self Standard Family High Deductible Self High Deductible Family Avera Health Plans High Self High Family Coventry Health Care of Iowa High Self High Family High Deductible Self High Deductible Family Health Alliance HMO High Self High Family HealthPartners Open Access Deductible Se Open Access Deductible Fa John Deere Health Plan High Self High Family Sioux Valley Health Plan High Self High Family Standard Self Standard Family Aetna HealthFund
755 IN1 IN2 DQ1 DQ2 171 172 174 175 721 722 AV1 AV2 SV1 SV2 SV4 SV5 FX1 FX2 534 535 YH1 YH2 AU1 AU2 AU4 AU5
280.22 New Plan New Plan 216.09 485.23 167.51 430.02 New Plan New Plan New Plan New Plan 194.74 454.78 151.36 408.77 121.75 314.65 181.36 423.25 180.36 432.85 151.51 371.19 222.21 511.33 199.46 458.52
293.77 183.59 417.60 196.62 439.70 193.90 430.02 174.90 387.88 224.70 487.45 214.20 500.21 151.36 408.77 137.77 356.25 197.67 461.34 185.76 445.84 159.71 391.30 209.32 481.67 199.37 458.52
260.72 162.94 370.62 164.31 373.15 164.31 373.15 155.22 344.24 164.31 373.15 164.31 373.15 134.33 362.78 122.27 316.17 164.31 373.15 164.31 373.15 141.74 347.28 164.31 373.15 164.31 373.15
33.05 20.65 46.98 32.31 66.55 29.59 56.87 19.68 43.64 60.39 114.30 49.89 127.06 17.03 45.99 15.50 40.08 33.36 88.19 21.45 72.69 17.97 44.02 45.01 108.52 35.06 85.37
1.53 N/A N/A -29.04 -66.60 10.75 -21.07 N/A N/A N/A N/A 9.89 24.36 0.00 -10.70 1.80 4.68 6.74 17.02 -4.17 -8.08 0.93 2.26 -22.46 -50.73 -9.66 -21.07
IN
IN
IA
IA
IA
IA
IA
IA
KS
Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family KS Aetna Open Access High Self High Family Community Health Plan High Self High Family Coventry Health Care of Kansas-Wichita/Salinas High Self High Family Standard Self Standard Family High Deductible Self High Deductible Family Coventry Health Care of Kansas-Kansas City High Self High Family Standard Self Standard Family High Deductible Self High Deductible Family Humana CoverageFirst Consumer Driven Self Consumer Driven Family Humana Health Plan, Inc. High Self High Family Standard Self Standard Family Preferred Plus of Kansas High Self High Family UnitedHealthcare of the Midwest High Self
221 222 224 225 KS1 KS2 IC1 IC2 7W1 7W2 7W4 7W5 7G1 7G2 HA1 HA2 HA4 HA5 9H1 9H2 PH1 PH2 MS1 MS2 MS4 MS5 VA1 VA2 GX1
136.80 314.65 153.73 353.59 144.33 370.81 138.65 381.71 157.04 400.45 148.70 379.17 121.04 298.91 148.84 384.11 140.97 363.79 128.89 332.53 78.54 180.64 192.85 443.55 127.14 292.44 219.52 583.94 New Plan
135.55 311.79 150.58 343.31 171.96 420.57 156.16 429.88 217.80 555.38 201.78 520.56 121.04 298.91 158.58 409.23 146.95 379.13 128.89 332.53 86.38 198.66 214.40 493.11 130.99 301.26 219.38 583.54 161.34
120.30 276.71 133.64 304.69 152.61 373.15 138.59 373.15 164.31 373.15 164.31 373.15 107.42 265.28 140.74 363.19 130.42 336.48 114.39 295.12 76.66 176.31 164.31 373.15 116.25 267.37 164.31 373.15 143.19
15.25 35.08 16.94 38.62 19.35 47.42 17.57 56.73 53.49 182.23 37.47 147.41 13.62 33.63 17.84 46.04 16.53 42.65 14.50 37.41 9.72 22.35 50.09 119.96 14.74 33.89 55.07 210.39 18.15
-0.14 -0.32 -0.35 -1.16 3.11 5.70 1.97 13.79 35.82 133.86 20.74 104.75 0.00 0.00 1.10 2.83 0.67 1.72 0.00 0.00 0.88 2.03 11.98 28.49 0.44 0.99 -9.71 -21.47 N/A
KS
KS
KS
KS
KS
KS
KS
High Family KY Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family KY Aetna Open Access High Self High Family KY Humana CoverageFirst Consumer Driven Self Consumer Driven Family Humana CoverageFirst Consumer Driven Self Consumer Driven Family Humana CoverageFirst Consumer Driven Self Consumer Driven Family United Healthcare of Ohio, Inc. High Self High Family Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family Coventry Health Care of Louisiana High Self High Family Standard Self Standard Family High Deductible Self High Deductible Family Coventry Health Care of Louisiana High Self High Family Standard Self
GX2 221 222 224 225 RD1 RD2 6N1 6N2 BM1 BM2 L81 L82 3U1 3U2 221 222 224 225 BJ1 BJ2 BJ4 BJ5 HB1 HB2 HS1 HS2 HS4
New Plan 136.80 314.65 153.73 353.59 162.03 393.74 122.71 282.26 117.81 270.96 98.18 225.80 251.27 554.90 136.80 314.65 153.73 353.59 155.12 360.26 123.19 286.11 New Plan New Plan New Plan New Plan New Plan
388.44 135.55 311.79 150.58 343.31 162.51 401.79 134.96 310.41 129.56 297.99 97.18 223.51 243.13 536.78 135.55 311.79 150.58 343.31 173.25 402.37 152.24 353.56 124.42 288.97 207.78 477.90 171.69
344.74 120.30 276.71 133.64 304.69 144.23 356.59 119.78 275.49 114.98 264.47 86.25 198.37 164.31 373.15 120.30 276.71 133.64 304.69 153.76 357.10 135.11 313.78 110.42 256.46 164.31 373.15 152.37
43.70 15.25 35.08 16.94 38.62 18.28 45.20 15.18 34.92 14.58 33.52 10.93 25.14 78.82 163.63 15.25 35.08 16.94 38.62 19.49 45.27 17.13 39.78 14.00 32.51 43.47 104.75 19.32
N/A -0.14 -0.32 -0.35 -1.16 0.05 0.90 1.38 3.17 1.33 3.04 -0.12 -0.26 -17.71 -39.19 -0.14 -0.32 -0.35 -1.16 2.04 4.74 3.27 7.59 N/A N/A N/A N/A N/A
KY
KY
KY
LA
LA
LA
LA
LA
LA
LA
LA
ME
MD
MD
Standard Family High Deductible Self High Deductible Family Coventry Health Care of Louisiana High Self High Family Standard Self Standard Family High Deductible Self High Deductible Family Humana CoverageFirst Consumer Driven Self Consumer Driven Family Humana CoverageFirst Consumer Driven Self Consumer Driven Family Humana CoverageFirst Consumer Driven Self Consumer Driven Family Vantage Health Plan, Inc. High Self High Family Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family Aetna Open Access High Self High Family Basic Self Basic Family
HS5 L31 L32 JA1 JA2 JA4 JA5 LT1 LT2 9J1 9J2 9L1 9L2 9S1 9S2 MV1 MV2 221 222 224 225 221 222 224 225 JN1 JN2 JN4 JN5
New Plan New Plan New Plan 162.59 377.62 130.53 303.17 New Plan New Plan 93.28 214.50 112.91 259.67 127.63 293.54 187.55 431.38 136.80 314.65 153.73 353.59 136.80 314.65 153.73 353.59 176.00 394.23 115.88 271.17
394.91 124.42 288.97 233.40 542.07 206.26 479.06 132.26 306.21 102.58 235.92 124.18 285.59 140.37 322.84 176.05 404.91 135.55 311.79 150.58 343.31 135.55 311.79 150.58 343.31 193.90 434.31 124.28 290.84
350.48 110.42 256.46 164.31 373.15 164.31 373.15 117.38 271.76 91.04 209.38 110.21 253.46 124.58 286.52 156.24 359.36 120.30 276.71 133.64 304.69 120.30 276.71 133.64 304.69 164.31 373.15 110.30 258.12
44.43 14.00 32.51 69.09 168.92 41.95 105.91 14.88 34.45 11.54 26.54 13.97 32.13 15.79 36.32 19.81 45.55 15.25 35.08 16.94 38.62 15.25 35.08 16.94 38.62 29.59 61.16 13.98 32.72
N/A N/A N/A 50.80 126.44 27.27 71.80 N/A N/A 1.05 2.41 1.27 2.92 1.43 3.30 -13.00 -33.75 -0.14 -0.32 -0.35 -1.16 -0.14 -0.32 -0.35 -1.16 8.33 16.81 0.94 2.21
MD
CareFirst BlueChoice High Self High Family 2G1 2G2 IG1 IG2 IG4 IG5 GZ1 GZ2 E31 E32 E34 E35 JP1 JP2 221 222 224 225 DA1 DA2 TE1 TE2 TE4 TE5 JV1 JV2 JV4 JV5 DV1 181.64 408.63 192.75 486.68 153.46 376.90 New Plan New Plan 159.22 378.96 128.15 305.00 161.10 386.69 136.80 314.65 153.73 353.59 188.40 499.23 168.29 425.79 New Plan New Plan 188.05 457.06 162.24 394.31 New Plan 194.80 438.26 177.98 444.95 139.66 349.14 122.00 294.92 178.64 425.17 107.15 255.01 175.65 421.63 135.55 311.79 150.58 343.31 197.13 522.37 201.41 458.24 167.76 381.71 206.35 501.51 186.40 453.03 188.47 164.31 373.15 157.96 373.15 123.95 309.86 108.28 261.74 158.54 373.15 95.10 226.32 155.89 373.15 120.30 276.71 133.64 304.69 164.31 373.15 164.31 373.15 148.89 338.77 164.31 373.15 164.31 373.15 164.31 30.49 65.11 20.02 71.80 15.71 39.28 13.72 33.18 20.10 52.02 12.05 28.69 19.76 48.48 15.25 35.08 16.94 38.62 32.82 149.22 37.10 85.09 18.87 42.94 42.04 128.36 22.09 79.88 24.16 3.59 8.56 -17.99 -62.80 -1.55 -3.12 N/A N/A 2.19 9.39 -2.37 -5.62 1.64 4.98 -0.14 -0.32 -0.35 -1.16 -0.84 2.07 18.17 11.38 N/A N/A 8.73 23.38 3.84 35.52 N/A
MD
Coventry Health Care High Self High Family Standard Self Standard Family High Deductible Self High Deductible Family Kaiser Foundation Health Plan Mid-Atlantic States High Self High Family Standard Self Standard Family M.D. IPA High Self High Family Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family Blue Cross and Blue Shield of Rhode Island. High Self High Family ConnectiCare High Self High Family Standard Self Standard Family Fallon Community Health Plan High Self High Family Standard Self Standard Family High Deductible Self
MD
MD
MA
MA
MA
MA
High Deductible Family MI Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family MI Bluecare Network of MI High Self High Family Standard Self Standard Family MI Bluecare Network of MI High Self High Family Standard Self Standard Family MI Bluecare Network of MI High Self High Family Standard Self Standard Family MI Bluecare Network of MI High Self High Family Standard Self Standard Family Grand Valley Health Plan High Self High Family Health Alliance Plan High Self High Family HealthPlus MI High Self High Family Humana CoverageFirst Consumer Driven Self
DV2 221 222 224 225 K51 K52 K54 K55 KR1 KR2 KR4 KR5 LN1 LN2 LN4 LN5 LX1 LX2 LX4 LX5 RL1 RL2 521 522 X51 X52 BW1
New Plan 136.80 314.65 153.73 353.59 155.56 435.35 New Plan New Plan 208.88 603.62 New Plan New Plan 212.46 511.63 New Plan New Plan 130.94 391.83 New Plan New Plan 166.77 469.05 140.85 373.24 201.60 460.39 New Plan
445.13 135.55 311.79 150.58 343.31 184.60 516.31 140.17 391.90 234.22 677.09 134.22 388.32 242.51 583.99 166.14 400.10 144.57 432.84 108.95 325.97 175.55 494.51 144.52 383.00 204.45 466.89 97.18
373.15 120.30 276.71 133.64 304.69 163.83 373.15 124.40 347.81 164.31 373.15 119.12 344.63 164.31 373.15 147.45 355.09 128.31 373.15 96.69 289.30 155.80 373.15 128.26 339.91 164.31 373.15 86.25
71.98 15.25 35.08 16.94 38.62 20.77 143.16 15.77 44.09 69.91 303.94 15.10 43.69 78.20 210.84 18.69 45.01 16.26 59.69 12.26 36.67 19.75 121.36 16.26 43.09 40.14 93.74 10.93
N/A -0.14 -0.32 -0.35 -1.16 3.27 59.89 N/A N/A 15.77 52.40 N/A N/A 20.48 51.29 N/A N/A 1.53 15.61 N/A N/A 0.99 4.39 0.41 1.10 -6.72 -14.57 N/A
MI
MI
MI
MI
Consumer Driven Family MI Humana CoverageFirst Consumer Driven Self Consumer Driven Family MI Humana CoverageFirst Consumer Driven Self Consumer Driven Family MI M-Care High Self High Family HealthPartners Classic/Open Access Deductible Classic Self Classic Family Open Access Deductible Se Open Access Deductible Fa HealthPartners Primary Clinic Plan High Self High Family Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family Aetna Open Access High Self High Family BlueCHOICE High Self High Family Community Health Plan High Self High Family Coventry Health Care of Kansas-Kansas City High Self High Family Standard Self Standard Family
BW2 FT1 FT2 GT1 GT2 EG1 EG2 531 532 534 535 HQ1 HQ2 221 222 224 225 KS1 KS2 9G1 9G2 IC1 IC2 HA1 HA2 HA4 HA5
New Plan New Plan New Plan New Plan New Plan 134.33 355.97 232.12 557.07 180.36 432.85 288.03 691.27 136.80 314.65 153.73 353.59 144.33 370.81 177.50 384.30 138.65 381.71 148.84 384.11 140.97 363.79
223.51 107.97 248.34 118.78 273.18 146.20 387.34 244.92 587.80 185.76 445.84 288.03 691.27 135.55 311.79 150.58 343.31 171.96 420.57 199.24 431.39 156.16 429.88 158.58 409.23 146.95 379.13
198.37 95.82 220.40 105.42 242.45 129.75 343.76 164.31 373.15 164.31 373.15 164.31 373.15 120.30 276.71 133.64 304.69 152.61 373.15 164.31 373.15 138.59 373.15 140.74 363.19 130.42 336.48
25.14 12.15 27.94 13.36 30.73 16.45 43.58 80.61 214.65 21.45 72.69 123.72 318.12 15.25 35.08 16.94 38.62 19.35 47.42 34.93 58.24 17.57 56.73 17.84 46.04 16.53 42.65
N/A N/A N/A N/A N/A 1.34 3.53 3.23 9.66 -4.17 -8.08 -9.57 -21.07 -0.14 -0.32 -0.35 -1.16 3.11 5.70 12.17 15.01 1.97 13.79 1.10 2.83 0.67 1.72
MN
MN
MO
MO
MO
MO
MO
MO
MO
MO
MO
MO
MO
MS
MT
NE
NE
High Deductible Self High Deductible Family Group Health Plan, Inc. High Self High Family High Deductible Self High Deductible Family Humana CoverageFirst Consumer Driven Self Consumer Driven Family Humana Health Plan, Inc. High Self High Family Standard Self Standard Family Mercy Health Plans High Self High Family UnitedHealthcare of the Midwest High Self High Family UnitedHealthcare of the Midwest High Self High Family Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family New West Health Services High Self High Family Avera Health Plans High Self High Family Coventry Health Care of Nebraska High Self
9H1 9H2 MM1 MM2 MM4 MM5 PH1 PH2 MS1 MS2 MS4 MS5 7M1 7M2 B91 B92 GX1 GX2 221 222 224 225 NV1 NV2 AV1 AV2 IE1
128.89 332.53 205.81 444.53 170.30 364.62 78.54 180.64 192.85 443.55 127.14 292.44 216.77 468.23 New Plan New Plan New Plan New Plan 136.80 314.65 153.73 353.59 168.68 360.30 194.74 454.78 168.95
128.89 332.53 230.52 497.90 184.04 394.61 86.38 198.66 214.40 493.11 130.99 301.26 242.78 524.42 164.70 387.08 161.34 388.44 135.55 311.79 150.58 343.31 169.53 362.12 214.20 500.21 179.09
114.39 295.12 164.31 373.15 163.34 350.22 76.66 176.31 164.31 373.15 116.25 267.37 164.31 373.15 146.17 343.53 143.19 344.74 120.30 276.71 133.64 304.69 150.46 321.38 164.31 373.15 158.94
14.50 37.41 66.21 124.75 20.70 44.39 9.72 22.35 50.09 119.96 14.74 33.89 78.47 151.27 18.53 43.55 18.15 43.70 15.25 35.08 16.94 38.62 19.07 40.74 49.89 127.06 20.15
0.00 0.00 15.14 32.30 1.54 3.37 0.88 2.03 11.98 28.49 0.44 0.99 16.44 35.12 N/A N/A N/A N/A -0.14 -0.32 -0.35 -1.16 0.09 0.21 9.89 24.36 1.14
High Family NV Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family NV Aetna Open Access High Self High Family NV Health Plan of Nevada High Self High Family NV Health Plan of Nevada High Self High Family NV PacifiCare of Nevada High Self High Family NH Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family NJ Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family NJ Aetna Open Access High Self High Family NJ Aetna Open Access High Self High Family NJ AmeriHealth HMO High Self High Family
IE2 221 222 224 225 Y11 Y12 2L1 2L2 NM1 NM2 K91 K92 221 222 224 225 221 222 224 225 JR1 JR2 P31 P32 FK1 FK2
425.18 136.80 314.65 153.73 353.59 154.67 385.13 157.62 403.53 92.61 237.12 139.07 315.69 136.80 314.65 153.73 353.59 136.80 314.65 153.73 353.59 New Plan New Plan 185.14 446.74 164.81 393.35
450.69 135.55 311.79 150.58 343.31 158.53 394.71 169.19 433.17 96.63 247.43 151.55 344.02 135.55 311.79 150.58 343.31 135.55 311.79 150.58 343.31 199.17 455.68 225.56 544.23 198.61 470.05
373.15 120.30 276.71 133.64 304.69 140.70 350.31 150.16 373.15 85.76 219.59 134.50 305.32 120.30 276.71 133.64 304.69 120.30 276.71 133.64 304.69 164.31 373.15 164.31 373.15 164.31 373.15
77.54 15.25 35.08 16.94 38.62 17.83 44.40 19.03 60.02 10.87 27.84 17.05 38.70 15.25 35.08 16.94 38.62 15.25 35.08 16.94 38.62 34.86 82.53 61.25 171.08 34.30 96.90
4.44 -0.14 -0.32 -0.35 -1.16 0.43 1.07 1.30 8.57 0.45 1.16 1.40 3.18 -0.14 -0.32 -0.35 -1.16 -0.14 -0.32 -0.35 -1.16 N/A N/A 30.85 76.42 15.76 52.65
NJ
Coventry Health Care High Self High Family Standard Self Standard Family High Deductible Self High Deductible Family 2J1 2J2 2J4 2J5 LK1 LK2 801 802 804 805 Q11 Q12 P21 P22 221 222 224 225 JC1 JC2 MK1 MK2 SG1 SG2 SG4 SG5 801 802 193.32 488.13 159.40 391.87 New Plan New Plan 200.91 502.28 170.15 397.20 153.91 377.69 166.62 434.50 136.80 314.65 153.73 353.59 177.65 437.30 130.07 325.87 155.33 391.44 New Plan New Plan 200.91 502.28 183.97 459.92 147.56 368.88 131.10 317.66 217.98 544.97 174.74 407.92 160.07 392.80 181.28 472.74 135.55 311.79 150.58 343.31 193.06 475.22 131.93 330.26 188.28 444.34 165.05 412.64 217.98 544.97 163.27 373.15 130.96 327.38 116.35 281.92 164.31 373.15 155.08 362.03 142.06 348.61 160.89 373.15 120.30 276.71 133.64 304.69 164.31 373.15 117.09 293.11 164.31 373.15 146.48 366.22 164.31 373.15 20.70 86.77 16.60 41.50 14.75 35.74 53.67 171.82 19.66 45.89 18.01 44.19 20.39 99.59 15.25 35.08 16.94 38.62 28.75 102.07 14.84 37.15 23.97 71.19 18.57 46.42 53.67 171.82 -17.88 -49.28 -1.33 -2.59 N/A N/A 7.50 21.62 0.52 0.77 0.70 1.70 1.65 17.17 -0.14 -0.32 -0.35 -1.16 5.84 16.85 0.21 0.49 6.50 27.15 N/A N/A 7.50 21.62
NJ
GHI Health Plan High Self High Family Standard Self Standard Family
NM
Lovelace Health Plan High Self High Family Presbyterian Health Plan High Self High Family Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family Aetna Open Access High Self High Family Blue Choice High Self High Family CDPHP Universal Benefits, Inc. High Self High Family Standard Self Standard Family GHI Health Plan High Self High Family
NM
NY
NY
NY
NY
NY
Standard Self Standard Family NY GHI HMO Select High Self High Family Standard Self Standard Family NY GHI HMO Select High Self High Family Standard Self Standard Family HIP of Greater New York High Self High Family Standard Self Standard Family HMO Blue High Self High Family HMOBlue-CNY High Self High Family Independent Health Assoc High Self High Family High Deductible Self High Deductible Family MVP Health Care High Self High Family MVP Health Care High Self High Family MVP Health Care High Self High Family
804 805 6V1 6V2 6V4 6V5 X41 X42 X44 X45 511 512 514 515 AH1 AH2 EB1 EB2 QA1 QA2 QA4 QA5 GA1 GA2 M91 M92 MX1 MX2
170.15 397.20 183.75 467.78 157.70 401.46 169.75 437.49 154.35 390.30 159.41 446.35 131.51 368.23 173.97 442.45 172.49 441.23 129.64 355.56 New Plan New Plan 148.03 382.28 161.06 415.92 166.04 428.80
174.74 407.92 210.10 532.86 178.51 451.02 185.78 474.00 174.00 442.87 176.11 493.13 153.80 430.63 252.78 645.41 195.74 477.76 138.58 380.09 145.19 346.40 160.66 414.92 176.35 455.43 179.52 463.53
155.08 362.03 164.31 373.15 158.43 373.15 164.31 373.15 154.43 373.15 156.30 373.15 136.50 373.15 164.31 373.15 164.31 373.15 122.99 337.33 128.86 307.43 142.59 368.24 156.51 373.15 159.32 373.15
19.66 45.89 45.79 159.71 20.08 77.87 21.47 100.85 19.57 69.72 19.81 119.98 17.30 57.48 88.47 272.26 31.43 104.61 15.59 42.76 16.33 38.97 18.07 46.68 19.84 82.28 20.20 90.38
0.52 0.77 16.78 44.01 2.34 28.49 2.37 15.44 2.21 25.81 1.88 25.71 2.51 16.05 68.90 181.89 12.02 15.46 1.01 2.76 N/A N/A 1.42 3.67 1.72 18.44 1.52 13.66
NY
NY
NY
NY
NY
NY
NY
NY
Preferred Care High Self High Family GV1 GV2 KQ1 KQ2 Q81 Q82 J61 J62 J64 J65 221 222 224 225 534 535 RU1 RU2 221 222 224 225 7D1 7D2 ND1 ND2 127.06 339.21 146.79 388.88 117.88 334.24 190.63 500.08 New Plan New Plan 136.80 314.65 153.73 353.59 180.36 432.85 125.18 321.73 136.80 314.65 153.73 353.59 148.35 353.07 164.58 430.12 128.96 345.06 177.03 468.73 140.68 398.85 196.37 511.53 177.65 463.98 135.55 311.79 150.58 343.31 185.76 445.84 134.32 345.20 135.55 311.79 150.58 343.31 171.42 407.99 194.21 468.83 114.45 306.24 157.11 373.15 124.85 353.98 164.31 373.15 157.66 373.15 120.30 276.71 133.64 304.69 164.31 373.15 119.21 306.37 120.30 276.71 133.64 304.69 152.14 362.09 164.31 373.15 14.51 38.82 19.92 95.58 15.83 44.87 32.06 138.38 19.99 90.83 15.25 35.08 16.94 38.62 21.45 72.69 15.11 38.83 15.25 35.08 16.94 38.62 19.28 45.90 29.90 95.68 0.22 0.66 3.41 51.83 2.57 7.27 -3.83 -9.62 N/A N/A -0.14 -0.32 -0.35 -1.16 -4.17 -8.08 1.03 2.64 -0.14 -0.32 -0.35 -1.16 2.59 6.18 11.38 17.64
NY
Univera Healthcare High Self High Family
NY
Univera Healthcare High Self High Family
NY
Vytra Health Plans High Self High Family Standard Self Standard Family
NC
Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family
ND
HealthPartners Open Access Deductible Se Open Access Deductible Fa Heart of America Health Plan High Self High Family Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family Aetna Open Access High Self High Family Aetna Open Access High Self High Family Aetna Open Access
ND
OH
OH
OH
OH
High Self High Family OH AultCare HMO High Self High Family High Deductible Self High Deductigle Family OH Blue HMO High Self High Family OH HMO Health Ohio High Self High Family OH Hometown Health Plan High Self High Family Humana CoverageFirst Consumer Driven Self Consumer Driven Family Kaiser Foundation Health Plan of Ohio High Self High Family Standard Self Standard Family Paramount Health Care High Self High Family SummaCare Health Plan High Self High Family SuperMed HMO High Self High Family The Health Plan of the Upper Ohio Valley High Self High Family United Healthcare of Ohio, Inc.
RD1 RD2 3A1 3A2 3A4 3A5 R51 R52 L41 L42 MZ1 MZ2 L81 L82 641 642 644 645 U21 U22 5W1 5W2 5M1 5M2 U41 U42
162.03 393.74 161.47 396.39 168.53 337.69 194.55 453.00 165.90 424.39 135.28 338.22 98.18 225.80 171.87 421.77 New Plan New Plan 166.24 440.16 182.53 419.84 224.03 573.06 145.32 334.22
162.51 401.79 176.88 434.26 168.53 337.69 215.96 493.77 177.48 454.00 128.91 322.23 97.18 223.51 188.88 463.55 158.00 387.74 170.83 452.28 191.48 459.57 305.18 780.64 159.20 366.17
144.23 356.59 156.98 373.15 149.57 299.70 164.31 373.15 157.51 373.15 114.41 285.98 86.25 198.37 164.31 373.15 140.23 344.12 151.61 373.15 164.31 373.15 164.31 373.15 141.29 324.98
18.28 45.20 19.90 61.11 18.96 37.99 51.65 120.62 19.97 80.85 14.50 36.25 10.93 25.14 24.57 90.40 17.77 43.62 19.22 79.13 27.17 86.42 140.87 407.49 17.91 41.19
0.05 0.90 1.73 16.52 0.00 0.00 11.84 19.70 1.31 8.54 -0.72 -1.80 -0.12 -0.26 5.23 20.71 N/A N/A 0.52 -8.95 -0.62 18.66 71.58 186.51 1.56 3.59
OH
OH
OH
OH
OH
OH
OH
OH
OH
OK
OK
OK
OK
OR
OR
PA
PA
High Self High Family United Healthcare of Ohio, Inc. High Self High Family United Healthcare of Ohio, Inc. High Self High Family Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family Aetna Open Access High Self High Family Globalhealth, Inc. High Self High Family PacifiCare of Oklahoma High Self High Family Kaiser Foundation Health Plan of Northwest High Self High Family Standard Self Standard Family PacifiCare Northwest Region (Oregon/Washington) High Self High Family Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family Aetna Open Access High Self
3U1 3U2 AK1 AK2 CA1 CA2 221 222 224 225 SL1 SL2 IM1 IM2 2N1 2N2 571 572 574 575 7Z1 7Z2 221 222 224 225 P31
251.27 554.90 New Plan New Plan New Plan New Plan 136.80 314.65 153.73 353.59 171.40 397.68 150.01 361.55 170.39 407.54 172.99 394.77 158.89 362.58 186.09 416.41 136.80 314.65 153.73 353.59 185.14
243.13 536.78 165.11 396.39 173.25 417.02 135.55 311.79 150.58 343.31 209.32 485.61 166.96 402.40 191.59 447.32 186.00 424.48 155.72 355.36 194.84 436.00 135.55 311.79 150.58 343.31 225.56
164.31 373.15 146.54 351.80 153.76 370.11 120.30 276.71 133.64 304.69 164.31 373.15 148.18 357.13 164.31 373.15 164.31 373.15 138.20 315.38 164.31 373.15 120.30 276.71 133.64 304.69 164.31
78.82 163.63 18.57 44.59 19.49 46.91 15.25 35.08 16.94 38.62 45.01 112.46 18.78 45.27 27.28 74.17 21.69 51.33 17.52 39.98 30.53 62.85 15.25 35.08 16.94 38.62 61.25
-17.71 -39.19 N/A N/A N/A N/A -0.14 -0.32 -0.35 -1.16 25.73 66.86 1.90 4.60 8.11 18.71 2.23 6.92 -0.36 -0.81 -0.82 -1.48 -0.14 -0.32 -0.35 -1.16 30.85
High Family PA Aetna Open Access High Self High Family HealthAmerica Pennsylvania High Self High Family Standard Self Standard Family High Deductible Self High Deductible Family HealthAmerica Pennsylvania High Self High Family Standard Self Standard Family High Deductible Self High Deductible Family HealthAmerica Pennsylvania High Self High Family Standard Self Standard Family High Deductible Self High Deductible Family HealthAmerica Pennsylvania High Self High Family Standard Self Standard Family High Deductible Self High Deductible Family Keystone Health Plan Central High Self High Family Standard Self Standard Family
P32 YE1 YE2 261 262 264 265 Y61 Y62 4N1 4N2 4N4 4N5 YN1 YN2 PN1 PN2 PN4 PN5 9N1 9N2 SW1 SW2 SW4 SW5 YW1 YW2 S41 S42 S44 S45
446.74 134.23 370.14 170.32 434.34 158.98 405.41 151.89 373.42 238.06 547.54 211.05 485.42 190.76 431.16 233.60 536.37 209.40 480.70 183.76 414.45 202.73 466.28 186.46 428.86 171.59 387.10 208.21 496.79 New Plan New Plan
544.23 125.20 345.22 189.26 482.63 180.53 460.39 151.89 373.42 247.62 569.54 243.94 561.06 190.76 431.16 207.57 476.58 180.26 413.89 164.44 370.17 229.00 526.71 204.85 471.18 171.59 387.10 213.93 510.43 201.82 481.55
373.15 111.12 306.38 164.31 373.15 160.22 373.15 134.80 331.41 164.31 373.15 164.31 373.15 164.31 373.15 164.31 373.15 159.98 367.33 145.94 328.53 164.31 373.15 164.31 373.15 152.29 343.55 164.31 373.15 164.31 373.15
171.08 14.08 38.84 24.95 109.48 20.31 87.24 17.09 42.01 83.31 196.39 79.63 187.91 26.45 58.01 43.26 103.43 20.28 46.56 18.50 41.64 64.69 153.56 40.54 98.03 19.30 43.55 49.62 137.28 37.51 108.40
76.42 -1.02 -2.80 5.79 27.22 2.42 33.91 0.00 0.00 -0.01 0.93 23.32 54.57 -9.57 -21.07 -35.60 -80.86 -34.38 -82.06 -10.52 -20.73 16.70 39.36 8.82 21.25 0.00 0.00 -3.85 -7.43 N/A N/A
PA
PA
PA
PA
PA
PA
PA
PR
PR
RI
SC
SC
SD
SD
SD
TN
Keystone Health Plan East High Self High Family UPMC Health Plan High Self High Family Humana Health Plans of Puerto Rico High Self High Family Triple-S High Self High Family Blue Cross and Blue Shield of Rhode Island. High Self High Family Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family Carolina Care High Self High Family Avera Health Plans High Self High Family HealthPartners Open Access Deductible Se Open Access Deductible Fa Sioux Valley Health Plan High Self High Family Standard Self Standard Family Aetna HealthFund Consumer Driven Self Consumer Driven Family
ED1 ED2 8W1 8W2 ZJ1 ZJ2 891 892 DA1 DA2 221 222 224 225 IB1 IB2 AV1 AV2 534 535 AU1 AU2 AU4 AU5 221 222
164.60 434.06 170.97 436.07 93.52 215.10 118.57 254.68 188.40 499.23 136.80 314.65 153.73 353.59 173.99 391.35 194.74 454.78 180.36 432.85 222.21 511.33 199.46 458.52 136.80 314.65
196.00 517.17 187.11 477.28 110.35 253.82 133.98 287.78 197.13 522.37 135.55 311.79 150.58 343.31 184.34 414.64 214.20 500.21 185.76 445.84 209.32 481.67 199.37 458.52 135.55 311.79
164.31 373.15 164.31 373.15 97.94 225.27 118.91 255.40 164.31 373.15 120.30 276.71 133.64 304.69 163.60 367.99 164.31 373.15 164.31 373.15 164.31 373.15 164.31 373.15 120.30 276.71
31.69 144.02 22.80 104.13 12.41 28.55 15.07 32.38 32.82 149.22 15.25 35.08 16.94 38.62 20.74 46.65 49.89 127.06 21.45 72.69 45.01 108.52 35.06 85.37 15.25 35.08
13.17 62.04 3.57 20.14 1.89 4.35 1.73 3.73 -0.84 2.07 -0.14 -0.32 -0.35 -1.16 1.17 2.62 9.89 24.36 -4.17 -8.08 -22.46 -50.73 -9.66 -21.07 -0.14 -0.32
High Deductible Self High Deductible Family TN Aetna Open Access High Self High Family TN Aetna Open Access High Self High Family TN Humana CoverageFirst Consumer Driven Self Consumer Driven Family TN Humana CoverageFirst Consumer Driven Self Consumer Driven Family TX Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family TX Aetna Open Access High Self High Family TX Aetna Open Access High Self High Family TX Aetna Open Access High Self High Family TX Firstcare High Self High Family TX Firstcare High Self High Family TX HMO Blue Texas High Self High Family
224 225 6J1 6J2 UB1 UB2 BT1 BT2 L61 L62 221 222 224 225 8G1 8G2 P11 P12 PU1 PU2 6U1 6U2 CK1 CK2 YM1 YM2
153.73 353.59 177.96 405.78 148.69 379.16 New Plan New Plan 98.18 225.80 136.80 314.65 153.73 353.59 171.57 428.34 154.64 389.57 178.16 437.09 160.02 343.77 212.34 456.11 183.46 449.08
150.58 343.31 198.52 452.61 149.30 380.70 124.18 285.59 118.78 273.18 135.55 311.79 150.58 343.31 188.92 471.64 159.55 401.92 199.87 490.35 161.63 347.50 197.36 424.33 205.35 502.66
133.64 304.69 164.31 373.15 132.50 337.87 110.21 253.46 105.42 242.45 120.30 276.71 133.64 304.69 164.31 373.15 141.60 356.70 164.31 373.15 143.45 308.41 164.31 373.15 164.31 373.15
16.94 38.62 34.21 79.46 16.80 42.83 13.97 32.13 13.36 30.73 15.25 35.08 16.94 38.62 24.61 98.49 17.95 45.22 35.56 117.20 18.18 39.09 33.05 51.18 41.04 129.51
-0.35 -1.16 10.99 25.76 0.07 0.17 N/A N/A 2.31 5.33 -0.14 -0.32 -0.35 -1.16 5.31 22.23 0.55 1.39 12.14 32.19 0.18 0.42 -24.55 -52.85 12.32 32.51
TX
Humana CoverageFirst Consumer Driven Self Consumer Driven Family T21 T22 T81 T82 TP1 TP2 TU1 TU2 TV1 TV2 UR1 UR2 UR4 UR5 HM1 HM2 GF1 GF2 9K1 9K2 9K4 9K5 VW1 VW2 221 222 117.81 270.96 112.91 259.67 103.08 237.09 98.18 225.80 107.98 248.38 206.58 475.14 148.36 341.20 174.11 435.29 175.41 402.82 193.20 425.06 New Plan New Plan 200.73 518.49 136.80 314.65 124.18 285.59 129.57 298.00 113.37 260.76 107.97 248.34 118.78 273.18 233.46 536.94 168.84 388.37 197.70 494.29 199.90 459.34 212.95 468.52 206.00 426.77 272.01 702.66 135.55 311.79 110.21 253.46 114.99 264.48 100.62 231.42 95.82 220.40 105.42 242.45 164.31 373.15 149.85 344.68 164.31 373.15 164.31 373.15 164.31 373.15 164.31 373.15 164.31 373.15 120.30 276.71 13.97 32.13 14.58 33.52 12.75 29.34 12.15 27.94 13.36 30.73 69.15 163.79 18.99 43.69 33.39 121.14 35.59 86.19 48.64 95.37 41.69 53.62 107.70 329.51 15.25 35.08 0.72 1.65 1.88 4.31 1.15 2.67 1.10 2.54 1.21 2.79 17.31 40.73 2.30 5.31 13.80 37.93 14.92 35.45 10.18 22.39 N/A N/A 61.71 163.10 -0.14 -0.32
TX
Humana CoverageFirst Consumer Driven Self Consumer Driven Family
TX
Humana CoverageFirst Consumer Driven Self Consumer Driven Family
TX
Humana CoverageFirst Consumer Driven Self Consumer Driven Family
TX
Humana CoverageFirst Consumer Driven Self Consumer Driven Family Humana Health Plan of Texas High Self High Family Standard Self Standard Family Mercy Health Plans High Self High Family Pacificare of Texas High Self High Family Altius Health Plans High Self High Family High Deductible Self High Deductible Family MVP Health Care High Self High Family Aetna HealthFund Consumer Driven Self Consumer Driven Family
TX
TX
TX
UT
VT
VA
High Deductible Self High Deductible Family VA Aetna Open Access High Self High Family Basic Self Basic Family VA CareFirst BlueChoice High Self High Family Kaiser Foundation Health Plan Mid-Atlantic States High Self High Family Standard Self Standard Family M.D. IPA High Self High Family Optima Health Plan High Self High Family Piedmont Community Healthcare High Self High Family Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family Aetna Open Access High Self High Family Group Health Cooperative High Self High Family Standard Self Standard Family
224 225 JN1 JN2 JN4 JN5 2G1 2G2 E31 E32 E34 E35 JP1 JP2 9R1 9R2 2C1 2C2 221 222 224 225 8J1 8J2 541 542 544 545
153.73 353.59 176.00 394.23 115.88 271.17 181.64 408.63 159.22 378.96 128.15 305.00 161.10 386.69 179.60 424.95 163.77 375.01 136.80 314.65 153.73 353.59 139.14 353.83 178.62 403.24 141.45 319.34
150.58 343.31 193.90 434.31 124.28 290.84 194.80 438.26 178.64 425.17 107.15 255.01 175.65 421.63 204.74 484.45 180.14 412.51 135.55 311.79 150.58 343.31 168.76 429.16 188.52 425.60 148.94 336.24
133.64 304.69 164.31 373.15 110.30 258.12 164.31 373.15 158.54 373.15 95.10 226.32 155.89 373.15 164.31 373.15 159.87 366.10 120.30 276.71 133.64 304.69 149.77 373.15 164.31 373.15 132.18 298.41
16.94 38.62 29.59 61.16 13.98 32.72 30.49 65.11 20.10 52.02 12.05 28.69 19.76 48.48 40.43 111.30 20.27 46.41 15.25 35.08 16.94 38.62 18.99 56.01 24.21 52.45 16.76 37.83
-0.35 -1.16 8.33 16.81 0.94 2.21 3.59 8.56 2.19 9.39 -2.37 -5.62 1.64 4.98 15.57 38.43 1.85 4.22 -0.14 -0.32 -0.35 -1.16 3.34 16.20 0.33 1.29 0.85 1.90
VA
VA
VA
VA
WA
WA
WA
WA
WA
WA
WA
WA
WV
WV
WI
WI
Group Health Cooperative High Self High Family Standard Self Standard Family Kaiser Foundation Health Plan of Northwest High Self High Family Standard Self Standard Family KPS Health Plans High Self High Family Standard Self Standard Family High Deductible Self High Deductible Family PacifiCare Northwest Region (Oregon/Washington) High Self High Family PacifiCare Northwest Region (Oregon/Washington) High Self High Family Aetna HealthFund Consumer Driven Self Consumer Driven Family High Deductible Self High Deductible Family The Health Plan of the Upper Ohio Valley High Self High Family Dean Health Plan High Self High Family Group Health Cooperative High Self High Family
VR1 VR2 VR4 VR5 571 572 574 575 VT1 VT2 L11 L12 L14 L15 7Z1 7Z2 SA1 SA2 221 222 224 225 U41 U42 WD1 WD2 WJ1 WJ2
173.91 424.02 147.12 338.36 172.99 394.77 158.89 362.58 187.92 410.62 153.89 332.16 New Plan New Plan 186.09 416.41 128.27 299.84 136.80 314.65 153.73 353.59 145.32 334.22 156.99 415.99 136.92 370.05
196.30 451.48 157.89 363.14 186.00 424.48 155.72 355.36 209.81 458.46 171.82 370.85 142.55 311.49 194.84 436.00 140.36 328.31 135.55 311.79 150.58 343.31 159.20 366.17 162.97 431.84 149.12 397.56
164.31 373.15 140.13 322.29 164.31 373.15 138.20 315.38 164.31 373.15 152.49 329.13 126.51 276.45 164.31 373.15 124.57 291.38 120.30 276.71 133.64 304.69 141.29 324.98 144.64 373.15 132.34 352.83
31.99 78.33 17.76 40.85 21.69 51.33 17.52 39.98 45.50 85.31 19.33 41.72 16.04 35.04 30.53 62.85 15.79 36.93 15.25 35.08 16.94 38.62 17.91 41.19 18.33 58.69 16.78 44.73
12.43 6.39 1.21 2.78 2.23 6.92 -0.36 -0.81 12.32 26.77 2.02 4.35 N/A N/A -0.82 -1.48 1.36 3.20 -0.14 -0.32 -0.35 -1.16 1.56 3.59 0.67 -5.22 1.38 3.10
WI
HealthPartners Classic/Open Access Deductible Classic Self Classic Family Open Access Deductible Se Open Access Deductible Fa WI HealthPartners Primary Clinic Plan High Self High Family WI Humana CoverageFirst Consumer Driven Self Consumer Driven Family WY WINhealth Partners High Self High Family
531 532 534 535 HQ1 HQ2 FB1 FB2 PV1 PV2
232.12 557.07 180.36 432.85 288.03 691.27 107.98 248.38 167.39 453.80
244.92 587.80 185.76 445.84 288.03 691.27 118.78 273.18 178.01 407.62
164.31 373.15 164.31 373.15 164.31 373.15 105.42 242.45 157.98 361.76
80.61 214.65 21.45 72.69 123.72 318.12 13.36 30.73 20.03 45.86
3.23 9.66 -4.17 -8.08 -9.57 -21.07 1.21 2.79 1.20 -55.86