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2016 Plan Information for Illinois
Choose a Location, Employee Type, & Payment Period
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Nationwide
Non-Postal
Certain Temporary Employees
Annuitant
U.S. Postal Service (Category 1)
Former Spouse Enrollee
Federal Deposit Insurance Corporation
Temporary Continuation of Coverage (TCC)
U.S. Postal Service (Category 2)
Tribal Employee
Biweekly
Every Four Weeks
Semi-Monthly
Monthly
Location Specific Rates
Contract
Enrollment Code
Enrollment Type
Option/Enrollment Type
Payment Period
Employee Payment
Aetna Direct
224
Non-Postal
HDHP Self
Monthly
130.08
Aetna Direct
225
Non-Postal
HDHP Self & Family
Monthly
286.94
Aetna Direct
226
Non-Postal
HDHP Self Plus One
Monthly
281.31
Aetna Direct
N61
Non-Postal
CDHP Self
Monthly
118.33
Aetna Direct
N62
Non-Postal
CDHP Self & Family
Monthly
298.42
Aetna Direct
N63
Non-Postal
CDHP Self Plus One
Monthly
259.5
Aetna HealthFund CDHP and Aetna Value Plan
H41
Non-Postal
CDHP Self
Monthly
215.17
Aetna HealthFund CDHP and Aetna Value Plan
H42
Non-Postal
CDHP Self & Family
Monthly
485.89
Aetna HealthFund CDHP and Aetna Value Plan
H43
Non-Postal
CDHP Self Plus One
Monthly
530.14
Aetna HealthFund CDHP and Aetna Value Plan
H44
Non-Postal
Basic Self
Monthly
134.18
Aetna HealthFund CDHP and Aetna Value Plan
H45
Non-Postal
Basic Self & Family
Monthly
307.96
Aetna HealthFund CDHP and Aetna Value Plan
H46
Non-Postal
Basic Self Plus One
Monthly
301.92
Blue Cross and Blue Shield of Illinois
A21
Non-Postal
High Self
Monthly
268.32
Blue Cross and Blue Shield of Illinois
A22
Non-Postal
High Self & Family
Monthly
752.96
Blue Cross and Blue Shield of Illinois
A23
Non-Postal
High Self Plus One
Monthly
580.38
Blue Preferred
9G1
Non-Postal
High Self
Monthly
213.66
Blue Preferred
9G2
Non-Postal
High Self & Family
Monthly
382.63
Blue Preferred
9G3
Non-Postal
High Self Plus One
Monthly
353.06
Health Alliance HMO/POS
FX1
Non-Postal
High Self
Monthly
299.18
Health Alliance HMO/POS
FX2
Non-Postal
High Self & Family
Monthly
1096.35
Health Alliance HMO/POS
FX3
Non-Postal
High Self Plus One
Monthly
600.21
Health Alliance HMO/POS
K84
Non-Postal
Standard Self
Monthly
162.61
Health Alliance HMO/POS
K85
Non-Postal
Standard Self & Family
Monthly
675.69
Health Alliance HMO/POS
K86
Non-Postal
Standard Self Plus One
Monthly
328.08
Humana CoverageFirst and Humana Value Plan
GB1
Non-Postal
CDHP Self
Monthly
170.3
Humana CoverageFirst and Humana Value Plan
GB2
Non-Postal
CDHP Self & Family
Monthly
364.91
Humana CoverageFirst and Humana Value Plan
GB3
Non-Postal
CDHP Self Plus One
Monthly
361.18
Humana CoverageFirst and Humana Value Plan
GB4
Non-Postal
Value Self
Monthly
116.61
Humana CoverageFirst and Humana Value Plan
GB5
Non-Postal
Value Self & Family
Monthly
262.37
Humana CoverageFirst and Humana Value Plan
GB6
Non-Postal
Value Self Plus One
Monthly
250.7
Humana CoverageFirst and Humana Value Plan
MW1
Non-Postal
CDHP Self
Monthly
206.75
Humana CoverageFirst and Humana Value Plan
MW2
Non-Postal
CDHP Self & Family
Monthly
446.92
Humana CoverageFirst and Humana Value Plan
MW3
Non-Postal
CDHP Self Plus One
Monthly
439.55
Humana CoverageFirst and Humana Value Plan
MW4
Non-Postal
Value Self
Monthly
116.61
Humana CoverageFirst and Humana Value Plan
MW5
Non-Postal
Value Self & Family
Monthly
262.37
Humana CoverageFirst and Humana Value Plan
MW6
Non-Postal
Value Self Plus One
Monthly
250.7
Humana Health Plan, Inc.
751
Non-Postal
High Self
Monthly
738.47
Humana Health Plan, Inc.
752
Non-Postal
High Self & Family
Monthly
1643.33
Humana Health Plan, Inc.
753
Non-Postal
High Self Plus One
Monthly
1582.77
Humana Health Plan, Inc.
754
Non-Postal
Standard Self
Monthly
284.92
Humana Health Plan, Inc.
755
Non-Postal
Standard Self & Family
Monthly
622.83
Humana Health Plan, Inc.
756
Non-Postal
Standard Self Plus One
Monthly
607.66
Humana Health Plan, Inc.
9F1
Non-Postal
High Self
Monthly
1028.41
Humana Health Plan, Inc.
9F2
Non-Postal
High Self & Family
Monthly
2295.71
Humana Health Plan, Inc.
9F3
Non-Postal
High Self Plus One
Monthly
2206.16
Humana Health Plan, Inc.
AB4
Non-Postal
Standard Self
Monthly
321.69
Humana Health Plan, Inc.
AB5
Non-Postal
Standard Self & Family
Monthly
705.57
Humana Health Plan, Inc.
AB6
Non-Postal
Standard Self Plus One
Monthly
686.68
Union Health Service
761
Non-Postal
High Self
Monthly
149.46
Union Health Service
762
Non-Postal
High Self & Family
Monthly
427.39
Union Health Service
763
Non-Postal
High Self Plus One
Monthly
326.88
UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced)
L91
Non-Postal
Value Self
Monthly
115.22
UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced)
L92
Non-Postal
Value Self & Family
Monthly
323.08
UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced)
L93
Non-Postal
Value Self Plus One
Monthly
225.02
UnitedHealthcare Plan of the River Valley Inc.
YH1
Non-Postal
High Self
Monthly
162.07
UnitedHealthcare Plan of the River Valley Inc.
YH2
Non-Postal
High Self & Family
Monthly
692.33
UnitedHealthcare Plan of the River Valley Inc.
YH3
Non-Postal
High Self Plus One
Monthly
304.85
U.S. Office of Personnel Management
1900 E Street, NW, Washington, DC 20415
202-606-1800
Federal Relay Service