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2016 Plan Information for Indiana
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
JS1
Non-Postal
CDHP Self
Monthly
412.06
Aetna HealthFund CDHP and Aetna Value Plan
JS2
Non-Postal
CDHP Self & Family
Monthly
934.7
Aetna HealthFund CDHP and Aetna Value Plan
JS3
Non-Postal
CDHP Self Plus One
Monthly
974.5
Aetna HealthFund CDHP and Aetna Value Plan
JS4
Non-Postal
Basic Self
Monthly
190.54
Aetna HealthFund CDHP and Aetna Value Plan
JS5
Non-Postal
Basic Self & Family
Monthly
431.94
Aetna HealthFund CDHP and Aetna Value Plan
JS6
Non-Postal
Basic Self Plus One
Monthly
476.71
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
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 of Ohio, Inc.
A61
Non-Postal
High Self
Monthly
293.91
Humana Health Plan of Ohio, Inc.
A62
Non-Postal
High Self & Family
Monthly
643.06
Humana Health Plan of Ohio, Inc.
A63
Non-Postal
High Self Plus One
Monthly
626.99
Humana Health Plan of Ohio, Inc.
A64
Non-Postal
Standard Self
Monthly
176.28
Humana Health Plan of Ohio, Inc.
A65
Non-Postal
Standard Self & Family
Monthly
378.38
Humana Health Plan of Ohio, Inc.
A66
Non-Postal
Standard Self Plus One
Monthly
374.05
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.
MH1
Non-Postal
High Self
Monthly
227.83
Humana Health Plan, Inc.
MH2
Non-Postal
High Self & Family
Monthly
494.37
Humana Health Plan, Inc.
MH3
Non-Postal
High Self Plus One
Monthly
484.92
Humana Health Plan, Inc.
MH4
Non-Postal
Standard Self
Monthly
164.86
Humana Health Plan, Inc.
MH5
Non-Postal
Standard Self & Family
Monthly
352.79
Humana Health Plan, Inc.
MH6
Non-Postal
Standard Self Plus One
Monthly
349.55
U.S. Office of Personnel Management
1900 E Street, NW, Washington, DC 20415
202-606-1800
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