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2017 Plan Information for Arizona
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
138.7
Aetna Direct
225
Non-Postal
HDHP Self & Family
Monthly
305.95
Aetna Direct
226
Non-Postal
HDHP Self Plus One
Monthly
299.95
Aetna Direct
N61
Non-Postal
CDHP Self
Monthly
120.05
Aetna Direct
N62
Non-Postal
CDHP Self & Family
Monthly
302.77
Aetna Direct
N63
Non-Postal
CDHP Self Plus One
Monthly
263.29
Aetna HealthFund CDHP and Aetna Value Plan
G51
Non-Postal
CDHP Self
Monthly
218.59
Aetna HealthFund CDHP and Aetna Value Plan
G52
Non-Postal
CDHP Self & Family
Monthly
499.44
Aetna HealthFund CDHP and Aetna Value Plan
G53
Non-Postal
CDHP Self Plus One
Monthly
547.43
Aetna HealthFund CDHP and Aetna Value Plan
G54
Non-Postal
Value Self
Monthly
133.71
Aetna HealthFund CDHP and Aetna Value Plan
G55
Non-Postal
Value Self & Family
Monthly
306.25
Aetna HealthFund CDHP and Aetna Value Plan
G56
Non-Postal
Value Self Plus One
Monthly
300.24
Aetna Open Access
WQ1
Non-Postal
High Self
Monthly
457.66
Aetna Open Access
WQ2
Non-Postal
High Self & Family
Monthly
1182.7
Aetna Open Access
WQ3
Non-Postal
High Self Plus One
Monthly
1223.91
Health Net of Arizona, Inc.
A74
Non-Postal
Standard Self
Monthly
265.56
Health Net of Arizona, Inc.
A75
Non-Postal
Standard Self & Family
Monthly
793.85
Health Net of Arizona, Inc.
A76
Non-Postal
Standard Self Plus One
Monthly
857.61
Humana Health Plan, Inc.
BF1
Non-Postal
High Self
Monthly
425.03
Humana Health Plan, Inc.
BF2
Non-Postal
High Self & Family
Monthly
942.33
Humana Health Plan, Inc.
BF3
Non-Postal
High Self Plus One
Monthly
915.57
Humana Health Plan, Inc.
BF4
Non-Postal
Standard Self
Monthly
210.23
Humana Health Plan, Inc.
BF5
Non-Postal
Standard Self & Family
Monthly
459.03
Humana Health Plan, Inc.
BF6
Non-Postal
Standard Self Plus One
Monthly
453.72
Humana Health Plan, Inc.
C71
Non-Postal
High Self
Monthly
257.94
Humana Health Plan, Inc.
C72
Non-Postal
High Self & Family
Monthly
566.41
Humana Health Plan, Inc.
C73
Non-Postal
High Self Plus One
Monthly
556.33
Humana Health Plan, Inc.
C74
Non-Postal
Standard Self
Monthly
170.58
Humana Health Plan, Inc.
C75
Non-Postal
Standard Self & Family
Monthly
369.83
Humana Health Plan, Inc.
C76
Non-Postal
Standard Self Plus One
Monthly
368.51
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
LU1
Non-Postal
HDHP Self
Monthly
123.09
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
LU2
Non-Postal
HDHP Self & Family
Monthly
307.72
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
LU3
Non-Postal
HDHP Self Plus One
Monthly
264.64
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
KT1
Non-Postal
High Self
Monthly
139.27
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
KT2
Non-Postal
High Self & Family
Monthly
348.18
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
KT3
Non-Postal
High Self Plus One
Monthly
299.43
U.S. Office of Personnel Management
1900 E Street, NW, Washington, DC 20415
202-606-1800
Federal Relay Service