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2017 Plan Information for Tennessee
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
F51
Non-Postal
CDHP Self
Monthly
236.68
Aetna HealthFund CDHP and Aetna Value Plan
F52
Non-Postal
CDHP Self & Family
Monthly
540.15
Aetna HealthFund CDHP and Aetna Value Plan
F53
Non-Postal
CDHP Self Plus One
Monthly
587.71
Aetna HealthFund CDHP and Aetna Value Plan
F54
Non-Postal
Value Self
Monthly
139.84
Aetna HealthFund CDHP and Aetna Value Plan
F55
Non-Postal
Value Self & Family
Monthly
320.21
Aetna HealthFund CDHP and Aetna Value Plan
F56
Non-Postal
Value Self Plus One
Monthly
313.93
Aetna Open Access
UB1
Non-Postal
High Self
Monthly
382.17
Aetna Open Access
UB2
Non-Postal
High Self & Family
Monthly
1115.45
Aetna Open Access
UB3
Non-Postal
High Self Plus One
Monthly
1157.32
Humana Health Plan, Inc.
GJ1
Non-Postal
High Self
Monthly
243.66
Humana Health Plan, Inc.
GJ2
Non-Postal
High Self & Family
Monthly
534.3
Humana Health Plan, Inc.
GJ3
Non-Postal
High Self Plus One
Monthly
525.65
Humana Health Plan, Inc.
GJ4
Non-Postal
Standard Self
Monthly
237.07
Humana Health Plan, Inc.
GJ5
Non-Postal
Standard Self & Family
Monthly
519.42
Humana Health Plan, Inc.
GJ6
Non-Postal
Standard Self Plus One
Monthly
511.46
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
LS1
Non-Postal
HDHP Self
Monthly
115.28
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
LS2
Non-Postal
HDHP Self & Family
Monthly
288.2
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
LS3
Non-Postal
HDHP Self Plus One
Monthly
247.85
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
KK1
Non-Postal
High Self
Monthly
139.64
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
KK2
Non-Postal
High Self & Family
Monthly
349.1
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
KK3
Non-Postal
High Self Plus One
Monthly
300.22
U.S. Office of Personnel Management
1900 E Street, NW, Washington, DC 20415
202-606-1800
Federal Relay Service