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2018 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
151.86
Aetna Direct
225
Non-Postal
HDHP Self & Family
Monthly
334.98
Aetna Direct
226
Non-Postal
HDHP Self Plus One
Monthly
328.41
Aetna Direct
N61
Non-Postal
CDHP Self
Monthly
131.92
Aetna Direct
N62
Non-Postal
CDHP Self & Family
Monthly
332.67
Aetna Direct
N63
Non-Postal
CDHP Self Plus One
Monthly
289.29
Aetna HealthFund CDHP and Aetna Value Plan
G51
Non-Postal
CDHP Self
Monthly
253.56
Aetna HealthFund CDHP and Aetna Value Plan
G52
Non-Postal
CDHP Self & Family
Monthly
581.25
Aetna HealthFund CDHP and Aetna Value Plan
G53
Non-Postal
CDHP Self Plus One
Monthly
630.59
Aetna HealthFund CDHP and Aetna Value Plan
G54
Non-Postal
Value Self
Monthly
137.4
Aetna HealthFund CDHP and Aetna Value Plan
G55
Non-Postal
Value Self & Family
Monthly
314.68
Aetna HealthFund CDHP and Aetna Value Plan
G56
Non-Postal
Value Self Plus One
Monthly
308.52
Aetna Open Access
WQ1
Non-Postal
High Self
Monthly
635.89
Aetna Open Access
WQ2
Non-Postal
High Self & Family
Monthly
1619.78
Aetna Open Access
WQ3
Non-Postal
High Self Plus One
Monthly
1658.8
Health Net of Arizona, Inc.
A74
Non-Postal
Standard Self
Monthly
283.53
Health Net of Arizona, Inc.
A75
Non-Postal
Standard Self & Family
Monthly
845.5
Health Net of Arizona, Inc.
A76
Non-Postal
Standard Self Plus One
Monthly
911.76
Humana CoverageFirst and Humana Value Plan
R61
Non-Postal
CDHP Self
Monthly
159.48
Humana CoverageFirst and Humana Value Plan
R62
Non-Postal
CDHP Self & Family
Monthly
358.84
Humana CoverageFirst and Humana Value Plan
R63
Non-Postal
CDHP Self Plus One
Monthly
342.9
Humana CoverageFirst and Humana Value Plan
R64
Non-Postal
Value Self
Monthly
129.92
Humana CoverageFirst and Humana Value Plan
R65
Non-Postal
Value Self & Family
Monthly
292.33
Humana CoverageFirst and Humana Value Plan
R66
Non-Postal
Value Self Plus One
Monthly
279.33
Humana CoverageFirst and Humana Value Plan
R91
Non-Postal
CDHP Self
Monthly
154.72
Humana CoverageFirst and Humana Value Plan
R92
Non-Postal
CDHP Self & Family
Monthly
348.12
Humana CoverageFirst and Humana Value Plan
R93
Non-Postal
CDHP Self Plus One
Monthly
332.65
Humana CoverageFirst and Humana Value Plan
R94
Non-Postal
Value Self
Monthly
123.19
Humana CoverageFirst and Humana Value Plan
R95
Non-Postal
Value Self & Family
Monthly
277.18
Humana CoverageFirst and Humana Value Plan
R96
Non-Postal
Value Self Plus One
Monthly
264.86
Humana Health Plan, Inc.
BF1
Non-Postal
High Self
Monthly
634.96
Humana Health Plan, Inc.
BF2
Non-Postal
High Self & Family
Monthly
1416.16
Humana Health Plan, Inc.
BF3
Non-Postal
High Self Plus One
Monthly
1369.25
Humana Health Plan, Inc.
BF4
Non-Postal
Standard Self
Monthly
297.42
Humana Health Plan, Inc.
BF5
Non-Postal
Standard Self & Family
Monthly
656.7
Humana Health Plan, Inc.
BF6
Non-Postal
Standard Self Plus One
Monthly
643.53
Humana Health Plan, Inc.
C71
Non-Postal
High Self
Monthly
322.77
Humana Health Plan, Inc.
C72
Non-Postal
High Self & Family
Monthly
713.72
Humana Health Plan, Inc.
C73
Non-Postal
High Self Plus One
Monthly
698.04
Humana Health Plan, Inc.
C74
Non-Postal
Standard Self
Monthly
180.22
Humana Health Plan, Inc.
C75
Non-Postal
Standard Self & Family
Monthly
392.97
Humana Health Plan, Inc.
C76
Non-Postal
Standard Self Plus One
Monthly
391.52
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
LU1
Non-Postal
HDHP Self
Monthly
120.73
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
LU2
Non-Postal
HDHP Self & Family
Monthly
301.81
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
LU3
Non-Postal
HDHP Self Plus One
Monthly
259.56
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
KT1
Non-Postal
High Self
Monthly
152.67
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
KT2
Non-Postal
High Self & Family
Monthly
396.61
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
KT3
Non-Postal
High Self Plus One
Monthly
328.24
U.S. Office of Personnel Management
1900 E Street, NW, Washington, DC 20415
202-606-1800
Federal Relay Service