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2019 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
164.93
Aetna Direct
225
Non-Postal
HDHP Self & Family
Monthly
363.8
Aetna Direct
226
Non-Postal
HDHP Self Plus One
Monthly
360.1
Aetna Direct
N61
Non-Postal
CDHP Self
Monthly
139.33
Aetna Direct
N62
Non-Postal
CDHP Self & Family
Monthly
351.38
Aetna Direct
N63
Non-Postal
CDHP Self Plus One
Monthly
305.56
Aetna HealthFund CDHP and Aetna Value Plan
JS1
Non-Postal
CDHP Self
Monthly
550.32
Aetna HealthFund CDHP and Aetna Value Plan
JS2
Non-Postal
CDHP Self & Family
Monthly
1253.16
Aetna HealthFund CDHP and Aetna Value Plan
JS3
Non-Postal
CDHP Self Plus One
Monthly
1301.1
Aetna HealthFund CDHP and Aetna Value Plan
JS4
Non-Postal
Value Self
Monthly
305.27
Aetna HealthFund CDHP and Aetna Value Plan
JS5
Non-Postal
Value Self & Family
Monthly
697.22
Aetna HealthFund CDHP and Aetna Value Plan
JS6
Non-Postal
Value Self Plus One
Monthly
750.66
Health Alliance HMO/POS
K84
Non-Postal
Standard Self
Monthly
160.61
Health Alliance HMO/POS
K85
Non-Postal
Standard Self & Family
Monthly
596.42
Health Alliance HMO/POS
K86
Non-Postal
Standard Self Plus One
Monthly
421.65
Humana CoverageFirst and Humana Value Plan
MW1
Non-Postal
CDHP Self
Monthly
258.34
Humana CoverageFirst and Humana Value Plan
MW2
Non-Postal
CDHP Self & Family
Monthly
565.22
Humana CoverageFirst and Humana Value Plan
MW3
Non-Postal
CDHP Self Plus One
Monthly
561.08
Humana CoverageFirst and Humana Value Plan
MW4
Non-Postal
Value Self
Monthly
152.2
Humana CoverageFirst and Humana Value Plan
MW5
Non-Postal
Value Self & Family
Monthly
342.45
Humana CoverageFirst and Humana Value Plan
MW6
Non-Postal
Value Self Plus One
Monthly
327.23
Humana CoverageFirst and Humana Value Plan
TC1
Non-Postal
CDHP Self
Monthly
155.53
Humana CoverageFirst and Humana Value Plan
TC2
Non-Postal
CDHP Self & Family
Monthly
349.94
Humana CoverageFirst and Humana Value Plan
TC3
Non-Postal
CDHP Self Plus One
Monthly
334.39
Humana CoverageFirst and Humana Value Plan
X31
Non-Postal
CDHP Self
Monthly
185.93
Humana CoverageFirst and Humana Value Plan
X32
Non-Postal
CDHP Self & Family
Monthly
402.29
Humana CoverageFirst and Humana Value Plan
X33
Non-Postal
CDHP Self Plus One
Monthly
405.42
Humana CoverageFirst and Humana Value Plan
X34
Non-Postal
Value Self
Monthly
142.57
Humana CoverageFirst and Humana Value Plan
X35
Non-Postal
Value Self & Family
Monthly
320.78
Humana CoverageFirst and Humana Value Plan
X36
Non-Postal
Value Self Plus One
Monthly
306.52
Humana Health Plan of Ohio, Inc.
A61
Non-Postal
High Self
Monthly
673.92
Humana Health Plan of Ohio, Inc.
A62
Non-Postal
High Self & Family
Monthly
1500.29
Humana Health Plan of Ohio, Inc.
A63
Non-Postal
High Self Plus One
Monthly
1454.63
Humana Health Plan of Ohio, Inc.
A64
Non-Postal
Standard Self
Monthly
431.56
Humana Health Plan of Ohio, Inc.
A65
Non-Postal
Standard Self & Family
Monthly
954.98
Humana Health Plan of Ohio, Inc.
A66
Non-Postal
Standard Self Plus One
Monthly
933.57
Humana Health Plan, Inc.
751
Non-Postal
High Self
Monthly
713.34
Humana Health Plan, Inc.
752
Non-Postal
High Self & Family
Monthly
1588.95
Humana Health Plan, Inc.
753
Non-Postal
High Self Plus One
Monthly
1539.33
Humana Health Plan, Inc.
754
Non-Postal
Standard Self
Monthly
356.94
Humana Health Plan, Inc.
755
Non-Postal
Standard Self & Family
Monthly
787.05
Humana Health Plan, Inc.
756
Non-Postal
Standard Self Plus One
Monthly
773.08
Humana Health Plan, Inc.
MH1
Non-Postal
High Self
Monthly
385.26
Humana Health Plan, Inc.
MH2
Non-Postal
High Self & Family
Monthly
850.77
Humana Health Plan, Inc.
MH3
Non-Postal
High Self Plus One
Monthly
833.97
Humana Health Plan, Inc.
MH4
Non-Postal
Standard Self
Monthly
223.67
Humana Health Plan, Inc.
MH5
Non-Postal
Standard Self & Family
Monthly
487.18
Humana Health Plan, Inc.
MH6
Non-Postal
Standard Self Plus One
Monthly
486.54
U.S. Office of Personnel Management
1900 E Street, NW, Washington, DC 20415
202-606-1800
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