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2019 Plan Information for Ohio
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
AultCare Insurance Company
3A1
Non-Postal
High Self
Monthly
270.77
AultCare Insurance Company
3A2
Non-Postal
High Self & Family
Monthly
762.48
AultCare Insurance Company
3A3
Non-Postal
High Self Plus One
Monthly
549.35
AultCare Insurance Company
3A4
Non-Postal
HDHP Self
Monthly
93.31
AultCare Insurance Company
3A5
Non-Postal
HDHP Self & Family
Monthly
298.58
AultCare Insurance Company
3A6
Non-Postal
HDHP Self Plus One
Monthly
177.28
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 of Ohio, Inc.
W61
Non-Postal
Basic Self
Monthly
146.44
Humana Health Plan of Ohio, Inc.
W62
Non-Postal
Basic Self & Family
Monthly
329.5
Humana Health Plan of Ohio, Inc.
W63
Non-Postal
Basic Self Plus One
Monthly
314.85
Medical Mutual of Ohio
644
Non-Postal
Standard Self
Monthly
359.04
Medical Mutual of Ohio
645
Non-Postal
Standard Self & Family
Monthly
920.43
Medical Mutual of Ohio
646
Non-Postal
Standard Self Plus One
Monthly
820.45
Medical Mutual of Ohio
UX1
Non-Postal
Basic Self
Monthly
120.64
Medical Mutual of Ohio
UX2
Non-Postal
Basic Self & Family
Monthly
289.54
Medical Mutual of Ohio
UX3
Non-Postal
Basic Self Plus One
Monthly
265.41
Medical Mutual of Ohio
X61
Non-Postal
Basic Self
Monthly
115.43
Medical Mutual of Ohio
X62
Non-Postal
Basic Self & Family
Monthly
277.03
Medical Mutual of Ohio
X63
Non-Postal
Basic Self Plus One
Monthly
253.94
Medical Mutual of Ohio
X64
Non-Postal
Standard Self
Monthly
307.24
Medical Mutual of Ohio
X65
Non-Postal
Standard Self & Family
Monthly
796.1
Medical Mutual of Ohio
X66
Non-Postal
Standard Self Plus One
Monthly
706.48
Medical Mutual of Ohio
YF1
Non-Postal
Basic Self
Monthly
122.64
Medical Mutual of Ohio
YF2
Non-Postal
Basic Self & Family
Monthly
294.34
Medical Mutual of Ohio
YF3
Non-Postal
Basic Self Plus One
Monthly
269.81
Medical Mutual of Ohio
YF4
Non-Postal
Standard Self
Monthly
421.12
Medical Mutual of Ohio
YF5
Non-Postal
Standard Self & Family
Monthly
1069.41
Medical Mutual of Ohio
YF6
Non-Postal
Standard Self Plus One
Monthly
957.01
U.S. Office of Personnel Management
1900 E Street, NW, Washington, DC 20415
202-606-1800
Federal Relay Service