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2019 Plan Information for Virginia
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
F51
Non-Postal
CDHP Self
Monthly
312.07
Aetna HealthFund CDHP and Aetna Value Plan
F52
Non-Postal
CDHP Self & Family
Monthly
710.52
Aetna HealthFund CDHP and Aetna Value Plan
F53
Non-Postal
CDHP Self Plus One
Monthly
763.81
Aetna HealthFund CDHP and Aetna Value Plan
F54
Non-Postal
Value Self
Monthly
209.72
Aetna HealthFund CDHP and Aetna Value Plan
F55
Non-Postal
Value Self & Family
Monthly
484.06
Aetna HealthFund CDHP and Aetna Value Plan
F56
Non-Postal
Value Self Plus One
Monthly
523.83
Aetna Open Access
JN1
Non-Postal
High Self
Monthly
620.41
Aetna Open Access
JN2
Non-Postal
High Self & Family
Monthly
1377.79
Aetna Open Access
JN3
Non-Postal
High Self Plus One
Monthly
1424.45
Aetna Open Access
JN4
Non-Postal
Basic Self
Monthly
181.74
Aetna Open Access
JN5
Non-Postal
Basic Self & Family
Monthly
419.06
Aetna Open Access
JN6
Non-Postal
Basic Self Plus One
Monthly
363.41
CareFirst BlueChoice
2G4
Non-Postal
Standard Self
Monthly
298.96
CareFirst BlueChoice
2G5
Non-Postal
Standard Self & Family
Monthly
757.06
CareFirst BlueChoice
2G6
Non-Postal
Standard Self Plus One
Monthly
528.75
CareFirst BlueChoice
B61
Non-Postal
HDHP Self
Monthly
129.57
CareFirst BlueChoice
B62
Non-Postal
HDHP Self & Family
Monthly
307.84
CareFirst BlueChoice
B63
Non-Postal
HDHP Self Plus One
Monthly
259.13
Kaiser Permanente - Mid-Atlantic States
E31
Non-Postal
High Self
Monthly
193.96
Kaiser Permanente - Mid-Atlantic States
E32
Non-Postal
High Self & Family
Monthly
454.96
Kaiser Permanente - Mid-Atlantic States
E33
Non-Postal
High Self Plus One
Monthly
526.56
Kaiser Permanente - Mid-Atlantic States
E34
Non-Postal
Standard Self
Monthly
130.44
Kaiser Permanente - Mid-Atlantic States
E35
Non-Postal
Standard Self & Family
Monthly
300
Kaiser Permanente - Mid-Atlantic States
E36
Non-Postal
Standard Self Plus One
Monthly
300
Kaiser Permanente - Mid-Atlantic States
T71
Non-Postal
Basic Self
Monthly
105.03
Kaiser Permanente - Mid-Atlantic States
T72
Non-Postal
Basic Self & Family
Monthly
256.54
Kaiser Permanente - Mid-Atlantic States
T73
Non-Postal
Basic Self Plus One
Monthly
233.72
M.D. IPA
JP1
Non-Postal
High Self
Monthly
292.14
M.D. IPA
JP2
Non-Postal
High Self & Family
Monthly
1079.35
M.D. IPA
JP3
Non-Postal
High Self Plus One
Monthly
477.94
Sentara Health Plans
PG1
Non-Postal
High Self
Monthly
179.75
Sentara Health Plans
PG2
Non-Postal
High Self & Family
Monthly
501.28
Sentara Health Plans
PG3
Non-Postal
High Self Plus One
Monthly
572.78
Sentara Health Plans
PG4
Non-Postal
HDHP Self
Monthly
151.3
Sentara Health Plans
PG5
Non-Postal
HDHP Self & Family
Monthly
333.75
Sentara Health Plans
PG6
Non-Postal
HDHP Self Plus One
Monthly
327.2
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
V41
Non-Postal
HDHP Self
Monthly
123.92
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
V42
Non-Postal
HDHP Self & Family
Monthly
285.01
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
V43
Non-Postal
HDHP Self Plus One
Monthly
266.43
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
LR1
Non-Postal
High Self
Monthly
169.22
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
LR2
Non-Postal
High Self & Family
Monthly
444.8
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
LR3
Non-Postal
High Self Plus One
Monthly
369.46
UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced)
L91
Non-Postal
Value Self
Monthly
109.26
UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced)
L92
Non-Postal
Value Self & Family
Monthly
306.37
UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced)
L93
Non-Postal
Value Self Plus One
Monthly
213.39
U.S. Office of Personnel Management
1900 E Street, NW, Washington, DC 20415
202-606-1800
Federal Relay Service
