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2020 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
217.96
Aetna Direct
225
Non-Postal
HDHP Self & Family
Monthly
423.58
Aetna Direct
226
Non-Postal
HDHP Self Plus One
Monthly
483.84
Aetna Direct
N61
Non-Postal
CDHP Self
Monthly
153.16
Aetna Direct
N62
Non-Postal
CDHP Self & Family
Monthly
386.25
Aetna Direct
N63
Non-Postal
CDHP Self Plus One
Monthly
335.89
Aetna Direct
Z24
Non-Postal
Advantage Self
Monthly
115.96
Aetna Direct
Z25
Non-Postal
Advantage Self & Family
Monthly
307.29
Aetna Direct
Z26
Non-Postal
Advantage Self Plus One
Monthly
255.11
Aetna HealthFund CDHP and Aetna Value Plan
G51
Non-Postal
CDHP Self
Monthly
393.66
Aetna HealthFund CDHP and Aetna Value Plan
G52
Non-Postal
CDHP Self & Family
Monthly
879.08
Aetna HealthFund CDHP and Aetna Value Plan
G53
Non-Postal
CDHP Self Plus One
Monthly
950.45
Aetna HealthFund CDHP and Aetna Value Plan
G54
Non-Postal
Value Self
Monthly
201.89
Aetna HealthFund CDHP and Aetna Value Plan
G55
Non-Postal
Value Self & Family
Monthly
448.35
Aetna HealthFund CDHP and Aetna Value Plan
G56
Non-Postal
Value Self Plus One
Monthly
508.11
Aetna Open Access
WQ1
Non-Postal
High Self
Monthly
650.32
Aetna Open Access
WQ2
Non-Postal
High Self & Family
Monthly
1635.25
Aetna Open Access
WQ3
Non-Postal
High Self Plus One
Monthly
1699.08
Humana CoverageFirst and Humana Value Plan
R61
Non-Postal
CDHP Self
Monthly
207.95
Humana CoverageFirst and Humana Value Plan
R62
Non-Postal
CDHP Self & Family
Monthly
433.25
Humana CoverageFirst and Humana Value Plan
R63
Non-Postal
CDHP Self Plus One
Monthly
453.12
Humana CoverageFirst and Humana Value Plan
R64
Non-Postal
Value Self
Monthly
143.63
Humana CoverageFirst and Humana Value Plan
R65
Non-Postal
Value Self & Family
Monthly
323.17
Humana CoverageFirst and Humana Value Plan
R66
Non-Postal
Value Self Plus One
Monthly
308.81
Humana CoverageFirst and Humana Value Plan
R91
Non-Postal
CDHP Self
Monthly
164.47
Humana CoverageFirst and Humana Value Plan
R92
Non-Postal
CDHP Self & Family
Monthly
370.05
Humana CoverageFirst and Humana Value Plan
R93
Non-Postal
CDHP Self Plus One
Monthly
353.6
Humana CoverageFirst and Humana Value Plan
R94
Non-Postal
Value Self
Monthly
130.95
Humana CoverageFirst and Humana Value Plan
R95
Non-Postal
Value Self & Family
Monthly
294.64
Humana CoverageFirst and Humana Value Plan
R96
Non-Postal
Value Self Plus One
Monthly
281.55
Humana Health Plan, Inc.
BF1
Non-Postal
High Self
Monthly
918.66
Humana Health Plan, Inc.
BF2
Non-Postal
High Self & Family
Monthly
2032.25
Humana Health Plan, Inc.
BF3
Non-Postal
High Self Plus One
Monthly
1981.09
Humana Health Plan, Inc.
BF4
Non-Postal
Standard Self
Monthly
643.41
Humana Health Plan, Inc.
BF5
Non-Postal
Standard Self & Family
Monthly
1413.06
Humana Health Plan, Inc.
BF6
Non-Postal
Standard Self Plus One
Monthly
1389.4
Humana Health Plan, Inc.
C71
Non-Postal
High Self
Monthly
507.04
Humana Health Plan, Inc.
C72
Non-Postal
High Self & Family
Monthly
1106.17
Humana Health Plan, Inc.
C73
Non-Postal
High Self Plus One
Monthly
1096.14
Humana Health Plan, Inc.
C74
Non-Postal
Standard Self
Monthly
273.26
Humana Health Plan, Inc.
C75
Non-Postal
Standard Self & Family
Monthly
580.17
Humana Health Plan, Inc.
C76
Non-Postal
Standard Self Plus One
Monthly
593.47
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
LU1
Non-Postal
HDHP Self
Monthly
110.96
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
LU2
Non-Postal
HDHP Self & Family
Monthly
255.21
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
LU3
Non-Postal
HDHP Self Plus One
Monthly
238.57
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
KT1
Non-Postal
High Self
Monthly
213.93
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
KT2
Non-Postal
High Self & Family
Monthly
627.88
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
KT3
Non-Postal
High Self Plus One
Monthly
465.99
UnitedHealthcare Insurance Company, Inc. Choice Plus Primary
WF1
Non-Postal
High Self
Monthly
130.71
UnitedHealthcare Insurance Company, Inc. Choice Plus Primary
WF2
Non-Postal
High Self & Family
Monthly
309.1
UnitedHealthcare Insurance Company, Inc. Choice Plus Primary
WF3
Non-Postal
High Self Plus One
Monthly
281.01
UnitedHealthcare Insurance Company, Inc. Choice Primary
VD1
Non-Postal
High Self
Monthly
130.5
UnitedHealthcare Insurance Company, Inc. Choice Primary
VD2
Non-Postal
High Self & Family
Monthly
308.59
UnitedHealthcare Insurance Company, Inc. Choice Primary
VD3
Non-Postal
High Self Plus One
Monthly
280.56
U.S. Office of Personnel Management
1900 E Street, NW, Washington, DC 20415
202-606-1800
Federal Relay Service