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2020 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
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
JS1
Non-Postal
CDHP Self
Monthly
493.15
Aetna HealthFund CDHP and Aetna Value Plan
JS2
Non-Postal
CDHP Self & Family
Monthly
1104.63
Aetna HealthFund CDHP and Aetna Value Plan
JS3
Non-Postal
CDHP Self Plus One
Monthly
1173.73
Aetna HealthFund CDHP and Aetna Value Plan
JS4
Non-Postal
Value Self
Monthly
562.64
Aetna HealthFund CDHP and Aetna Value Plan
JS5
Non-Postal
Value Self & Family
Monthly
1266.57
Aetna HealthFund CDHP and Aetna Value Plan
JS6
Non-Postal
Value Self Plus One
Monthly
1334.06
Health Alliance HMO/POS
K84
Non-Postal
Standard Self
Monthly
167.03
Health Alliance HMO/POS
K85
Non-Postal
Standard Self & Family
Monthly
619.97
Health Alliance HMO/POS
K86
Non-Postal
Standard Self Plus One
Monthly
455.52
Humana CoverageFirst and Humana Value Plan
MW1
Non-Postal
CDHP Self
Monthly
405.18
Humana CoverageFirst and Humana Value Plan
MW2
Non-Postal
CDHP Self & Family
Monthly
877.13
Humana CoverageFirst and Humana Value Plan
MW3
Non-Postal
CDHP Self Plus One
Monthly
877.24
Humana CoverageFirst and Humana Value Plan
MW4
Non-Postal
Value Self
Monthly
244.07
Humana CoverageFirst and Humana Value Plan
MW5
Non-Postal
Value Self & Family
Monthly
514.5
Humana CoverageFirst and Humana Value Plan
MW6
Non-Postal
Value Self Plus One
Monthly
530.79
Humana CoverageFirst and Humana Value Plan
TC1
Non-Postal
CDHP Self
Monthly
164.87
Humana CoverageFirst and Humana Value Plan
TC2
Non-Postal
CDHP Self & Family
Monthly
370.93
Humana CoverageFirst and Humana Value Plan
TC3
Non-Postal
CDHP Self Plus One
Monthly
354.45
Humana CoverageFirst and Humana Value Plan
X31
Non-Postal
CDHP Self
Monthly
288.6
Humana CoverageFirst and Humana Value Plan
X32
Non-Postal
CDHP Self & Family
Monthly
614.75
Humana CoverageFirst and Humana Value Plan
X33
Non-Postal
CDHP Self Plus One
Monthly
626.56
Humana CoverageFirst and Humana Value Plan
X34
Non-Postal
Value Self
Monthly
153.78
Humana CoverageFirst and Humana Value Plan
X35
Non-Postal
Value Self & Family
Monthly
346.01
Humana CoverageFirst and Humana Value Plan
X36
Non-Postal
Value Self Plus One
Monthly
330.63
Humana Health Plan of Ohio, Inc.
A61
Non-Postal
High Self
Monthly
990.14
Humana Health Plan of Ohio, Inc.
A62
Non-Postal
High Self & Family
Monthly
2193.21
Humana Health Plan of Ohio, Inc.
A63
Non-Postal
High Self Plus One
Monthly
2134.88
Humana Health Plan of Ohio, Inc.
A64
Non-Postal
Standard Self
Monthly
661.33
Humana Health Plan of Ohio, Inc.
A65
Non-Postal
Standard Self & Family
Monthly
1453.4
Humana Health Plan of Ohio, Inc.
A66
Non-Postal
Standard Self Plus One
Monthly
1427.94
Humana Health Plan, Inc.
751
Non-Postal
High Self
Monthly
728.1
Humana Health Plan, Inc.
752
Non-Postal
High Self & Family
Monthly
1603.59
Humana Health Plan, Inc.
753
Non-Postal
High Self Plus One
Monthly
1571.48
Humana Health Plan, Inc.
754
Non-Postal
Standard Self
Monthly
441.06
Humana Health Plan, Inc.
755
Non-Postal
Standard Self & Family
Monthly
957.75
Humana Health Plan, Inc.
756
Non-Postal
Standard Self Plus One
Monthly
954.33
Humana Health Plan, Inc.
MH1
Non-Postal
High Self
Monthly
594.12
Humana Health Plan, Inc.
MH2
Non-Postal
High Self & Family
Monthly
1302.17
Humana Health Plan, Inc.
MH3
Non-Postal
High Self Plus One
Monthly
1283.43
Humana Health Plan, Inc.
MH4
Non-Postal
Standard Self
Monthly
348.81
Humana Health Plan, Inc.
MH5
Non-Postal
Standard Self & Family
Monthly
750.16
Humana Health Plan, Inc.
MH6
Non-Postal
Standard Self Plus One
Monthly
755.97
U.S. Office of Personnel Management
1900 E Street, NW, Washington, DC 20415
202-606-1800
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