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2020 Plan Information for Pennsylvania
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
H41
Non-Postal
CDHP Self
Monthly
317.63
Aetna HealthFund CDHP and Aetna Value Plan
H42
Non-Postal
CDHP Self & Family
Monthly
704.43
Aetna HealthFund CDHP and Aetna Value Plan
H43
Non-Postal
CDHP Self Plus One
Monthly
777.66
Aetna HealthFund CDHP and Aetna Value Plan
H44
Non-Postal
Value Self
Monthly
296.2
Aetna HealthFund CDHP and Aetna Value Plan
H45
Non-Postal
Value Self & Family
Monthly
668.16
Aetna HealthFund CDHP and Aetna Value Plan
H46
Non-Postal
Value Self Plus One
Monthly
723.6
Aetna Open Access
P31
Non-Postal
High Self
Monthly
945.77
Aetna Open Access
P32
Non-Postal
High Self & Family
Monthly
2347.52
Aetna Open Access
P33
Non-Postal
High Self Plus One
Monthly
2404.29
Aetna Open Access
P34
Non-Postal
Basic Self
Monthly
799.24
Aetna Open Access
P35
Non-Postal
Basic Self & Family
Monthly
1856.66
Aetna Open Access
P36
Non-Postal
Basic Self Plus One
Monthly
1918.28
Aetna Open Access
YE1
Non-Postal
High Self
Monthly
704.29
Aetna Open Access
YE2
Non-Postal
High Self & Family
Monthly
1867.17
Aetna Open Access
YE3
Non-Postal
High Self Plus One
Monthly
1928.72
Geisinger Health Plan
GG4
Non-Postal
Standard Self
Monthly
311.89
Geisinger Health Plan
GG5
Non-Postal
Standard Self & Family
Monthly
699.66
Geisinger Health Plan
GG6
Non-Postal
Standard Self Plus One
Monthly
685.45
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
V41
Non-Postal
HDHP Self
Monthly
121.64
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
V42
Non-Postal
HDHP Self & Family
Monthly
279.78
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
V43
Non-Postal
HDHP Self Plus One
Monthly
261.53
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
LR1
Non-Postal
High Self
Monthly
204.05
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
LR2
Non-Postal
High Self & Family
Monthly
510.27
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
LR3
Non-Postal
High Self Plus One
Monthly
444.73
UnitedHealthcare Insurance Company, Inc. Choice Plus Primary
AS1
Non-Postal
High Self
Monthly
131.45
UnitedHealthcare Insurance Company, Inc. Choice Plus Primary
AS2
Non-Postal
High Self & Family
Monthly
310.84
UnitedHealthcare Insurance Company, Inc. Choice Plus Primary
AS3
Non-Postal
High Self Plus One
Monthly
282.6
UnitedHealthcare Insurance Company, Inc. Choice Primary
Y81
Non-Postal
High Self
Monthly
126.68
UnitedHealthcare Insurance Company, Inc. Choice Primary
Y82
Non-Postal
High Self & Family
Monthly
299.56
UnitedHealthcare Insurance Company, Inc. Choice Primary
Y83
Non-Postal
High Self Plus One
Monthly
272.34
UPMC Health Plan
8W1
Non-Postal
High Self
Monthly
425.55
UPMC Health Plan
8W2
Non-Postal
High Self & Family
Monthly
1016.82
UPMC Health Plan
8W3
Non-Postal
High Self Plus One
Monthly
1015.02
UPMC Health Plan
8W4
Non-Postal
HDHP Self
Monthly
152.66
UPMC Health Plan
8W5
Non-Postal
HDHP Self & Family
Monthly
351.25
UPMC Health Plan
8W6
Non-Postal
HDHP Self Plus One
Monthly
337.91
UPMC Health Plan
UW4
Non-Postal
Standard Self
Monthly
168.42
UPMC Health Plan
UW5
Non-Postal
Standard Self & Family
Monthly
396.72
UPMC Health Plan
UW6
Non-Postal
Standard Self Plus One
Monthly
421.94
UPMC Health Plan
YS1
Non-Postal
High Self
Monthly
631.51
UPMC Health Plan
YS2
Non-Postal
High Self & Family
Monthly
1500.85
UPMC Health Plan
YS3
Non-Postal
High Self Plus One
Monthly
1478.43
UPMC Health Plan
YS4
Non-Postal
HDHP Self
Monthly
264.96
UPMC Health Plan
YS5
Non-Postal
HDHP Self & Family
Monthly
607.03
UPMC Health Plan
YS6
Non-Postal
HDHP Self Plus One
Monthly
629.46
UPMC Health Plan
YT4
Non-Postal
Standard Self
Monthly
393.25
UPMC Health Plan
YT5
Non-Postal
Standard Self & Family
Monthly
937.95
UPMC Health Plan
YT6
Non-Postal
Standard Self Plus One
Monthly
940.2
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1900 E Street, NW, Washington, DC 20415
202-606-1800
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