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2020 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
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
F51
Non-Postal
CDHP Self
Monthly
318.39
Aetna HealthFund CDHP and Aetna Value Plan
F52
Non-Postal
CDHP Self & Family
Monthly
706.7
Aetna HealthFund CDHP and Aetna Value Plan
F53
Non-Postal
CDHP Self Plus One
Monthly
779.74
Aetna HealthFund CDHP and Aetna Value Plan
F54
Non-Postal
Value Self
Monthly
309.14
Aetna HealthFund CDHP and Aetna Value Plan
F55
Non-Postal
Value Self & Family
Monthly
693.59
Aetna HealthFund CDHP and Aetna Value Plan
F56
Non-Postal
Value Self Plus One
Monthly
748.52
Aetna Open Access
JN1
Non-Postal
High Self
Monthly
626.73
Aetna Open Access
JN2
Non-Postal
High Self & Family
Monthly
1373.41
Aetna Open Access
JN3
Non-Postal
High Self Plus One
Monthly
1439.84
Aetna Open Access
JN4
Non-Postal
Basic Self
Monthly
186.26
Aetna Open Access
JN5
Non-Postal
Basic Self & Family
Monthly
411.32
Aetna Open Access
JN6
Non-Postal
Basic Self Plus One
Monthly
372.73
Aetna Open Access
QQ4
Non-Postal
Saver Self
Monthly
148.8
Aetna Open Access
QQ5
Non-Postal
Saver Self & Family
Monthly
340.53
Aetna Open Access
QQ6
Non-Postal
Saver Self Plus One
Monthly
312.7
CareFirst BlueChoice
2G4
Non-Postal
Standard Self
Monthly
334.7
CareFirst BlueChoice
2G5
Non-Postal
Standard Self & Family
Monthly
824.94
CareFirst BlueChoice
2G6
Non-Postal
Standard Self Plus One
Monthly
598.8
CareFirst BlueChoice
B61
Non-Postal
HDHP Self
Monthly
142.52
CareFirst BlueChoice
B62
Non-Postal
HDHP Self & Family
Monthly
338.63
CareFirst BlueChoice
B63
Non-Postal
HDHP Self Plus One
Monthly
285.04
CareFirst BlueChoice
B64
Non-Postal
Blue Value Plus Self
Monthly
195.15
CareFirst BlueChoice
B65
Non-Postal
Blue Value Plus Self & Family
Monthly
493.44
CareFirst BlueChoice
B66
Non-Postal
Blue Value Plus Self Plus One
Monthly
353
Kaiser Permanente - Mid-Atlantic States
E31
Non-Postal
High Self
Monthly
211.98
Kaiser Permanente - Mid-Atlantic States
E32
Non-Postal
High Self & Family
Monthly
478.51
Kaiser Permanente - Mid-Atlantic States
E33
Non-Postal
High Self Plus One
Monthly
570.27
Kaiser Permanente - Mid-Atlantic States
E34
Non-Postal
Standard Self
Monthly
142.89
Kaiser Permanente - Mid-Atlantic States
E35
Non-Postal
Standard Self & Family
Monthly
328.62
Kaiser Permanente - Mid-Atlantic States
E36
Non-Postal
Standard Self Plus One
Monthly
328.62
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
365.77
M.D. IPA
JP2
Non-Postal
High Self & Family
Monthly
1274.02
M.D. IPA
JP3
Non-Postal
High Self Plus One
Monthly
619.78
Sentara Health Plans
PG1
Non-Postal
High Self
Monthly
181.26
Sentara Health Plans
PG2
Non-Postal
High Self & Family
Monthly
488.34
Sentara Health Plans
PG3
Non-Postal
High Self Plus One
Monthly
579.97
Sentara Health Plans
PG4
Non-Postal
HDHP Self
Monthly
161.1
Sentara Health Plans
PG5
Non-Postal
HDHP Self & Family
Monthly
355.37
Sentara Health Plans
PG6
Non-Postal
HDHP Self Plus One
Monthly
348.4
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 Advanced)
L91
Non-Postal
Value Self
Monthly
130.37
UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced)
L92
Non-Postal
Value Self & Family
Monthly
365.56
UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced)
L93
Non-Postal
Value Self Plus One
Monthly
254.61
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
U.S. Office of Personnel Management
1900 E Street, NW, Washington, DC 20415
202-606-1800
Federal Relay Service