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2021 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
262.6
Aetna Direct
225
Non-Postal
HDHP Self & Family
Monthly
515.62
Aetna Direct
226
Non-Postal
HDHP Self Plus One
Monthly
578.72
Aetna Direct
N61
Non-Postal
CDHP Self
Monthly
153.96
Aetna Direct
N62
Non-Postal
CDHP Self & Family
Monthly
388.27
Aetna Direct
N63
Non-Postal
CDHP Self Plus One
Monthly
337.64
Aetna Direct
Z24
Non-Postal
Advantage Self
Monthly
125
Aetna Direct
Z25
Non-Postal
Advantage Self & Family
Monthly
331.25
Aetna Direct
Z26
Non-Postal
Advantage Self Plus One
Monthly
275
Aetna HealthFund CDHP and Aetna Value Plan
JS1
Non-Postal
CDHP Self
Monthly
486.51
Aetna HealthFund CDHP and Aetna Value Plan
JS2
Non-Postal
CDHP Self & Family
Monthly
1083.94
Aetna HealthFund CDHP and Aetna Value Plan
JS3
Non-Postal
CDHP Self Plus One
Monthly
1158.17
Aetna HealthFund CDHP and Aetna Value Plan
JS4
Non-Postal
Value Self
Monthly
571.16
Aetna HealthFund CDHP and Aetna Value Plan
JS5
Non-Postal
Value Self & Family
Monthly
1280.59
Aetna HealthFund CDHP and Aetna Value Plan
JS6
Non-Postal
Value Self Plus One
Monthly
1352.91
Health Alliance HMO/POS
K84
Non-Postal
Standard Self
Monthly
170.89
Health Alliance HMO/POS
K85
Non-Postal
Standard Self & Family
Monthly
396.09
Health Alliance HMO/POS
K86
Non-Postal
Standard Self Plus One
Monthly
365.4
Humana CoverageFirst and Humana Value Plan
MW1
Non-Postal
CDHP Self
Monthly
502.54
Humana CoverageFirst and Humana Value Plan
MW2
Non-Postal
CDHP Self & Family
Monthly
1090.27
Humana CoverageFirst and Humana Value Plan
MW3
Non-Postal
CDHP Self Plus One
Monthly
1084.7
Humana CoverageFirst and Humana Value Plan
MW4
Non-Postal
Value Self
Monthly
284.34
Humana CoverageFirst and Humana Value Plan
MW5
Non-Postal
Value Self & Family
Monthly
599.19
Humana CoverageFirst and Humana Value Plan
MW6
Non-Postal
Value Self Plus One
Monthly
615.51
Humana CoverageFirst and Humana Value Plan
TC1
Non-Postal
CDHP Self
Monthly
215.15
Humana CoverageFirst and Humana Value Plan
TC2
Non-Postal
CDHP Self & Family
Monthly
443.58
Humana CoverageFirst and Humana Value Plan
TC3
Non-Postal
CDHP Self Plus One
Monthly
466.79
Humana CoverageFirst and Humana Value Plan
X31
Non-Postal
CDHP Self
Monthly
315.99
Humana CoverageFirst and Humana Value Plan
X32
Non-Postal
CDHP Self & Family
Monthly
670.5
Humana CoverageFirst and Humana Value Plan
X33
Non-Postal
CDHP Self Plus One
Monthly
683.61
Humana CoverageFirst and Humana Value Plan
X34
Non-Postal
Value Self
Monthly
161.47
Humana CoverageFirst and Humana Value Plan
X35
Non-Postal
Value Self & Family
Monthly
363.31
Humana CoverageFirst and Humana Value Plan
X36
Non-Postal
Value Self Plus One
Monthly
347.16
Humana Health Plan of Ohio, Inc.
A61
Non-Postal
High Self
Monthly
1052.61
Humana Health Plan of Ohio, Inc.
A62
Non-Postal
High Self & Family
Monthly
2327.89
Humana Health Plan of Ohio, Inc.
A63
Non-Postal
High Self Plus One
Monthly
2267.33
Humana Health Plan of Ohio, Inc.
A64
Non-Postal
Standard Self
Monthly
707.36
Humana Health Plan of Ohio, Inc.
A65
Non-Postal
Standard Self & Family
Monthly
1551.09
Humana Health Plan of Ohio, Inc.
A66
Non-Postal
Standard Self Plus One
Monthly
1525.03
Humana Health Plan, Inc.
751
Non-Postal
High Self
Monthly
845.59
Humana Health Plan, Inc.
752
Non-Postal
High Self & Family
Monthly
1862.12
Humana Health Plan, Inc.
753
Non-Postal
High Self Plus One
Monthly
1822.26
Humana Health Plan, Inc.
754
Non-Postal
Standard Self
Monthly
521.93
Humana Health Plan, Inc.
755
Non-Postal
Standard Self & Family
Monthly
1133.82
Humana Health Plan, Inc.
756
Non-Postal
Standard Self Plus One
Monthly
1126.37
Humana Health Plan, Inc.
MH1
Non-Postal
High Self
Monthly
692.06
Humana Health Plan, Inc.
MH2
Non-Postal
High Self & Family
Monthly
1516.62
Humana Health Plan, Inc.
MH3
Non-Postal
High Self Plus One
Monthly
1492.1
Humana Health Plan, Inc.
MH4
Non-Postal
Standard Self
Monthly
422.2
Humana Health Plan, Inc.
MH5
Non-Postal
Standard Self & Family
Monthly
909.41
Humana Health Plan, Inc.
MH6
Non-Postal
Standard Self Plus One
Monthly
911.89
UnitedHealthcare Advantage Plan
Y51
Non-Postal
High Self
Monthly
102.93
UnitedHealthcare Advantage Plan
Y52
Non-Postal
High Self & Family
Monthly
272.77
UnitedHealthcare Advantage Plan
Y53
Non-Postal
High Self Plus One
Monthly
226.45
U.S. Office of Personnel Management
1900 E Street, NW, Washington, DC 20415
202-606-1800
Federal Relay Service