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2021 Plan Information for Ohio
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
AultCare Insurance Company
3A1
Non-Postal
High Self
Monthly
352.46
AultCare Insurance Company
3A2
Non-Postal
High Self & Family
Monthly
945.08
AultCare Insurance Company
3A3
Non-Postal
High Self Plus One
Monthly
718.08
AultCare Insurance Company
3A4
Non-Postal
HDHP Self
Monthly
116.47
AultCare Insurance Company
3A5
Non-Postal
HDHP Self & Family
Monthly
372.94
AultCare Insurance Company
3A6
Non-Postal
HDHP Self Plus One
Monthly
221.42
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 of Ohio, Inc.
W61
Non-Postal
Basic Self
Monthly
159.76
Humana Health Plan of Ohio, Inc.
W62
Non-Postal
Basic Self & Family
Monthly
359.48
Humana Health Plan of Ohio, Inc.
W63
Non-Postal
Basic Self Plus One
Monthly
343.5
Medical Mutual of Ohio
644
Non-Postal
Standard Self
Monthly
417.54
Medical Mutual of Ohio
645
Non-Postal
Standard Self & Family
Monthly
1040.11
Medical Mutual of Ohio
646
Non-Postal
Standard Self Plus One
Monthly
948.96
Medical Mutual of Ohio
UX1
Non-Postal
Basic Self
Monthly
102.8
Medical Mutual of Ohio
UX2
Non-Postal
Basic Self & Family
Monthly
246.73
Medical Mutual of Ohio
UX3
Non-Postal
Basic Self Plus One
Monthly
226.17
Medical Mutual of Ohio
X61
Non-Postal
Basic Self
Monthly
101.32
Medical Mutual of Ohio
X62
Non-Postal
Basic Self & Family
Monthly
243.17
Medical Mutual of Ohio
X63
Non-Postal
Basic Self Plus One
Monthly
222.91
Medical Mutual of Ohio
X64
Non-Postal
Standard Self
Monthly
337.92
Medical Mutual of Ohio
X65
Non-Postal
Standard Self & Family
Monthly
849.01
Medical Mutual of Ohio
X66
Non-Postal
Standard Self Plus One
Monthly
773.79
Medical Mutual of Ohio
YF1
Non-Postal
Basic Self
Monthly
103.76
Medical Mutual of Ohio
YF2
Non-Postal
Basic Self & Family
Monthly
249.02
Medical Mutual of Ohio
YF3
Non-Postal
Basic Self Plus One
Monthly
228.27
Medical Mutual of Ohio
YF4
Non-Postal
Standard Self
Monthly
462.44
Medical Mutual of Ohio
YF5
Non-Postal
Standard Self & Family
Monthly
1147.83
Medical Mutual of Ohio
YF6
Non-Postal
Standard Self Plus One
Monthly
1047.72
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