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2021 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
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
H41
Non-Postal
CDHP Self
Monthly
303.42
Aetna HealthFund CDHP and Aetna Value Plan
H42
Non-Postal
CDHP Self & Family
Monthly
666.53
Aetna HealthFund CDHP and Aetna Value Plan
H43
Non-Postal
CDHP Self Plus One
Monthly
745.27
Aetna HealthFund CDHP and Aetna Value Plan
H44
Non-Postal
Value Self
Monthly
294.06
Aetna HealthFund CDHP and Aetna Value Plan
H45
Non-Postal
Value Self & Family
Monthly
657.95
Aetna HealthFund CDHP and Aetna Value Plan
H46
Non-Postal
Value Self Plus One
Monthly
718.23
Aetna Open Access
P31
Non-Postal
High Self
Monthly
1064.81
Aetna Open Access
P32
Non-Postal
High Self & Family
Monthly
2632.5
Aetna Open Access
P33
Non-Postal
High Self Plus One
Monthly
2691.42
Aetna Open Access
P34
Non-Postal
Basic Self
Monthly
982.11
Aetna Open Access
P35
Non-Postal
Basic Self & Family
Monthly
2276.13
Aetna Open Access
P36
Non-Postal
Basic Self Plus One
Monthly
2338.57
Aetna Open Access
YE1
Non-Postal
High Self
Monthly
683.13
Aetna Open Access
YE2
Non-Postal
High Self & Family
Monthly
1811.42
Aetna Open Access
YE3
Non-Postal
High Self Plus One
Monthly
1878.48
Geisinger Health Plan
AJ1
Non-Postal
Basic Self
Monthly
278.64
Geisinger Health Plan
AJ2
Non-Postal
Basic Self & Family
Monthly
618.11
Geisinger Health Plan
AJ3
Non-Postal
Basic Self Plus One
Monthly
611.83
Geisinger Health Plan
GG4
Non-Postal
Standard Self
Monthly
389.27
Geisinger Health Plan
GG5
Non-Postal
Standard Self & Family
Monthly
871.41
Geisinger Health Plan
GG6
Non-Postal
Standard Self Plus One
Monthly
850.92
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
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
V41
Non-Postal
HDHP Self
Monthly
129.98
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
V42
Non-Postal
HDHP Self & Family
Monthly
298.95
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
V43
Non-Postal
HDHP Self Plus One
Monthly
279.45
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
LR1
Non-Postal
High Self
Monthly
246.98
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
LR2
Non-Postal
High Self & Family
Monthly
607.62
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
LR3
Non-Postal
High Self Plus One
Monthly
535.17
UnitedHealthcare Insurance Company, Inc. Choice Plus Primary
AS1
Non-Postal
High Self
Monthly
149.87
UnitedHealthcare Insurance Company, Inc. Choice Plus Primary
AS2
Non-Postal
High Self & Family
Monthly
354.44
UnitedHealthcare Insurance Company, Inc. Choice Plus Primary
AS3
Non-Postal
High Self Plus One
Monthly
322.22
UnitedHealthcare Insurance Company, Inc. Choice Primary
Y81
Non-Postal
High Self
Monthly
144.18
UnitedHealthcare Insurance Company, Inc. Choice Primary
Y82
Non-Postal
High Self & Family
Monthly
340.98
UnitedHealthcare Insurance Company, Inc. Choice Primary
Y83
Non-Postal
High Self Plus One
Monthly
309.98
UPMC Health Plan
8W4
Non-Postal
HDHP Self
Monthly
160.41
UPMC Health Plan
8W5
Non-Postal
HDHP Self & Family
Monthly
369.22
UPMC Health Plan
8W6
Non-Postal
HDHP Self Plus One
Monthly
355.18
UPMC Health Plan
UW4
Non-Postal
Standard Self
Monthly
170.55
UPMC Health Plan
UW5
Non-Postal
Standard Self & Family
Monthly
400.31
UPMC Health Plan
UW6
Non-Postal
Standard Self Plus One
Monthly
412.58
UPMC Health Plan
YS4
Non-Postal
HDHP Self
Monthly
285.03
UPMC Health Plan
YS5
Non-Postal
HDHP Self & Family
Monthly
649.7
UPMC Health Plan
YS6
Non-Postal
HDHP Self Plus One
Monthly
674.14
UPMC Health Plan
YT4
Non-Postal
Standard Self
Monthly
442.89
UPMC Health Plan
YT5
Non-Postal
Standard Self & Family
Monthly
1050.42
UPMC Health Plan
YT6
Non-Postal
Standard Self Plus One
Monthly
1051.62
U.S. Office of Personnel Management
1900 E Street, NW, Washington, DC 20415
202-606-1800
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