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2021 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
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
F51
Non-Postal
CDHP Self
Monthly
328.32
Aetna HealthFund CDHP and Aetna Value Plan
F52
Non-Postal
CDHP Self & Family
Monthly
723.82
Aetna HealthFund CDHP and Aetna Value Plan
F53
Non-Postal
CDHP Self Plus One
Monthly
801.65
Aetna HealthFund CDHP and Aetna Value Plan
F54
Non-Postal
Value Self
Monthly
298.4
Aetna HealthFund CDHP and Aetna Value Plan
F55
Non-Postal
Value Self & Family
Monthly
663.67
Aetna HealthFund CDHP and Aetna Value Plan
F56
Non-Postal
Value Self Plus One
Monthly
723.8
Aetna Open Access
JN1
Non-Postal
High Self
Monthly
653.15
Aetna Open Access
JN2
Non-Postal
High Self & Family
Monthly
1426.84
Aetna Open Access
JN3
Non-Postal
High Self Plus One
Monthly
1497.69
Aetna Open Access
JN4
Non-Postal
Basic Self
Monthly
191
Aetna Open Access
JN5
Non-Postal
Basic Self & Family
Monthly
416.71
Aetna Open Access
JN6
Non-Postal
Basic Self Plus One
Monthly
380.17
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
364.39
CareFirst BlueChoice
2G5
Non-Postal
Standard Self & Family
Monthly
891.21
CareFirst BlueChoice
2G6
Non-Postal
Standard Self Plus One
Monthly
654.45
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
200.25
CareFirst BlueChoice
B65
Non-Postal
Blue Value Plus Self & Family
Monthly
501.17
CareFirst BlueChoice
B66
Non-Postal
Blue Value Plus Self Plus One
Monthly
361.82
Kaiser Permanente - Mid-Atlantic States
E31
Non-Postal
High Self
Monthly
222.82
Kaiser Permanente - Mid-Atlantic States
E32
Non-Postal
High Self & Family
Monthly
498.14
Kaiser Permanente - Mid-Atlantic States
E33
Non-Postal
High Self Plus One
Monthly
595.19
Kaiser Permanente - Mid-Atlantic States
E34
Non-Postal
Standard Self
Monthly
149.57
Kaiser Permanente - Mid-Atlantic States
E35
Non-Postal
Standard Self & Family
Monthly
344.01
Kaiser Permanente - Mid-Atlantic States
E36
Non-Postal
Standard Self Plus One
Monthly
344.01
Kaiser Permanente - Mid-Atlantic States
T71
Non-Postal
Basic Self
Monthly
106.93
Kaiser Permanente - Mid-Atlantic States
T72
Non-Postal
Basic Self & Family
Monthly
274.88
Kaiser Permanente - Mid-Atlantic States
T73
Non-Postal
Basic Self Plus One
Monthly
237.96
M.D. IPA
JP1
Non-Postal
High Self
Monthly
427.47
M.D. IPA
JP2
Non-Postal
High Self & Family
Monthly
1448.07
M.D. IPA
JP3
Non-Postal
High Self Plus One
Monthly
735.93
Sentara Health Plans
PG1
Non-Postal
High Self
Monthly
196.13
Sentara Health Plans
PG2
Non-Postal
High Self & Family
Monthly
520.48
Sentara Health Plans
PG3
Non-Postal
High Self Plus One
Monthly
617.4
Sentara Health Plans
PG4
Non-Postal
HDHP Self
Monthly
151.27
Sentara Health Plans
PG5
Non-Postal
HDHP Self & Family
Monthly
333.69
Sentara Health Plans
PG6
Non-Postal
HDHP Self Plus One
Monthly
327.15
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 Advanced)
L91
Non-Postal
Value Self
Monthly
138.65
UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced)
L92
Non-Postal
Value Self & Family
Monthly
388.79
UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced)
L93
Non-Postal
Value Self Plus One
Monthly
270.79
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
U.S. Office of Personnel Management
1900 E Street, NW, Washington, DC 20415
202-606-1800
Federal Relay Service