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2022 Plan Information for Georgia
Choose a Location, Employee Type, & Payment Period
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Nationwide
Federal & U.S. Postal Service Employee
Certain Temporary Employees
Annuitant
Former Spouse Enrollee
Federal Deposit Insurance Corporation
Temporary Continuation of Coverage (TCC)
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
293.78
Aetna Direct
225
Non-Postal
HDHP Self & Family
Monthly
574.3
Aetna Direct
226
Non-Postal
HDHP Self Plus One
Monthly
645.93
Aetna Direct
N61
Non-Postal
CDHP Self
Monthly
157.07
Aetna Direct
N62
Non-Postal
CDHP Self & Family
Monthly
396.12
Aetna Direct
N63
Non-Postal
CDHP Self Plus One
Monthly
344.47
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
340.12
Aetna HealthFund CDHP and Aetna Value Plan
F52
Non-Postal
CDHP Self & Family
Monthly
741.15
Aetna HealthFund CDHP and Aetna Value Plan
F53
Non-Postal
CDHP Self Plus One
Monthly
828.75
Aetna HealthFund CDHP and Aetna Value Plan
F54
Non-Postal
Value Self
Monthly
365
Aetna HealthFund CDHP and Aetna Value Plan
F55
Non-Postal
Value Self & Family
Monthly
806.69
Aetna HealthFund CDHP and Aetna Value Plan
F56
Non-Postal
Value Self Plus One
Monthly
873.75
Aetna Open Access
2U1
Non-Postal
High Self
Monthly
1199.1
Aetna Open Access
2U2
Non-Postal
High Self & Family
Monthly
2740.18
Aetna Open Access
2U3
Non-Postal
High Self Plus One
Monthly
2807.98
Blue Open Access POS
QM1
Non-Postal
High Self
Monthly
175.43
Blue Open Access POS
QM2
Non-Postal
High Self & Family
Monthly
599.49
Blue Open Access POS
QM3
Non-Postal
High Self Plus One
Monthly
448.78
Humana CoverageFirst and Humana Value Plan
AD1
Non-Postal
CDHP Self
Monthly
635.98
Humana CoverageFirst and Humana Value Plan
AD2
Non-Postal
CDHP Self & Family
Monthly
1380.66
Humana CoverageFirst and Humana Value Plan
AD3
Non-Postal
CDHP Self Plus One
Monthly
1371.28
Humana CoverageFirst and Humana Value Plan
AD4
Non-Postal
Value Self
Monthly
295.51
Humana CoverageFirst and Humana Value Plan
AD5
Non-Postal
Value Self & Family
Monthly
614.55
Humana CoverageFirst and Humana Value Plan
AD6
Non-Postal
Value Self Plus One
Monthly
639.23
Humana CoverageFirst and Humana Value Plan
AR1
Non-Postal
HDHP Self
Monthly
119.36
Humana CoverageFirst and Humana Value Plan
AR2
Non-Postal
HDHP Self & Family
Monthly
297.43
Humana CoverageFirst and Humana Value Plan
AR3
Non-Postal
HDHP Self Plus One
Monthly
261.81
Humana CoverageFirst and Humana Value Plan
AZ1
Non-Postal
HDHP Self
Monthly
118.1
Humana CoverageFirst and Humana Value Plan
AZ2
Non-Postal
HDHP Self & Family
Monthly
294.26
Humana CoverageFirst and Humana Value Plan
AZ3
Non-Postal
HDHP Self Plus One
Monthly
259.03
Humana CoverageFirst and Humana Value Plan
B21
Non-Postal
HDHP Self
Monthly
121.75
Humana CoverageFirst and Humana Value Plan
B22
Non-Postal
HDHP Self & Family
Monthly
303.4
Humana CoverageFirst and Humana Value Plan
B23
Non-Postal
HDHP Self Plus One
Monthly
267.07
Humana CoverageFirst and Humana Value Plan
LM1
Non-Postal
CDHP Self
Monthly
253.98
Humana CoverageFirst and Humana Value Plan
LM2
Non-Postal
CDHP Self & Family
Monthly
521.19
Humana CoverageFirst and Humana Value Plan
LM3
Non-Postal
CDHP Self Plus One
Monthly
549.99
Humana CoverageFirst and Humana Value Plan
LM4
Non-Postal
Value Self
Monthly
211.6
Humana CoverageFirst and Humana Value Plan
LM5
Non-Postal
Value Self & Family
Monthly
425.86
Humana CoverageFirst and Humana Value Plan
LM6
Non-Postal
Value Self Plus One
Monthly
458.9
Humana CoverageFirst and Humana Value Plan
S91
Non-Postal
CDHP Self
Monthly
296.57
Humana CoverageFirst and Humana Value Plan
S92
Non-Postal
CDHP Self & Family
Monthly
617.04
Humana CoverageFirst and Humana Value Plan
S93
Non-Postal
CDHP Self Plus One
Monthly
641.59
Humana CoverageFirst and Humana Value Plan
S94
Non-Postal
Value Self
Monthly
164.64
Humana CoverageFirst and Humana Value Plan
S95
Non-Postal
Value Self & Family
Monthly
370.43
Humana CoverageFirst and Humana Value Plan
S96
Non-Postal
Value Self Plus One
Monthly
353.97
Humana Employers Health Plan of Georgia, Inc.
CB4
Non-Postal
Standard Self
Monthly
721.15
Humana Employers Health Plan of Georgia, Inc.
CB5
Non-Postal
Standard Self & Family
Monthly
1572.35
Humana Employers Health Plan of Georgia, Inc.
CB6
Non-Postal
Standard Self Plus One
Monthly
1554.43
Humana Employers Health Plan of Georgia, Inc.
DG4
Non-Postal
Standard Self
Monthly
900.32
Humana Employers Health Plan of Georgia, Inc.
DG5
Non-Postal
Standard Self & Family
Monthly
1975.48
Humana Employers Health Plan of Georgia, Inc.
DG6
Non-Postal
Standard Self Plus One
Monthly
1939.71
Humana Employers Health Plan of Georgia, Inc.
DN4
Non-Postal
Standard Self
Monthly
343.63
Humana Employers Health Plan of Georgia, Inc.
DN5
Non-Postal
Standard Self & Family
Monthly
722.82
Humana Employers Health Plan of Georgia, Inc.
DN6
Non-Postal
Standard Self Plus One
Monthly
742.69
Humana Employers Health Plan of Georgia, Inc.
Q71
Non-Postal
Basic Self
Monthly
341.58
Humana Employers Health Plan of Georgia, Inc.
Q72
Non-Postal
Basic Self & Family
Monthly
718.31
Humana Employers Health Plan of Georgia, Inc.
Q73
Non-Postal
Basic Self Plus One
Monthly
738.33
Humana Employers Health Plan of Georgia, Inc.
RJ1
Non-Postal
Basic Self
Monthly
175.83
Humana Employers Health Plan of Georgia, Inc.
RJ2
Non-Postal
Basic Self & Family
Monthly
395.63
Humana Employers Health Plan of Georgia, Inc.
RJ3
Non-Postal
Basic Self Plus One
Monthly
378.04
Humana Employers Health Plan of Georgia, Inc.
RM1
Non-Postal
Basic Self
Monthly
261.34
Humana Employers Health Plan of Georgia, Inc.
RM2
Non-Postal
Basic Self & Family
Monthly
537.77
Humana Employers Health Plan of Georgia, Inc.
RM3
Non-Postal
Basic Self Plus One
Monthly
565.82
Kaiser Permanente - Georgia
F81
Non-Postal
High Self
Monthly
239.18
Kaiser Permanente - Georgia
F82
Non-Postal
High Self & Family
Monthly
495.62
Kaiser Permanente - Georgia
F83
Non-Postal
High Self Plus One
Monthly
602.87
Kaiser Permanente - Georgia
F84
Non-Postal
Standard Self
Monthly
150.18
Kaiser Permanente - Georgia
F85
Non-Postal
Standard Self & Family
Monthly
339.4
Kaiser Permanente - Georgia
F86
Non-Postal
Standard Self Plus One
Monthly
339.4
Kaiser Permanente - Georgia
LA1
Non-Postal
Prosper Self
Monthly
99.66
Kaiser Permanente - Georgia
LA2
Non-Postal
Prosper Self & Family
Monthly
258.74
Kaiser Permanente - Georgia
LA3
Non-Postal
Prosper Self Plus One
Monthly
225.23
UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced)
LV1
Non-Postal
Value Self
Monthly
367.36
UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced)
LV2
Non-Postal
Value Self & Family
Monthly
1449.69
UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced)
LV3
Non-Postal
Value Self Plus One
Monthly
793.76
UnitedHealthcare Insurance Company, Inc. Choice Plus Primary
AS1
Non-Postal
High Self
Monthly
162.73
UnitedHealthcare Insurance Company, Inc. Choice Plus Primary
AS2
Non-Postal
High Self & Family
Monthly
384.86
UnitedHealthcare Insurance Company, Inc. Choice Plus Primary
AS3
Non-Postal
High Self Plus One
Monthly
349.87
UnitedHealthcare Insurance Company, Inc. Choice Primary
Y81
Non-Postal
High Self
Monthly
145.31
UnitedHealthcare Insurance Company, Inc. Choice Primary
Y82
Non-Postal
High Self & Family
Monthly
343.67
UnitedHealthcare Insurance Company, Inc. Choice Primary
Y83
Non-Postal
High Self Plus One
Monthly
312.43
U.S. Office of Personnel Management
1900 E Street, NW, Washington, DC 20415
202-606-1800
Federal Relay Service