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2022 Plan Information for Illinois
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
H41
Non-Postal
CDHP Self
Monthly
295.66
Aetna HealthFund CDHP and Aetna Value Plan
H42
Non-Postal
CDHP Self & Family
Monthly
639.27
Aetna HealthFund CDHP and Aetna Value Plan
H43
Non-Postal
CDHP Self Plus One
Monthly
728.26
Aetna HealthFund CDHP and Aetna Value Plan
H44
Non-Postal
Value Self
Monthly
303.2
Aetna HealthFund CDHP and Aetna Value Plan
H45
Non-Postal
Value Self & Family
Monthly
669.5
Aetna HealthFund CDHP and Aetna Value Plan
H46
Non-Postal
Value Self Plus One
Monthly
739.24
Blue Preferred
9G1
Non-Postal
High Self
Monthly
375.18
Blue Preferred
9G2
Non-Postal
High Self & Family
Monthly
895.37
Blue Preferred
9G3
Non-Postal
High Self Plus One
Monthly
868.81
Blue Preferred
9G4
Non-Postal
Standard Self
Monthly
153.5
Blue Preferred
9G5
Non-Postal
Standard Self & Family
Monthly
547.67
Blue Preferred
9G6
Non-Postal
Standard Self Plus One
Monthly
461.5
Health Alliance HMO/POS
K84
Non-Postal
Standard Self
Monthly
176.02
Health Alliance HMO/POS
K85
Non-Postal
Standard Self & Family
Monthly
407.97
Health Alliance HMO/POS
K86
Non-Postal
Standard Self Plus One
Monthly
376.36
Humana CoverageFirst and Humana Value Plan
AW1
Non-Postal
HDHP Self
Monthly
105.17
Humana CoverageFirst and Humana Value Plan
AW2
Non-Postal
HDHP Self & Family
Monthly
261.95
Humana CoverageFirst and Humana Value Plan
AW3
Non-Postal
HDHP Self Plus One
Monthly
230.6
Humana CoverageFirst and Humana Value Plan
BB1
Non-Postal
HDHP Self
Monthly
111.32
Humana CoverageFirst and Humana Value Plan
BB2
Non-Postal
HDHP Self & Family
Monthly
277.33
Humana CoverageFirst and Humana Value Plan
BB3
Non-Postal
HDHP Self Plus One
Monthly
244.13
Humana CoverageFirst and Humana Value Plan
GB1
Non-Postal
CDHP Self
Monthly
789.3
Humana CoverageFirst and Humana Value Plan
GB2
Non-Postal
CDHP Self & Family
Monthly
1725.6
Humana CoverageFirst and Humana Value Plan
GB3
Non-Postal
CDHP Self Plus One
Monthly
1700.92
Humana CoverageFirst and Humana Value Plan
GB4
Non-Postal
Value Self
Monthly
297.38
Humana CoverageFirst and Humana Value Plan
GB5
Non-Postal
Value Self & Family
Monthly
618.76
Humana CoverageFirst and Humana Value Plan
GB6
Non-Postal
Value Self Plus One
Monthly
643.22
Humana CoverageFirst and Humana Value Plan
MW1
Non-Postal
CDHP Self
Monthly
526.22
Humana CoverageFirst and Humana Value Plan
MW2
Non-Postal
CDHP Self & Family
Monthly
1133.86
Humana CoverageFirst and Humana Value Plan
MW3
Non-Postal
CDHP Self Plus One
Monthly
1135.38
Humana CoverageFirst and Humana Value Plan
MW4
Non-Postal
Value Self
Monthly
269.17
Humana CoverageFirst and Humana Value Plan
MW5
Non-Postal
Value Self & Family
Monthly
555.32
Humana CoverageFirst and Humana Value Plan
MW6
Non-Postal
Value Self Plus One
Monthly
582.62
Humana Health Plan, Inc.
751
Non-Postal
High Self
Monthly
872.71
Humana Health Plan, Inc.
752
Non-Postal
High Self & Family
Monthly
1913.34
Humana Health Plan, Inc.
753
Non-Postal
High Self Plus One
Monthly
1880.28
Humana Health Plan, Inc.
754
Non-Postal
Standard Self
Monthly
525.27
Humana Health Plan, Inc.
755
Non-Postal
Standard Self & Family
Monthly
1131.61
Humana Health Plan, Inc.
756
Non-Postal
Standard Self Plus One
Monthly
1133.3
Humana Health Plan, Inc.
9F1
Non-Postal
High Self
Monthly
1586.11
Humana Health Plan, Inc.
9F2
Non-Postal
High Self & Family
Monthly
3518.49
Humana Health Plan, Inc.
9F3
Non-Postal
High Self Plus One
Monthly
3414.04
Humana Health Plan, Inc.
AB1
Non-Postal
Basic Self
Monthly
315.4
Humana Health Plan, Inc.
AB2
Non-Postal
Basic Self & Family
Monthly
659.45
Humana Health Plan, Inc.
AB3
Non-Postal
Basic Self Plus One
Monthly
682.11
Humana Health Plan, Inc.
AB4
Non-Postal
Standard Self
Monthly
916.93
Humana Health Plan, Inc.
AB5
Non-Postal
Standard Self & Family
Monthly
2012.9
Humana Health Plan, Inc.
AB6
Non-Postal
Standard Self Plus One
Monthly
1975.41
Humana Health Plan, Inc.
RW1
Non-Postal
Basic Self
Monthly
308.97
Humana Health Plan, Inc.
RW2
Non-Postal
Basic Self & Family
Monthly
644.93
Humana Health Plan, Inc.
RW3
Non-Postal
Basic Self Plus One
Monthly
668.22
UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced)
L91
Non-Postal
Value Self
Monthly
165.94
UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced)
L92
Non-Postal
Value Self & Family
Monthly
396.6
UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced)
L93
Non-Postal
Value Self Plus One
Monthly
331.88
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