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2022 Plan Information for Indiana
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
JS1
Non-Postal
CDHP Self
Monthly
506.81
Aetna HealthFund CDHP and Aetna Value Plan
JS2
Non-Postal
CDHP Self & Family
Monthly
1120.71
Aetna HealthFund CDHP and Aetna Value Plan
JS3
Non-Postal
CDHP Self Plus One
Monthly
1204.54
Aetna HealthFund CDHP and Aetna Value Plan
JS4
Non-Postal
Value Self
Monthly
563.98
Aetna HealthFund CDHP and Aetna Value Plan
JS5
Non-Postal
Value Self & Family
Monthly
1254.69
Aetna HealthFund CDHP and Aetna Value Plan
JS6
Non-Postal
Value Self Plus One
Monthly
1337.24
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
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
DT1
Non-Postal
HDHP Self
Monthly
123.93
Humana CoverageFirst and Humana Value Plan
DT2
Non-Postal
HDHP Self & Family
Monthly
308.85
Humana CoverageFirst and Humana Value Plan
DT3
Non-Postal
HDHP Self Plus One
Monthly
271.87
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 CoverageFirst and Humana Value Plan
TC1
Non-Postal
CDHP Self
Monthly
226.53
Humana CoverageFirst and Humana Value Plan
TC2
Non-Postal
CDHP Self & Family
Monthly
459.38
Humana CoverageFirst and Humana Value Plan
TC3
Non-Postal
CDHP Self Plus One
Monthly
490.94
Humana CoverageFirst and Humana Value Plan
TC4
Non-Postal
Value Self
Monthly
144.93
Humana CoverageFirst and Humana Value Plan
TC5
Non-Postal
Value Self & Family
Monthly
326.1
Humana CoverageFirst and Humana Value Plan
TC6
Non-Postal
Value Self Plus One
Monthly
311.61
Humana CoverageFirst and Humana Value Plan
X31
Non-Postal
CDHP Self
Monthly
371.84
Humana CoverageFirst and Humana Value Plan
X32
Non-Postal
CDHP Self & Family
Monthly
786.39
Humana CoverageFirst and Humana Value Plan
X33
Non-Postal
CDHP Self Plus One
Monthly
803.42
Humana CoverageFirst and Humana Value Plan
X34
Non-Postal
Value Self
Monthly
173.58
Humana CoverageFirst and Humana Value Plan
X35
Non-Postal
Value Self & Family
Monthly
390.56
Humana CoverageFirst and Humana Value Plan
X36
Non-Postal
Value Self Plus One
Monthly
373.2
Humana Health Plan of Ohio, Inc.
A64
Non-Postal
Standard Self
Monthly
712.55
Humana Health Plan of Ohio, Inc.
A65
Non-Postal
Standard Self & Family
Monthly
1553
Humana Health Plan of Ohio, Inc.
A66
Non-Postal
Standard Self Plus One
Monthly
1535.93
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.
MH4
Non-Postal
Standard Self
Monthly
462.37
Humana Health Plan, Inc.
MH5
Non-Postal
Standard Self & Family
Monthly
990.01
Humana Health Plan, Inc.
MH6
Non-Postal
Standard Self Plus One
Monthly
997.97
U.S. Office of Personnel Management
1900 E Street, NW, Washington, DC 20415
202-606-1800
Federal Relay Service