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2022 Plan Information for Missouri
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
G51
Non-Postal
CDHP Self
Monthly
604.57
Aetna HealthFund CDHP and Aetna Value Plan
G52
Non-Postal
CDHP Self & Family
Monthly
1345.26
Aetna HealthFund CDHP and Aetna Value Plan
G53
Non-Postal
CDHP Self Plus One
Monthly
1426.9
Aetna HealthFund CDHP and Aetna Value Plan
G54
Non-Postal
Value Self
Monthly
303.85
Aetna HealthFund CDHP and Aetna Value Plan
G55
Non-Postal
Value Self & Family
Monthly
667.12
Aetna HealthFund CDHP and Aetna Value Plan
G56
Non-Postal
Value Self Plus One
Monthly
736.93
Aetna Open Access
HA1
Non-Postal
High Self
Monthly
658.45
Aetna Open Access
HA2
Non-Postal
High Self & Family
Monthly
1564.59
Aetna Open Access
HA3
Non-Postal
High Self Plus One
Monthly
1644.07
Aetna Open Access
HA4
Non-Postal
Standard Self
Monthly
378.84
Aetna Open Access
HA5
Non-Postal
Standard Self & Family
Monthly
902.52
Aetna Open Access
HA6
Non-Postal
Standard Self Plus One
Monthly
988.56
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
Humana CoverageFirst and Humana Value Plan
BK1
Non-Postal
HDHP Self
Monthly
100.78
Humana CoverageFirst and Humana Value Plan
BK2
Non-Postal
HDHP Self & Family
Monthly
250.98
Humana CoverageFirst and Humana Value Plan
BK3
Non-Postal
HDHP Self Plus One
Monthly
220.94
Humana CoverageFirst and Humana Value Plan
PH1
Non-Postal
CDHP Self
Monthly
227.5
Humana CoverageFirst and Humana Value Plan
PH2
Non-Postal
CDHP Self & Family
Monthly
461.65
Humana CoverageFirst and Humana Value Plan
PH3
Non-Postal
CDHP Self Plus One
Monthly
493.09
Humana CoverageFirst and Humana Value Plan
PH4
Non-Postal
Value Self
Monthly
141.79
Humana CoverageFirst and Humana Value Plan
PH5
Non-Postal
Value Self & Family
Monthly
319.04
Humana CoverageFirst and Humana Value Plan
PH6
Non-Postal
Value Self Plus One
Monthly
304.86
Humana Health Plan, Inc.
MS4
Non-Postal
Standard Self
Monthly
760.11
Humana Health Plan, Inc.
MS5
Non-Postal
Standard Self & Family
Monthly
1660.03
Humana Health Plan, Inc.
MS6
Non-Postal
Standard Self Plus One
Monthly
1638.24
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