2022 Plan Information for New York
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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 | EP1 | Non-Postal | CDHP Self | Monthly | 625.84 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP2 | Non-Postal | CDHP Self & Family | Monthly | 1393.17 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP3 | Non-Postal | CDHP Self Plus One | Monthly | 1474.31 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP4 | Non-Postal | Value Self | Monthly | 397.24 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP5 | Non-Postal | Value Self & Family | Monthly | 880.55 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP6 | Non-Postal | Value Self Plus One | Monthly | 946.14 |
| Aetna Open Access | JC1 | Non-Postal | High Self | Monthly | 1198.38 |
| Aetna Open Access | JC2 | Non-Postal | High Self & Family | Monthly | 3028.18 |
| Aetna Open Access | JC3 | Non-Postal | High Self Plus One | Monthly | 3093.13 |
| Aetna Open Access | JC4 | Non-Postal | Basic Self | Monthly | 932.3 |
| Aetna Open Access | JC5 | Non-Postal | Basic Self & Family | Monthly | 2324.14 |
| Aetna Open Access | JC6 | Non-Postal | Basic Self Plus One | Monthly | 2396.07 |
| CDPHP Universal Benefits, Inc. | SG4 | Non-Postal | Standard Self | Monthly | 243.23 |
| CDPHP Universal Benefits, Inc. | SG5 | Non-Postal | Standard Self & Family | Monthly | 613.06 |
| CDPHP Universal Benefits, Inc. | SG6 | Non-Postal | Standard Self Plus One | Monthly | 581.03 |
| EmblemHealth Plan | 804 | Non-Postal | Standard Self | Monthly | 509.32 |
| EmblemHealth Plan | 805 | Non-Postal | Standard Self & Family | Monthly | 1278.77 |
| EmblemHealth Plan | 806 | Non-Postal | Standard Self Plus One | Monthly | 1282.04 |
| HIP of Greater New York | 511 | Non-Postal | High Self | Monthly | 520.22 |
| HIP of Greater New York | 512 | Non-Postal | High Self & Family | Monthly | 1810.64 |
| HIP of Greater New York | 513 | Non-Postal | High Self Plus One | Monthly | 782.04 |
| HIP of Greater New York | YL4 | Non-Postal | Standard Self | Monthly | 444.77 |
| HIP of Greater New York | YL5 | Non-Postal | Standard Self & Family | Monthly | 1591.18 |
| HIP of Greater New York | YL6 | Non-Postal | Standard Self Plus One | Monthly | 644.17 |
| Independent Health Assoc | C54 | Non-Postal | Standard Self | Monthly | 207.24 |
| Independent Health Assoc | C55 | Non-Postal | Standard Self & Family | Monthly | 748.04 |
| Independent Health Assoc | C56 | Non-Postal | Standard Self Plus One | Monthly | 744.66 |
| Independent Health Assoc | QA1 | Non-Postal | High Self | Monthly | 270.12 |
| Independent Health Assoc | QA2 | Non-Postal | High Self & Family | Monthly | 917.8 |
| Independent Health Assoc | QA3 | Non-Postal | High Self Plus One | Monthly | 904.95 |
| Independent Health Assoc | QA4 | Non-Postal | HDHP Self | Monthly | 150.3 |
| Independent Health Assoc | QA5 | Non-Postal | HDHP Self & Family | Monthly | 388.19 |
| Independent Health Assoc | QA6 | Non-Postal | HDHP Self Plus One | Monthly | 369.34 |