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2022 Plan Information for Pennsylvania
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
Aetna Open Access
P31
Non-Postal
High Self
Monthly
1232.01
Aetna Open Access
P32
Non-Postal
High Self & Family
Monthly
3029.32
Aetna Open Access
P33
Non-Postal
High Self Plus One
Monthly
3094.28
Aetna Open Access
P34
Non-Postal
Basic Self
Monthly
1191.23
Aetna Open Access
P35
Non-Postal
Basic Self & Family
Monthly
2752.34
Aetna Open Access
P36
Non-Postal
Basic Self Plus One
Monthly
2820
Aetna Open Access
YE1
Non-Postal
High Self
Monthly
651.15
Aetna Open Access
YE2
Non-Postal
High Self & Family
Monthly
1723.24
Aetna Open Access
YE3
Non-Postal
High Self Plus One
Monthly
1801.13
Geisinger Health Plan
AJ1
Non-Postal
Basic Self
Monthly
360.47
Geisinger Health Plan
AJ2
Non-Postal
Basic Self & Family
Monthly
796.01
Geisinger Health Plan
AJ3
Non-Postal
Basic Self Plus One
Monthly
788.51
Geisinger Health Plan
GG4
Non-Postal
Standard Self
Monthly
462
Geisinger Health Plan
GG5
Non-Postal
Standard Self & Family
Monthly
1028.47
Geisinger Health Plan
GG6
Non-Postal
Standard Self Plus One
Monthly
1007.87
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
V41
Non-Postal
HDHP Self
Monthly
165.45
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
V42
Non-Postal
HDHP Self & Family
Monthly
378.55
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
V43
Non-Postal
HDHP Self Plus One
Monthly
355.73
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
LR1
Non-Postal
High Self
Monthly
291.63
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
LR2
Non-Postal
High Self & Family
Monthly
704.6
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
LR3
Non-Postal
High Self Plus One
Monthly
630.98
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
UPMC Health Plan
8W4
Non-Postal
HDHP Self
Monthly
166.99
UPMC Health Plan
8W5
Non-Postal
HDHP Self & Family
Monthly
384.8
UPMC Health Plan
8W6
Non-Postal
HDHP Self Plus One
Monthly
369.87
UPMC Health Plan
UW4
Non-Postal
Standard Self
Monthly
192.68
UPMC Health Plan
UW5
Non-Postal
Standard Self & Family
Monthly
454.96
UPMC Health Plan
UW6
Non-Postal
Standard Self Plus One
Monthly
489.49
U.S. Office of Personnel Management
1900 E Street, NW, Washington, DC 20415
202-606-1800
Federal Relay Service
