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2022 Plan Information for Virginia
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
F51
Non-Postal
CDHP Self
Monthly
340.12
Aetna HealthFund CDHP and Aetna Value Plan
F52
Non-Postal
CDHP Self & Family
Monthly
741.15
Aetna HealthFund CDHP and Aetna Value Plan
F53
Non-Postal
CDHP Self Plus One
Monthly
828.75
Aetna HealthFund CDHP and Aetna Value Plan
F54
Non-Postal
Value Self
Monthly
365
Aetna HealthFund CDHP and Aetna Value Plan
F55
Non-Postal
Value Self & Family
Monthly
806.69
Aetna HealthFund CDHP and Aetna Value Plan
F56
Non-Postal
Value Self Plus One
Monthly
873.75
Aetna Open Access
JN1
Non-Postal
High Self
Monthly
721.02
Aetna Open Access
JN2
Non-Postal
High Self & Family
Monthly
1569.73
Aetna Open Access
JN3
Non-Postal
High Self Plus One
Monthly
1649.09
Aetna Open Access
JN4
Non-Postal
Basic Self
Monthly
208.93
Aetna Open Access
JN5
Non-Postal
Basic Self & Family
Monthly
448.28
Aetna Open Access
JN6
Non-Postal
Basic Self Plus One
Monthly
417.23
Aetna Open Access
QQ4
Non-Postal
Saver Self
Monthly
148.8
Aetna Open Access
QQ5
Non-Postal
Saver Self & Family
Monthly
340.53
Aetna Open Access
QQ6
Non-Postal
Saver Self Plus One
Monthly
312.7
CareFirst BlueChoice
2G4
Non-Postal
Standard Self
Monthly
375.05
CareFirst BlueChoice
2G5
Non-Postal
Standard Self & Family
Monthly
907.64
CareFirst BlueChoice
2G6
Non-Postal
Standard Self Plus One
Monthly
674.42
CareFirst BlueChoice
B61
Non-Postal
HDHP Self
Monthly
151.08
CareFirst BlueChoice
B62
Non-Postal
HDHP Self & Family
Monthly
358.95
CareFirst BlueChoice
B63
Non-Postal
HDHP Self Plus One
Monthly
302.14
CareFirst BlueChoice
B64
Non-Postal
Blue Value Plus Self
Monthly
193.14
CareFirst BlueChoice
B65
Non-Postal
Blue Value Plus Self & Family
Monthly
475.43
CareFirst BlueChoice
B66
Non-Postal
Blue Value Plus Self Plus One
Monthly
361.82
Healthkeepers
9V1
Non-Postal
HDHP Self
Monthly
134.3
Healthkeepers
9V2
Non-Postal
HDHP Self & Family
Monthly
327.01
Healthkeepers
9V3
Non-Postal
HDHP Self Plus One
Monthly
305.52
Kaiser Permanente - Mid-Atlantic States
E31
Non-Postal
High Self
Monthly
226.07
Kaiser Permanente - Mid-Atlantic States
E32
Non-Postal
High Self & Family
Monthly
496.25
Kaiser Permanente - Mid-Atlantic States
E33
Non-Postal
High Self Plus One
Monthly
603.5
Kaiser Permanente - Mid-Atlantic States
E34
Non-Postal
Standard Self
Monthly
151.81
Kaiser Permanente - Mid-Atlantic States
E35
Non-Postal
Standard Self & Family
Monthly
349.16
Kaiser Permanente - Mid-Atlantic States
E36
Non-Postal
Standard Self Plus One
Monthly
349.16
Kaiser Permanente - Mid-Atlantic States
T71
Non-Postal
Prosper Self
Monthly
92.22
Kaiser Permanente - Mid-Atlantic States
T72
Non-Postal
Prosper Self & Family
Monthly
262.83
Kaiser Permanente - Mid-Atlantic States
T73
Non-Postal
Prosper Self Plus One
Monthly
216.73
M.D. IPA
JP1
Non-Postal
High Self
Monthly
481.46
M.D. IPA
JP2
Non-Postal
High Self & Family
Monthly
1593.71
M.D. IPA
JP3
Non-Postal
High Self Plus One
Monthly
839.73
Sentara Health Plans
PG1
Non-Postal
High Self
Monthly
189.02
Sentara Health Plans
PG2
Non-Postal
High Self & Family
Monthly
494.74
Sentara Health Plans
PG3
Non-Postal
High Self Plus One
Monthly
601.86
Sentara Health Plans
PG4
Non-Postal
HDHP Self
Monthly
142.2
Sentara Health Plans
PG5
Non-Postal
HDHP Self & Family
Monthly
313.67
Sentara Health Plans
PG6
Non-Postal
HDHP Self Plus One
Monthly
307.52
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 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
