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2023 Plan Information for Illinois
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
269.92
Aetna Direct
225
Non-Postal
HDHP Self & Family
Monthly
511.92
Aetna Direct
226
Non-Postal
HDHP Self Plus One
Monthly
586.26
Aetna Direct
N61
Non-Postal
CDHP Self
Monthly
160.35
Aetna Direct
N62
Non-Postal
CDHP Self & Family
Monthly
404.39
Aetna Direct
N63
Non-Postal
CDHP Self Plus One
Monthly
351.67
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
302.2
Aetna HealthFund CDHP and Aetna Value Plan
H42
Non-Postal
CDHP Self & Family
Monthly
646.78
Aetna HealthFund CDHP and Aetna Value Plan
H43
Non-Postal
CDHP Self Plus One
Monthly
737.95
Aetna HealthFund CDHP and Aetna Value Plan
H44
Non-Postal
Value Self
Monthly
338.43
Aetna HealthFund CDHP and Aetna Value Plan
H45
Non-Postal
Value Self & Family
Monthly
743.37
Aetna HealthFund CDHP and Aetna Value Plan
H46
Non-Postal
Value Self Plus One
Monthly
813.13
Health Alliance HMO/POS
K84
Non-Postal
Standard Self
Monthly
225.85
Health Alliance HMO/POS
K85
Non-Postal
Standard Self & Family
Monthly
524.23
Health Alliance HMO/POS
K86
Non-Postal
Standard Self Plus One
Monthly
475.09
Humana CoverageFirst and Humana Value Plan
AW1
Non-Postal
HDHP Self
Monthly
108.33
Humana CoverageFirst and Humana Value Plan
AW2
Non-Postal
HDHP Self & Family
Monthly
269.81
Humana CoverageFirst and Humana Value Plan
AW3
Non-Postal
HDHP Self Plus One
Monthly
237.52
Humana CoverageFirst and Humana Value Plan
BB1
Non-Postal
HDHP Self
Monthly
114.66
Humana CoverageFirst and Humana Value Plan
BB2
Non-Postal
HDHP Self & Family
Monthly
285.65
Humana CoverageFirst and Humana Value Plan
BB3
Non-Postal
HDHP Self Plus One
Monthly
251.45
Humana CoverageFirst and Humana Value Plan
GB1
Non-Postal
CDHP Self
Monthly
770.29
Humana CoverageFirst and Humana Value Plan
GB2
Non-Postal
CDHP Self & Family
Monthly
1674.49
Humana CoverageFirst and Humana Value Plan
GB3
Non-Postal
CDHP Self Plus One
Monthly
1651.54
Humana CoverageFirst and Humana Value Plan
GB4
Non-Postal
Value Self
Monthly
273.43
Humana CoverageFirst and Humana Value Plan
GB5
Non-Postal
Value Self & Family
Monthly
556.58
Humana CoverageFirst and Humana Value Plan
GB6
Non-Postal
Value Self Plus One
Monthly
583.2
Humana CoverageFirst and Humana Value Plan
MW1
Non-Postal
CDHP Self
Monthly
534.77
Humana CoverageFirst and Humana Value Plan
MW2
Non-Postal
CDHP Self & Family
Monthly
1144.81
Humana CoverageFirst and Humana Value Plan
MW3
Non-Postal
CDHP Self Plus One
Monthly
1145.28
Humana CoverageFirst and Humana Value Plan
MW4
Non-Postal
Value Self
Monthly
252.96
Humana CoverageFirst and Humana Value Plan
MW5
Non-Postal
Value Self & Family
Monthly
510.54
Humana CoverageFirst and Humana Value Plan
MW6
Non-Postal
Value Self Plus One
Monthly
539.28
Humana Health Plan, Inc.
751
Non-Postal
High Self
Monthly
882.61
Humana Health Plan, Inc.
752
Non-Postal
High Self & Family
Monthly
1927.25
Humana Health Plan, Inc.
753
Non-Postal
High Self Plus One
Monthly
1893
Humana Health Plan, Inc.
754
Non-Postal
Standard Self
Monthly
597.69
Humana Health Plan, Inc.
755
Non-Postal
Standard Self & Family
Monthly
1286.25
Humana Health Plan, Inc.
756
Non-Postal
Standard Self Plus One
Monthly
1280.48
Humana Health Plan, Inc.
9F1
Non-Postal
High Self
Monthly
2129.01
Humana Health Plan, Inc.
9F2
Non-Postal
High Self & Family
Monthly
4731.66
Humana Health Plan, Inc.
9F3
Non-Postal
High Self Plus One
Monthly
4572.71
Humana Health Plan, Inc.
AB1
Non-Postal
Basic Self
Monthly
385.77
Humana Health Plan, Inc.
AB2
Non-Postal
Basic Self & Family
Monthly
809.43
Humana Health Plan, Inc.
AB3
Non-Postal
Basic Self Plus One
Monthly
824.87
Humana Health Plan, Inc.
AB4
Non-Postal
Standard Self
Monthly
952.03
Humana Health Plan, Inc.
AB5
Non-Postal
Standard Self & Family
Monthly
2083.54
Humana Health Plan, Inc.
AB6
Non-Postal
Standard Self Plus One
Monthly
2042.34
Humana Health Plan, Inc.
RW1
Non-Postal
Basic Self
Monthly
372.06
Humana Health Plan, Inc.
RW2
Non-Postal
Basic Self & Family
Monthly
778.53
Humana Health Plan, Inc.
RW3
Non-Postal
Basic Self Plus One
Monthly
795.32
UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced)
L91
Non-Postal
Value Self
Monthly
174.25
UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced)
L92
Non-Postal
Value Self & Family
Monthly
418.2
UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced)
L93
Non-Postal
Value Self Plus One
Monthly
370.29
UnitedHealthcare Insurance Company, Inc. Choice Plus Primary
AS1
Non-Postal
High Self
Monthly
177.95
UnitedHealthcare Insurance Company, Inc. Choice Plus Primary
AS2
Non-Postal
High Self & Family
Monthly
420.84
UnitedHealthcare Insurance Company, Inc. Choice Plus Primary
AS3
Non-Postal
High Self Plus One
Monthly
382.58
UnitedHealthcare Insurance Company, Inc. Choice Primary
Y81
Non-Postal
High Self
Monthly
168.85
UnitedHealthcare Insurance Company, Inc. Choice Primary
Y82
Non-Postal
High Self & Family
Monthly
399.34
UnitedHealthcare Insurance Company, Inc. Choice Primary
Y83
Non-Postal
High Self Plus One
Monthly
363.03
U.S. Office of Personnel Management
1900 E Street, NW, Washington, DC 20415
202-606-1800
Federal Relay Service