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2023 Plan Information for Indiana
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
JS1
Non-Postal
CDHP Self
Monthly
603.67
Aetna HealthFund CDHP and Aetna Value Plan
JS2
Non-Postal
CDHP Self & Family
Monthly
1334.15
Aetna HealthFund CDHP and Aetna Value Plan
JS3
Non-Postal
CDHP Self Plus One
Monthly
1418.08
Aetna HealthFund CDHP and Aetna Value Plan
JS4
Non-Postal
Value Self
Monthly
544.24
Aetna HealthFund CDHP and Aetna Value Plan
JS5
Non-Postal
Value Self & Family
Monthly
1202.31
Aetna HealthFund CDHP and Aetna Value Plan
JS6
Non-Postal
Value Self Plus One
Monthly
1287.61
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
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
DT1
Non-Postal
HDHP Self
Monthly
127.65
Humana CoverageFirst and Humana Value Plan
DT2
Non-Postal
HDHP Self & Family
Monthly
318.12
Humana CoverageFirst and Humana Value Plan
DT3
Non-Postal
HDHP Self Plus One
Monthly
280.02
Humana CoverageFirst and Humana Value Plan
FZ1
Non-Postal
HDHP Self
Monthly
103.42
Humana CoverageFirst and Humana Value Plan
FZ2
Non-Postal
HDHP Self & Family
Monthly
257.54
Humana CoverageFirst and Humana Value Plan
FZ3
Non-Postal
HDHP Self Plus One
Monthly
226.71
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 CoverageFirst and Humana Value Plan
TC1
Non-Postal
CDHP Self
Monthly
243.53
Humana CoverageFirst and Humana Value Plan
TC2
Non-Postal
CDHP Self & Family
Monthly
489.28
Humana CoverageFirst and Humana Value Plan
TC3
Non-Postal
CDHP Self Plus One
Monthly
518.98
Humana CoverageFirst and Humana Value Plan
TC4
Non-Postal
Value Self
Monthly
156.52
Humana CoverageFirst and Humana Value Plan
TC5
Non-Postal
Value Self & Family
Monthly
352.19
Humana CoverageFirst and Humana Value Plan
TC6
Non-Postal
Value Self Plus One
Monthly
336.54
Humana CoverageFirst and Humana Value Plan
X31
Non-Postal
CDHP Self
Monthly
389.28
Humana CoverageFirst and Humana Value Plan
X32
Non-Postal
CDHP Self & Family
Monthly
817.27
Humana CoverageFirst and Humana Value Plan
X33
Non-Postal
CDHP Self Plus One
Monthly
832.37
Humana CoverageFirst and Humana Value Plan
X34
Non-Postal
Value Self
Monthly
183.13
Humana CoverageFirst and Humana Value Plan
X35
Non-Postal
Value Self & Family
Monthly
412.04
Humana CoverageFirst and Humana Value Plan
X36
Non-Postal
Value Self Plus One
Monthly
393.73
Humana Health Plan of Ohio, Inc.
A64
Non-Postal
Standard Self
Monthly
741.73
Humana Health Plan of Ohio, Inc.
A65
Non-Postal
Standard Self & Family
Monthly
1610.31
Humana Health Plan of Ohio, Inc.
A66
Non-Postal
Standard Self Plus One
Monthly
1590.16
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.
MH4
Non-Postal
Standard Self
Monthly
535.99
Humana Health Plan, Inc.
MH5
Non-Postal
Standard Self & Family
Monthly
1147.36
Humana Health Plan, Inc.
MH6
Non-Postal
Standard Self Plus One
Monthly
1147.75
Indiana University Health Plans, Inc
FS1
Non-Postal
High Self
Monthly
151.56
Indiana University Health Plans, Inc
FS2
Non-Postal
High Self & Family
Monthly
424.36
Indiana University Health Plans, Inc
FS3
Non-Postal
High Self Plus One
Monthly
333.43
U.S. Office of Personnel Management
1900 E Street, NW, Washington, DC 20415
202-606-1800
Federal Relay Service