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2023 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
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
Aetna Open Access
P31
Non-Postal
High Self
Monthly
1175.24
Aetna Open Access
P32
Non-Postal
High Self & Family
Monthly
2888.97
Aetna Open Access
P33
Non-Postal
High Self Plus One
Monthly
2957.54
Aetna Open Access
P34
Non-Postal
Basic Self
Monthly
1191.3
Aetna Open Access
P35
Non-Postal
Basic Self & Family
Monthly
2746.36
Aetna Open Access
P36
Non-Postal
Basic Self Plus One
Monthly
2816.28
Aetna Open Access
YE1
Non-Postal
High Self
Monthly
640.96
Aetna Open Access
YE2
Non-Postal
High Self & Family
Monthly
1697.74
Aetna Open Access
YE3
Non-Postal
High Self Plus One
Monthly
1778.1
Geisinger Health Plan
AJ1
Non-Postal
Basic Self
Monthly
302.81
Geisinger Health Plan
AJ2
Non-Postal
Basic Self & Family
Monthly
656.96
Geisinger Health Plan
AJ3
Non-Postal
Basic Self Plus One
Monthly
655.76
Geisinger Health Plan
GG4
Non-Postal
Standard Self
Monthly
394.24
Geisinger Health Plan
GG5
Non-Postal
Standard Self & Family
Monthly
866.24
Geisinger Health Plan
GG6
Non-Postal
Standard Self Plus One
Monthly
853.28
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
V41
Non-Postal
HDHP Self
Monthly
166.3
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
V42
Non-Postal
HDHP Self & Family
Monthly
382.46
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
V43
Non-Postal
HDHP Self Plus One
Monthly
357.53
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
LR1
Non-Postal
High Self
Monthly
345.28
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
LR2
Non-Postal
High Self & Family
Monthly
827.19
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
LR3
Non-Postal
High Self Plus One
Monthly
737.71
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
UPMC Health Plan
8W4
Non-Postal
HDHP Self
Monthly
176.19
UPMC Health Plan
8W5
Non-Postal
HDHP Self & Family
Monthly
406.44
UPMC Health Plan
8W6
Non-Postal
HDHP Self Plus One
Monthly
390.48
UPMC Health Plan
UW4
Non-Postal
Standard Self
Monthly
183.08
UPMC Health Plan
UW5
Non-Postal
Standard Self & Family
Monthly
431.4
UPMC Health Plan
UW6
Non-Postal
Standard Self Plus One
Monthly
432.12
U.S. Office of Personnel Management
1900 E Street, NW, Washington, DC 20415
202-606-1800
Federal Relay Service
