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2025 Plan Information for Pennsylvania
Choose a Location, Employee Type, & Payment Period
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Texas
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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
292.93
Aetna Direct
225
Non-Postal
HDHP Self & Family
Monthly
523.23
Aetna Direct
226
Non-Postal
HDHP Self Plus One
Monthly
621.86
Aetna Direct
N61
Non-Postal
CDHP Self
Monthly
166.53
Aetna Direct
N62
Non-Postal
CDHP Self & Family
Monthly
419.96
Aetna Direct
N63
Non-Postal
CDHP Self Plus One
Monthly
365.21
Aetna Direct
Z24
Non-Postal
Advantage Self
Monthly
115.34
Aetna Direct
Z25
Non-Postal
Advantage Self & Family
Monthly
305.63
Aetna Direct
Z26
Non-Postal
Advantage Self Plus One
Monthly
253.74
Aetna HealthFund CDHP and Aetna Value Plan
H41
Non-Postal
CDHP Self
Monthly
497.38
Aetna HealthFund CDHP and Aetna Value Plan
H42
Non-Postal
CDHP Self & Family
Monthly
1058.39
Aetna HealthFund CDHP and Aetna Value Plan
H43
Non-Postal
CDHP Self Plus One
Monthly
1172.32
Aetna HealthFund CDHP and Aetna Value Plan
H44
Non-Postal
Value Self
Monthly
759.11
Aetna HealthFund CDHP and Aetna Value Plan
H45
Non-Postal
Value Self & Family
Monthly
1676.78
Aetna HealthFund CDHP and Aetna Value Plan
H46
Non-Postal
Value Self Plus One
Monthly
1752.73
Aetna Open Access
P31
Non-Postal
High Self
Monthly
1180.64
Aetna Open Access
P32
Non-Postal
High Self & Family
Monthly
2880.82
Aetna Open Access
P33
Non-Postal
High Self Plus One
Monthly
2976.16
Aetna Open Access
P34
Non-Postal
Basic Self
Monthly
1149.01
Aetna Open Access
P35
Non-Postal
Basic Self & Family
Monthly
2618.35
Aetna Open Access
P36
Non-Postal
Basic Self Plus One
Monthly
2716.22
Aetna Open Access
YE1
Non-Postal
High Self
Monthly
1050.99
Aetna Open Access
YE2
Non-Postal
High Self & Family
Monthly
2713.25
Aetna Open Access
YE3
Non-Postal
High Self Plus One
Monthly
2810.28
Geisinger Health Plan
AJ1
Non-Postal
Basic Self
Monthly
365.78
Geisinger Health Plan
AJ2
Non-Postal
Basic Self & Family
Monthly
768.6
Geisinger Health Plan
AJ3
Non-Postal
Basic Self Plus One
Monthly
777.45
Geisinger Health Plan
GG4
Non-Postal
Standard Self
Monthly
461.26
Geisinger Health Plan
GG5
Non-Postal
Standard Self & Family
Monthly
987.24
Geisinger Health Plan
GG6
Non-Postal
Standard Self Plus One
Monthly
983.78
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
V41
Non-Postal
HDHP Self
Monthly
175.54
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
V42
Non-Postal
HDHP Self & Family
Monthly
401.81
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
V43
Non-Postal
HDHP Self Plus One
Monthly
377.41
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
LR1
Non-Postal
High Self
Monthly
486.55
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
LR2
Non-Postal
High Self & Family
Monthly
1136.22
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
LR3
Non-Postal
High Self Plus One
Monthly
1026.27
UnitedHealthcare Insurance Company, Inc. Choice Plus Primary
AS1
Non-Postal
High Self
Monthly
205.69
UnitedHealthcare Insurance Company, Inc. Choice Plus Primary
AS2
Non-Postal
High Self & Family
Monthly
486.46
UnitedHealthcare Insurance Company, Inc. Choice Plus Primary
AS3
Non-Postal
High Self Plus One
Monthly
442.23
UnitedHealthcare Insurance Company, Inc. Choice Primary
Y81
Non-Postal
High Self
Monthly
176.44
UnitedHealthcare Insurance Company, Inc. Choice Primary
Y82
Non-Postal
High Self & Family
Monthly
417.28
UnitedHealthcare Insurance Company, Inc. Choice Primary
Y83
Non-Postal
High Self Plus One
Monthly
379.35
UPMC Health Plan
8W4
Non-Postal
HDHP Self
Monthly
178.39
UPMC Health Plan
8W5
Non-Postal
HDHP Self & Family
Monthly
474.48
UPMC Health Plan
8W6
Non-Postal
HDHP Self Plus One
Monthly
426.13
UPMC Health Plan
UW4
Non-Postal
Standard Self
Monthly
193.52
UPMC Health Plan
UW5
Non-Postal
Standard Self & Family
Monthly
574.88
UPMC Health Plan
UW6
Non-Postal
Standard Self Plus One
Monthly
480.2
U.S. Office of Personnel Management
1900 E Street, NW, Washington, DC 20415
202-606-1800
Federal Relay Service
