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Healthcare

Tribal Premium Rates for the Federal Employees Health Benefits Program

FFS (Fee-for-Service/Nationwide Plans)

Plan - Option Enrollment Code 2018 Total Monthly Premium 2019 Monthly Premium Rates - Total Premium 2019 Monthly Premium Rates - Tribal Employer Pays 2019 Monthly Premium Rates - Employee Pays 2019 Monthly Premium Rates - Change in Employee Payment
Nationwide 10 - Standard Self 104 741.89 741.89 498.72 243.17 -2.01
Nationwide 10 - Standard Self & Family 105 1719.32 1719.32 1138.19 581.13 -8.10
Nationwide 10 - Standard Self Plus One 106 1622.42 1622.42 1066.59 555.83 -2.76
Nationwide 11 - Basic Self 111 638.95 638.95 479.21 159.74 0.00
Nationwide 11 - Basic Self & Family 112 1522.21 1522.21 1138.19 384.02 -8.10
Nationwide 11 - Basic Self Plus One 113 1436.15 1436.15 1066.59 369.56 -2.76
Nationwide 31 - High Self 311 721.11 728.33 498.72 229.61 5.21
Nationwide 31 - High Self & Family 312 1713.47 1816.25 1138.19 678.06 94.68
Nationwide 31 - High Self Plus One 313 1586.46 1602.32 1066.59 535.73 13.10
Nationwide 31 - Standard Self 314 476.13 509.45 382.09 127.36 8.33
Nationwide 31 - Standard Self & Family 315 1126.02 1283.66 962.75 320.91 39.41
Nationwide 31 - Standard Self Plus One 316 1023.69 1095.34 821.51 273.83 17.91
Nationwide 32 - CDHP Self 324 464.23 473.53 355.15 118.38 2.32
Nationwide 32 - CDHP Self & Family 325 1026.61 1067.67 800.75 266.92 10.27
Nationwide 32 - CDHP Self Plus One 326 1004.23 1034.35 775.76 258.59 7.53
Nationwide 32 - High Self 321 667.42 682.09 498.72 183.37 12.66
Nationwide 32 - High Self & Family 322 1498.71 1531.68 1138.19 393.49 18.81
Nationwide 32 - High Self Plus One 323 1469.13 1501.44 1066.59 434.85 29.55
Nationwide 34 - HDHP Self 341 501.26 508.78 381.59 127.19 1.88
Nationwide 34 - HDHP Self & Family 342 1185.43 1262.50 946.88 315.62 19.26
Nationwide 34 - HDHP Self Plus One 343 1077.70 1093.86 820.40 273.46 4.04
Nationwide 41 - Value Self 414 497.06 477.17 357.88 119.29 -4.97
Nationwide 41 - Value Self & Family 415 1201.24 1153.19 864.89 288.30 -12.01
Nationwide 41 - Value Self Plus One 416 1177.71 1130.61 847.96 282.65 -11.78
Nationwide 42 - High Self 421 696.28 696.28 498.72 197.56 -2.01
Nationwide 42 - High Self & Family 422 1671.09 1671.09 1138.19 532.90 -8.10
Nationwide 42 - High Self Plus One 423 1531.83 1531.83 1066.59 465.24 -2.76
Nationwide 44 - High Self 441 912.69 912.69 498.72 413.97 -2.01
Nationwide 44 - High Self & Family 442 2190.44 2190.44 1138.19 1052.25 -8.10
Nationwide 44 - High Self Plus One 443 2007.89 2007.89 1066.59 941.30 -2.76
Nationwide 44 - Standard Self 444 708.15 686.90 498.72 188.18 -23.26
Nationwide 44 - Standard Self & Family 445 1628.77 1579.93 1138.19 441.74 -56.94
Nationwide 44 - Standard Self Plus One 446 1557.96 1511.23 1066.59 444.64 -49.49
Nationwide 45 - Standard Self 454 582.44 576.64 432.48 144.16 -1.45
Nationwide 45 - Standard Self & Family 455 1353.56 1340.04 1005.03 335.01 -3.38
Nationwide 45 - Standard Self Plus One 456 1340.69 1327.28 995.46 331.82 -3.35
Nationwide 47 - CDHP Self 474 554.43 597.68 448.26 149.42 10.81
Nationwide 47 - CDHP Self & Family 475 1330.59 1417.09 1062.82 354.27 21.62
Nationwide 47 - CDHP Self Plus One 476 1219.73 1299.00 974.25 324.75 19.82
Nationwide 47 - High Self 471 698.30 726.22 498.72 227.50 25.91
Nationwide 47 - High Self & Family 472 1675.87 1742.91 1138.19 604.72 58.94
Nationwide 47 - High Self Plus One 473 1466.38 1525.03 1066.59 458.44 55.89
Nationwide 48 - HDHP Self 481 567.71 562.03 421.52 140.51 -1.42
Nationwide 48 - HDHP Self & Family 482 1319.13 1305.94 979.46 326.48 -3.30
Nationwide 48 - HDHP Self Plus One 483 1256.34 1243.78 932.84 310.94 -3.14
Nationwide Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - FEP Blue Focus Self 131 New Plan 460.59 345.44 115.15 New Plan
Nationwide Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - FEP Blue Focus Self & Family 132 New Plan 1089.18 816.89 272.29 New Plan
Nationwide Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - FEP Blue Focus Self Plus One 133 New Plan 990.21 742.66 247.55 New Plan
Nationwide KM - Value Self KM1 381.01 388.64 291.48 97.16 1.91
Nationwide KM - Value Self & Family KM2 842.90 876.63 657.47 219.16 8.44
Nationwide KM - Value Self Plus One KM3 824.14 848.86 636.65 212.21 6.18
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