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Tribal Premium Rates for the Federal Employees Health Benefits Program
FFS (Fee-for-Service/Nationwide Plans)
Nationwide APWU Health Plan - CDHP Self
474
597.68
597.68
448.26
149.42
0.00
Nationwide APWU Health Plan - CDHP Self & Family
475
1417.09
1417.09
1062.82
354.27
0.00
Nationwide APWU Health Plan - CDHP Self Plus One
476
1299.00
1299.00
974.25
324.75
0.00
Nationwide APWU Health Plan - High Self
471
726.22
726.22
510.84
215.38
-12.12
Nationwide APWU Health Plan - High Self & Family
472
1742.91
1742.91
1184.02
558.89
-45.83
Nationwide APWU Health Plan - High Self Plus One
473
1525.03
1525.03
1092.26
432.77
-25.67
Nationwide Blue Cross and Blue Shield Service Benefit Plan Basic Option - Basic Self
111
638.95
658.19
493.64
164.55
4.81
Nationwide Blue Cross and Blue Shield Service Benefit Plan Basic Option - Basic Self & Family
112
1522.21
1598.33
1184.02
414.31
30.29
Nationwide Blue Cross and Blue Shield Service Benefit Plan Basic Option - Basic Self Plus One
113
1436.15
1479.25
1092.26
386.99
17.43
Nationwide Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - FEP Blue Focus Self
131
460.59
460.59
345.44
115.15
0.00
Nationwide Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - FEP Blue Focus Self & Family
132
1089.18
1089.18
816.89
272.29
0.00
Nationwide Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - FEP Blue Focus Self Plus One
133
990.21
990.21
742.66
247.55
0.00
Nationwide Blue Cross and Blue Shield Service Benefit Plan Standard Option - Standard Self
104
741.89
764.14
510.84
253.30
10.13
Nationwide Blue Cross and Blue Shield Service Benefit Plan Standard Option - Standard Self & Family
105
1719.32
1805.29
1184.02
621.27
40.14
Nationwide Blue Cross and Blue Shield Service Benefit Plan Standard Option - Standard Self Plus One
106
1622.42
1671.09
1092.26
578.83
23.00
Nationwide Compass Rose Health Plan - High Self
421
696.28
731.10
510.84
220.26
22.70
Nationwide Compass Rose Health Plan - High Self & Family
422
1671.09
1754.65
1184.02
570.63
37.73
Nationwide Compass Rose Health Plan - High Self Plus One
423
1531.83
1608.43
1092.26
516.17
50.93
Nationwide GEHA Benefit Plan - High Self
311
728.33
739.25
510.84
228.41
-1.20
Nationwide GEHA Benefit Plan - High Self & Family
312
1816.25
1843.53
1184.02
659.51
-18.55
Nationwide GEHA Benefit Plan - High Self Plus One
313
1602.32
1626.37
1092.26
534.11
-1.62
Nationwide GEHA Benefit Plan - Standard Self
314
509.45
524.72
393.54
131.18
3.82
Nationwide GEHA Benefit Plan - Standard Self & Family
315
1283.66
1347.84
1010.88
336.96
16.05
Nationwide GEHA Benefit Plan - Standard Self Plus One
316
1095.34
1128.21
846.16
282.05
8.22
Nationwide GEHA HDHP - HDHP Self
341
508.78
513.85
385.39
128.46
1.27
Nationwide GEHA HDHP - HDHP Self & Family
342
1262.50
1300.35
975.26
325.09
9.47
Nationwide GEHA HDHP - HDHP Self Plus One
343
1093.86
1104.81
828.61
276.20
2.74
Nationwide GEHA Indemnity Benefit Plan - Elevate Plus Self
251
New Plan
629.83
472.37
157.46
New Plan
Nationwide GEHA Indemnity Benefit Plan - Elevate Plus Self & Family
252
New Plan
1561.97
1171.48
390.49
New Plan
Nationwide GEHA Indemnity Benefit Plan - Elevate Plus Self Plus One
253
New Plan
1461.18
1092.26
368.92
New Plan
Nationwide GEHA Indemnity Benefit Plan - Elevate Self
254
New Plan
410.13
307.60
102.53
New Plan
Nationwide GEHA Indemnity Benefit Plan - Elevate Self & Family
255
New Plan
1148.40
861.30
287.10
New Plan
Nationwide GEHA Indemnity Benefit Plan - Elevate Self Plus One
256
New Plan
943.32
707.49
235.83
New Plan
Nationwide MHBP Consumer Option - HDHP Self
481
562.03
573.28
429.96
143.32
2.81
Nationwide MHBP Consumer Option - HDHP Self & Family
482
1305.94
1332.07
999.05
333.02
6.54
Nationwide MHBP Consumer Option - HDHP Self Plus One
483
1243.78
1268.65
951.49
317.16
6.22
Nationwide MHBP Standard Option - Standard Self
454
576.64
570.85
428.14
142.71
-1.45
Nationwide MHBP Standard Option - Standard Self & Family
455
1340.04
1326.65
994.99
331.66
-3.35
Nationwide MHBP Standard Option - Standard Self Plus One
456
1327.28
1314.02
985.52
328.50
-3.32
Nationwide MHBP Value Plan - Value Self
414
477.17
453.31
339.98
113.33
-5.96
Nationwide MHBP Value Plan - Value Self & Family
415
1153.19
1095.53
821.65
273.88
-14.42
Nationwide MHBP Value Plan - Value Self Plus One
416
1130.61
1074.08
805.56
268.52
-14.13
Nationwide NALC Health Benefit Plan - CDHP Self
324
473.53
473.53
355.15
118.38
0.00
Nationwide NALC Health Benefit Plan - CDHP Self & Family
325
1067.67
1089.03
816.77
272.26
5.34
Nationwide NALC Health Benefit Plan - CDHP Self Plus One
326
1034.35
1044.68
783.51
261.17
2.58
Nationwide NALC Health Benefit Plan - High Self
321
682.09
707.66
510.84
196.82
13.45
Nationwide NALC Health Benefit Plan - High Self & Family
322
1531.68
1592.96
1184.02
408.94
15.45
Nationwide NALC Health Benefit Plan - High Self Plus One
323
1501.44
1565.27
1092.26
473.01
38.16
Nationwide NALC Health Benefit Plan - Value Self
KM1
388.64
388.64
291.48
97.16
0.00
Nationwide NALC Health Benefit Plan - Value Self & Family
KM2
876.63
894.16
670.62
223.54
4.38
Nationwide NALC Health Benefit Plan - Value Self Plus One
KM3
848.86
857.35
643.01
214.34
2.13
Nationwide SAMBA Health Benefit Plan - High Self
441
912.69
901.75
510.84
390.91
-23.06
Nationwide SAMBA Health Benefit Plan - High Self & Family
442
2190.44
2164.15
1184.02
980.13
-72.12
Nationwide SAMBA Health Benefit Plan - High Self Plus One
443
2007.89
1983.82
1092.26
891.56
-49.74
Nationwide SAMBA Health Benefit Plan - Standard Self
444
686.90
680.51
510.38
170.13
-18.05
Nationwide SAMBA Health Benefit Plan - Standard Self & Family
445
1579.93
1552.55
1164.41
388.14
-53.60
Nationwide SAMBA Health Benefit Plan - Standard Self Plus One
446
1511.23
1464.67
1092.26
372.41
-72.23
U.S. Office of Personnel Management
1900 E Street, NW, Washington, DC 20415
202-606-1800
Federal Relay Service