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Healthcare

Temporary Continuation of Coverage (TCC) Premium Rates and Former Spouse Premiums

FFS (Fee-for-Service/Nationwide Plans)

Plan - Option Enrollment Code 2020 TCC Premium 2021 TCC Monthly Premiums - Total Premium 2021 TCC Monthly Premiums - Government Pays 2021 TCC Monthly Premiums - Employee Pays 2021 TCC Monthly Premiums - Change in Employee Payment 2020 Former Spouse Premium 2021 Former Spouse Monthly Premiums - Total Premium 2021 Former Spouse Monthly Premiums - Government Pays 2021 Former Spouse Monthly Premiums - Employee Pays 2021 Former Spouse Monthly Premiums - Change in Employee Payment
Nationwide APWU Health Plan - CDHP Self 474 609.63 615.73 0.00 615.73 6.10 597.68 603.66 0.00 603.66 5.98
Nationwide APWU Health Plan - CDHP Self & Family 475 1445.43 1459.89 0.00 1459.89 14.46 1417.09 1431.26 0.00 1431.26 14.17
Nationwide APWU Health Plan - CDHP Self Plus One 476 1324.98 1338.22 0.00 1338.22 13.24 1299.00 1311.98 0.00 1311.98 12.98
Nationwide APWU Health Plan - High Self 471 740.74 762.98 0.00 762.98 22.24 726.22 748.02 0.00 748.02 21.80
Nationwide APWU Health Plan - High Self & Family 472 1777.77 1831.09 0.00 1831.09 53.32 1742.91 1795.19 0.00 1795.19 52.28
Nationwide APWU Health Plan - High Self Plus One 473 1555.53 1602.19 0.00 1602.19 46.66 1525.03 1570.77 0.00 1570.77 45.74
Nationwide Blue Cross and Blue Shield Service Benefit Plan Basic Option - Basic Self 111 671.35 694.86 0.00 694.86 23.51 658.19 681.24 0.00 681.24 23.05
Nationwide Blue Cross and Blue Shield Service Benefit Plan Basic Option - Basic Self & Family 112 1630.30 1687.38 0.00 1687.38 57.08 1598.33 1654.29 0.00 1654.29 55.96
Nationwide Blue Cross and Blue Shield Service Benefit Plan Basic Option - Basic Self Plus One 113 1508.84 1561.65 0.00 1561.65 52.81 1479.25 1531.03 0.00 1531.03 51.78
Nationwide Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - FEP Blue Focus Self 131 469.80 469.80 0.00 469.80 0.00 460.59 460.59 0.00 460.59 0.00
Nationwide Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - FEP Blue Focus Self & Family 132 1110.96 1110.96 0.00 1110.96 0.00 1089.18 1089.18 0.00 1089.18 0.00
Nationwide Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - FEP Blue Focus Self Plus One 133 1010.01 1010.01 0.00 1010.01 0.00 990.21 990.21 0.00 990.21 0.00
Nationwide Blue Cross and Blue Shield Service Benefit Plan Standard Option - Standard Self 104 779.42 806.72 0.00 806.72 27.30 764.14 790.90 0.00 790.90 26.76
Nationwide Blue Cross and Blue Shield Service Benefit Plan Standard Option - Standard Self & Family 105 1841.40 1905.84 0.00 1905.84 64.44 1805.29 1868.47 0.00 1868.47 63.18
Nationwide Blue Cross and Blue Shield Service Benefit Plan Standard Option - Standard Self Plus One 106 1704.51 1764.18 0.00 1764.18 59.67 1671.09 1729.59 0.00 1729.59 58.50
Nationwide Compass Rose Health Plan - High Self 421 745.72 768.09 0.00 768.09 22.37 731.10 753.03 0.00 753.03 21.93
Nationwide Compass Rose Health Plan - High Self & Family 422 1789.74 1843.43 0.00 1843.43 53.69 1754.65 1807.28 0.00 1807.28 52.63
Nationwide Compass Rose Health Plan - High Self Plus One 423 1640.60 1689.81 0.00 1689.81 49.21 1608.43 1656.68 0.00 1656.68 48.25
Nationwide Foreign Service Benefit Plan - High Self 401 609.85 634.32 0.00 634.32 24.47 597.89 621.88 0.00 621.88 23.99
Nationwide Foreign Service Benefit Plan - High Self & Family 402 1508.76 1569.15 0.00 1569.15 60.39 1479.18 1538.38 0.00 1538.38 59.20
Nationwide Foreign Service Benefit Plan - High Self Plus One 403 1493.76 1538.58 0.00 1538.58 44.82 1464.47 1508.41 0.00 1508.41 43.94
Nationwide GEHA Benefit Plan - High Self 311 754.04 772.88 0.00 772.88 18.84 739.25 757.73 0.00 757.73 18.48
Nationwide GEHA Benefit Plan - High Self & Family 312 1880.40 1936.80 0.00 1936.80 56.40 1843.53 1898.82 0.00 1898.82 55.29
Nationwide GEHA Benefit Plan - High Self Plus One 313 1658.90 1700.35 0.00 1700.35 41.45 1626.37 1667.01 0.00 1667.01 40.64
Nationwide GEHA Benefit Plan - Standard Self 314 535.21 553.96 0.00 553.96 18.75 524.72 543.10 0.00 543.10 18.38
Nationwide GEHA Benefit Plan - Standard Self & Family 315 1374.80 1457.27 0.00 1457.27 82.47 1347.84 1428.70 0.00 1428.70 80.86
Nationwide GEHA Benefit Plan - Standard Self Plus One 316 1150.77 1191.05 0.00 1191.05 40.28 1128.21 1167.70 0.00 1167.70 39.49
Nationwide GEHA HDHP - HDHP Self 341 524.13 542.49 0.00 542.49 18.36 513.85 531.85 0.00 531.85 18.00
Nationwide GEHA HDHP - HDHP Self & Family 342 1326.36 1405.96 0.00 1405.96 79.60 1300.35 1378.39 0.00 1378.39 78.04
Nationwide GEHA HDHP - HDHP Self Plus One 343 1126.91 1166.35 0.00 1166.35 39.44 1104.81 1143.48 0.00 1143.48 38.67
Nationwide GEHA Indemnity Benefit Plan - Elevate Plus Self 251 642.43 666.18 0.00 666.18 23.75 629.83 653.12 0.00 653.12 23.29
Nationwide GEHA Indemnity Benefit Plan - Elevate Plus Self & Family 252 1593.21 1652.13 0.00 1652.13 58.92 1561.97 1619.74 0.00 1619.74 57.77
Nationwide GEHA Indemnity Benefit Plan - Elevate Plus Self Plus One 253 1490.40 1532.13 0.00 1532.13 41.73 1461.18 1502.09 0.00 1502.09 40.91
Nationwide GEHA Indemnity Benefit Plan - Elevate Self 254 418.33 418.33 0.00 418.33 0.00 410.13 410.13 0.00 410.13 0.00
Nationwide GEHA Indemnity Benefit Plan - Elevate Self & Family 255 1171.37 1171.37 0.00 1171.37 0.00 1148.40 1148.40 0.00 1148.40 0.00
Nationwide GEHA Indemnity Benefit Plan - Elevate Self Plus One 256 962.19 962.19 0.00 962.19 0.00 943.32 943.32 0.00 943.32 0.00
Nationwide MHBP Consumer Option - HDHP Self 481 584.75 643.20 0.00 643.20 58.45 573.28 630.59 0.00 630.59 57.31
Nationwide MHBP Consumer Option - HDHP Self & Family 482 1358.71 1494.58 0.00 1494.58 135.87 1332.07 1465.27 0.00 1465.27 133.20
Nationwide MHBP Consumer Option - HDHP Self Plus One 483 1294.02 1423.42 0.00 1423.42 129.40 1268.65 1395.51 0.00 1395.51 126.86
Nationwide MHBP Standard Option - Standard Self 454 582.27 634.70 0.00 634.70 52.43 570.85 622.25 0.00 622.25 51.40
Nationwide MHBP Standard Option - Standard Self & Family 455 1353.18 1474.98 0.00 1474.98 121.80 1326.65 1446.06 0.00 1446.06 119.41
Nationwide MHBP Standard Option - Standard Self Plus One 456 1340.30 1460.95 0.00 1460.95 120.65 1314.02 1432.30 0.00 1432.30 118.28
Nationwide MHBP Value Plan - Value Self 414 462.38 471.64 0.00 471.64 9.26 453.31 462.39 0.00 462.39 9.08
Nationwide MHBP Value Plan - Value Self & Family 415 1117.44 1139.81 0.00 1139.81 22.37 1095.53 1117.46 0.00 1117.46 21.93
Nationwide MHBP Value Plan - Value Self Plus One 416 1095.56 1117.49 0.00 1117.49 21.93 1074.08 1095.58 0.00 1095.58 21.50
Nationwide NALC Health Benefit Plan - CDHP Self 324 483.00 483.00 0.00 483.00 0.00 473.53 473.53 0.00 473.53 0.00
Nationwide NALC Health Benefit Plan - CDHP Self & Family 325 1110.81 1121.93 0.00 1121.93 11.12 1089.03 1099.93 0.00 1099.93 10.90
Nationwide NALC Health Benefit Plan - CDHP Self Plus One 326 1065.57 1065.57 0.00 1065.57 0.00 1044.68 1044.68 0.00 1044.68 0.00
Nationwide NALC Health Benefit Plan - High Self 321 721.81 743.47 0.00 743.47 21.66 707.66 728.89 0.00 728.89 21.23
Nationwide NALC Health Benefit Plan - High Self & Family 322 1624.82 1681.67 0.00 1681.67 56.85 1592.96 1648.70 0.00 1648.70 55.74
Nationwide NALC Health Benefit Plan - High Self Plus One 323 1596.58 1644.46 0.00 1644.46 47.88 1565.27 1612.22 0.00 1612.22 46.95
Nationwide NALC Health Benefit Plan - Value Self KM1 396.41 396.41 0.00 396.41 0.00 388.64 388.64 0.00 388.64 0.00
Nationwide NALC Health Benefit Plan - Value Self & Family KM2 912.04 921.17 0.00 921.17 9.13 894.16 903.11 0.00 903.11 8.95
Nationwide NALC Health Benefit Plan - Value Self Plus One KM3 874.50 874.50 0.00 874.50 0.00 857.35 857.35 0.00 857.35 0.00
Nationwide Panama Canal Area Benefit Plan - High Self 431 641.10 673.17 0.00 673.17 32.07 628.53 659.97 0.00 659.97 31.44
Nationwide Panama Canal Area Benefit Plan - High Self & Family 432 1338.24 1405.14 0.00 1405.14 66.90 1312.00 1377.59 0.00 1377.59 65.59
Nationwide Panama Canal Area Benefit Plan - High Self Plus One 433 1279.57 1343.54 0.00 1343.54 63.97 1254.48 1317.20 0.00 1317.20 62.72
Nationwide Rural Carrier Benefit Plan - High Self 381 791.18 813.94 0.00 813.94 22.76 775.67 797.98 0.00 797.98 22.31
Nationwide Rural Carrier Benefit Plan - High Self & Family 382 1622.14 1727.58 0.00 1727.58 105.44 1590.33 1693.71 0.00 1693.71 103.38
Nationwide Rural Carrier Benefit Plan - High Self Plus One 383 1566.89 1644.71 0.00 1644.71 77.82 1536.17 1612.46 0.00 1612.46 76.29
Nationwide SAMBA Health Benefit Plan - High Self 441 919.79 892.17 0.00 892.17 -27.62 901.75 874.68 0.00 874.68 -27.07
Nationwide SAMBA Health Benefit Plan - High Self & Family 442 2207.43 2141.20 0.00 2141.20 -66.23 2164.15 2099.22 0.00 2099.22 -64.93
Nationwide SAMBA Health Benefit Plan - High Self Plus One 443 2023.50 1962.79 0.00 1962.79 -60.71 1983.82 1924.30 0.00 1924.30 -59.52
Nationwide SAMBA Health Benefit Plan - Standard Self 444 694.12 714.94 0.00 714.94 20.82 680.51 700.92 0.00 700.92 20.41
Nationwide SAMBA Health Benefit Plan - Standard Self & Family 445 1583.60 1631.11 0.00 1631.11 47.51 1552.55 1599.13 0.00 1599.13 46.58
Nationwide SAMBA Health Benefit Plan - Standard Self Plus One 446 1493.96 1538.78 0.00 1538.78 44.82 1464.67 1508.61 0.00 1508.61 43.94
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