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Non-Postal Premium Rates for the Federal Employees Health Benefits Program
HMO (Regional Plans with Specific Service Areas)
Alabama Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Alabama Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Alabama Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Alabama Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Alabama Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Alabama Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
382.72 |
393.11 |
241.58 |
151.53 |
4.58 |
829.23 |
851.74 |
523.42 |
328.32 |
9.93 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
872.64 |
896.32 |
562.25 |
334.07 |
7.90 |
1890.72 |
1942.03 |
1218.21 |
723.82 |
17.12 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
864.00 |
887.45 |
517.46 |
369.99 |
10.11 |
1872.00 |
1922.81 |
1121.16 |
801.65 |
21.91 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
378.45 |
379.30 |
241.58 |
137.72 |
-4.96 |
819.98 |
821.82 |
523.42 |
298.40 |
-10.74 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
866.59 |
868.56 |
562.25 |
306.31 |
-13.81 |
1877.61 |
1881.88 |
1218.21 |
663.67 |
-29.92 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
849.59 |
851.52 |
517.46 |
334.06 |
-11.41 |
1840.78 |
1844.96 |
1121.16 |
723.80 |
-24.72 |
Alabama Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Alabama Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Alabama Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Alabama UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
242.68 |
276.68 |
207.51 |
69.17 |
8.50 |
525.81 |
599.47 |
449.60 |
149.87 |
18.42 |
Alabama UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
573.86 |
654.35 |
490.76 |
163.59 |
20.13 |
1243.36 |
1417.76 |
1063.32 |
354.44 |
43.60 |
Alabama UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
521.73 |
594.87 |
446.15 |
148.72 |
18.29 |
1130.42 |
1288.89 |
966.67 |
322.22 |
39.62 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LS1 |
209.88 |
224.24 |
168.18 |
56.06 |
3.59 |
454.74 |
485.85 |
364.39 |
121.46 |
7.78 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LS2 |
482.73 |
515.77 |
386.83 |
128.94 |
8.26 |
1045.92 |
1117.50 |
838.13 |
279.37 |
17.89 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LS3 |
451.25 |
482.12 |
361.59 |
120.53 |
7.72 |
977.71 |
1044.59 |
783.44 |
261.15 |
16.72 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KK1 |
329.48 |
354.94 |
241.58 |
113.36 |
19.65 |
713.87 |
769.04 |
523.42 |
245.62 |
42.59 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KK2 |
823.71 |
887.37 |
562.25 |
325.12 |
47.88 |
1784.71 |
1922.64 |
1218.21 |
704.43 |
103.74 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KK3 |
708.40 |
763.14 |
517.46 |
245.68 |
41.40 |
1534.87 |
1653.47 |
1121.16 |
532.31 |
89.70 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
233.88 |
266.18 |
199.64 |
66.54 |
8.07 |
506.74 |
576.72 |
432.54 |
144.18 |
17.50 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
553.03 |
629.51 |
472.13 |
157.38 |
19.12 |
1198.23 |
1363.94 |
1022.96 |
340.98 |
41.42 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
502.79 |
572.28 |
429.21 |
143.07 |
17.37 |
1089.38 |
1239.94 |
929.96 |
309.98 |
37.64 |
Alabama UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Alabama UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Alabama UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Alaska Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Alaska Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Alaska Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Alaska Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Alaska Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Alaska Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
JS4 |
495.45 |
505.19 |
241.58 |
263.61 |
3.93 |
1073.48 |
1094.58 |
523.42 |
571.16 |
8.52 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
JS5 |
1131.04 |
1153.29 |
562.25 |
591.04 |
6.47 |
2450.59 |
2498.80 |
1218.21 |
1280.59 |
14.02 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
JS6 |
1119.84 |
1141.88 |
517.46 |
624.42 |
8.70 |
2426.32 |
2474.07 |
1121.16 |
1352.91 |
18.85 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
JS1 |
463.38 |
466.12 |
241.58 |
224.54 |
-3.07 |
1003.99 |
1009.93 |
523.42 |
486.51 |
-6.64 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
JS2 |
1056.30 |
1062.53 |
562.25 |
500.28 |
-9.55 |
2288.65 |
2302.15 |
1218.21 |
1083.94 |
-20.69 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
JS3 |
1045.84 |
1052.00 |
517.46 |
534.54 |
-7.18 |
2265.99 |
2279.33 |
1121.16 |
1158.17 |
-15.56 |
Alaska Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Alaska Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Alaska Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Arizona Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Arizona Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Arizona Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Arizona Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Arizona Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Arizona Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
328.95 |
330.94 |
241.58 |
89.36 |
-3.82 |
712.73 |
717.04 |
523.42 |
193.62 |
-8.27 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
753.40 |
757.97 |
562.25 |
195.72 |
-11.21 |
1632.37 |
1642.27 |
1218.21 |
424.06 |
-24.29 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
738.63 |
743.12 |
517.46 |
225.66 |
-8.85 |
1600.37 |
1610.09 |
1121.16 |
488.93 |
-19.18 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
417.46 |
488.66 |
241.58 |
247.08 |
65.39 |
904.50 |
1058.76 |
523.42 |
535.34 |
141.68 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
952.20 |
1114.65 |
562.25 |
552.40 |
146.67 |
2063.10 |
2415.08 |
1218.21 |
1196.87 |
317.79 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
942.79 |
1103.63 |
517.46 |
586.17 |
147.50 |
2042.71 |
2391.20 |
1121.16 |
1270.04 |
319.59 |
Arizona Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Arizona Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Arizona Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Arizona Aetna Open Access - High Self |
WQ1 |
535.92 |
621.08 |
241.58 |
379.50 |
79.35 |
1161.16 |
1345.67 |
523.42 |
822.25 |
171.93 |
Arizona Aetna Open Access - High Self & Family |
WQ2 |
1301.20 |
1507.96 |
562.25 |
945.71 |
190.98 |
2819.27 |
3267.25 |
1218.21 |
2049.04 |
413.79 |
Arizona Aetna Open Access - High Self Plus One |
WQ3 |
1288.31 |
1493.01 |
517.46 |
975.55 |
191.36 |
2791.34 |
3234.86 |
1121.16 |
2113.70 |
414.62 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self |
R61 |
331.75 |
374.88 |
241.58 |
133.30 |
37.32 |
718.79 |
812.24 |
523.42 |
288.82 |
80.87 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
R62 |
746.43 |
843.46 |
562.25 |
281.21 |
81.25 |
1617.27 |
1827.50 |
1218.21 |
609.29 |
176.04 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
R63 |
713.25 |
805.98 |
517.46 |
288.52 |
79.39 |
1545.38 |
1746.29 |
1121.16 |
625.13 |
172.01 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self |
R64 |
265.17 |
299.64 |
224.73 |
74.91 |
8.62 |
574.54 |
649.22 |
486.92 |
162.30 |
18.67 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self & Family |
R65 |
596.62 |
674.18 |
505.64 |
168.54 |
19.39 |
1292.68 |
1460.72 |
1095.54 |
365.18 |
42.01 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
R66 |
570.11 |
644.22 |
483.17 |
161.05 |
18.52 |
1235.24 |
1395.81 |
1046.86 |
348.95 |
40.14 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self |
R94 |
241.76 |
263.52 |
197.64 |
65.88 |
5.44 |
523.81 |
570.96 |
428.22 |
142.74 |
11.79 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self & Family |
R95 |
543.95 |
592.90 |
444.68 |
148.22 |
12.23 |
1178.56 |
1284.62 |
963.47 |
321.15 |
26.51 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
R96 |
519.78 |
566.56 |
424.92 |
141.64 |
11.70 |
1126.19 |
1227.55 |
920.66 |
306.89 |
25.34 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self |
R91 |
303.64 |
330.96 |
241.58 |
89.38 |
13.47 |
657.89 |
717.08 |
523.42 |
193.66 |
29.19 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
R92 |
683.17 |
744.65 |
558.49 |
186.16 |
15.37 |
1480.20 |
1613.41 |
1210.06 |
403.35 |
33.30 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
R93 |
652.80 |
711.55 |
517.46 |
194.09 |
30.89 |
1414.40 |
1541.69 |
1121.16 |
420.53 |
66.93 |
Arizona Humana Health Plan, Inc. - Standard Self |
C74 |
361.89 |
412.55 |
241.58 |
170.97 |
44.85 |
784.10 |
893.86 |
523.42 |
370.44 |
97.18 |
Arizona Humana Health Plan, Inc. - Standard Self & Family |
C75 |
814.24 |
928.23 |
562.25 |
365.98 |
98.21 |
1764.19 |
2011.17 |
1218.21 |
792.96 |
212.79 |
Arizona Humana Health Plan, Inc. - Standard Self Plus One |
C76 |
778.03 |
886.95 |
517.46 |
369.49 |
95.58 |
1685.73 |
1921.73 |
1121.16 |
800.57 |
207.10 |
Arizona Humana Health Plan, Inc. - High Self |
C71 |
469.79 |
535.56 |
241.58 |
293.98 |
59.96 |
1017.88 |
1160.38 |
523.42 |
636.96 |
129.92 |
Arizona Humana Health Plan, Inc. - High Self & Family |
C72 |
1057.01 |
1205.00 |
562.25 |
642.75 |
132.21 |
2290.19 |
2610.83 |
1218.21 |
1392.62 |
286.45 |
Arizona Humana Health Plan, Inc. - High Self Plus One |
C73 |
1010.03 |
1151.44 |
517.46 |
633.98 |
128.07 |
2188.40 |
2494.79 |
1121.16 |
1373.63 |
277.49 |
Arizona Humana Health Plan, Inc. - High Self |
BF1 |
659.77 |
679.56 |
241.58 |
437.98 |
13.98 |
1429.50 |
1472.38 |
523.42 |
948.96 |
30.30 |
Arizona Humana Health Plan, Inc. - High Self & Family |
BF2 |
1484.43 |
1528.97 |
562.25 |
966.72 |
28.76 |
3216.27 |
3312.77 |
1218.21 |
2094.56 |
62.31 |
Arizona Humana Health Plan, Inc. - High Self Plus One |
BF3 |
1418.47 |
1461.01 |
517.46 |
943.55 |
29.20 |
3073.35 |
3165.52 |
1121.16 |
2044.36 |
63.27 |
Arizona Humana Health Plan, Inc. - Standard Self |
BF4 |
532.73 |
575.35 |
241.58 |
333.77 |
36.81 |
1154.25 |
1246.59 |
523.42 |
723.17 |
79.76 |
Arizona Humana Health Plan, Inc. - Standard Self & Family |
BF5 |
1198.65 |
1294.54 |
562.25 |
732.29 |
80.11 |
2597.08 |
2804.84 |
1218.21 |
1586.63 |
173.57 |
Arizona Humana Health Plan, Inc. - Standard Self Plus One |
BF6 |
1145.38 |
1237.02 |
517.46 |
719.56 |
78.30 |
2481.66 |
2680.21 |
1121.16 |
1559.05 |
169.65 |
Arizona UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
WF1 |
241.32 |
287.18 |
215.39 |
71.79 |
11.46 |
522.86 |
622.22 |
466.67 |
155.55 |
24.84 |
Arizona UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
WF2 |
570.64 |
679.17 |
509.38 |
169.79 |
27.13 |
1236.39 |
1471.54 |
1103.66 |
367.88 |
58.78 |
Arizona UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
WF3 |
518.79 |
617.43 |
463.07 |
154.36 |
24.66 |
1124.05 |
1337.77 |
1003.33 |
334.44 |
53.43 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LU1 |
204.85 |
243.77 |
182.83 |
60.94 |
9.73 |
443.84 |
528.17 |
396.13 |
132.04 |
21.08 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LU2 |
471.16 |
560.66 |
420.50 |
140.16 |
22.37 |
1020.85 |
1214.76 |
911.07 |
303.69 |
48.48 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LU3 |
440.43 |
524.10 |
393.08 |
131.02 |
20.91 |
954.27 |
1135.55 |
851.66 |
283.89 |
45.32 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KT1 |
334.51 |
360.98 |
241.58 |
119.40 |
20.66 |
724.77 |
782.12 |
523.42 |
258.70 |
44.77 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KT2 |
836.26 |
902.47 |
562.25 |
340.22 |
50.43 |
1811.90 |
1955.35 |
1218.21 |
737.14 |
109.26 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KT3 |
719.19 |
776.11 |
517.46 |
258.65 |
43.58 |
1558.25 |
1681.57 |
1121.16 |
560.41 |
94.42 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
VD1 |
240.93 |
286.71 |
215.03 |
71.68 |
11.45 |
522.02 |
621.21 |
465.91 |
155.30 |
24.80 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
VD2 |
569.71 |
678.06 |
508.55 |
169.51 |
27.08 |
1234.37 |
1469.13 |
1101.85 |
367.28 |
58.69 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
VD3 |
517.95 |
616.42 |
462.32 |
154.10 |
24.61 |
1122.23 |
1335.58 |
1001.69 |
333.89 |
53.33 |
Arizona UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Arizona UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Arizona UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Arkansas Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Arkansas Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Arkansas Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Arkansas Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Arkansas Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Arkansas Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
382.72 |
393.11 |
241.58 |
151.53 |
4.58 |
829.23 |
851.74 |
523.42 |
328.32 |
9.93 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
872.64 |
896.32 |
562.25 |
334.07 |
7.90 |
1890.72 |
1942.03 |
1218.21 |
723.82 |
17.12 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
864.00 |
887.45 |
517.46 |
369.99 |
10.11 |
1872.00 |
1922.81 |
1121.16 |
801.65 |
21.91 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
378.45 |
379.30 |
241.58 |
137.72 |
-4.96 |
819.98 |
821.82 |
523.42 |
298.40 |
-10.74 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
866.59 |
868.56 |
562.25 |
306.31 |
-13.81 |
1877.61 |
1881.88 |
1218.21 |
663.67 |
-29.92 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
849.59 |
851.52 |
517.46 |
334.06 |
-11.41 |
1840.78 |
1844.96 |
1121.16 |
723.80 |
-24.72 |
Arkansas Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Arkansas Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Arkansas Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Arkansas QualChoice - High Self |
DH1 |
347.17 |
354.12 |
241.58 |
112.54 |
1.14 |
752.20 |
767.26 |
523.42 |
243.84 |
2.48 |
Arkansas QualChoice - High Self & Family |
DH2 |
905.52 |
923.63 |
562.25 |
361.38 |
2.33 |
1961.96 |
2001.20 |
1218.21 |
782.99 |
5.05 |
Arkansas QualChoice - High Self Plus One |
DH3 |
674.39 |
687.89 |
515.92 |
171.97 |
1.70 |
1461.18 |
1490.43 |
1117.82 |
372.61 |
3.69 |
Arkansas QualChoice - Standard Self |
DH4 |
271.04 |
276.46 |
207.35 |
69.11 |
1.35 |
587.25 |
599.00 |
449.25 |
149.75 |
2.94 |
Arkansas QualChoice - Standard Self & Family |
DH5 |
706.96 |
721.12 |
540.84 |
180.28 |
3.54 |
1531.75 |
1562.43 |
1171.82 |
390.61 |
7.67 |
Arkansas QualChoice - Standard Self Plus One |
DH6 |
526.51 |
537.06 |
402.80 |
134.26 |
2.63 |
1140.77 |
1163.63 |
872.72 |
290.91 |
5.72 |
Arkansas UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
242.68 |
276.68 |
207.51 |
69.17 |
8.50 |
525.81 |
599.47 |
449.60 |
149.87 |
18.42 |
Arkansas UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
573.86 |
654.35 |
490.76 |
163.59 |
20.13 |
1243.36 |
1417.76 |
1063.32 |
354.44 |
43.60 |
Arkansas UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
521.73 |
594.87 |
446.15 |
148.72 |
18.29 |
1130.42 |
1288.89 |
966.67 |
322.22 |
39.62 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LS1 |
209.88 |
224.24 |
168.18 |
56.06 |
3.59 |
454.74 |
485.85 |
364.39 |
121.46 |
7.78 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LS2 |
482.73 |
515.77 |
386.83 |
128.94 |
8.26 |
1045.92 |
1117.50 |
838.13 |
279.37 |
17.89 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LS3 |
451.25 |
482.12 |
361.59 |
120.53 |
7.72 |
977.71 |
1044.59 |
783.44 |
261.15 |
16.72 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KK1 |
329.48 |
354.94 |
241.58 |
113.36 |
19.65 |
713.87 |
769.04 |
523.42 |
245.62 |
42.59 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KK2 |
823.71 |
887.37 |
562.25 |
325.12 |
47.88 |
1784.71 |
1922.64 |
1218.21 |
704.43 |
103.74 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KK3 |
708.40 |
763.14 |
517.46 |
245.68 |
41.40 |
1534.87 |
1653.47 |
1121.16 |
532.31 |
89.70 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
233.88 |
266.18 |
199.64 |
66.54 |
8.07 |
506.74 |
576.72 |
432.54 |
144.18 |
17.50 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
553.03 |
629.51 |
472.13 |
157.38 |
19.12 |
1198.23 |
1363.94 |
1022.96 |
340.98 |
41.42 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
502.79 |
572.28 |
429.21 |
143.07 |
17.37 |
1089.38 |
1239.94 |
929.96 |
309.98 |
37.64 |
Arkansas UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Arkansas UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Arkansas UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
California Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
California Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
California Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
California Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
California Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
California Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
California Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
JS4 |
495.45 |
505.19 |
241.58 |
263.61 |
3.93 |
1073.48 |
1094.58 |
523.42 |
571.16 |
8.52 |
California Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
JS5 |
1131.04 |
1153.29 |
562.25 |
591.04 |
6.47 |
2450.59 |
2498.80 |
1218.21 |
1280.59 |
14.02 |
California Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
JS6 |
1119.84 |
1141.88 |
517.46 |
624.42 |
8.70 |
2426.32 |
2474.07 |
1121.16 |
1352.91 |
18.85 |
California Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
JS1 |
463.38 |
466.12 |
241.58 |
224.54 |
-3.07 |
1003.99 |
1009.93 |
523.42 |
486.51 |
-6.64 |
California Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
JS2 |
1056.30 |
1062.53 |
562.25 |
500.28 |
-9.55 |
2288.65 |
2302.15 |
1218.21 |
1083.94 |
-20.69 |
California Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
JS3 |
1045.84 |
1052.00 |
517.46 |
534.54 |
-7.18 |
2265.99 |
2279.33 |
1121.16 |
1158.17 |
-15.56 |
California Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
California Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
California Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
California Aetna Open Access - High Self |
2X1 |
406.40 |
432.31 |
241.58 |
190.73 |
20.10 |
880.53 |
936.67 |
523.42 |
413.25 |
43.56 |
California Aetna Open Access - High Self & Family |
2X2 |
954.11 |
1014.93 |
562.25 |
452.68 |
45.04 |
2067.24 |
2199.02 |
1218.21 |
980.81 |
97.59 |
California Aetna Open Access - High Self Plus One |
2X3 |
935.40 |
995.03 |
517.46 |
477.57 |
46.29 |
2026.70 |
2155.90 |
1121.16 |
1034.74 |
100.30 |
California Anthem Blue Cross Select HMO - High Self |
B31 |
357.29 |
357.29 |
241.58 |
115.71 |
-5.81 |
774.13 |
774.13 |
523.42 |
250.71 |
-12.58 |
California Anthem Blue Cross Select HMO - High Self & Family |
B32 |
816.42 |
816.42 |
562.25 |
254.17 |
-15.78 |
1768.91 |
1768.91 |
1218.21 |
550.70 |
-34.19 |
California Anthem Blue Cross Select HMO - High Self Plus One |
B33 |
757.46 |
757.46 |
517.46 |
240.00 |
-13.34 |
1641.16 |
1641.16 |
1121.16 |
520.00 |
-28.90 |
California Blue Shield of California - Access + HMO Self |
SI1 |
384.85 |
396.40 |
241.58 |
154.82 |
5.74 |
833.84 |
858.87 |
523.42 |
335.45 |
12.45 |
California Blue Shield of California - Access + HMO Self & Family |
SI2 |
885.16 |
911.72 |
562.25 |
349.47 |
10.78 |
1917.85 |
1975.39 |
1218.21 |
757.18 |
23.35 |
California Blue Shield of California - Access + HMO Self Plus One |
SI3 |
846.67 |
872.07 |
517.46 |
354.61 |
12.06 |
1834.45 |
1889.49 |
1121.16 |
768.33 |
26.14 |
California Health Net of California - Basic Self |
P61 |
149.71 |
168.02 |
126.02 |
42.00 |
4.57 |
324.37 |
364.04 |
273.03 |
91.01 |
9.92 |
California Health Net of California - Basic Self & Family |
P62 |
359.29 |
403.26 |
302.45 |
100.81 |
10.99 |
778.46 |
873.73 |
655.30 |
218.43 |
23.82 |
California Health Net of California - Basic Self Plus One |
P63 |
329.35 |
369.66 |
277.25 |
92.41 |
10.07 |
713.59 |
800.93 |
600.70 |
200.23 |
21.83 |
California Health Net of California - High Self |
LP1 |
483.86 |
467.53 |
241.58 |
225.95 |
-22.14 |
1048.36 |
1012.98 |
523.42 |
489.56 |
-47.96 |
California Health Net of California - High Self & Family |
LP2 |
1161.26 |
1122.08 |
562.25 |
559.83 |
-54.96 |
2516.06 |
2431.17 |
1218.21 |
1212.96 |
-119.08 |
California Health Net of California - High Self Plus One |
LP3 |
1064.49 |
1028.57 |
517.46 |
511.11 |
-49.26 |
2306.40 |
2228.57 |
1121.16 |
1107.41 |
-106.73 |
California Health Net of California - High Self |
LB1 |
697.18 |
715.68 |
241.58 |
474.10 |
12.69 |
1510.56 |
1550.64 |
523.42 |
1027.22 |
27.50 |
California Health Net of California - High Self & Family |
LB2 |
1673.25 |
1717.61 |
562.25 |
1155.36 |
28.58 |
3625.38 |
3721.49 |
1218.21 |
2503.28 |
61.92 |
California Health Net of California - High Self Plus One |
LB3 |
1533.81 |
1574.47 |
517.46 |
1057.01 |
27.32 |
3323.26 |
3411.35 |
1121.16 |
2290.19 |
59.19 |
California Health Net of California - Standard Self |
LB4 |
618.71 |
676.68 |
241.58 |
435.10 |
52.16 |
1340.54 |
1466.14 |
523.42 |
942.72 |
113.02 |
California Health Net of California - Standard Self & Family |
LB5 |
1484.90 |
1624.02 |
562.25 |
1061.77 |
123.34 |
3217.28 |
3518.71 |
1218.21 |
2300.50 |
267.24 |
California Health Net of California - Standard Self Plus One |
LB6 |
1361.16 |
1488.69 |
517.46 |
971.23 |
114.19 |
2949.18 |
3225.50 |
1121.16 |
2104.34 |
247.42 |
California Health Net of California - Basic Self |
T41 |
407.00 |
412.70 |
241.58 |
171.12 |
-0.11 |
881.83 |
894.18 |
523.42 |
370.76 |
-0.23 |
California Health Net of California - Basic Self & Family |
T42 |
976.80 |
990.48 |
562.25 |
428.23 |
-2.10 |
2116.40 |
2146.04 |
1218.21 |
927.83 |
-4.55 |
California Health Net of California - Basic Self Plus One |
T43 |
895.41 |
907.94 |
517.46 |
390.48 |
-0.81 |
1940.06 |
1967.20 |
1121.16 |
846.04 |
-1.76 |
California Kaiser Permanente - Fresno California - Standard Self |
NZ4 |
261.60 |
272.36 |
204.27 |
68.09 |
2.69 |
566.80 |
590.11 |
442.58 |
147.53 |
5.83 |
California Kaiser Permanente - Fresno California - Standard Self & Family |
NZ5 |
604.59 |
629.48 |
472.11 |
157.37 |
6.22 |
1309.95 |
1363.87 |
1022.90 |
340.97 |
13.48 |
California Kaiser Permanente - Fresno California - Standard Self Plus One |
NZ6 |
604.59 |
629.48 |
472.11 |
157.37 |
6.22 |
1309.95 |
1363.87 |
1022.90 |
340.97 |
13.48 |
California Kaiser Permanente - Fresno California - High Self |
NZ1 |
358.58 |
370.61 |
241.58 |
129.03 |
6.22 |
776.92 |
802.99 |
523.42 |
279.57 |
13.49 |
California Kaiser Permanente - Fresno California - High Self & Family |
NZ2 |
828.77 |
856.55 |
562.25 |
294.30 |
12.00 |
1795.67 |
1855.86 |
1218.21 |
637.65 |
26.00 |
California Kaiser Permanente - Fresno California - High Self Plus One |
NZ3 |
828.77 |
856.55 |
517.46 |
339.09 |
14.44 |
1795.67 |
1855.86 |
1121.16 |
734.70 |
31.29 |
California Kaiser Permanente - Northern California - Basic Self |
KC1 |
300.96 |
300.96 |
225.72 |
75.24 |
0.00 |
652.08 |
652.08 |
489.06 |
163.02 |
0.00 |
California Kaiser Permanente - Northern California - Basic Self & Family |
KC2 |
704.24 |
704.24 |
528.18 |
176.06 |
0.00 |
1525.85 |
1525.85 |
1144.39 |
381.46 |
0.00 |
California Kaiser Permanente - Northern California - Basic Self Plus One |
KC3 |
704.24 |
704.24 |
517.46 |
186.78 |
-13.34 |
1525.85 |
1525.85 |
1121.16 |
404.69 |
-28.90 |
California Kaiser Permanente - Northern California - High Self |
591 |
461.75 |
468.25 |
241.58 |
226.67 |
0.69 |
1000.46 |
1014.54 |
523.42 |
491.12 |
1.50 |
California Kaiser Permanente - Northern California - High Self & Family |
592 |
1102.25 |
1117.78 |
562.25 |
555.53 |
-0.25 |
2388.21 |
2421.86 |
1218.21 |
1203.65 |
-0.54 |
California Kaiser Permanente - Northern California - High Self Plus One |
593 |
1102.25 |
1117.78 |
517.46 |
600.32 |
2.19 |
2388.21 |
2421.86 |
1121.16 |
1300.70 |
4.75 |
California Kaiser Permanente - Northern California - Standard Self |
594 |
373.79 |
379.70 |
241.58 |
138.12 |
0.10 |
809.88 |
822.68 |
523.42 |
299.26 |
0.22 |
California Kaiser Permanente - Northern California - Standard Self & Family |
595 |
874.65 |
888.51 |
562.25 |
326.26 |
-1.92 |
1895.08 |
1925.11 |
1218.21 |
706.90 |
-4.16 |
California Kaiser Permanente - Northern California - Standard Self Plus One |
596 |
874.65 |
888.51 |
517.46 |
371.05 |
0.52 |
1895.08 |
1925.11 |
1121.16 |
803.95 |
1.13 |
California Kaiser Permanente - Southern California - Standard Self |
624 |
215.22 |
218.51 |
163.88 |
54.63 |
0.83 |
466.31 |
473.44 |
355.08 |
118.36 |
1.78 |
California Kaiser Permanente - Southern California - Standard Self & Family |
625 |
497.40 |
505.02 |
378.77 |
126.25 |
1.90 |
1077.70 |
1094.21 |
820.66 |
273.55 |
4.13 |
California Kaiser Permanente - Southern California - Standard Self Plus One |
626 |
497.40 |
505.02 |
378.77 |
126.25 |
1.90 |
1077.70 |
1094.21 |
820.66 |
273.55 |
4.13 |
California Kaiser Permanente - Southern California - High Self |
621 |
339.42 |
346.24 |
241.58 |
104.66 |
1.01 |
735.41 |
750.19 |
523.42 |
226.77 |
2.20 |
California Kaiser Permanente - Southern California - High Self & Family |
622 |
784.46 |
800.23 |
562.25 |
237.98 |
-0.01 |
1699.66 |
1733.83 |
1218.21 |
515.62 |
-0.02 |
California Kaiser Permanente - Southern California - High Self Plus One |
623 |
784.46 |
800.23 |
517.46 |
282.77 |
2.43 |
1699.66 |
1733.83 |
1121.16 |
612.67 |
5.27 |
California UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
California UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
California UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Colorado Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Colorado Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Colorado Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Colorado Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Colorado Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Colorado Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
328.95 |
330.94 |
241.58 |
89.36 |
-3.82 |
712.73 |
717.04 |
523.42 |
193.62 |
-8.27 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
753.40 |
757.97 |
562.25 |
195.72 |
-11.21 |
1632.37 |
1642.27 |
1218.21 |
424.06 |
-24.29 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
738.63 |
743.12 |
517.46 |
225.66 |
-8.85 |
1600.37 |
1610.09 |
1121.16 |
488.93 |
-19.18 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
417.46 |
488.66 |
241.58 |
247.08 |
65.39 |
904.50 |
1058.76 |
523.42 |
535.34 |
141.68 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
952.20 |
1114.65 |
562.25 |
552.40 |
146.67 |
2063.10 |
2415.08 |
1218.21 |
1196.87 |
317.79 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
942.79 |
1103.63 |
517.46 |
586.17 |
147.50 |
2042.71 |
2391.20 |
1121.16 |
1270.04 |
319.59 |
Colorado Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Colorado Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Colorado Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Colorado BlueAdvantageHMO on the Pathway HMO Network - High Self |
WW1 |
293.70 |
293.70 |
220.28 |
73.42 |
0.00 |
636.35 |
636.35 |
477.26 |
159.09 |
0.00 |
Colorado BlueAdvantageHMO on the Pathway HMO Network - High Self & Family |
WW2 |
715.15 |
715.15 |
536.36 |
178.79 |
0.00 |
1549.49 |
1549.49 |
1162.12 |
387.37 |
0.00 |
Colorado BlueAdvantageHMO on the Pathway HMO Network - High Self Plus One |
WW3 |
668.15 |
668.15 |
501.11 |
167.04 |
0.00 |
1447.66 |
1447.66 |
1085.75 |
361.91 |
0.00 |
Colorado Humana Health Plan, Inc. - High Self |
NR1 |
379.16 |
443.62 |
241.58 |
202.04 |
58.65 |
821.51 |
961.18 |
523.42 |
437.76 |
127.09 |
Colorado Humana Health Plan, Inc. - High Self & Family |
NR2 |
853.11 |
998.14 |
562.25 |
435.89 |
129.25 |
1848.41 |
2162.64 |
1218.21 |
944.43 |
280.04 |
Colorado Humana Health Plan, Inc. - High Self Plus One |
NR3 |
815.20 |
953.78 |
517.46 |
436.32 |
125.24 |
1766.27 |
2066.52 |
1121.16 |
945.36 |
271.35 |
Colorado Humana Health Plan, Inc. - Standard Self |
NR4 |
262.76 |
307.42 |
230.57 |
76.85 |
11.16 |
569.31 |
666.08 |
499.56 |
166.52 |
24.19 |
Colorado Humana Health Plan, Inc. - Standard Self & Family |
NR5 |
591.22 |
691.72 |
518.79 |
172.93 |
25.13 |
1280.98 |
1498.73 |
1124.05 |
374.68 |
54.44 |
Colorado Humana Health Plan, Inc. - Standard Self Plus One |
NR6 |
564.93 |
660.96 |
495.72 |
165.24 |
24.01 |
1224.02 |
1432.08 |
1074.06 |
358.02 |
52.02 |
Colorado Humana Health Plan, Inc. - Basic Self |
RZ1 |
240.83 |
245.65 |
184.24 |
61.41 |
1.20 |
521.80 |
532.24 |
399.18 |
133.06 |
2.61 |
Colorado Humana Health Plan, Inc. - Basic Self & Family |
RZ2 |
541.86 |
552.70 |
414.53 |
138.17 |
2.71 |
1174.03 |
1197.52 |
898.14 |
299.38 |
5.87 |
Colorado Humana Health Plan, Inc. - Basic Self Plus One |
RZ3 |
517.80 |
528.15 |
396.11 |
132.04 |
2.59 |
1121.90 |
1144.33 |
858.25 |
286.08 |
5.61 |
Colorado Humana Health Plan, Inc. - High Self |
NT1 |
352.97 |
384.74 |
241.58 |
143.16 |
25.96 |
764.77 |
833.60 |
523.42 |
310.18 |
56.25 |
Colorado Humana Health Plan, Inc. - High Self & Family |
NT2 |
794.21 |
865.69 |
562.25 |
303.44 |
55.70 |
1720.79 |
1875.66 |
1218.21 |
657.45 |
120.68 |
Colorado Humana Health Plan, Inc. - High Self Plus One |
NT3 |
758.90 |
827.20 |
517.46 |
309.74 |
54.96 |
1644.28 |
1792.27 |
1121.16 |
671.11 |
119.09 |
Colorado Humana Health Plan, Inc. - Standard Self |
NT4 |
249.93 |
272.43 |
204.32 |
68.11 |
5.63 |
541.52 |
590.27 |
442.70 |
147.57 |
12.19 |
Colorado Humana Health Plan, Inc. - Standard Self & Family |
NT5 |
562.36 |
612.98 |
459.74 |
153.24 |
12.65 |
1218.45 |
1328.12 |
996.09 |
332.03 |
27.42 |
Colorado Humana Health Plan, Inc. - Standard Self Plus One |
NT6 |
537.39 |
585.75 |
439.31 |
146.44 |
12.09 |
1164.35 |
1269.13 |
951.85 |
317.28 |
26.19 |
Colorado Humana Health Plan, Inc. - Basic Self |
R21 |
245.13 |
286.80 |
215.10 |
71.70 |
10.42 |
531.12 |
621.40 |
466.05 |
155.35 |
22.57 |
Colorado Humana Health Plan, Inc. - Basic Self & Family |
R22 |
551.54 |
645.31 |
483.98 |
161.33 |
23.45 |
1195.00 |
1398.17 |
1048.63 |
349.54 |
50.79 |
Colorado Humana Health Plan, Inc. - Basic Self Plus One |
R23 |
527.03 |
616.63 |
462.47 |
154.16 |
22.40 |
1141.90 |
1336.03 |
1002.02 |
334.01 |
48.54 |
Colorado Kaiser Permanente - Colorado - Standard Self |
654 |
309.83 |
305.00 |
228.75 |
76.25 |
-1.21 |
671.30 |
660.83 |
495.62 |
165.21 |
-2.61 |
Colorado Kaiser Permanente - Colorado - Standard Self & Family |
655 |
700.21 |
689.29 |
516.97 |
172.32 |
-2.73 |
1517.12 |
1493.46 |
1120.10 |
373.36 |
-5.92 |
Colorado Kaiser Permanente - Colorado - Standard Self Plus One |
656 |
700.21 |
689.29 |
516.97 |
172.32 |
-23.77 |
1517.12 |
1493.46 |
1120.10 |
373.36 |
-51.50 |
Colorado Kaiser Permanente - Colorado - High Self |
651 |
364.23 |
356.72 |
241.58 |
115.14 |
-13.32 |
789.17 |
772.89 |
523.42 |
249.47 |
-28.86 |
Colorado Kaiser Permanente - Colorado - High Self & Family |
652 |
823.16 |
806.19 |
562.25 |
243.94 |
-32.75 |
1783.51 |
1746.75 |
1218.21 |
528.54 |
-70.95 |
Colorado Kaiser Permanente - Colorado - High Self Plus One |
653 |
823.16 |
806.19 |
517.46 |
288.73 |
-30.31 |
1783.51 |
1746.75 |
1121.16 |
625.59 |
-65.66 |
Colorado Kaiser Permanente - Colorado - Basic Self |
N41 |
223.74 |
205.62 |
154.22 |
51.40 |
-4.53 |
484.77 |
445.51 |
334.13 |
111.38 |
-9.81 |
Colorado Kaiser Permanente - Colorado - Basic Self & Family |
N42 |
505.66 |
505.82 |
379.37 |
126.45 |
0.04 |
1095.60 |
1095.94 |
821.96 |
273.98 |
0.08 |
Colorado Kaiser Permanente - Colorado - Basic Self Plus One |
N43 |
505.66 |
464.70 |
348.53 |
116.17 |
-10.24 |
1095.60 |
1006.85 |
755.14 |
251.71 |
-22.19 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LU1 |
204.85 |
243.77 |
182.83 |
60.94 |
9.73 |
443.84 |
528.17 |
396.13 |
132.04 |
21.08 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LU2 |
471.16 |
560.66 |
420.50 |
140.16 |
22.37 |
1020.85 |
1214.76 |
911.07 |
303.69 |
48.48 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LU3 |
440.43 |
524.10 |
393.08 |
131.02 |
20.91 |
954.27 |
1135.55 |
851.66 |
283.89 |
45.32 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KT1 |
334.51 |
360.98 |
241.58 |
119.40 |
20.66 |
724.77 |
782.12 |
523.42 |
258.70 |
44.77 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KT2 |
836.26 |
902.47 |
562.25 |
340.22 |
50.43 |
1811.90 |
1955.35 |
1218.21 |
737.14 |
109.26 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KT3 |
719.19 |
776.11 |
517.46 |
258.65 |
43.58 |
1558.25 |
1681.57 |
1121.16 |
560.41 |
94.42 |
Colorado UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Colorado UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Colorado UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Connecticut Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Connecticut Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Connecticut Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Connecticut Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Connecticut Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Connecticut Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
350.59 |
387.52 |
241.58 |
145.94 |
31.12 |
759.61 |
839.63 |
523.42 |
316.21 |
67.44 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
802.85 |
887.39 |
562.25 |
325.14 |
68.76 |
1739.51 |
1922.68 |
1218.21 |
704.47 |
148.98 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
787.10 |
869.98 |
517.46 |
352.52 |
69.54 |
1705.38 |
1884.96 |
1121.16 |
763.80 |
150.68 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
496.50 |
519.07 |
241.58 |
277.49 |
16.76 |
1075.75 |
1124.65 |
523.42 |
601.23 |
36.32 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
1132.30 |
1183.79 |
562.25 |
621.54 |
35.71 |
2453.32 |
2564.88 |
1218.21 |
1346.67 |
77.37 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
1121.09 |
1172.06 |
517.46 |
654.60 |
37.63 |
2429.03 |
2539.46 |
1121.16 |
1418.30 |
81.53 |
Connecticut Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Connecticut Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Connecticut Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Connecticut UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Connecticut UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Connecticut UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Delaware Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Delaware Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Delaware Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Delaware Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Delaware Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Delaware Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
350.59 |
387.52 |
241.58 |
145.94 |
31.12 |
759.61 |
839.63 |
523.42 |
316.21 |
67.44 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
802.85 |
887.39 |
562.25 |
325.14 |
68.76 |
1739.51 |
1922.68 |
1218.21 |
704.47 |
148.98 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
787.10 |
869.98 |
517.46 |
352.52 |
69.54 |
1705.38 |
1884.96 |
1121.16 |
763.80 |
150.68 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
496.50 |
519.07 |
241.58 |
277.49 |
16.76 |
1075.75 |
1124.65 |
523.42 |
601.23 |
36.32 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
1132.30 |
1183.79 |
562.25 |
621.54 |
35.71 |
2453.32 |
2564.88 |
1218.21 |
1346.67 |
77.37 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
1121.09 |
1172.06 |
517.46 |
654.60 |
37.63 |
2429.03 |
2539.46 |
1121.16 |
1418.30 |
81.53 |
Delaware Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Delaware Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Delaware Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Delaware Aetna Open Access - Basic Self |
P34 |
604.65 |
694.86 |
241.58 |
453.28 |
84.40 |
1310.08 |
1505.53 |
523.42 |
982.11 |
182.87 |
Delaware Aetna Open Access - Basic Self & Family |
P35 |
1403.39 |
1612.77 |
562.25 |
1050.52 |
193.60 |
3040.68 |
3494.34 |
1218.21 |
2276.13 |
419.47 |
Delaware Aetna Open Access - Basic Self Plus One |
P36 |
1389.48 |
1596.80 |
517.46 |
1079.34 |
193.98 |
3010.54 |
3459.73 |
1121.16 |
2338.57 |
420.29 |
Delaware Aetna Open Access - High Self |
P31 |
672.28 |
733.03 |
241.58 |
491.45 |
54.94 |
1456.61 |
1588.23 |
523.42 |
1064.81 |
119.04 |
Delaware Aetna Open Access - High Self & Family |
P32 |
1629.94 |
1777.25 |
562.25 |
1215.00 |
131.53 |
3531.54 |
3850.71 |
1218.21 |
2632.50 |
284.98 |
Delaware Aetna Open Access - High Self Plus One |
P33 |
1613.79 |
1759.65 |
517.46 |
1242.19 |
132.52 |
3496.55 |
3812.58 |
1121.16 |
2691.42 |
287.13 |
Delaware UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Delaware UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Delaware UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
District Of Columbia Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
District Of Columbia Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
District Of Columbia Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
District Of Columbia Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
District Of Columbia Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
District Of Columbia Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
382.72 |
393.11 |
241.58 |
151.53 |
4.58 |
829.23 |
851.74 |
523.42 |
328.32 |
9.93 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
872.64 |
896.32 |
562.25 |
334.07 |
7.90 |
1890.72 |
1942.03 |
1218.21 |
723.82 |
17.12 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
864.00 |
887.45 |
517.46 |
369.99 |
10.11 |
1872.00 |
1922.81 |
1121.16 |
801.65 |
21.91 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
378.45 |
379.30 |
241.58 |
137.72 |
-4.96 |
819.98 |
821.82 |
523.42 |
298.40 |
-10.74 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
866.59 |
868.56 |
562.25 |
306.31 |
-13.81 |
1877.61 |
1881.88 |
1218.21 |
663.67 |
-29.92 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
849.59 |
851.52 |
517.46 |
334.06 |
-11.41 |
1840.78 |
1844.96 |
1121.16 |
723.80 |
-24.72 |
District Of Columbia Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
District Of Columbia Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
District Of Columbia Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
District Of Columbia Aetna Open Access - High Self |
JN1 |
525.03 |
543.03 |
241.58 |
301.45 |
12.19 |
1137.57 |
1176.57 |
523.42 |
653.15 |
26.42 |
District Of Columbia Aetna Open Access - High Self & Family |
JN2 |
1180.35 |
1220.79 |
562.25 |
658.54 |
24.66 |
2557.43 |
2645.05 |
1218.21 |
1426.84 |
53.43 |
District Of Columbia Aetna Open Access - High Self Plus One |
JN3 |
1168.66 |
1208.70 |
517.46 |
691.24 |
26.70 |
2532.10 |
2618.85 |
1121.16 |
1497.69 |
57.85 |
District Of Columbia Aetna Open Access - Basic Self |
JN4 |
321.74 |
329.73 |
241.58 |
88.15 |
2.18 |
697.10 |
714.42 |
523.42 |
191.00 |
4.74 |
District Of Columbia Aetna Open Access - Basic Self & Family |
JN5 |
736.31 |
754.58 |
562.25 |
192.33 |
2.49 |
1595.34 |
1634.92 |
1218.21 |
416.71 |
5.39 |
District Of Columbia Aetna Open Access - Basic Self Plus One |
JN6 |
676.15 |
692.92 |
517.46 |
175.46 |
3.43 |
1464.99 |
1501.33 |
1121.16 |
380.17 |
7.44 |
District Of Columbia Aetna Saver (Open Access) - Saver Self |
QQ4 |
274.71 |
274.71 |
206.03 |
68.68 |
0.00 |
595.21 |
595.21 |
446.41 |
148.80 |
0.00 |
District Of Columbia Aetna Saver (Open Access) - Saver Self & Family |
QQ5 |
628.68 |
628.67 |
471.50 |
157.17 |
0.00 |
1362.14 |
1362.12 |
1021.59 |
340.53 |
0.00 |
District Of Columbia Aetna Saver (Open Access) - Saver Self Plus One |
QQ6 |
577.30 |
577.30 |
432.98 |
144.32 |
0.00 |
1250.82 |
1250.82 |
938.12 |
312.70 |
0.00 |
District Of Columbia CareFirst BlueChoice - Standard Self |
2G4 |
390.25 |
409.76 |
241.58 |
168.18 |
13.70 |
845.54 |
887.81 |
523.42 |
364.39 |
29.69 |
District Of Columbia CareFirst BlueChoice - Standard Self & Family |
2G5 |
927.21 |
973.58 |
562.25 |
411.33 |
30.59 |
2008.96 |
2109.42 |
1218.21 |
891.21 |
66.27 |
District Of Columbia CareFirst BlueChoice - Standard Self Plus One |
2G6 |
780.49 |
819.51 |
517.46 |
302.05 |
25.68 |
1691.06 |
1775.61 |
1121.16 |
654.45 |
55.65 |
District Of Columbia CareFirst BlueChoice - HDHP Self |
B61 |
263.12 |
263.12 |
197.34 |
65.78 |
0.00 |
570.09 |
570.09 |
427.57 |
142.52 |
0.00 |
District Of Columbia CareFirst BlueChoice - HDHP Self & Family |
B62 |
625.16 |
625.16 |
468.87 |
156.29 |
0.00 |
1354.51 |
1354.51 |
1015.88 |
338.63 |
0.00 |
District Of Columbia CareFirst BlueChoice - HDHP Self Plus One |
B63 |
526.23 |
526.23 |
394.67 |
131.56 |
0.00 |
1140.17 |
1140.17 |
855.13 |
285.04 |
0.00 |
District Of Columbia CareFirst BlueChoice - Blue Value Plus Self |
B64 |
325.84 |
334.00 |
241.58 |
92.42 |
2.35 |
705.99 |
723.67 |
523.42 |
200.25 |
5.10 |
District Of Columbia CareFirst BlueChoice - Blue Value Plus Self & Family |
B65 |
774.21 |
793.56 |
562.25 |
231.31 |
3.57 |
1677.46 |
1719.38 |
1218.21 |
501.17 |
7.73 |
District Of Columbia CareFirst BlueChoice - Blue Value Plus Self Plus One |
B66 |
651.70 |
667.98 |
500.99 |
166.99 |
4.07 |
1412.02 |
1447.29 |
1085.47 |
361.82 |
8.82 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - Basic Self |
T71 |
193.90 |
197.41 |
148.06 |
49.35 |
0.88 |
420.12 |
427.72 |
320.79 |
106.93 |
1.90 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - Basic Self & Family |
T72 |
473.61 |
507.47 |
380.60 |
126.87 |
8.47 |
1026.16 |
1099.52 |
824.64 |
274.88 |
18.34 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - Basic Self Plus One |
T73 |
431.49 |
439.31 |
329.48 |
109.83 |
1.96 |
934.90 |
951.84 |
713.88 |
237.96 |
4.24 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - Standard Self |
E34 |
263.79 |
276.13 |
207.10 |
69.03 |
3.08 |
571.55 |
598.28 |
448.71 |
149.57 |
6.68 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - Standard Self & Family |
E35 |
606.69 |
635.10 |
476.33 |
158.77 |
7.10 |
1314.50 |
1376.05 |
1032.04 |
344.01 |
15.39 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - Standard Self Plus One |
E36 |
606.69 |
635.10 |
476.33 |
158.77 |
7.10 |
1314.50 |
1376.05 |
1032.04 |
344.01 |
15.39 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - High Self |
E31 |
333.61 |
344.42 |
241.58 |
102.84 |
5.00 |
722.82 |
746.24 |
523.42 |
222.82 |
10.84 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - High Self & Family |
E32 |
767.32 |
792.16 |
562.25 |
229.91 |
9.06 |
1662.53 |
1716.35 |
1218.21 |
498.14 |
19.63 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - High Self Plus One |
E33 |
767.32 |
792.16 |
517.46 |
274.70 |
11.50 |
1662.53 |
1716.35 |
1121.16 |
595.19 |
24.92 |
District Of Columbia M.D. IPA - High Self |
JP1 |
404.59 |
438.87 |
241.58 |
197.29 |
28.47 |
876.61 |
950.89 |
523.42 |
427.47 |
61.70 |
District Of Columbia M.D. IPA - High Self & Family |
JP2 |
1134.48 |
1230.59 |
562.25 |
668.34 |
80.33 |
2458.04 |
2666.28 |
1218.21 |
1448.07 |
174.05 |
District Of Columbia M.D. IPA - High Self Plus One |
JP3 |
790.17 |
857.12 |
517.46 |
339.66 |
53.61 |
1712.04 |
1857.09 |
1121.16 |
735.93 |
116.15 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
242.68 |
276.68 |
207.51 |
69.17 |
8.50 |
525.81 |
599.47 |
449.60 |
149.87 |
18.42 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
573.86 |
654.35 |
490.76 |
163.59 |
20.13 |
1243.36 |
1417.76 |
1063.32 |
354.44 |
43.60 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
521.73 |
594.87 |
446.15 |
148.72 |
18.29 |
1130.42 |
1288.89 |
966.67 |
322.22 |
39.62 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
V41 |
224.57 |
239.96 |
179.97 |
59.99 |
3.85 |
486.57 |
519.91 |
389.93 |
129.98 |
8.34 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
V42 |
516.51 |
551.91 |
413.93 |
137.98 |
8.85 |
1119.11 |
1195.81 |
896.86 |
298.95 |
19.17 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
V43 |
482.83 |
515.91 |
386.93 |
128.98 |
8.27 |
1046.13 |
1117.81 |
838.36 |
279.45 |
17.92 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
LR1 |
329.95 |
355.57 |
241.58 |
113.99 |
19.81 |
714.89 |
770.40 |
523.42 |
246.98 |
42.93 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
LR2 |
781.98 |
842.69 |
562.25 |
280.44 |
44.93 |
1694.29 |
1825.83 |
1218.21 |
607.62 |
97.35 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
LR3 |
709.38 |
764.46 |
517.46 |
247.00 |
41.74 |
1536.99 |
1656.33 |
1121.16 |
535.17 |
90.44 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
L91 |
240.69 |
255.98 |
191.99 |
63.99 |
3.82 |
521.50 |
554.62 |
415.97 |
138.65 |
8.28 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
L92 |
674.89 |
717.76 |
538.32 |
179.44 |
10.72 |
1462.26 |
1555.15 |
1166.36 |
388.79 |
23.23 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self Plus One |
L93 |
470.06 |
499.93 |
374.95 |
124.98 |
7.47 |
1018.46 |
1083.18 |
812.39 |
270.79 |
16.18 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
233.88 |
266.18 |
199.64 |
66.54 |
8.07 |
506.74 |
576.72 |
432.54 |
144.18 |
17.50 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
553.03 |
629.51 |
472.13 |
157.38 |
19.12 |
1198.23 |
1363.94 |
1022.96 |
340.98 |
41.42 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
502.79 |
572.28 |
429.21 |
143.07 |
17.37 |
1089.38 |
1239.94 |
929.96 |
309.98 |
37.64 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
District Of Columbia UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
District Of Columbia UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Florida Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Florida Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Florida Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Florida Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Florida Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Florida Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
382.72 |
393.11 |
241.58 |
151.53 |
4.58 |
829.23 |
851.74 |
523.42 |
328.32 |
9.93 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
872.64 |
896.32 |
562.25 |
334.07 |
7.90 |
1890.72 |
1942.03 |
1218.21 |
723.82 |
17.12 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
864.00 |
887.45 |
517.46 |
369.99 |
10.11 |
1872.00 |
1922.81 |
1121.16 |
801.65 |
21.91 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
378.45 |
379.30 |
241.58 |
137.72 |
-4.96 |
819.98 |
821.82 |
523.42 |
298.40 |
-10.74 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
866.59 |
868.56 |
562.25 |
306.31 |
-13.81 |
1877.61 |
1881.88 |
1218.21 |
663.67 |
-29.92 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
849.59 |
851.52 |
517.46 |
334.06 |
-11.41 |
1840.78 |
1844.96 |
1121.16 |
723.80 |
-24.72 |
Florida Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Florida Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Florida Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Florida AvMed - HDHP Self |
WZ1 |
371.61 |
351.73 |
241.58 |
110.15 |
-25.69 |
805.16 |
762.08 |
523.42 |
238.66 |
-55.66 |
Florida AvMed - HDHP Self & Family |
WZ2 |
863.70 |
813.23 |
562.25 |
250.98 |
-66.25 |
1871.35 |
1762.00 |
1218.21 |
543.79 |
-143.54 |
Florida AvMed - HDHP Self Plus One |
WZ3 |
748.77 |
705.54 |
517.46 |
188.08 |
-56.57 |
1622.34 |
1528.67 |
1121.16 |
407.51 |
-122.57 |
Florida AvMed - Standard Self |
ML4 |
327.34 |
378.91 |
241.58 |
137.33 |
45.76 |
709.24 |
820.97 |
523.42 |
297.55 |
99.15 |
Florida AvMed - Standard Self & Family |
ML5 |
796.99 |
922.58 |
562.25 |
360.33 |
109.81 |
1726.81 |
1998.92 |
1218.21 |
780.71 |
237.92 |
Florida AvMed - Standard Self Plus One |
ML6 |
687.40 |
795.72 |
517.46 |
278.26 |
94.98 |
1489.37 |
1724.06 |
1121.16 |
602.90 |
205.79 |
Florida Capital Health Plan - High Self |
EA1 |
314.13 |
318.68 |
239.01 |
79.67 |
1.14 |
680.62 |
690.47 |
517.85 |
172.62 |
2.47 |
Florida Capital Health Plan - High Self & Family |
EA2 |
728.00 |
738.55 |
553.91 |
184.64 |
2.64 |
1577.33 |
1600.19 |
1200.14 |
400.05 |
5.72 |
Florida Capital Health Plan - High Self Plus One |
EA3 |
686.96 |
696.92 |
517.46 |
179.46 |
-3.38 |
1488.41 |
1509.99 |
1121.16 |
388.83 |
-7.32 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self |
W94 |
237.04 |
270.22 |
202.67 |
67.55 |
8.29 |
513.59 |
585.48 |
439.11 |
146.37 |
17.97 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self & Family |
W95 |
533.34 |
608.00 |
456.00 |
152.00 |
18.67 |
1155.57 |
1317.33 |
988.00 |
329.33 |
40.44 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
W96 |
509.63 |
580.98 |
435.74 |
145.24 |
17.83 |
1104.20 |
1258.79 |
944.09 |
314.70 |
38.65 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self |
W91 |
280.20 |
319.43 |
239.57 |
79.86 |
9.81 |
607.10 |
692.10 |
519.08 |
173.02 |
21.25 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
W92 |
630.44 |
718.70 |
539.03 |
179.67 |
22.06 |
1365.95 |
1557.18 |
1167.89 |
389.29 |
47.80 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
W93 |
602.43 |
686.76 |
515.07 |
171.69 |
21.08 |
1305.27 |
1487.98 |
1115.99 |
371.99 |
45.67 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self |
QP1 |
334.64 |
354.72 |
241.58 |
113.14 |
14.27 |
725.05 |
768.56 |
523.42 |
245.14 |
30.93 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
QP2 |
753.94 |
799.18 |
562.25 |
236.93 |
29.46 |
1633.54 |
1731.56 |
1218.21 |
513.35 |
63.83 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
QP3 |
720.43 |
763.65 |
517.46 |
246.19 |
29.88 |
1560.93 |
1654.58 |
1121.16 |
533.42 |
64.75 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self |
QP4 |
239.70 |
254.08 |
190.56 |
63.52 |
3.60 |
519.35 |
550.51 |
412.88 |
137.63 |
7.79 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self & Family |
QP5 |
539.30 |
571.66 |
428.75 |
142.91 |
8.09 |
1168.48 |
1238.60 |
928.95 |
309.65 |
17.53 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
QP6 |
515.34 |
546.26 |
409.70 |
136.56 |
7.73 |
1116.57 |
1183.56 |
887.67 |
295.89 |
16.75 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self |
MJ4 |
239.82 |
259.01 |
194.26 |
64.75 |
4.80 |
519.61 |
561.19 |
420.89 |
140.30 |
10.40 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self & Family |
MJ5 |
539.60 |
582.77 |
437.08 |
145.69 |
10.79 |
1169.13 |
1262.67 |
947.00 |
315.67 |
23.39 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
MJ6 |
515.62 |
556.87 |
417.65 |
139.22 |
10.32 |
1117.18 |
1206.55 |
904.91 |
301.64 |
22.35 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self |
MJ1 |
437.57 |
472.58 |
241.58 |
231.00 |
29.20 |
948.07 |
1023.92 |
523.42 |
500.50 |
63.27 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
MJ2 |
984.53 |
1063.29 |
562.25 |
501.04 |
62.98 |
2133.15 |
2303.80 |
1218.21 |
1085.59 |
136.46 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
MJ3 |
940.78 |
1016.05 |
517.46 |
498.59 |
61.93 |
2038.36 |
2201.44 |
1121.16 |
1080.28 |
134.18 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self |
X24 |
227.62 |
236.72 |
177.54 |
59.18 |
2.28 |
493.18 |
512.89 |
384.67 |
128.22 |
4.93 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self & Family |
X25 |
512.15 |
532.64 |
399.48 |
133.16 |
5.12 |
1109.66 |
1154.05 |
865.54 |
288.51 |
11.10 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
X26 |
489.39 |
508.97 |
381.73 |
127.24 |
4.89 |
1060.35 |
1102.77 |
827.08 |
275.69 |
10.60 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self |
X21 |
269.07 |
279.83 |
209.87 |
69.96 |
2.69 |
582.99 |
606.30 |
454.73 |
151.57 |
5.82 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
X22 |
605.42 |
629.64 |
472.23 |
157.41 |
6.06 |
1311.74 |
1364.22 |
1023.17 |
341.05 |
13.12 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
X23 |
578.51 |
601.65 |
451.24 |
150.41 |
5.78 |
1253.44 |
1303.58 |
977.69 |
325.89 |
12.53 |
Florida Humana Medical Plan, Inc. - Standard Self |
LL4 |
496.13 |
550.71 |
241.58 |
309.13 |
48.77 |
1074.95 |
1193.21 |
523.42 |
669.79 |
105.68 |
Florida Humana Medical Plan, Inc. - Standard Self & Family |
LL5 |
1116.28 |
1239.07 |
562.25 |
676.82 |
107.01 |
2418.61 |
2684.65 |
1218.21 |
1466.44 |
231.85 |
Florida Humana Medical Plan, Inc. - Standard Self Plus One |
LL6 |
1066.67 |
1184.00 |
517.46 |
666.54 |
103.99 |
2311.12 |
2565.33 |
1121.16 |
1444.17 |
225.31 |
Florida Humana Medical Plan, Inc. - High Self |
LL1 |
765.76 |
788.74 |
241.58 |
547.16 |
17.17 |
1659.15 |
1708.94 |
523.42 |
1185.52 |
37.21 |
Florida Humana Medical Plan, Inc. - High Self & Family |
LL2 |
1722.95 |
1774.64 |
562.25 |
1212.39 |
35.91 |
3733.06 |
3845.05 |
1218.21 |
2626.84 |
77.80 |
Florida Humana Medical Plan, Inc. - High Self Plus One |
LL3 |
1646.37 |
1695.76 |
517.46 |
1178.30 |
36.05 |
3567.14 |
3674.15 |
1121.16 |
2552.99 |
78.11 |
Florida Humana Medical Plan, Inc. - High Self |
EE1 |
514.68 |
576.43 |
241.58 |
334.85 |
55.94 |
1115.14 |
1248.93 |
523.42 |
725.51 |
121.21 |
Florida Humana Medical Plan, Inc. - High Self & Family |
EE2 |
1158.03 |
1296.99 |
562.25 |
734.74 |
123.18 |
2509.07 |
2810.15 |
1218.21 |
1591.94 |
266.89 |
Florida Humana Medical Plan, Inc. - High Self Plus One |
EE3 |
1106.58 |
1239.37 |
517.46 |
721.91 |
119.45 |
2397.59 |
2685.30 |
1121.16 |
1564.14 |
258.81 |
Florida Humana Medical Plan, Inc. - Standard Self |
EE4 |
460.21 |
515.43 |
241.58 |
273.85 |
49.41 |
997.12 |
1116.77 |
523.42 |
593.35 |
107.07 |
Florida Humana Medical Plan, Inc. - Standard Self & Family |
EE5 |
1035.46 |
1159.71 |
562.25 |
597.46 |
108.47 |
2243.50 |
2512.71 |
1218.21 |
1294.50 |
235.02 |
Florida Humana Medical Plan, Inc. - Standard Self Plus One |
EE6 |
989.44 |
1108.17 |
517.46 |
590.71 |
105.39 |
2143.79 |
2401.04 |
1121.16 |
1279.88 |
228.35 |
Florida Humana Medical Plan, Inc. - Standard Self |
E24 |
330.47 |
353.60 |
241.58 |
112.02 |
17.32 |
716.02 |
766.13 |
523.42 |
242.71 |
37.53 |
Florida Humana Medical Plan, Inc. - Standard Self & Family |
E25 |
743.54 |
795.59 |
562.25 |
233.34 |
36.27 |
1611.00 |
1723.78 |
1218.21 |
505.57 |
78.59 |
Florida Humana Medical Plan, Inc. - Standard Self Plus One |
E26 |
710.49 |
760.22 |
517.46 |
242.76 |
36.39 |
1539.40 |
1647.14 |
1121.16 |
525.98 |
78.84 |
Florida Humana Medical Plan, Inc. - High Self |
E21 |
555.07 |
593.92 |
241.58 |
352.34 |
33.04 |
1202.65 |
1286.83 |
523.42 |
763.41 |
71.60 |
Florida Humana Medical Plan, Inc. - High Self & Family |
E22 |
1248.86 |
1336.28 |
562.25 |
774.03 |
71.64 |
2705.86 |
2895.27 |
1218.21 |
1677.06 |
155.22 |
Florida Humana Medical Plan, Inc. - High Self Plus One |
E23 |
1193.36 |
1276.89 |
517.46 |
759.43 |
70.19 |
2585.61 |
2766.60 |
1121.16 |
1645.44 |
152.09 |
Florida Humana Medical Plan, Inc. - High Self |
EX1 |
412.34 |
470.07 |
241.58 |
228.49 |
51.92 |
893.40 |
1018.49 |
523.42 |
495.07 |
112.51 |
Florida Humana Medical Plan, Inc. - High Self & Family |
EX2 |
927.74 |
1057.63 |
562.25 |
495.38 |
114.11 |
2010.10 |
2291.53 |
1218.21 |
1073.32 |
247.24 |
Florida Humana Medical Plan, Inc. - High Self Plus One |
EX3 |
886.51 |
1010.62 |
517.46 |
493.16 |
110.77 |
1920.77 |
2189.68 |
1121.16 |
1068.52 |
240.01 |
Florida Humana Medical Plan, Inc. - Standard Self |
EX4 |
337.95 |
385.26 |
241.58 |
143.68 |
41.50 |
732.23 |
834.73 |
523.42 |
311.31 |
89.92 |
Florida Humana Medical Plan, Inc. - Standard Self & Family |
EX5 |
760.39 |
866.84 |
562.25 |
304.59 |
90.67 |
1647.51 |
1878.15 |
1218.21 |
659.94 |
196.45 |
Florida Humana Medical Plan, Inc. - Standard Self Plus One |
EX6 |
726.59 |
828.31 |
517.46 |
310.85 |
88.38 |
1574.28 |
1794.67 |
1121.16 |
673.51 |
191.49 |
Florida UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
242.68 |
276.68 |
207.51 |
69.17 |
8.50 |
525.81 |
599.47 |
449.60 |
149.87 |
18.42 |
Florida UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
573.86 |
654.35 |
490.76 |
163.59 |
20.13 |
1243.36 |
1417.76 |
1063.32 |
354.44 |
43.60 |
Florida UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
521.73 |
594.87 |
446.15 |
148.72 |
18.29 |
1130.42 |
1288.89 |
966.67 |
322.22 |
39.62 |
Florida UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LS1 |
209.88 |
224.24 |
168.18 |
56.06 |
3.59 |
454.74 |
485.85 |
364.39 |
121.46 |
7.78 |
Florida UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LS2 |
482.73 |
515.77 |
386.83 |
128.94 |
8.26 |
1045.92 |
1117.50 |
838.13 |
279.37 |
17.89 |
Florida UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LS3 |
451.25 |
482.12 |
361.59 |
120.53 |
7.72 |
977.71 |
1044.59 |
783.44 |
261.15 |
16.72 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KK1 |
329.48 |
354.94 |
241.58 |
113.36 |
19.65 |
713.87 |
769.04 |
523.42 |
245.62 |
42.59 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KK2 |
823.71 |
887.37 |
562.25 |
325.12 |
47.88 |
1784.71 |
1922.64 |
1218.21 |
704.43 |
103.74 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KK3 |
708.40 |
763.14 |
517.46 |
245.68 |
41.40 |
1534.87 |
1653.47 |
1121.16 |
532.31 |
89.70 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
LV1 |
323.74 |
346.44 |
241.58 |
104.86 |
16.89 |
701.44 |
750.62 |
523.42 |
227.20 |
36.60 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
LV2 |
971.21 |
1039.34 |
562.25 |
477.09 |
52.35 |
2104.29 |
2251.90 |
1218.21 |
1033.69 |
113.42 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self Plus One |
LV3 |
696.03 |
744.87 |
517.46 |
227.41 |
35.50 |
1508.07 |
1613.89 |
1121.16 |
492.73 |
76.92 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
233.88 |
266.18 |
199.64 |
66.54 |
8.07 |
506.74 |
576.72 |
432.54 |
144.18 |
17.50 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
553.03 |
629.51 |
472.13 |
157.38 |
19.12 |
1198.23 |
1363.94 |
1022.96 |
340.98 |
41.42 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
502.79 |
572.28 |
429.21 |
143.07 |
17.37 |
1089.38 |
1239.94 |
929.96 |
309.98 |
37.64 |
Florida UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Florida UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Florida UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Georgia Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Georgia Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Georgia Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Georgia Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Georgia Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Georgia Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
382.72 |
393.11 |
241.58 |
151.53 |
4.58 |
829.23 |
851.74 |
523.42 |
328.32 |
9.93 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
872.64 |
896.32 |
562.25 |
334.07 |
7.90 |
1890.72 |
1942.03 |
1218.21 |
723.82 |
17.12 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
864.00 |
887.45 |
517.46 |
369.99 |
10.11 |
1872.00 |
1922.81 |
1121.16 |
801.65 |
21.91 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
378.45 |
379.30 |
241.58 |
137.72 |
-4.96 |
819.98 |
821.82 |
523.42 |
298.40 |
-10.74 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
866.59 |
868.56 |
562.25 |
306.31 |
-13.81 |
1877.61 |
1881.88 |
1218.21 |
663.67 |
-29.92 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
849.59 |
851.52 |
517.46 |
334.06 |
-11.41 |
1840.78 |
1844.96 |
1121.16 |
723.80 |
-24.72 |
Georgia Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Georgia Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Georgia Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Georgia Aetna Open Access - High Self |
2U1 |
800.01 |
833.47 |
241.58 |
591.89 |
27.65 |
1733.36 |
1805.85 |
523.42 |
1282.43 |
59.91 |
Georgia Aetna Open Access - High Self & Family |
2U2 |
1842.78 |
1919.87 |
562.25 |
1357.62 |
61.31 |
3992.69 |
4159.72 |
1218.21 |
2941.51 |
132.84 |
Georgia Aetna Open Access - High Self Plus One |
2U3 |
1824.53 |
1900.86 |
517.46 |
1383.40 |
62.99 |
3953.15 |
4118.53 |
1121.16 |
2997.37 |
136.48 |
Georgia Blue Open Access POS - High Self |
QM1 |
288.54 |
302.96 |
227.22 |
75.74 |
3.61 |
625.17 |
656.41 |
492.31 |
164.10 |
7.81 |
Georgia Blue Open Access POS - High Self & Family |
QM2 |
757.14 |
779.85 |
562.25 |
217.60 |
6.93 |
1640.47 |
1689.68 |
1218.21 |
471.47 |
15.02 |
Georgia Blue Open Access POS - High Self Plus One |
QM3 |
635.88 |
667.67 |
500.75 |
166.92 |
7.95 |
1377.74 |
1446.62 |
1084.97 |
361.65 |
17.22 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self |
S94 |
254.72 |
282.74 |
212.06 |
70.68 |
7.00 |
551.89 |
612.60 |
459.45 |
153.15 |
15.18 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self & Family |
S95 |
573.11 |
636.16 |
477.12 |
159.04 |
15.76 |
1241.74 |
1378.35 |
1033.76 |
344.59 |
34.16 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
S96 |
547.65 |
607.89 |
455.92 |
151.97 |
15.06 |
1186.58 |
1317.10 |
987.83 |
329.27 |
32.63 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self |
S91 |
319.91 |
355.11 |
241.58 |
113.53 |
29.39 |
693.14 |
769.41 |
523.42 |
245.99 |
63.69 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
S92 |
719.82 |
798.99 |
562.25 |
236.74 |
56.79 |
1559.61 |
1731.15 |
1218.21 |
512.94 |
123.04 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
S93 |
687.82 |
763.48 |
517.46 |
246.02 |
62.32 |
1490.28 |
1654.21 |
1121.16 |
533.05 |
135.03 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self |
AD4 |
340.40 |
381.25 |
241.58 |
139.67 |
35.04 |
737.53 |
826.04 |
523.42 |
302.62 |
75.93 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self & Family |
AD5 |
765.88 |
857.78 |
562.25 |
295.53 |
76.12 |
1659.41 |
1858.52 |
1218.21 |
640.31 |
164.92 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
AD6 |
731.85 |
819.67 |
517.46 |
302.21 |
74.48 |
1585.68 |
1775.95 |
1121.16 |
654.79 |
161.37 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self |
AD1 |
449.25 |
503.16 |
241.58 |
261.58 |
48.10 |
973.38 |
1090.18 |
523.42 |
566.76 |
104.22 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
AD2 |
1010.80 |
1132.09 |
562.25 |
569.84 |
105.51 |
2190.07 |
2452.86 |
1218.21 |
1234.65 |
228.60 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
AD3 |
965.88 |
1081.78 |
517.46 |
564.32 |
102.56 |
2092.74 |
2343.86 |
1121.16 |
1222.70 |
222.22 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self |
LM1 |
313.49 |
344.83 |
241.58 |
103.25 |
24.88 |
679.23 |
747.13 |
523.42 |
223.71 |
53.90 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
LM2 |
705.37 |
775.90 |
562.25 |
213.65 |
37.31 |
1528.30 |
1681.12 |
1218.21 |
462.91 |
80.84 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
LM3 |
674.01 |
741.42 |
517.46 |
223.96 |
54.07 |
1460.36 |
1606.41 |
1121.16 |
485.25 |
117.15 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self |
LM4 |
296.56 |
326.22 |
241.58 |
84.64 |
10.50 |
642.55 |
706.81 |
523.42 |
183.39 |
22.75 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self & Family |
LM5 |
667.25 |
733.98 |
550.49 |
183.49 |
16.68 |
1445.71 |
1590.29 |
1192.72 |
397.57 |
36.14 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
LM6 |
637.60 |
701.37 |
517.46 |
183.91 |
24.51 |
1381.47 |
1519.64 |
1121.16 |
398.48 |
53.11 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self |
RM1 |
299.32 |
332.25 |
241.58 |
90.67 |
15.84 |
648.53 |
719.88 |
523.42 |
196.46 |
34.33 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self & Family |
RM2 |
673.49 |
747.57 |
560.68 |
186.89 |
18.52 |
1459.23 |
1619.74 |
1214.81 |
404.93 |
40.12 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self Plus One |
RM3 |
643.55 |
714.34 |
517.46 |
196.88 |
35.99 |
1394.36 |
1547.74 |
1121.16 |
426.58 |
77.99 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self |
DN4 |
335.09 |
375.30 |
241.58 |
133.72 |
34.40 |
726.03 |
813.15 |
523.42 |
289.73 |
74.54 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self & Family |
DN5 |
753.93 |
844.40 |
562.25 |
282.15 |
74.69 |
1633.52 |
1829.53 |
1218.21 |
611.32 |
161.82 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self Plus One |
DN6 |
720.43 |
806.88 |
517.46 |
289.42 |
73.11 |
1560.93 |
1748.24 |
1121.16 |
627.08 |
158.41 |
Georgia Humana Employers Health Plan of Georgia, Inc. - High Self |
DN1 |
360.28 |
403.51 |
241.58 |
161.93 |
37.42 |
780.61 |
874.27 |
523.42 |
350.85 |
81.08 |
Georgia Humana Employers Health Plan of Georgia, Inc. - High Self & Family |
DN2 |
810.63 |
907.90 |
562.25 |
345.65 |
81.49 |
1756.37 |
1967.12 |
1218.21 |
748.91 |
176.56 |
Georgia Humana Employers Health Plan of Georgia, Inc. - High Self Plus One |
DN3 |
774.60 |
867.56 |
517.46 |
350.10 |
79.62 |
1678.30 |
1879.71 |
1121.16 |
758.55 |
172.51 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self |
RJ1 |
276.04 |
309.16 |
231.87 |
77.29 |
8.28 |
598.09 |
669.85 |
502.39 |
167.46 |
17.94 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self & Family |
RJ2 |
621.10 |
695.64 |
521.73 |
173.91 |
18.64 |
1345.72 |
1507.22 |
1130.42 |
376.80 |
40.37 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self Plus One |
RJ3 |
593.50 |
664.72 |
498.54 |
166.18 |
17.81 |
1285.92 |
1440.23 |
1080.17 |
360.06 |
38.58 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self |
Q71 |
352.06 |
390.79 |
241.58 |
149.21 |
32.92 |
762.80 |
846.71 |
523.42 |
323.29 |
71.33 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self & Family |
Q72 |
792.15 |
879.28 |
562.25 |
317.03 |
71.35 |
1716.33 |
1905.11 |
1218.21 |
686.90 |
154.59 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self Plus One |
Q73 |
756.93 |
840.20 |
517.46 |
322.74 |
69.93 |
1640.02 |
1820.43 |
1121.16 |
699.27 |
151.51 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self |
CB4 |
577.13 |
525.18 |
241.58 |
283.60 |
-57.76 |
1250.45 |
1137.89 |
523.42 |
614.47 |
-125.14 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self & Family |
CB5 |
1298.54 |
1181.68 |
562.25 |
619.43 |
-132.64 |
2813.50 |
2560.31 |
1218.21 |
1342.10 |
-287.38 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self Plus One |
CB6 |
1240.83 |
1129.16 |
517.46 |
611.70 |
-125.01 |
2688.47 |
2446.51 |
1121.16 |
1325.35 |
-270.86 |
Georgia Humana Employers Health Plan of Georgia, Inc. - High Self |
CB1 |
530.11 |
588.41 |
241.58 |
346.83 |
52.49 |
1148.57 |
1274.89 |
523.42 |
751.47 |
113.74 |
Georgia Humana Employers Health Plan of Georgia, Inc. - High Self & Family |
CB2 |
1192.80 |
1324.00 |
562.25 |
761.75 |
115.42 |
2584.40 |
2868.67 |
1218.21 |
1650.46 |
250.08 |
Georgia Humana Employers Health Plan of Georgia, Inc. - High Self Plus One |
CB3 |
1139.82 |
1265.20 |
517.46 |
747.74 |
112.04 |
2469.61 |
2741.27 |
1121.16 |
1620.11 |
242.76 |
Georgia Humana Employers Health Plan of Georgia, Inc. - High Self |
DG1 |
610.12 |
640.63 |
241.58 |
399.05 |
24.70 |
1321.93 |
1388.03 |
523.42 |
864.61 |
53.52 |
Georgia Humana Employers Health Plan of Georgia, Inc. - High Self & Family |
DG2 |
1372.77 |
1441.41 |
562.25 |
879.16 |
52.86 |
2974.34 |
3123.06 |
1218.21 |
1904.85 |
114.53 |
Georgia Humana Employers Health Plan of Georgia, Inc. - High Self Plus One |
DG3 |
1311.78 |
1377.37 |
517.46 |
859.91 |
52.25 |
2842.19 |
2984.30 |
1121.16 |
1863.14 |
113.21 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self |
DG4 |
540.85 |
600.35 |
241.58 |
358.77 |
53.69 |
1171.84 |
1300.76 |
523.42 |
777.34 |
116.34 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self & Family |
DG5 |
1216.94 |
1350.79 |
562.25 |
788.54 |
118.07 |
2636.70 |
2926.71 |
1218.21 |
1708.50 |
255.82 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self Plus One |
DG6 |
1162.88 |
1290.79 |
517.46 |
773.33 |
114.57 |
2519.57 |
2796.71 |
1121.16 |
1675.55 |
248.24 |
Georgia Kaiser Permanente - Georgia - High Self |
F81 |
336.94 |
346.66 |
241.58 |
105.08 |
3.91 |
730.04 |
751.10 |
523.42 |
227.68 |
8.48 |
Georgia Kaiser Permanente - Georgia - High Self & Family |
F82 |
761.48 |
783.46 |
562.25 |
221.21 |
6.20 |
1649.87 |
1697.50 |
1218.21 |
479.29 |
13.44 |
Georgia Kaiser Permanente - Georgia - High Self Plus One |
F83 |
761.48 |
783.46 |
517.46 |
266.00 |
8.64 |
1649.87 |
1697.50 |
1121.16 |
576.34 |
18.73 |
Georgia Kaiser Permanente - Georgia - Standard Self |
F84 |
254.92 |
268.20 |
201.15 |
67.05 |
3.32 |
552.33 |
581.10 |
435.83 |
145.27 |
7.19 |
Georgia Kaiser Permanente - Georgia - Standard Self & Family |
F85 |
576.12 |
606.12 |
454.59 |
151.53 |
7.50 |
1248.26 |
1313.26 |
984.95 |
328.31 |
16.25 |
Georgia Kaiser Permanente - Georgia - Standard Self Plus One |
F86 |
576.12 |
606.12 |
454.59 |
151.53 |
7.50 |
1248.26 |
1313.26 |
984.95 |
328.31 |
16.25 |
Georgia Kaiser Permanente - Georgia - Basic Self |
LA1 |
181.55 |
193.34 |
145.01 |
48.33 |
2.94 |
393.36 |
418.90 |
314.18 |
104.72 |
6.38 |
Georgia Kaiser Permanente - Georgia - Basic Self & Family |
LA2 |
410.30 |
436.92 |
327.69 |
109.23 |
6.66 |
888.98 |
946.66 |
710.00 |
236.66 |
14.42 |
Georgia Kaiser Permanente - Georgia - Basic Self Plus One |
LA3 |
410.30 |
436.92 |
327.69 |
109.23 |
6.66 |
888.98 |
946.66 |
710.00 |
236.66 |
14.42 |
Georgia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
242.68 |
276.68 |
207.51 |
69.17 |
8.50 |
525.81 |
599.47 |
449.60 |
149.87 |
18.42 |
Georgia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
573.86 |
654.35 |
490.76 |
163.59 |
20.13 |
1243.36 |
1417.76 |
1063.32 |
354.44 |
43.60 |
Georgia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
521.73 |
594.87 |
446.15 |
148.72 |
18.29 |
1130.42 |
1288.89 |
966.67 |
322.22 |
39.62 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
LV1 |
323.74 |
346.44 |
241.58 |
104.86 |
16.89 |
701.44 |
750.62 |
523.42 |
227.20 |
36.60 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
LV2 |
971.21 |
1039.34 |
562.25 |
477.09 |
52.35 |
2104.29 |
2251.90 |
1218.21 |
1033.69 |
113.42 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self Plus One |
LV3 |
696.03 |
744.87 |
517.46 |
227.41 |
35.50 |
1508.07 |
1613.89 |
1121.16 |
492.73 |
76.92 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
233.88 |
266.18 |
199.64 |
66.54 |
8.07 |
506.74 |
576.72 |
432.54 |
144.18 |
17.50 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
553.03 |
629.51 |
472.13 |
157.38 |
19.12 |
1198.23 |
1363.94 |
1022.96 |
340.98 |
41.42 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
502.79 |
572.28 |
429.21 |
143.07 |
17.37 |
1089.38 |
1239.94 |
929.96 |
309.98 |
37.64 |
Georgia UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Georgia UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Georgia UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Guam Calvo's SelectCare - Standard Self |
B44 |
183.11 |
198.36 |
148.77 |
49.59 |
3.81 |
396.74 |
429.78 |
322.34 |
107.44 |
8.26 |
Guam Calvo's SelectCare - Standard Self & Family |
B45 |
532.03 |
576.33 |
432.25 |
144.08 |
11.07 |
1152.73 |
1248.72 |
936.54 |
312.18 |
24.00 |
Guam Calvo's SelectCare - Standard Self Plus One |
B46 |
360.97 |
391.02 |
293.27 |
97.75 |
7.51 |
782.10 |
847.21 |
635.41 |
211.80 |
16.28 |
Guam Calvo's SelectCare - High Self |
B41 |
226.87 |
240.78 |
180.59 |
60.19 |
3.47 |
491.55 |
521.69 |
391.27 |
130.42 |
7.53 |
Guam Calvo's SelectCare - High Self & Family |
B42 |
600.87 |
637.74 |
478.31 |
159.43 |
9.21 |
1301.89 |
1381.77 |
1036.33 |
345.44 |
19.97 |
Guam Calvo's SelectCare - High Self Plus One |
B43 |
442.72 |
469.88 |
352.41 |
117.47 |
6.79 |
959.23 |
1018.07 |
763.55 |
254.52 |
14.71 |
Guam TakeCare - HDHP Self |
KX1 |
57.34 |
55.63 |
41.72 |
13.91 |
-0.42 |
124.24 |
120.53 |
90.40 |
30.13 |
-0.93 |
Guam TakeCare - HDHP Self & Family |
KX2 |
156.61 |
149.15 |
111.86 |
37.29 |
-1.86 |
339.32 |
323.16 |
242.37 |
80.79 |
-4.04 |
Guam TakeCare - HDHP Self Plus One |
KX3 |
141.28 |
134.28 |
100.71 |
33.57 |
-1.75 |
306.11 |
290.94 |
218.21 |
72.73 |
-3.80 |
Guam TakeCare - Standard Self |
JK4 |
179.65 |
186.67 |
140.00 |
46.67 |
1.76 |
389.24 |
404.45 |
303.34 |
101.11 |
3.80 |
Guam TakeCare - Standard Self & Family |
JK5 |
508.76 |
528.64 |
396.48 |
132.16 |
4.97 |
1102.31 |
1145.39 |
859.04 |
286.35 |
10.77 |
Guam TakeCare - Standard Self Plus One |
JK6 |
354.07 |
367.91 |
275.93 |
91.98 |
3.46 |
767.15 |
797.14 |
597.86 |
199.28 |
7.49 |
Guam TakeCare - High Self |
JK1 |
227.24 |
229.76 |
172.32 |
57.44 |
0.63 |
492.35 |
497.81 |
373.36 |
124.45 |
1.36 |
Guam TakeCare - High Self & Family |
JK2 |
542.03 |
548.02 |
411.02 |
137.00 |
1.49 |
1174.40 |
1187.38 |
890.54 |
296.84 |
3.24 |
Guam TakeCare - High Self Plus One |
JK3 |
448.95 |
453.92 |
340.44 |
113.48 |
1.24 |
972.73 |
983.49 |
737.62 |
245.87 |
2.69 |
Hawaii Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Hawaii Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Hawaii Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Hawaii Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Hawaii Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Hawaii Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
JS4 |
495.45 |
505.19 |
241.58 |
263.61 |
3.93 |
1073.48 |
1094.58 |
523.42 |
571.16 |
8.52 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
JS5 |
1131.04 |
1153.29 |
562.25 |
591.04 |
6.47 |
2450.59 |
2498.80 |
1218.21 |
1280.59 |
14.02 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
JS6 |
1119.84 |
1141.88 |
517.46 |
624.42 |
8.70 |
2426.32 |
2474.07 |
1121.16 |
1352.91 |
18.85 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
JS1 |
463.38 |
466.12 |
241.58 |
224.54 |
-3.07 |
1003.99 |
1009.93 |
523.42 |
486.51 |
-6.64 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
JS2 |
1056.30 |
1062.53 |
562.25 |
500.28 |
-9.55 |
2288.65 |
2302.15 |
1218.21 |
1083.94 |
-20.69 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
JS3 |
1045.84 |
1052.00 |
517.46 |
534.54 |
-7.18 |
2265.99 |
2279.33 |
1121.16 |
1158.17 |
-15.56 |
Hawaii Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Hawaii Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Hawaii Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Hawaii HMSA Plan - High Self |
871 |
291.34 |
291.34 |
218.51 |
72.83 |
0.00 |
631.24 |
631.24 |
473.43 |
157.81 |
0.00 |
Hawaii HMSA Plan - High Self & Family |
872 |
654.93 |
654.93 |
491.20 |
163.73 |
0.00 |
1419.02 |
1419.02 |
1064.27 |
354.75 |
0.00 |
Hawaii HMSA Plan - High Self Plus One |
873 |
638.34 |
638.34 |
478.76 |
159.58 |
0.00 |
1383.07 |
1383.07 |
1037.30 |
345.77 |
0.00 |
Hawaii HMSA Plan - Standard Self |
874 |
198.91 |
209.46 |
157.10 |
52.36 |
2.63 |
430.97 |
453.83 |
340.37 |
113.46 |
5.72 |
Hawaii HMSA Plan - Standard Self & Family |
875 |
447.15 |
470.85 |
353.14 |
117.71 |
5.92 |
968.83 |
1020.18 |
765.14 |
255.04 |
12.83 |
Hawaii HMSA Plan - Standard Self Plus One |
876 |
435.80 |
458.90 |
344.18 |
114.72 |
5.77 |
944.23 |
994.28 |
745.71 |
248.57 |
12.51 |
Hawaii Kaiser Permanente - Hawaii - High Self |
631 |
311.79 |
311.79 |
233.84 |
77.95 |
0.00 |
675.55 |
675.55 |
506.66 |
168.89 |
0.00 |
Hawaii Kaiser Permanente - Hawaii - High Self & Family |
632 |
695.31 |
695.31 |
521.48 |
173.83 |
0.00 |
1506.51 |
1506.51 |
1129.88 |
376.63 |
0.00 |
Hawaii Kaiser Permanente - Hawaii - High Self Plus One |
633 |
695.31 |
695.31 |
517.46 |
177.85 |
-13.34 |
1506.51 |
1506.51 |
1121.16 |
385.35 |
-28.90 |
Hawaii Kaiser Permanente - Hawaii - Standard Self |
634 |
222.07 |
233.16 |
174.87 |
58.29 |
2.77 |
481.15 |
505.18 |
378.89 |
126.29 |
6.00 |
Hawaii Kaiser Permanente - Hawaii - Standard Self & Family |
635 |
495.22 |
519.93 |
389.95 |
129.98 |
6.18 |
1072.98 |
1126.52 |
844.89 |
281.63 |
13.39 |
Hawaii Kaiser Permanente - Hawaii - Standard Self Plus One |
636 |
495.22 |
519.93 |
389.95 |
129.98 |
6.18 |
1072.98 |
1126.52 |
844.89 |
281.63 |
13.39 |
Idaho Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Idaho Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Idaho Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Idaho Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Idaho Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Idaho Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
382.37 |
381.62 |
241.58 |
140.04 |
-6.56 |
828.47 |
826.84 |
523.42 |
303.42 |
-14.21 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
871.59 |
869.88 |
562.25 |
307.63 |
-17.49 |
1888.45 |
1884.74 |
1218.21 |
666.53 |
-37.90 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
863.04 |
861.43 |
517.46 |
343.97 |
-14.95 |
1869.92 |
1866.43 |
1121.16 |
745.27 |
-32.39 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
372.48 |
377.30 |
241.58 |
135.72 |
-0.99 |
807.04 |
817.48 |
523.42 |
294.06 |
-2.14 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
854.85 |
865.92 |
562.25 |
303.67 |
-4.71 |
1852.18 |
1876.16 |
1218.21 |
657.95 |
-10.21 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
838.09 |
848.95 |
517.46 |
331.49 |
-2.48 |
1815.86 |
1839.39 |
1121.16 |
718.23 |
-5.37 |
Idaho Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Idaho Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Idaho Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Idaho Altius Health Plan - High Self |
9K1 |
465.72 |
483.86 |
241.58 |
242.28 |
12.33 |
1009.06 |
1048.36 |
523.42 |
524.94 |
26.72 |
Idaho Altius Health Plan - High Self & Family |
9K2 |
1029.93 |
1070.06 |
562.25 |
507.81 |
24.35 |
2231.52 |
2318.46 |
1218.21 |
1100.25 |
52.75 |
Idaho Altius Health Plan - High Self Plus One |
9K3 |
1019.73 |
1059.46 |
517.46 |
542.00 |
26.39 |
2209.42 |
2295.50 |
1121.16 |
1174.34 |
57.18 |
Idaho Altius Health Plan - HDHP Self |
9K4 |
244.26 |
310.38 |
232.79 |
77.59 |
16.53 |
529.23 |
672.49 |
504.37 |
168.12 |
35.81 |
Idaho Altius Health Plan - HDHP Self & Family |
9K5 |
510.48 |
648.66 |
486.50 |
162.16 |
34.54 |
1106.04 |
1405.43 |
1054.07 |
351.36 |
74.85 |
Idaho Altius Health Plan - HDHP Self Plus One |
9K6 |
500.48 |
635.93 |
476.95 |
158.98 |
33.86 |
1084.37 |
1377.85 |
1033.39 |
344.46 |
73.37 |
Idaho Altius Health Plan - Standard Self |
DK4 |
351.37 |
407.59 |
241.58 |
166.01 |
50.41 |
761.30 |
883.11 |
523.42 |
359.69 |
109.23 |
Idaho Altius Health Plan - Standard Self & Family |
DK5 |
775.95 |
900.09 |
562.25 |
337.84 |
108.36 |
1681.23 |
1950.20 |
1218.21 |
731.99 |
234.78 |
Idaho Altius Health Plan - Standard Self Plus One |
DK6 |
768.26 |
891.17 |
517.46 |
373.71 |
109.57 |
1664.56 |
1930.87 |
1121.16 |
809.71 |
237.41 |
Idaho Kaiser Permanente - Washington Core - Standard Self |
544 |
278.83 |
285.24 |
213.93 |
71.31 |
1.60 |
604.13 |
618.02 |
463.52 |
154.50 |
3.47 |
Idaho Kaiser Permanente - Washington Core - Standard Self & Family |
545 |
641.32 |
656.05 |
492.04 |
164.01 |
3.68 |
1389.53 |
1421.44 |
1066.08 |
355.36 |
7.98 |
Idaho Kaiser Permanente - Washington Core - Standard Self Plus One |
546 |
641.32 |
656.05 |
492.04 |
164.01 |
3.68 |
1389.53 |
1421.44 |
1066.08 |
355.36 |
7.98 |
Idaho Kaiser Permanente - Washington Core - High Self |
541 |
390.34 |
398.66 |
241.58 |
157.08 |
2.51 |
845.74 |
863.76 |
523.42 |
340.34 |
5.44 |
Idaho Kaiser Permanente - Washington Core - High Self & Family |
542 |
858.76 |
877.04 |
562.25 |
314.79 |
2.50 |
1860.65 |
1900.25 |
1218.21 |
682.04 |
5.41 |
Idaho Kaiser Permanente - Washington Core - High Self Plus One |
543 |
858.76 |
877.04 |
517.46 |
359.58 |
4.94 |
1860.65 |
1900.25 |
1121.16 |
779.09 |
10.70 |
Idaho Kaiser Permanente - Washington Core - Prosper Self |
PT4 |
New Plan |
180.00 |
135.00 |
45.00 |
New Plan |
New Plan |
390.00 |
292.50 |
97.50 |
New Plan |
Idaho Kaiser Permanente - Washington Core - Prosper Self & Family |
PT5 |
New Plan |
503.99 |
377.99 |
126.00 |
New Plan |
New Plan |
1091.98 |
818.99 |
272.99 |
New Plan |
Idaho Kaiser Permanente - Washington Core - Prosper Self Plus One |
PT6 |
New Plan |
436.00 |
327.00 |
109.00 |
New Plan |
New Plan |
944.67 |
708.50 |
236.17 |
New Plan |
Idaho UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Idaho UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Idaho UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Illinois Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Illinois Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Illinois Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Illinois Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Illinois Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Illinois Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
382.37 |
381.62 |
241.58 |
140.04 |
-6.56 |
828.47 |
826.84 |
523.42 |
303.42 |
-14.21 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
871.59 |
869.88 |
562.25 |
307.63 |
-17.49 |
1888.45 |
1884.74 |
1218.21 |
666.53 |
-37.90 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
863.04 |
861.43 |
517.46 |
343.97 |
-14.95 |
1869.92 |
1866.43 |
1121.16 |
745.27 |
-32.39 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
372.48 |
377.30 |
241.58 |
135.72 |
-0.99 |
807.04 |
817.48 |
523.42 |
294.06 |
-2.14 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
854.85 |
865.92 |
562.25 |
303.67 |
-4.71 |
1852.18 |
1876.16 |
1218.21 |
657.95 |
-10.21 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
838.09 |
848.95 |
517.46 |
331.49 |
-2.48 |
1815.86 |
1839.39 |
1121.16 |
718.23 |
-5.37 |
Illinois Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Illinois Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Illinois Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Illinois Blue Preferred - High Self |
9G1 |
384.56 |
403.49 |
241.58 |
161.91 |
13.12 |
833.21 |
874.23 |
523.42 |
350.81 |
28.44 |
Illinois Blue Preferred - High Self & Family |
9G2 |
857.94 |
915.93 |
562.25 |
353.68 |
42.21 |
1858.87 |
1984.52 |
1218.21 |
766.31 |
91.46 |
Illinois Blue Preferred - High Self Plus One |
9G3 |
812.58 |
859.44 |
517.46 |
341.98 |
33.52 |
1760.59 |
1862.12 |
1121.16 |
740.96 |
72.63 |
Illinois Blue Preferred - Standard Self |
9G4 |
277.21 |
292.46 |
219.35 |
73.11 |
3.81 |
600.62 |
633.66 |
475.25 |
158.41 |
8.26 |
Illinois Blue Preferred - Standard Self & Family |
9G5 |
787.85 |
811.49 |
562.25 |
249.24 |
7.86 |
1707.01 |
1758.23 |
1218.21 |
540.02 |
17.03 |
Illinois Blue Preferred - Standard Self Plus One |
9G6 |
712.48 |
726.73 |
517.46 |
209.27 |
0.91 |
1543.71 |
1574.58 |
1121.16 |
453.42 |
1.97 |
Illinois Health Alliance HMO - Standard Self |
K84 |
308.37 |
315.49 |
236.62 |
78.87 |
1.78 |
668.14 |
683.56 |
512.67 |
170.89 |
3.86 |
Illinois Health Alliance HMO - Standard Self & Family |
K85 |
832.61 |
731.24 |
548.43 |
182.81 |
-103.33 |
1803.99 |
1584.35 |
1188.26 |
396.09 |
-223.88 |
Illinois Health Alliance HMO - Standard Self Plus One |
K86 |
714.36 |
674.59 |
505.94 |
168.65 |
-41.59 |
1547.78 |
1461.61 |
1096.21 |
365.40 |
-90.12 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self |
GB4 |
349.91 |
363.91 |
241.58 |
122.33 |
8.19 |
758.14 |
788.47 |
523.42 |
265.05 |
17.75 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self & Family |
GB5 |
787.28 |
818.77 |
562.25 |
256.52 |
15.71 |
1705.77 |
1774.00 |
1218.21 |
555.79 |
34.04 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
GB6 |
752.29 |
782.38 |
517.46 |
264.92 |
16.75 |
1629.96 |
1695.16 |
1121.16 |
574.00 |
36.30 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self |
GB1 |
544.86 |
566.65 |
241.58 |
325.07 |
15.98 |
1180.53 |
1227.74 |
523.42 |
704.32 |
34.63 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
GB2 |
1225.91 |
1274.95 |
562.25 |
712.70 |
33.26 |
2656.14 |
2762.39 |
1218.21 |
1544.18 |
72.06 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
GB3 |
1171.44 |
1218.30 |
517.46 |
700.84 |
33.52 |
2538.12 |
2639.65 |
1121.16 |
1518.49 |
72.63 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self |
MW4 |
348.42 |
372.81 |
241.58 |
131.23 |
18.58 |
754.91 |
807.76 |
523.42 |
284.34 |
40.27 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self & Family |
MW5 |
783.93 |
838.80 |
562.25 |
276.55 |
39.09 |
1698.52 |
1817.40 |
1218.21 |
599.19 |
84.69 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
MW6 |
749.10 |
801.54 |
517.46 |
284.08 |
39.10 |
1623.05 |
1736.67 |
1121.16 |
615.51 |
84.72 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self |
MW1 |
422.78 |
473.52 |
241.58 |
231.94 |
44.93 |
916.02 |
1025.96 |
523.42 |
502.54 |
97.36 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
MW2 |
951.30 |
1065.45 |
562.25 |
503.20 |
98.37 |
2061.15 |
2308.48 |
1218.21 |
1090.27 |
213.14 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
MW3 |
909.00 |
1018.09 |
517.46 |
500.63 |
95.75 |
1969.50 |
2205.86 |
1121.16 |
1084.70 |
207.46 |
Illinois Humana Health Plan, Inc. - Standard Self |
754 |
439.34 |
482.47 |
241.58 |
240.89 |
37.32 |
951.90 |
1045.35 |
523.42 |
521.93 |
80.87 |
Illinois Humana Health Plan, Inc. - Standard Self & Family |
755 |
988.51 |
1085.55 |
562.25 |
523.30 |
81.26 |
2141.77 |
2352.03 |
1218.21 |
1133.82 |
176.07 |
Illinois Humana Health Plan, Inc. - Standard Self Plus One |
756 |
944.58 |
1037.32 |
517.46 |
519.86 |
79.40 |
2046.59 |
2247.53 |
1121.16 |
1126.37 |
172.04 |
Illinois Humana Health Plan, Inc. - High Self |
751 |
571.82 |
631.85 |
241.58 |
390.27 |
54.22 |
1238.94 |
1369.01 |
523.42 |
845.59 |
117.49 |
Illinois Humana Health Plan, Inc. - High Self & Family |
752 |
1286.59 |
1421.69 |
562.25 |
859.44 |
119.32 |
2787.61 |
3080.33 |
1218.21 |
1862.12 |
258.53 |
Illinois Humana Health Plan, Inc. - High Self Plus One |
753 |
1229.42 |
1358.50 |
517.46 |
841.04 |
115.74 |
2663.74 |
2943.42 |
1121.16 |
1822.26 |
250.78 |
Illinois Humana Health Plan, Inc. - High Self |
9F1 |
894.61 |
930.39 |
241.58 |
688.81 |
29.97 |
1938.32 |
2015.85 |
523.42 |
1492.43 |
64.95 |
Illinois Humana Health Plan, Inc. - High Self & Family |
9F2 |
2012.86 |
2093.37 |
562.25 |
1531.12 |
64.73 |
4361.20 |
4535.64 |
1218.21 |
3317.43 |
140.25 |
Illinois Humana Health Plan, Inc. - High Self Plus One |
9F3 |
1923.39 |
2000.32 |
517.46 |
1482.86 |
63.59 |
4167.35 |
4334.03 |
1121.16 |
3212.87 |
137.78 |
Illinois Humana Health Plan, Inc. - Standard Self |
AB4 |
530.55 |
573.09 |
241.58 |
331.51 |
36.73 |
1149.53 |
1241.70 |
523.42 |
718.28 |
79.59 |
Illinois Humana Health Plan, Inc. - Standard Self & Family |
AB5 |
1193.74 |
1289.49 |
562.25 |
727.24 |
79.97 |
2586.44 |
2793.90 |
1218.21 |
1575.69 |
173.27 |
Illinois Humana Health Plan, Inc. - Standard Self Plus One |
AB6 |
1140.69 |
1232.18 |
517.46 |
714.72 |
78.15 |
2471.50 |
2669.72 |
1121.16 |
1548.56 |
169.32 |
Illinois Humana Health Plan, Inc. - Basic Self |
AB1 |
349.22 |
363.19 |
241.58 |
121.61 |
8.16 |
756.64 |
786.91 |
523.42 |
263.49 |
17.69 |
Illinois Humana Health Plan, Inc. - Basic Self & Family |
AB2 |
785.77 |
817.20 |
562.25 |
254.95 |
15.65 |
1702.50 |
1770.60 |
1218.21 |
552.39 |
33.91 |
Illinois Humana Health Plan, Inc. - Basic Self Plus One |
AB3 |
750.85 |
780.88 |
517.46 |
263.42 |
16.69 |
1626.84 |
1691.91 |
1121.16 |
570.75 |
36.17 |
Illinois Humana Health Plan, Inc. - Basic Self |
RW1 |
345.34 |
378.02 |
241.58 |
136.44 |
26.87 |
748.24 |
819.04 |
523.42 |
295.62 |
58.22 |
Illinois Humana Health Plan, Inc. - Basic Self & Family |
RW2 |
777.02 |
850.55 |
562.25 |
288.30 |
57.75 |
1683.54 |
1842.86 |
1218.21 |
624.65 |
125.13 |
Illinois Humana Health Plan, Inc. - Basic Self Plus One |
RW3 |
742.49 |
812.75 |
517.46 |
295.29 |
56.92 |
1608.73 |
1760.96 |
1121.16 |
639.80 |
123.33 |
Illinois Union Health Service - High Self |
761 |
343.42 |
360.95 |
241.58 |
119.37 |
11.72 |
744.08 |
782.06 |
523.42 |
258.64 |
25.40 |
Illinois Union Health Service - High Self & Family |
762 |
877.68 |
905.96 |
562.25 |
343.71 |
12.50 |
1901.64 |
1962.91 |
1218.21 |
744.70 |
27.08 |
Illinois Union Health Service - High Self Plus One |
763 |
770.00 |
799.54 |
517.46 |
282.08 |
16.20 |
1668.33 |
1732.34 |
1121.16 |
611.18 |
35.11 |
Illinois UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
242.68 |
276.68 |
207.51 |
69.17 |
8.50 |
525.81 |
599.47 |
449.60 |
149.87 |
18.42 |
Illinois UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
573.86 |
654.35 |
490.76 |
163.59 |
20.13 |
1243.36 |
1417.76 |
1063.32 |
354.44 |
43.60 |
Illinois UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
521.73 |
594.87 |
446.15 |
148.72 |
18.29 |
1130.42 |
1288.89 |
966.67 |
322.22 |
39.62 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
L91 |
240.69 |
255.98 |
191.99 |
63.99 |
3.82 |
521.50 |
554.62 |
415.97 |
138.65 |
8.28 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
L92 |
674.89 |
717.76 |
538.32 |
179.44 |
10.72 |
1462.26 |
1555.15 |
1166.36 |
388.79 |
23.23 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self Plus One |
L93 |
470.06 |
499.93 |
374.95 |
124.98 |
7.47 |
1018.46 |
1083.18 |
812.39 |
270.79 |
16.18 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
233.88 |
266.18 |
199.64 |
66.54 |
8.07 |
506.74 |
576.72 |
432.54 |
144.18 |
17.50 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
553.03 |
629.51 |
472.13 |
157.38 |
19.12 |
1198.23 |
1363.94 |
1022.96 |
340.98 |
41.42 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
502.79 |
572.28 |
429.21 |
143.07 |
17.37 |
1089.38 |
1239.94 |
929.96 |
309.98 |
37.64 |
Illinois UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Illinois UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Illinois UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Indiana Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Indiana Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Indiana Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Indiana Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Indiana Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Indiana Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
JS4 |
495.45 |
505.19 |
241.58 |
263.61 |
3.93 |
1073.48 |
1094.58 |
523.42 |
571.16 |
8.52 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
JS5 |
1131.04 |
1153.29 |
562.25 |
591.04 |
6.47 |
2450.59 |
2498.80 |
1218.21 |
1280.59 |
14.02 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
JS6 |
1119.84 |
1141.88 |
517.46 |
624.42 |
8.70 |
2426.32 |
2474.07 |
1121.16 |
1352.91 |
18.85 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
JS1 |
463.38 |
466.12 |
241.58 |
224.54 |
-3.07 |
1003.99 |
1009.93 |
523.42 |
486.51 |
-6.64 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
JS2 |
1056.30 |
1062.53 |
562.25 |
500.28 |
-9.55 |
2288.65 |
2302.15 |
1218.21 |
1083.94 |
-20.69 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
JS3 |
1045.84 |
1052.00 |
517.46 |
534.54 |
-7.18 |
2265.99 |
2279.33 |
1121.16 |
1158.17 |
-15.56 |
Indiana Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Indiana Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Indiana Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Indiana Health Alliance HMO - Standard Self |
K84 |
308.37 |
315.49 |
236.62 |
78.87 |
1.78 |
668.14 |
683.56 |
512.67 |
170.89 |
3.86 |
Indiana Health Alliance HMO - Standard Self & Family |
K85 |
832.61 |
731.24 |
548.43 |
182.81 |
-103.33 |
1803.99 |
1584.35 |
1188.26 |
396.09 |
-223.88 |
Indiana Health Alliance HMO - Standard Self Plus One |
K86 |
714.36 |
674.59 |
505.94 |
168.65 |
-41.59 |
1547.78 |
1461.61 |
1096.21 |
365.40 |
-90.12 |
Indiana Humana CoverageFirst - CDHP Self |
TC1 |
304.37 |
340.88 |
241.58 |
99.30 |
23.21 |
659.47 |
738.57 |
523.42 |
215.15 |
50.28 |
Indiana Humana CoverageFirst - CDHP Self & Family |
TC2 |
684.80 |
766.98 |
562.25 |
204.73 |
33.53 |
1483.73 |
1661.79 |
1218.21 |
443.58 |
72.65 |
Indiana Humana CoverageFirst - CDHP Self Plus One |
TC3 |
654.38 |
732.90 |
517.46 |
215.44 |
51.85 |
1417.82 |
1587.95 |
1121.16 |
466.79 |
112.34 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self |
MW4 |
348.42 |
372.81 |
241.58 |
131.23 |
18.58 |
754.91 |
807.76 |
523.42 |
284.34 |
40.27 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self & Family |
MW5 |
783.93 |
838.80 |
562.25 |
276.55 |
39.09 |
1698.52 |
1817.40 |
1218.21 |
599.19 |
84.69 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
MW6 |
749.10 |
801.54 |
517.46 |
284.08 |
39.10 |
1623.05 |
1736.67 |
1121.16 |
615.51 |
84.72 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self |
MW1 |
422.78 |
473.52 |
241.58 |
231.94 |
44.93 |
916.02 |
1025.96 |
523.42 |
502.54 |
97.36 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
MW2 |
951.30 |
1065.45 |
562.25 |
503.20 |
98.37 |
2061.15 |
2308.48 |
1218.21 |
1090.27 |
213.14 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
MW3 |
909.00 |
1018.09 |
517.46 |
500.63 |
95.75 |
1969.50 |
2205.86 |
1121.16 |
1084.70 |
207.46 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self |
X34 |
283.90 |
298.10 |
223.58 |
74.52 |
3.55 |
615.12 |
645.88 |
484.41 |
161.47 |
7.69 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self & Family |
X35 |
638.79 |
670.73 |
503.05 |
167.68 |
7.98 |
1384.05 |
1453.25 |
1089.94 |
363.31 |
17.30 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
X36 |
610.40 |
640.92 |
480.69 |
160.23 |
7.63 |
1322.53 |
1388.66 |
1041.50 |
347.16 |
16.53 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self |
X31 |
368.97 |
387.42 |
241.58 |
145.84 |
12.64 |
799.44 |
839.41 |
523.42 |
315.99 |
27.39 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
X32 |
830.20 |
871.71 |
562.25 |
309.46 |
25.73 |
1798.77 |
1888.71 |
1218.21 |
670.50 |
55.75 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
X33 |
793.30 |
832.97 |
517.46 |
315.51 |
26.33 |
1718.82 |
1804.77 |
1121.16 |
683.61 |
57.05 |
Indiana Humana Health Plan of Ohio, Inc. - High Self |
A61 |
692.76 |
727.40 |
241.58 |
485.82 |
28.83 |
1500.98 |
1576.03 |
523.42 |
1052.61 |
62.47 |
Indiana Humana Health Plan of Ohio, Inc. - High Self & Family |
A62 |
1558.72 |
1636.66 |
562.25 |
1074.41 |
62.16 |
3377.23 |
3546.10 |
1218.21 |
2327.89 |
134.68 |
Indiana Humana Health Plan of Ohio, Inc. - High Self Plus One |
A63 |
1489.45 |
1563.92 |
517.46 |
1046.46 |
61.13 |
3227.14 |
3388.49 |
1121.16 |
2267.33 |
132.45 |
Indiana Humana Health Plan of Ohio, Inc. - Standard Self |
A64 |
541.00 |
568.05 |
241.58 |
326.47 |
21.24 |
1172.17 |
1230.78 |
523.42 |
707.36 |
46.03 |
Indiana Humana Health Plan of Ohio, Inc. - Standard Self & Family |
A65 |
1217.27 |
1278.14 |
562.25 |
715.89 |
45.09 |
2637.42 |
2769.30 |
1218.21 |
1551.09 |
97.69 |
Indiana Humana Health Plan of Ohio, Inc. - Standard Self Plus One |
A66 |
1163.17 |
1221.32 |
517.46 |
703.86 |
44.81 |
2520.20 |
2646.19 |
1121.16 |
1525.03 |
97.09 |
Indiana Humana Health Plan, Inc. - Standard Self |
754 |
439.34 |
482.47 |
241.58 |
240.89 |
37.32 |
951.90 |
1045.35 |
523.42 |
521.93 |
80.87 |
Indiana Humana Health Plan, Inc. - Standard Self & Family |
755 |
988.51 |
1085.55 |
562.25 |
523.30 |
81.26 |
2141.77 |
2352.03 |
1218.21 |
1133.82 |
176.07 |
Indiana Humana Health Plan, Inc. - Standard Self Plus One |
756 |
944.58 |
1037.32 |
517.46 |
519.86 |
79.40 |
2046.59 |
2247.53 |
1121.16 |
1126.37 |
172.04 |
Indiana Humana Health Plan, Inc. - High Self |
751 |
571.82 |
631.85 |
241.58 |
390.27 |
54.22 |
1238.94 |
1369.01 |
523.42 |
845.59 |
117.49 |
Indiana Humana Health Plan, Inc. - High Self & Family |
752 |
1286.59 |
1421.69 |
562.25 |
859.44 |
119.32 |
2787.61 |
3080.33 |
1218.21 |
1862.12 |
258.53 |
Indiana Humana Health Plan, Inc. - High Self Plus One |
753 |
1229.42 |
1358.50 |
517.46 |
841.04 |
115.74 |
2663.74 |
2943.42 |
1121.16 |
1822.26 |
250.78 |
Indiana Humana Health Plan, Inc. - High Self |
MH1 |
509.98 |
560.99 |
241.58 |
319.41 |
45.20 |
1104.96 |
1215.48 |
523.42 |
692.06 |
97.94 |
Indiana Humana Health Plan, Inc. - High Self & Family |
MH2 |
1147.47 |
1262.23 |
562.25 |
699.98 |
98.98 |
2486.19 |
2734.83 |
1218.21 |
1516.62 |
214.45 |
Indiana Humana Health Plan, Inc. - High Self Plus One |
MH3 |
1096.47 |
1206.12 |
517.46 |
688.66 |
96.31 |
2375.69 |
2613.26 |
1121.16 |
1492.10 |
208.67 |
Indiana Humana Health Plan, Inc. - Standard Self |
MH4 |
396.76 |
436.44 |
241.58 |
194.86 |
33.87 |
859.65 |
945.62 |
523.42 |
422.20 |
73.39 |
Indiana Humana Health Plan, Inc. - Standard Self & Family |
MH5 |
892.70 |
981.98 |
562.25 |
419.73 |
73.50 |
1934.18 |
2127.62 |
1218.21 |
909.41 |
159.25 |
Indiana Humana Health Plan, Inc. - Standard Self Plus One |
MH6 |
853.03 |
938.33 |
517.46 |
420.87 |
71.96 |
1848.23 |
2033.05 |
1121.16 |
911.89 |
155.92 |
Indiana UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Indiana UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Indiana UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Iowa Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Iowa Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Iowa Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Iowa Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Iowa Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Iowa Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
382.37 |
381.62 |
241.58 |
140.04 |
-6.56 |
828.47 |
826.84 |
523.42 |
303.42 |
-14.21 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
871.59 |
869.88 |
562.25 |
307.63 |
-17.49 |
1888.45 |
1884.74 |
1218.21 |
666.53 |
-37.90 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
863.04 |
861.43 |
517.46 |
343.97 |
-14.95 |
1869.92 |
1866.43 |
1121.16 |
745.27 |
-32.39 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
372.48 |
377.30 |
241.58 |
135.72 |
-0.99 |
807.04 |
817.48 |
523.42 |
294.06 |
-2.14 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
854.85 |
865.92 |
562.25 |
303.67 |
-4.71 |
1852.18 |
1876.16 |
1218.21 |
657.95 |
-10.21 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
838.09 |
848.95 |
517.46 |
331.49 |
-2.48 |
1815.86 |
1839.39 |
1121.16 |
718.23 |
-5.37 |
Iowa Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Iowa Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Iowa Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Iowa Health Alliance HMO - Standard Self |
K84 |
308.37 |
315.49 |
236.62 |
78.87 |
1.78 |
668.14 |
683.56 |
512.67 |
170.89 |
3.86 |
Iowa Health Alliance HMO - Standard Self & Family |
K85 |
832.61 |
731.24 |
548.43 |
182.81 |
-103.33 |
1803.99 |
1584.35 |
1188.26 |
396.09 |
-223.88 |
Iowa Health Alliance HMO - Standard Self Plus One |
K86 |
714.36 |
674.59 |
505.94 |
168.65 |
-41.59 |
1547.78 |
1461.61 |
1096.21 |
365.40 |
-90.12 |
Iowa HealthPartners - Standard Self |
V34 |
212.27 |
235.11 |
176.33 |
58.78 |
5.71 |
459.92 |
509.41 |
382.06 |
127.35 |
12.37 |
Iowa HealthPartners - Standard Self & Family |
V35 |
517.11 |
572.74 |
429.56 |
143.18 |
13.90 |
1120.41 |
1240.94 |
930.71 |
310.23 |
30.13 |
Iowa HealthPartners - Standard Self Plus One |
V36 |
469.13 |
519.60 |
389.70 |
129.90 |
12.62 |
1016.45 |
1125.80 |
844.35 |
281.45 |
27.34 |
Iowa HealthPartners - High Self |
V31 |
328.76 |
308.34 |
231.26 |
77.08 |
-15.91 |
712.31 |
668.07 |
501.05 |
167.02 |
-34.45 |
Iowa HealthPartners - High Self & Family |
V32 |
800.86 |
751.10 |
562.25 |
188.85 |
-65.54 |
1735.20 |
1627.38 |
1218.21 |
409.17 |
-142.01 |
Iowa HealthPartners - High Self Plus One |
V33 |
726.56 |
681.42 |
511.07 |
170.35 |
-52.09 |
1574.21 |
1476.41 |
1107.31 |
369.10 |
-112.85 |
Iowa UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
242.68 |
276.68 |
207.51 |
69.17 |
8.50 |
525.81 |
599.47 |
449.60 |
149.87 |
18.42 |
Iowa UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
573.86 |
654.35 |
490.76 |
163.59 |
20.13 |
1243.36 |
1417.76 |
1063.32 |
354.44 |
43.60 |
Iowa UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
521.73 |
594.87 |
446.15 |
148.72 |
18.29 |
1130.42 |
1288.89 |
966.67 |
322.22 |
39.62 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
N71 |
281.73 |
319.78 |
239.84 |
79.94 |
9.51 |
610.42 |
692.86 |
519.65 |
173.21 |
20.61 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
N72 |
647.99 |
735.49 |
551.62 |
183.87 |
21.87 |
1403.98 |
1593.56 |
1195.17 |
398.39 |
47.40 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
N73 |
605.73 |
687.52 |
515.64 |
171.88 |
20.45 |
1312.42 |
1489.63 |
1117.22 |
372.41 |
44.31 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
LJ1 |
332.39 |
358.54 |
241.58 |
116.96 |
20.34 |
720.18 |
776.84 |
523.42 |
253.42 |
44.08 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
LJ2 |
830.99 |
896.36 |
562.25 |
334.11 |
49.59 |
1800.48 |
1942.11 |
1218.21 |
723.90 |
107.44 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
LJ3 |
714.65 |
770.87 |
517.46 |
253.41 |
42.88 |
1548.41 |
1670.22 |
1121.16 |
549.06 |
92.91 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
233.88 |
266.18 |
199.64 |
66.54 |
8.07 |
506.74 |
576.72 |
432.54 |
144.18 |
17.50 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
553.03 |
629.51 |
472.13 |
157.38 |
19.12 |
1198.23 |
1363.94 |
1022.96 |
340.98 |
41.42 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
502.79 |
572.28 |
429.21 |
143.07 |
17.37 |
1089.38 |
1239.94 |
929.96 |
309.98 |
37.64 |
Iowa UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Iowa UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Iowa UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Kansas Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Kansas Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Kansas Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Kansas Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Kansas Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Kansas Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
328.95 |
330.94 |
241.58 |
89.36 |
-3.82 |
712.73 |
717.04 |
523.42 |
193.62 |
-8.27 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
753.40 |
757.97 |
562.25 |
195.72 |
-11.21 |
1632.37 |
1642.27 |
1218.21 |
424.06 |
-24.29 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
738.63 |
743.12 |
517.46 |
225.66 |
-8.85 |
1600.37 |
1610.09 |
1121.16 |
488.93 |
-19.18 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
417.46 |
488.66 |
241.58 |
247.08 |
65.39 |
904.50 |
1058.76 |
523.42 |
535.34 |
141.68 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
952.20 |
1114.65 |
562.25 |
552.40 |
146.67 |
2063.10 |
2415.08 |
1218.21 |
1196.87 |
317.79 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
942.79 |
1103.63 |
517.46 |
586.17 |
147.50 |
2042.71 |
2391.20 |
1121.16 |
1270.04 |
319.59 |
Kansas Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Kansas Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Kansas Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Kansas Aetna Open Access - High Self |
HA1 |
507.66 |
533.78 |
241.58 |
292.20 |
20.31 |
1099.93 |
1156.52 |
523.42 |
633.10 |
44.01 |
Kansas Aetna Open Access - High Self & Family |
HA2 |
1199.16 |
1260.88 |
562.25 |
698.63 |
45.94 |
2598.18 |
2731.91 |
1218.21 |
1513.70 |
99.54 |
Kansas Aetna Open Access - High Self Plus One |
HA3 |
1187.32 |
1248.41 |
517.46 |
730.95 |
47.75 |
2572.53 |
2704.89 |
1121.16 |
1583.73 |
103.46 |
Kansas Aetna Open Access - Standard Self |
HA4 |
330.63 |
416.01 |
241.58 |
174.43 |
79.57 |
716.37 |
901.36 |
523.42 |
377.94 |
172.41 |
Kansas Aetna Open Access - Standard Self & Family |
HA5 |
780.41 |
981.94 |
562.25 |
419.69 |
185.75 |
1690.89 |
2127.54 |
1218.21 |
909.33 |
402.46 |
Kansas Aetna Open Access - Standard Self Plus One |
HA6 |
772.69 |
972.22 |
517.46 |
454.76 |
186.19 |
1674.16 |
2106.48 |
1121.16 |
985.32 |
403.42 |
Kansas Humana CoverageFirst and Humana Value Plan - Value Self |
PH4 |
223.40 |
243.51 |
182.63 |
60.88 |
5.03 |
484.03 |
527.61 |
395.71 |
131.90 |
10.89 |
Kansas Humana CoverageFirst and Humana Value Plan - Value Self & Family |
PH5 |
502.66 |
547.90 |
410.93 |
136.97 |
11.31 |
1089.10 |
1187.12 |
890.34 |
296.78 |
24.51 |
Kansas Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
PH6 |
480.31 |
523.55 |
392.66 |
130.89 |
10.81 |
1040.67 |
1134.36 |
850.77 |
283.59 |
23.42 |
Kansas Humana CoverageFirst and Humana Value Plan - CDHP Self |
PH1 |
330.05 |
349.86 |
241.58 |
108.28 |
14.00 |
715.11 |
758.03 |
523.42 |
234.61 |
30.34 |
Kansas Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
PH2 |
742.63 |
787.19 |
562.25 |
224.94 |
28.78 |
1609.03 |
1705.58 |
1218.21 |
487.37 |
62.36 |
Kansas Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
PH3 |
709.62 |
752.20 |
517.46 |
234.74 |
29.24 |
1537.51 |
1629.77 |
1121.16 |
508.61 |
63.36 |
Kansas Humana Health Plan, Inc. - High Self |
MS1 |
795.31 |
829.31 |
241.58 |
587.73 |
28.19 |
1723.17 |
1796.84 |
523.42 |
1273.42 |
61.09 |
Kansas Humana Health Plan, Inc. - High Self & Family |
MS2 |
1789.44 |
1865.95 |
562.25 |
1303.70 |
60.73 |
3877.12 |
4042.89 |
1218.21 |
2824.68 |
131.58 |
Kansas Humana Health Plan, Inc. - High Self Plus One |
MS3 |
1709.91 |
1783.00 |
517.46 |
1265.54 |
59.75 |
3704.81 |
3863.17 |
1121.16 |
2742.01 |
129.46 |
Kansas Humana Health Plan, Inc. - Standard Self |
MS4 |
492.46 |
554.12 |
241.58 |
312.54 |
55.85 |
1067.00 |
1200.59 |
523.42 |
677.17 |
121.01 |
Kansas Humana Health Plan, Inc. - Standard Self & Family |
MS5 |
1108.05 |
1246.77 |
562.25 |
684.52 |
122.94 |
2400.78 |
2701.34 |
1218.21 |
1483.13 |
266.37 |
Kansas Humana Health Plan, Inc. - Standard Self Plus One |
MS6 |
1058.81 |
1191.38 |
517.46 |
673.92 |
119.23 |
2294.09 |
2581.32 |
1121.16 |
1460.16 |
258.33 |
Kansas UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Kansas UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Kansas UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Kentucky Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Kentucky Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Kentucky Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Kentucky Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Kentucky Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Kentucky Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Kentucky Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
382.37 |
381.62 |
241.58 |
140.04 |
-6.56 |
828.47 |
826.84 |
523.42 |
303.42 |
-14.21 |
Kentucky Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
871.59 |
869.88 |
562.25 |
307.63 |
-17.49 |
1888.45 |
1884.74 |
1218.21 |
666.53 |
-37.90 |
Kentucky Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
863.04 |
861.43 |
517.46 |
343.97 |
-14.95 |
1869.92 |
1866.43 |
1121.16 |
745.27 |
-32.39 |
Kentucky Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
372.48 |
377.30 |
241.58 |
135.72 |
-0.99 |
807.04 |
817.48 |
523.42 |
294.06 |
-2.14 |
Kentucky Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
854.85 |
865.92 |
562.25 |
303.67 |
-4.71 |
1852.18 |
1876.16 |
1218.21 |
657.95 |
-10.21 |
Kentucky Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
838.09 |
848.95 |
517.46 |
331.49 |
-2.48 |
1815.86 |
1839.39 |
1121.16 |
718.23 |
-5.37 |
Kentucky Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Kentucky Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Kentucky Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Kentucky Humana CoverageFirst - CDHP Self |
TC1 |
304.37 |
340.88 |
241.58 |
99.30 |
23.21 |
659.47 |
738.57 |
523.42 |
215.15 |
50.28 |
Kentucky Humana CoverageFirst - CDHP Self & Family |
TC2 |
684.80 |
766.98 |
562.25 |
204.73 |
33.53 |
1483.73 |
1661.79 |
1218.21 |
443.58 |
72.65 |
Kentucky Humana CoverageFirst - CDHP Self Plus One |
TC3 |
654.38 |
732.90 |
517.46 |
215.44 |
51.85 |
1417.82 |
1587.95 |
1121.16 |
466.79 |
112.34 |
Kentucky Humana CoverageFirst - CDHP Self |
6N1 |
353.86 |
382.17 |
241.58 |
140.59 |
22.50 |
766.70 |
828.04 |
523.42 |
304.62 |
48.76 |
Kentucky Humana CoverageFirst - CDHP Self & Family |
6N2 |
796.19 |
859.88 |
562.25 |
297.63 |
47.91 |
1725.08 |
1863.07 |
1218.21 |
644.86 |
103.80 |
Kentucky Humana CoverageFirst - CDHP Self Plus One |
6N3 |
760.80 |
821.67 |
517.46 |
304.21 |
47.53 |
1648.40 |
1780.29 |
1121.16 |
659.13 |
102.99 |
Kentucky Humana CoverageFirst and Humana Value Plan - Value Self |
X34 |
283.90 |
298.10 |
223.58 |
74.52 |
3.55 |
615.12 |
645.88 |
484.41 |
161.47 |
7.69 |
Kentucky Humana CoverageFirst and Humana Value Plan - Value Self & Family |
X35 |
638.79 |
670.73 |
503.05 |
167.68 |
7.98 |
1384.05 |
1453.25 |
1089.94 |
363.31 |
17.30 |
Kentucky Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
X36 |
610.40 |
640.92 |
480.69 |
160.23 |
7.63 |
1322.53 |
1388.66 |
1041.50 |
347.16 |
16.53 |
Kentucky Humana CoverageFirst and Humana Value Plan - CDHP Self |
X31 |
368.97 |
387.42 |
241.58 |
145.84 |
12.64 |
799.44 |
839.41 |
523.42 |
315.99 |
27.39 |
Kentucky Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
X32 |
830.20 |
871.71 |
562.25 |
309.46 |
25.73 |
1798.77 |
1888.71 |
1218.21 |
670.50 |
55.75 |
Kentucky Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
X33 |
793.30 |
832.97 |
517.46 |
315.51 |
26.33 |
1718.82 |
1804.77 |
1121.16 |
683.61 |
57.05 |
Kentucky Humana Health Plan of Ohio, Inc. - High Self |
A61 |
692.76 |
727.40 |
241.58 |
485.82 |
28.83 |
1500.98 |
1576.03 |
523.42 |
1052.61 |
62.47 |
Kentucky Humana Health Plan of Ohio, Inc. - High Self & Family |
A62 |
1558.72 |
1636.66 |
562.25 |
1074.41 |
62.16 |
3377.23 |
3546.10 |
1218.21 |
2327.89 |
134.68 |
Kentucky Humana Health Plan of Ohio, Inc. - High Self Plus One |
A63 |
1489.45 |
1563.92 |
517.46 |
1046.46 |
61.13 |
3227.14 |
3388.49 |
1121.16 |
2267.33 |
132.45 |
Kentucky Humana Health Plan of Ohio, Inc. - Standard Self |
A64 |
541.00 |
568.05 |
241.58 |
326.47 |
21.24 |
1172.17 |
1230.78 |
523.42 |
707.36 |
46.03 |
Kentucky Humana Health Plan of Ohio, Inc. - Standard Self & Family |
A65 |
1217.27 |
1278.14 |
562.25 |
715.89 |
45.09 |
2637.42 |
2769.30 |
1218.21 |
1551.09 |
97.69 |
Kentucky Humana Health Plan of Ohio, Inc. - Standard Self Plus One |
A66 |
1163.17 |
1221.32 |
517.46 |
703.86 |
44.81 |
2520.20 |
2646.19 |
1121.16 |
1525.03 |
97.09 |
Kentucky Humana Health Plan of Ohio, Inc. - Basic Self |
W61 |
280.90 |
294.95 |
221.21 |
73.74 |
3.52 |
608.62 |
639.06 |
479.30 |
159.76 |
7.61 |
Kentucky Humana Health Plan of Ohio, Inc. - Basic Self & Family |
W62 |
632.05 |
663.66 |
497.75 |
165.91 |
7.90 |
1369.44 |
1437.93 |
1078.45 |
359.48 |
17.12 |
Kentucky Humana Health Plan of Ohio, Inc. - Basic Self Plus One |
W63 |
603.96 |
634.16 |
475.62 |
158.54 |
7.55 |
1308.58 |
1374.01 |
1030.51 |
343.50 |
16.36 |
Kentucky Humana Health Plan, Inc. - High Self |
MI1 |
637.59 |
663.10 |
241.58 |
421.52 |
19.70 |
1381.45 |
1436.72 |
523.42 |
913.30 |
42.69 |
Kentucky Humana Health Plan, Inc. - High Self & Family |
MI2 |
1434.57 |
1491.94 |
562.25 |
929.69 |
41.59 |
3108.24 |
3232.54 |
1218.21 |
2014.33 |
90.11 |
Kentucky Humana Health Plan, Inc. - High Self Plus One |
MI3 |
1370.81 |
1425.65 |
517.46 |
908.19 |
41.50 |
2970.09 |
3088.91 |
1121.16 |
1967.75 |
89.92 |
Kentucky Humana Health Plan, Inc. - Standard Self |
MI4 |
408.46 |
424.80 |
241.58 |
183.22 |
10.53 |
885.00 |
920.40 |
523.42 |
396.98 |
22.82 |
Kentucky Humana Health Plan, Inc. - Standard Self & Family |
MI5 |
919.02 |
955.78 |
562.25 |
393.53 |
20.98 |
1991.21 |
2070.86 |
1218.21 |
852.65 |
45.46 |
Kentucky Humana Health Plan, Inc. - Standard Self Plus One |
MI6 |
878.19 |
913.31 |
517.46 |
395.85 |
21.78 |
1902.75 |
1978.84 |
1121.16 |
857.68 |
47.19 |
Kentucky Humana Health Plan, Inc. - High Self |
MH1 |
509.98 |
560.99 |
241.58 |
319.41 |
45.20 |
1104.96 |
1215.48 |
523.42 |
692.06 |
97.94 |
Kentucky Humana Health Plan, Inc. - High Self & Family |
MH2 |
1147.47 |
1262.23 |
562.25 |
699.98 |
98.98 |
2486.19 |
2734.83 |
1218.21 |
1516.62 |
214.45 |
Kentucky Humana Health Plan, Inc. - High Self Plus One |
MH3 |
1096.47 |
1206.12 |
517.46 |
688.66 |
96.31 |
2375.69 |
2613.26 |
1121.16 |
1492.10 |
208.67 |
Kentucky Humana Health Plan, Inc. - Standard Self |
MH4 |
396.76 |
436.44 |
241.58 |
194.86 |
33.87 |
859.65 |
945.62 |
523.42 |
422.20 |
73.39 |
Kentucky Humana Health Plan, Inc. - Standard Self & Family |
MH5 |
892.70 |
981.98 |
562.25 |
419.73 |
73.50 |
1934.18 |
2127.62 |
1218.21 |
909.41 |
159.25 |
Kentucky Humana Health Plan, Inc. - Standard Self Plus One |
MH6 |
853.03 |
938.33 |
517.46 |
420.87 |
71.96 |
1848.23 |
2033.05 |
1121.16 |
911.89 |
155.92 |
Kentucky UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
242.68 |
276.68 |
207.51 |
69.17 |
8.50 |
525.81 |
599.47 |
449.60 |
149.87 |
18.42 |
Kentucky UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
573.86 |
654.35 |
490.76 |
163.59 |
20.13 |
1243.36 |
1417.76 |
1063.32 |
354.44 |
43.60 |
Kentucky UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
521.73 |
594.87 |
446.15 |
148.72 |
18.29 |
1130.42 |
1288.89 |
966.67 |
322.22 |
39.62 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
N71 |
281.73 |
319.78 |
239.84 |
79.94 |
9.51 |
610.42 |
692.86 |
519.65 |
173.21 |
20.61 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
N72 |
647.99 |
735.49 |
551.62 |
183.87 |
21.87 |
1403.98 |
1593.56 |
1195.17 |
398.39 |
47.40 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
N73 |
605.73 |
687.52 |
515.64 |
171.88 |
20.45 |
1312.42 |
1489.63 |
1117.22 |
372.41 |
44.31 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
LJ1 |
332.39 |
358.54 |
241.58 |
116.96 |
20.34 |
720.18 |
776.84 |
523.42 |
253.42 |
44.08 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
LJ2 |
830.99 |
896.36 |
562.25 |
334.11 |
49.59 |
1800.48 |
1942.11 |
1218.21 |
723.90 |
107.44 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
LJ3 |
714.65 |
770.87 |
517.46 |
253.41 |
42.88 |
1548.41 |
1670.22 |
1121.16 |
549.06 |
92.91 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
233.88 |
266.18 |
199.64 |
66.54 |
8.07 |
506.74 |
576.72 |
432.54 |
144.18 |
17.50 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
553.03 |
629.51 |
472.13 |
157.38 |
19.12 |
1198.23 |
1363.94 |
1022.96 |
340.98 |
41.42 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
502.79 |
572.28 |
429.21 |
143.07 |
17.37 |
1089.38 |
1239.94 |
929.96 |
309.98 |
37.64 |
Kentucky UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Kentucky UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Kentucky UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Louisiana Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Louisiana Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Louisiana Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Louisiana Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Louisiana Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Louisiana Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Louisiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
382.72 |
393.11 |
241.58 |
151.53 |
4.58 |
829.23 |
851.74 |
523.42 |
328.32 |
9.93 |
Louisiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
872.64 |
896.32 |
562.25 |
334.07 |
7.90 |
1890.72 |
1942.03 |
1218.21 |
723.82 |
17.12 |
Louisiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
864.00 |
887.45 |
517.46 |
369.99 |
10.11 |
1872.00 |
1922.81 |
1121.16 |
801.65 |
21.91 |
Louisiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
378.45 |
379.30 |
241.58 |
137.72 |
-4.96 |
819.98 |
821.82 |
523.42 |
298.40 |
-10.74 |
Louisiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
866.59 |
868.56 |
562.25 |
306.31 |
-13.81 |
1877.61 |
1881.88 |
1218.21 |
663.67 |
-29.92 |
Louisiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
849.59 |
851.52 |
517.46 |
334.06 |
-11.41 |
1840.78 |
1844.96 |
1121.16 |
723.80 |
-24.72 |
Louisiana Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Louisiana Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Louisiana Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - Standard Self |
BC4 |
311.14 |
342.25 |
241.58 |
100.67 |
22.89 |
674.14 |
741.54 |
523.42 |
218.12 |
49.59 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - Standard Self & Family |
BC5 |
700.06 |
770.06 |
562.25 |
207.81 |
32.80 |
1516.80 |
1668.46 |
1218.21 |
450.25 |
71.05 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - Standard Self Plus One |
BC6 |
668.94 |
735.83 |
517.46 |
218.37 |
51.14 |
1449.37 |
1594.30 |
1121.16 |
473.14 |
110.80 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - High Self |
BC1 |
416.00 |
457.60 |
241.58 |
216.02 |
35.79 |
901.33 |
991.47 |
523.42 |
468.05 |
77.56 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - High Self & Family |
BC2 |
936.01 |
1029.61 |
562.25 |
467.36 |
77.82 |
2028.02 |
2230.82 |
1218.21 |
1012.61 |
168.61 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - High Self Plus One |
BC3 |
894.41 |
983.85 |
517.46 |
466.39 |
76.10 |
1937.89 |
2131.68 |
1121.16 |
1010.52 |
164.89 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - High Self |
AE1 |
494.50 |
558.78 |
241.58 |
317.20 |
58.47 |
1071.42 |
1210.69 |
523.42 |
687.27 |
126.69 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - High Self & Family |
AE2 |
1112.60 |
1257.25 |
562.25 |
695.00 |
128.87 |
2410.63 |
2724.04 |
1218.21 |
1505.83 |
279.22 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - High Self Plus One |
AE3 |
1063.16 |
1201.38 |
517.46 |
683.92 |
124.88 |
2303.51 |
2602.99 |
1121.16 |
1481.83 |
270.58 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - Standard Self |
AE4 |
372.67 |
421.12 |
241.58 |
179.54 |
42.64 |
807.45 |
912.43 |
523.42 |
389.01 |
92.40 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - Standard Self & Family |
AE5 |
838.52 |
947.53 |
562.25 |
385.28 |
93.23 |
1816.79 |
2052.98 |
1218.21 |
834.77 |
202.00 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - Standard Self Plus One |
AE6 |
801.25 |
905.41 |
517.46 |
387.95 |
90.82 |
1736.04 |
1961.72 |
1121.16 |
840.56 |
196.78 |
Louisiana UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
242.68 |
276.68 |
207.51 |
69.17 |
8.50 |
525.81 |
599.47 |
449.60 |
149.87 |
18.42 |
Louisiana UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
573.86 |
654.35 |
490.76 |
163.59 |
20.13 |
1243.36 |
1417.76 |
1063.32 |
354.44 |
43.60 |
Louisiana UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
521.73 |
594.87 |
446.15 |
148.72 |
18.29 |
1130.42 |
1288.89 |
966.67 |
322.22 |
39.62 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LS1 |
209.88 |
224.24 |
168.18 |
56.06 |
3.59 |
454.74 |
485.85 |
364.39 |
121.46 |
7.78 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LS2 |
482.73 |
515.77 |
386.83 |
128.94 |
8.26 |
1045.92 |
1117.50 |
838.13 |
279.37 |
17.89 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LS3 |
451.25 |
482.12 |
361.59 |
120.53 |
7.72 |
977.71 |
1044.59 |
783.44 |
261.15 |
16.72 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KK1 |
329.48 |
354.94 |
241.58 |
113.36 |
19.65 |
713.87 |
769.04 |
523.42 |
245.62 |
42.59 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KK2 |
823.71 |
887.37 |
562.25 |
325.12 |
47.88 |
1784.71 |
1922.64 |
1218.21 |
704.43 |
103.74 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KK3 |
708.40 |
763.14 |
517.46 |
245.68 |
41.40 |
1534.87 |
1653.47 |
1121.16 |
532.31 |
89.70 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
233.88 |
266.18 |
199.64 |
66.54 |
8.07 |
506.74 |
576.72 |
432.54 |
144.18 |
17.50 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
553.03 |
629.51 |
472.13 |
157.38 |
19.12 |
1198.23 |
1363.94 |
1022.96 |
340.98 |
41.42 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
502.79 |
572.28 |
429.21 |
143.07 |
17.37 |
1089.38 |
1239.94 |
929.96 |
309.98 |
37.64 |
Louisiana UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Louisiana UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Louisiana UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Maine Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Maine Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Maine Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Maine Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Maine Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Maine Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Maine Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
350.59 |
387.52 |
241.58 |
145.94 |
31.12 |
759.61 |
839.63 |
523.42 |
316.21 |
67.44 |
Maine Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
802.85 |
887.39 |
562.25 |
325.14 |
68.76 |
1739.51 |
1922.68 |
1218.21 |
704.47 |
148.98 |
Maine Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
787.10 |
869.98 |
517.46 |
352.52 |
69.54 |
1705.38 |
1884.96 |
1121.16 |
763.80 |
150.68 |
Maine Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
496.50 |
519.07 |
241.58 |
277.49 |
16.76 |
1075.75 |
1124.65 |
523.42 |
601.23 |
36.32 |
Maine Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
1132.30 |
1183.79 |
562.25 |
621.54 |
35.71 |
2453.32 |
2564.88 |
1218.21 |
1346.67 |
77.37 |
Maine Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
1121.09 |
1172.06 |
517.46 |
654.60 |
37.63 |
2429.03 |
2539.46 |
1121.16 |
1418.30 |
81.53 |
Maine Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Maine Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Maine Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Maine UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Maine UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Maine UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Maryland Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Maryland Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Maryland Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Maryland Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Maryland Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Maryland Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Maryland Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
382.72 |
393.11 |
241.58 |
151.53 |
4.58 |
829.23 |
851.74 |
523.42 |
328.32 |
9.93 |
Maryland Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
872.64 |
896.32 |
562.25 |
334.07 |
7.90 |
1890.72 |
1942.03 |
1218.21 |
723.82 |
17.12 |
Maryland Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
864.00 |
887.45 |
517.46 |
369.99 |
10.11 |
1872.00 |
1922.81 |
1121.16 |
801.65 |
21.91 |
Maryland Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
378.45 |
379.30 |
241.58 |
137.72 |
-4.96 |
819.98 |
821.82 |
523.42 |
298.40 |
-10.74 |
Maryland Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
866.59 |
868.56 |
562.25 |
306.31 |
-13.81 |
1877.61 |
1881.88 |
1218.21 |
663.67 |
-29.92 |
Maryland Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
849.59 |
851.52 |
517.46 |
334.06 |
-11.41 |
1840.78 |
1844.96 |
1121.16 |
723.80 |
-24.72 |
Maryland Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Maryland Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Maryland Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Maryland Aetna Open Access - High Self |
JN1 |
525.03 |
543.03 |
241.58 |
301.45 |
12.19 |
1137.57 |
1176.57 |
523.42 |
653.15 |
26.42 |
Maryland Aetna Open Access - High Self & Family |
JN2 |
1180.35 |
1220.79 |
562.25 |
658.54 |
24.66 |
2557.43 |
2645.05 |
1218.21 |
1426.84 |
53.43 |
Maryland Aetna Open Access - High Self Plus One |
JN3 |
1168.66 |
1208.70 |
517.46 |
691.24 |
26.70 |
2532.10 |
2618.85 |
1121.16 |
1497.69 |
57.85 |
Maryland Aetna Open Access - Basic Self |
JN4 |
321.74 |
329.73 |
241.58 |
88.15 |
2.18 |
697.10 |
714.42 |
523.42 |
191.00 |
4.74 |
Maryland Aetna Open Access - Basic Self & Family |
JN5 |
736.31 |
754.58 |
562.25 |
192.33 |
2.49 |
1595.34 |
1634.92 |
1218.21 |
416.71 |
5.39 |
Maryland Aetna Open Access - Basic Self Plus One |
JN6 |
676.15 |
692.92 |
517.46 |
175.46 |
3.43 |
1464.99 |
1501.33 |
1121.16 |
380.17 |
7.44 |
Maryland Aetna Saver (Open Access) - Saver Self |
QQ4 |
274.71 |
274.71 |
206.03 |
68.68 |
0.00 |
595.21 |
595.21 |
446.41 |
148.80 |
0.00 |
Maryland Aetna Saver (Open Access) - Saver Self & Family |
QQ5 |
628.68 |
628.67 |
471.50 |
157.17 |
0.00 |
1362.14 |
1362.12 |
1021.59 |
340.53 |
0.00 |
Maryland Aetna Saver (Open Access) - Saver Self Plus One |
QQ6 |
577.30 |
577.30 |
432.98 |
144.32 |
0.00 |
1250.82 |
1250.82 |
938.12 |
312.70 |
0.00 |
Maryland CareFirst BlueChoice - Standard Self |
2G4 |
390.25 |
409.76 |
241.58 |
168.18 |
13.70 |
845.54 |
887.81 |
523.42 |
364.39 |
29.69 |
Maryland CareFirst BlueChoice - Standard Self & Family |
2G5 |
927.21 |
973.58 |
562.25 |
411.33 |
30.59 |
2008.96 |
2109.42 |
1218.21 |
891.21 |
66.27 |
Maryland CareFirst BlueChoice - Standard Self Plus One |
2G6 |
780.49 |
819.51 |
517.46 |
302.05 |
25.68 |
1691.06 |
1775.61 |
1121.16 |
654.45 |
55.65 |
Maryland CareFirst BlueChoice - HDHP Self |
B61 |
263.12 |
263.12 |
197.34 |
65.78 |
0.00 |
570.09 |
570.09 |
427.57 |
142.52 |
0.00 |
Maryland CareFirst BlueChoice - HDHP Self & Family |
B62 |
625.16 |
625.16 |
468.87 |
156.29 |
0.00 |
1354.51 |
1354.51 |
1015.88 |
338.63 |
0.00 |
Maryland CareFirst BlueChoice - HDHP Self Plus One |
B63 |
526.23 |
526.23 |
394.67 |
131.56 |
0.00 |
1140.17 |
1140.17 |
855.13 |
285.04 |
0.00 |
Maryland CareFirst BlueChoice - Blue Value Plus Self |
B64 |
325.84 |
334.00 |
241.58 |
92.42 |
2.35 |
705.99 |
723.67 |
523.42 |
200.25 |
5.10 |
Maryland CareFirst BlueChoice - Blue Value Plus Self & Family |
B65 |
774.21 |
793.56 |
562.25 |
231.31 |
3.57 |
1677.46 |
1719.38 |
1218.21 |
501.17 |
7.73 |
Maryland CareFirst BlueChoice - Blue Value Plus Self Plus One |
B66 |
651.70 |
667.98 |
500.99 |
166.99 |
4.07 |
1412.02 |
1447.29 |
1085.47 |
361.82 |
8.82 |
Maryland Kaiser Permanente - Mid-Atlantic States - Basic Self |
T71 |
193.90 |
197.41 |
148.06 |
49.35 |
0.88 |
420.12 |
427.72 |
320.79 |
106.93 |
1.90 |
Maryland Kaiser Permanente - Mid-Atlantic States - Basic Self & Family |
T72 |
473.61 |
507.47 |
380.60 |
126.87 |
8.47 |
1026.16 |
1099.52 |
824.64 |
274.88 |
18.34 |
Maryland Kaiser Permanente - Mid-Atlantic States - Basic Self Plus One |
T73 |
431.49 |
439.31 |
329.48 |
109.83 |
1.96 |
934.90 |
951.84 |
713.88 |
237.96 |
4.24 |
Maryland Kaiser Permanente - Mid-Atlantic States - Standard Self |
E34 |
263.79 |
276.13 |
207.10 |
69.03 |
3.08 |
571.55 |
598.28 |
448.71 |
149.57 |
6.68 |
Maryland Kaiser Permanente - Mid-Atlantic States - Standard Self & Family |
E35 |
606.69 |
635.10 |
476.33 |
158.77 |
7.10 |
1314.50 |
1376.05 |
1032.04 |
344.01 |
15.39 |
Maryland Kaiser Permanente - Mid-Atlantic States - Standard Self Plus One |
E36 |
606.69 |
635.10 |
476.33 |
158.77 |
7.10 |
1314.50 |
1376.05 |
1032.04 |
344.01 |
15.39 |
Maryland Kaiser Permanente - Mid-Atlantic States - High Self |
E31 |
333.61 |
344.42 |
241.58 |
102.84 |
5.00 |
722.82 |
746.24 |
523.42 |
222.82 |
10.84 |
Maryland Kaiser Permanente - Mid-Atlantic States - High Self & Family |
E32 |
767.32 |
792.16 |
562.25 |
229.91 |
9.06 |
1662.53 |
1716.35 |
1218.21 |
498.14 |
19.63 |
Maryland Kaiser Permanente - Mid-Atlantic States - High Self Plus One |
E33 |
767.32 |
792.16 |
517.46 |
274.70 |
11.50 |
1662.53 |
1716.35 |
1121.16 |
595.19 |
24.92 |
Maryland M.D. IPA - High Self |
JP1 |
404.59 |
438.87 |
241.58 |
197.29 |
28.47 |
876.61 |
950.89 |
523.42 |
427.47 |
61.70 |
Maryland M.D. IPA - High Self & Family |
JP2 |
1134.48 |
1230.59 |
562.25 |
668.34 |
80.33 |
2458.04 |
2666.28 |
1218.21 |
1448.07 |
174.05 |
Maryland M.D. IPA - High Self Plus One |
JP3 |
790.17 |
857.12 |
517.46 |
339.66 |
53.61 |
1712.04 |
1857.09 |
1121.16 |
735.93 |
116.15 |
Maryland UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
242.68 |
276.68 |
207.51 |
69.17 |
8.50 |
525.81 |
599.47 |
449.60 |
149.87 |
18.42 |
Maryland UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
573.86 |
654.35 |
490.76 |
163.59 |
20.13 |
1243.36 |
1417.76 |
1063.32 |
354.44 |
43.60 |
Maryland UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
521.73 |
594.87 |
446.15 |
148.72 |
18.29 |
1130.42 |
1288.89 |
966.67 |
322.22 |
39.62 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
V41 |
224.57 |
239.96 |
179.97 |
59.99 |
3.85 |
486.57 |
519.91 |
389.93 |
129.98 |
8.34 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
V42 |
516.51 |
551.91 |
413.93 |
137.98 |
8.85 |
1119.11 |
1195.81 |
896.86 |
298.95 |
19.17 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
V43 |
482.83 |
515.91 |
386.93 |
128.98 |
8.27 |
1046.13 |
1117.81 |
838.36 |
279.45 |
17.92 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
LR1 |
329.95 |
355.57 |
241.58 |
113.99 |
19.81 |
714.89 |
770.40 |
523.42 |
246.98 |
42.93 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
LR2 |
781.98 |
842.69 |
562.25 |
280.44 |
44.93 |
1694.29 |
1825.83 |
1218.21 |
607.62 |
97.35 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
LR3 |
709.38 |
764.46 |
517.46 |
247.00 |
41.74 |
1536.99 |
1656.33 |
1121.16 |
535.17 |
90.44 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
L91 |
240.69 |
255.98 |
191.99 |
63.99 |
3.82 |
521.50 |
554.62 |
415.97 |
138.65 |
8.28 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
L92 |
674.89 |
717.76 |
538.32 |
179.44 |
10.72 |
1462.26 |
1555.15 |
1166.36 |
388.79 |
23.23 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self Plus One |
L93 |
470.06 |
499.93 |
374.95 |
124.98 |
7.47 |
1018.46 |
1083.18 |
812.39 |
270.79 |
16.18 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
233.88 |
266.18 |
199.64 |
66.54 |
8.07 |
506.74 |
576.72 |
432.54 |
144.18 |
17.50 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
553.03 |
629.51 |
472.13 |
157.38 |
19.12 |
1198.23 |
1363.94 |
1022.96 |
340.98 |
41.42 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
502.79 |
572.28 |
429.21 |
143.07 |
17.37 |
1089.38 |
1239.94 |
929.96 |
309.98 |
37.64 |
Maryland UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Maryland UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Maryland UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Massachusetts Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Massachusetts Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Massachusetts Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Massachusetts Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Massachusetts Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Massachusetts Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
350.59 |
387.52 |
241.58 |
145.94 |
31.12 |
759.61 |
839.63 |
523.42 |
316.21 |
67.44 |
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
802.85 |
887.39 |
562.25 |
325.14 |
68.76 |
1739.51 |
1922.68 |
1218.21 |
704.47 |
148.98 |
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
787.10 |
869.98 |
517.46 |
352.52 |
69.54 |
1705.38 |
1884.96 |
1121.16 |
763.80 |
150.68 |
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
496.50 |
519.07 |
241.58 |
277.49 |
16.76 |
1075.75 |
1124.65 |
523.42 |
601.23 |
36.32 |
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
1132.30 |
1183.79 |
562.25 |
621.54 |
35.71 |
2453.32 |
2564.88 |
1218.21 |
1346.67 |
77.37 |
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
1121.09 |
1172.06 |
517.46 |
654.60 |
37.63 |
2429.03 |
2539.46 |
1121.16 |
1418.30 |
81.53 |
Massachusetts Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Massachusetts Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Massachusetts Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Massachusetts UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Massachusetts UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Massachusetts UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Michigan Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Michigan Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Michigan Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Michigan Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Michigan Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Michigan Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Michigan Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
328.95 |
330.94 |
241.58 |
89.36 |
-3.82 |
712.73 |
717.04 |
523.42 |
193.62 |
-8.27 |
Michigan Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
753.40 |
757.97 |
562.25 |
195.72 |
-11.21 |
1632.37 |
1642.27 |
1218.21 |
424.06 |
-24.29 |
Michigan Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
738.63 |
743.12 |
517.46 |
225.66 |
-8.85 |
1600.37 |
1610.09 |
1121.16 |
488.93 |
-19.18 |
Michigan Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
417.46 |
488.66 |
241.58 |
247.08 |
65.39 |
904.50 |
1058.76 |
523.42 |
535.34 |
141.68 |
Michigan Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
952.20 |
1114.65 |
562.25 |
552.40 |
146.67 |
2063.10 |
2415.08 |
1218.21 |
1196.87 |
317.79 |
Michigan Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
942.79 |
1103.63 |
517.46 |
586.17 |
147.50 |
2042.71 |
2391.20 |
1121.16 |
1270.04 |
319.59 |
Michigan Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Michigan Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Michigan Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Michigan Blue Care Network of Michigan - High Self |
LX1 |
342.86 |
353.45 |
241.58 |
111.87 |
4.78 |
742.86 |
765.81 |
523.42 |
242.39 |
10.37 |
Michigan Blue Care Network of Michigan - High Self & Family |
LX2 |
836.58 |
862.42 |
562.25 |
300.17 |
10.06 |
1812.59 |
1868.58 |
1218.21 |
650.37 |
21.80 |
Michigan Blue Care Network of Michigan - High Self Plus One |
LX3 |
788.57 |
812.95 |
517.46 |
295.49 |
11.04 |
1708.57 |
1761.39 |
1121.16 |
640.23 |
23.92 |
Michigan Blue Care Network of Michigan - High Self |
K51 |
442.03 |
459.92 |
241.58 |
218.34 |
12.08 |
957.73 |
996.49 |
523.42 |
473.07 |
26.18 |
Michigan Blue Care Network of Michigan - High Self & Family |
K52 |
1078.53 |
1122.21 |
562.25 |
559.96 |
27.90 |
2336.82 |
2431.46 |
1218.21 |
1213.25 |
60.45 |
Michigan Blue Care Network of Michigan - High Self Plus One |
K53 |
1016.64 |
1057.83 |
517.46 |
540.37 |
27.85 |
2202.72 |
2291.97 |
1121.16 |
1170.81 |
60.35 |
Michigan Health Alliance Plan - High Self |
521 |
363.64 |
388.70 |
241.58 |
147.12 |
19.25 |
787.89 |
842.18 |
523.42 |
318.76 |
41.71 |
Michigan Health Alliance Plan - High Self & Family |
522 |
887.28 |
948.43 |
562.25 |
386.18 |
45.37 |
1922.44 |
2054.93 |
1218.21 |
836.72 |
98.30 |
Michigan Health Alliance Plan - High Self Plus One |
523 |
836.37 |
894.00 |
517.46 |
376.54 |
44.29 |
1812.14 |
1937.00 |
1121.16 |
815.84 |
95.96 |
Michigan Health Alliance Plan - Standard Self |
GY4 |
283.49 |
257.33 |
193.00 |
64.33 |
-6.54 |
614.23 |
557.55 |
418.16 |
139.39 |
-14.17 |
Michigan Health Alliance Plan - Standard Self & Family |
GY5 |
691.74 |
627.88 |
470.91 |
156.97 |
-15.96 |
1498.77 |
1360.41 |
1020.31 |
340.10 |
-34.59 |
Michigan Health Alliance Plan - Standard Self Plus One |
GY6 |
652.05 |
591.85 |
443.89 |
147.96 |
-15.05 |
1412.78 |
1282.34 |
961.76 |
320.58 |
-32.61 |
Michigan Priority Health - High Self |
LE1 |
424.42 |
478.75 |
241.58 |
237.17 |
48.52 |
919.58 |
1037.29 |
523.42 |
513.87 |
105.13 |
Michigan Priority Health - High Self & Family |
LE2 |
997.39 |
1125.06 |
562.25 |
562.81 |
111.89 |
2161.01 |
2437.63 |
1218.21 |
1219.42 |
242.43 |
Michigan Priority Health - High Self Plus One |
LE3 |
933.72 |
1053.25 |
517.46 |
535.79 |
106.19 |
2023.06 |
2282.04 |
1121.16 |
1160.88 |
230.08 |
Michigan Priority Health - Standard Self |
LE4 |
248.92 |
271.10 |
203.33 |
67.77 |
5.54 |
539.33 |
587.38 |
440.54 |
146.84 |
12.01 |
Michigan Priority Health - Standard Self & Family |
LE5 |
584.97 |
637.07 |
477.80 |
159.27 |
13.03 |
1267.44 |
1380.32 |
1035.24 |
345.08 |
28.22 |
Michigan Priority Health - Standard Self Plus One |
LE6 |
547.63 |
596.41 |
447.31 |
149.10 |
12.19 |
1186.53 |
1292.22 |
969.17 |
323.05 |
26.42 |
Michigan Priority Health - Value Self |
Y41 |
218.42 |
218.42 |
163.82 |
54.60 |
0.00 |
473.24 |
473.24 |
354.93 |
118.31 |
0.00 |
Michigan Priority Health - Value Self & Family |
Y42 |
513.29 |
513.29 |
384.97 |
128.32 |
0.00 |
1112.13 |
1112.13 |
834.10 |
278.03 |
0.00 |
Michigan Priority Health - Value Self Plus One |
Y43 |
480.52 |
480.52 |
360.39 |
120.13 |
0.00 |
1041.13 |
1041.13 |
780.85 |
260.28 |
0.00 |
Michigan UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Michigan UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Michigan UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Minnesota Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Minnesota Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Minnesota Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Minnesota Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Minnesota Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Minnesota Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Minnesota Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
382.37 |
381.62 |
241.58 |
140.04 |
-6.56 |
828.47 |
826.84 |
523.42 |
303.42 |
-14.21 |
Minnesota Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
871.59 |
869.88 |
562.25 |
307.63 |
-17.49 |
1888.45 |
1884.74 |
1218.21 |
666.53 |
-37.90 |
Minnesota Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
863.04 |
861.43 |
517.46 |
343.97 |
-14.95 |
1869.92 |
1866.43 |
1121.16 |
745.27 |
-32.39 |
Minnesota Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
372.48 |
377.30 |
241.58 |
135.72 |
-0.99 |
807.04 |
817.48 |
523.42 |
294.06 |
-2.14 |
Minnesota Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
854.85 |
865.92 |
562.25 |
303.67 |
-4.71 |
1852.18 |
1876.16 |
1218.21 |
657.95 |
-10.21 |
Minnesota Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
838.09 |
848.95 |
517.46 |
331.49 |
-2.48 |
1815.86 |
1839.39 |
1121.16 |
718.23 |
-5.37 |
Minnesota Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Minnesota Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Minnesota Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Minnesota HealthPartners - Standard Self |
V34 |
212.27 |
235.11 |
176.33 |
58.78 |
5.71 |
459.92 |
509.41 |
382.06 |
127.35 |
12.37 |
Minnesota HealthPartners - Standard Self & Family |
V35 |
517.11 |
572.74 |
429.56 |
143.18 |
13.90 |
1120.41 |
1240.94 |
930.71 |
310.23 |
30.13 |
Minnesota HealthPartners - Standard Self Plus One |
V36 |
469.13 |
519.60 |
389.70 |
129.90 |
12.62 |
1016.45 |
1125.80 |
844.35 |
281.45 |
27.34 |
Minnesota HealthPartners - High Self |
V31 |
328.76 |
308.34 |
231.26 |
77.08 |
-15.91 |
712.31 |
668.07 |
501.05 |
167.02 |
-34.45 |
Minnesota HealthPartners - High Self & Family |
V32 |
800.86 |
751.10 |
562.25 |
188.85 |
-65.54 |
1735.20 |
1627.38 |
1218.21 |
409.17 |
-142.01 |
Minnesota HealthPartners - High Self Plus One |
V33 |
726.56 |
681.42 |
511.07 |
170.35 |
-52.09 |
1574.21 |
1476.41 |
1107.31 |
369.10 |
-112.85 |
Minnesota UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Minnesota UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Minnesota UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Mississippi Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Mississippi Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Mississippi Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Mississippi Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Mississippi Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Mississippi Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Mississippi Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
382.37 |
381.62 |
241.58 |
140.04 |
-6.56 |
828.47 |
826.84 |
523.42 |
303.42 |
-14.21 |
Mississippi Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
871.59 |
869.88 |
562.25 |
307.63 |
-17.49 |
1888.45 |
1884.74 |
1218.21 |
666.53 |
-37.90 |
Mississippi Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
863.04 |
861.43 |
517.46 |
343.97 |
-14.95 |
1869.92 |
1866.43 |
1121.16 |
745.27 |
-32.39 |
Mississippi Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
372.48 |
377.30 |
241.58 |
135.72 |
-0.99 |
807.04 |
817.48 |
523.42 |
294.06 |
-2.14 |
Mississippi Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
854.85 |
865.92 |
562.25 |
303.67 |
-4.71 |
1852.18 |
1876.16 |
1218.21 |
657.95 |
-10.21 |
Mississippi Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
838.09 |
848.95 |
517.46 |
331.49 |
-2.48 |
1815.86 |
1839.39 |
1121.16 |
718.23 |
-5.37 |
Mississippi Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Mississippi Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Mississippi Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Mississippi UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
242.68 |
276.68 |
207.51 |
69.17 |
8.50 |
525.81 |
599.47 |
449.60 |
149.87 |
18.42 |
Mississippi UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
573.86 |
654.35 |
490.76 |
163.59 |
20.13 |
1243.36 |
1417.76 |
1063.32 |
354.44 |
43.60 |
Mississippi UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
521.73 |
594.87 |
446.15 |
148.72 |
18.29 |
1130.42 |
1288.89 |
966.67 |
322.22 |
39.62 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LS1 |
209.88 |
224.24 |
168.18 |
56.06 |
3.59 |
454.74 |
485.85 |
364.39 |
121.46 |
7.78 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LS2 |
482.73 |
515.77 |
386.83 |
128.94 |
8.26 |
1045.92 |
1117.50 |
838.13 |
279.37 |
17.89 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LS3 |
451.25 |
482.12 |
361.59 |
120.53 |
7.72 |
977.71 |
1044.59 |
783.44 |
261.15 |
16.72 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KK1 |
329.48 |
354.94 |
241.58 |
113.36 |
19.65 |
713.87 |
769.04 |
523.42 |
245.62 |
42.59 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KK2 |
823.71 |
887.37 |
562.25 |
325.12 |
47.88 |
1784.71 |
1922.64 |
1218.21 |
704.43 |
103.74 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KK3 |
708.40 |
763.14 |
517.46 |
245.68 |
41.40 |
1534.87 |
1653.47 |
1121.16 |
532.31 |
89.70 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
233.88 |
266.18 |
199.64 |
66.54 |
8.07 |
506.74 |
576.72 |
432.54 |
144.18 |
17.50 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
553.03 |
629.51 |
472.13 |
157.38 |
19.12 |
1198.23 |
1363.94 |
1022.96 |
340.98 |
41.42 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
502.79 |
572.28 |
429.21 |
143.07 |
17.37 |
1089.38 |
1239.94 |
929.96 |
309.98 |
37.64 |
Mississippi UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Mississippi UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Mississippi UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Missouri Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Missouri Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Missouri Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Missouri Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Missouri Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Missouri Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Missouri Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
328.95 |
330.94 |
241.58 |
89.36 |
-3.82 |
712.73 |
717.04 |
523.42 |
193.62 |
-8.27 |
Missouri Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
753.40 |
757.97 |
562.25 |
195.72 |
-11.21 |
1632.37 |
1642.27 |
1218.21 |
424.06 |
-24.29 |
Missouri Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
738.63 |
743.12 |
517.46 |
225.66 |
-8.85 |
1600.37 |
1610.09 |
1121.16 |
488.93 |
-19.18 |
Missouri Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
417.46 |
488.66 |
241.58 |
247.08 |
65.39 |
904.50 |
1058.76 |
523.42 |
535.34 |
141.68 |
Missouri Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
952.20 |
1114.65 |
562.25 |
552.40 |
146.67 |
2063.10 |
2415.08 |
1218.21 |
1196.87 |
317.79 |
Missouri Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
942.79 |
1103.63 |
517.46 |
586.17 |
147.50 |
2042.71 |
2391.20 |
1121.16 |
1270.04 |
319.59 |
Missouri Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Missouri Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Missouri Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Missouri Aetna Open Access - High Self |
HA1 |
507.66 |
533.78 |
241.58 |
292.20 |
20.31 |
1099.93 |
1156.52 |
523.42 |
633.10 |
44.01 |
Missouri Aetna Open Access - High Self & Family |
HA2 |
1199.16 |
1260.88 |
562.25 |
698.63 |
45.94 |
2598.18 |
2731.91 |
1218.21 |
1513.70 |
99.54 |
Missouri Aetna Open Access - High Self Plus One |
HA3 |
1187.32 |
1248.41 |
517.46 |
730.95 |
47.75 |
2572.53 |
2704.89 |
1121.16 |
1583.73 |
103.46 |
Missouri Aetna Open Access - Standard Self |
HA4 |
330.63 |
416.01 |
241.58 |
174.43 |
79.57 |
716.37 |
901.36 |
523.42 |
377.94 |
172.41 |
Missouri Aetna Open Access - Standard Self & Family |
HA5 |
780.41 |
981.94 |
562.25 |
419.69 |
185.75 |
1690.89 |
2127.54 |
1218.21 |
909.33 |
402.46 |
Missouri Aetna Open Access - Standard Self Plus One |
HA6 |
772.69 |
972.22 |
517.46 |
454.76 |
186.19 |
1674.16 |
2106.48 |
1121.16 |
985.32 |
403.42 |
Missouri Blue Preferred - High Self |
9G1 |
384.56 |
403.49 |
241.58 |
161.91 |
13.12 |
833.21 |
874.23 |
523.42 |
350.81 |
28.44 |
Missouri Blue Preferred - High Self & Family |
9G2 |
857.94 |
915.93 |
562.25 |
353.68 |
42.21 |
1858.87 |
1984.52 |
1218.21 |
766.31 |
91.46 |
Missouri Blue Preferred - High Self Plus One |
9G3 |
812.58 |
859.44 |
517.46 |
341.98 |
33.52 |
1760.59 |
1862.12 |
1121.16 |
740.96 |
72.63 |
Missouri Blue Preferred - Standard Self |
9G4 |
277.21 |
292.46 |
219.35 |
73.11 |
3.81 |
600.62 |
633.66 |
475.25 |
158.41 |
8.26 |
Missouri Blue Preferred - Standard Self & Family |
9G5 |
787.85 |
811.49 |
562.25 |
249.24 |
7.86 |
1707.01 |
1758.23 |
1218.21 |
540.02 |
17.03 |
Missouri Blue Preferred - Standard Self Plus One |
9G6 |
712.48 |
726.73 |
517.46 |
209.27 |
0.91 |
1543.71 |
1574.58 |
1121.16 |
453.42 |
1.97 |
Missouri Humana CoverageFirst and Humana Value Plan - Value Self |
PH4 |
223.40 |
243.51 |
182.63 |
60.88 |
5.03 |
484.03 |
527.61 |
395.71 |
131.90 |
10.89 |
Missouri Humana CoverageFirst and Humana Value Plan - Value Self & Family |
PH5 |
502.66 |
547.90 |
410.93 |
136.97 |
11.31 |
1089.10 |
1187.12 |
890.34 |
296.78 |
24.51 |
Missouri Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
PH6 |
480.31 |
523.55 |
392.66 |
130.89 |
10.81 |
1040.67 |
1134.36 |
850.77 |
283.59 |
23.42 |
Missouri Humana CoverageFirst and Humana Value Plan - CDHP Self |
PH1 |
330.05 |
349.86 |
241.58 |
108.28 |
14.00 |
715.11 |
758.03 |
523.42 |
234.61 |
30.34 |
Missouri Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
PH2 |
742.63 |
787.19 |
562.25 |
224.94 |
28.78 |
1609.03 |
1705.58 |
1218.21 |
487.37 |
62.36 |
Missouri Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
PH3 |
709.62 |
752.20 |
517.46 |
234.74 |
29.24 |
1537.51 |
1629.77 |
1121.16 |
508.61 |
63.36 |
Missouri Humana Health Plan, Inc. - High Self |
MS1 |
795.31 |
829.31 |
241.58 |
587.73 |
28.19 |
1723.17 |
1796.84 |
523.42 |
1273.42 |
61.09 |
Missouri Humana Health Plan, Inc. - High Self & Family |
MS2 |
1789.44 |
1865.95 |
562.25 |
1303.70 |
60.73 |
3877.12 |
4042.89 |
1218.21 |
2824.68 |
131.58 |
Missouri Humana Health Plan, Inc. - High Self Plus One |
MS3 |
1709.91 |
1783.00 |
517.46 |
1265.54 |
59.75 |
3704.81 |
3863.17 |
1121.16 |
2742.01 |
129.46 |
Missouri Humana Health Plan, Inc. - Standard Self |
MS4 |
492.46 |
554.12 |
241.58 |
312.54 |
55.85 |
1067.00 |
1200.59 |
523.42 |
677.17 |
121.01 |
Missouri Humana Health Plan, Inc. - Standard Self & Family |
MS5 |
1108.05 |
1246.77 |
562.25 |
684.52 |
122.94 |
2400.78 |
2701.34 |
1218.21 |
1483.13 |
266.37 |
Missouri Humana Health Plan, Inc. - Standard Self Plus One |
MS6 |
1058.81 |
1191.38 |
517.46 |
673.92 |
119.23 |
2294.09 |
2581.32 |
1121.16 |
1460.16 |
258.33 |
Missouri UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
242.68 |
276.68 |
207.51 |
69.17 |
8.50 |
525.81 |
599.47 |
449.60 |
149.87 |
18.42 |
Missouri UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
573.86 |
654.35 |
490.76 |
163.59 |
20.13 |
1243.36 |
1417.76 |
1063.32 |
354.44 |
43.60 |
Missouri UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
521.73 |
594.87 |
446.15 |
148.72 |
18.29 |
1130.42 |
1288.89 |
966.67 |
322.22 |
39.62 |
Missouri UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
233.88 |
266.18 |
199.64 |
66.54 |
8.07 |
506.74 |
576.72 |
432.54 |
144.18 |
17.50 |
Missouri UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
553.03 |
629.51 |
472.13 |
157.38 |
19.12 |
1198.23 |
1363.94 |
1022.96 |
340.98 |
41.42 |
Missouri UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
502.79 |
572.28 |
429.21 |
143.07 |
17.37 |
1089.38 |
1239.94 |
929.96 |
309.98 |
37.64 |
Missouri UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Missouri UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Missouri UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Montana Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Montana Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Montana Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Montana Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Montana Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Montana Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Montana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
382.37 |
381.62 |
241.58 |
140.04 |
-6.56 |
828.47 |
826.84 |
523.42 |
303.42 |
-14.21 |
Montana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
871.59 |
869.88 |
562.25 |
307.63 |
-17.49 |
1888.45 |
1884.74 |
1218.21 |
666.53 |
-37.90 |
Montana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
863.04 |
861.43 |
517.46 |
343.97 |
-14.95 |
1869.92 |
1866.43 |
1121.16 |
745.27 |
-32.39 |
Montana Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
372.48 |
377.30 |
241.58 |
135.72 |
-0.99 |
807.04 |
817.48 |
523.42 |
294.06 |
-2.14 |
Montana Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
854.85 |
865.92 |
562.25 |
303.67 |
-4.71 |
1852.18 |
1876.16 |
1218.21 |
657.95 |
-10.21 |
Montana Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
838.09 |
848.95 |
517.46 |
331.49 |
-2.48 |
1815.86 |
1839.39 |
1121.16 |
718.23 |
-5.37 |
Montana Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Montana Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Montana Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Montana UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Montana UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Montana UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Nebraska Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Nebraska Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Nebraska Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Nebraska Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Nebraska Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Nebraska Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Nebraska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
382.37 |
381.62 |
241.58 |
140.04 |
-6.56 |
828.47 |
826.84 |
523.42 |
303.42 |
-14.21 |
Nebraska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
871.59 |
869.88 |
562.25 |
307.63 |
-17.49 |
1888.45 |
1884.74 |
1218.21 |
666.53 |
-37.90 |
Nebraska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
863.04 |
861.43 |
517.46 |
343.97 |
-14.95 |
1869.92 |
1866.43 |
1121.16 |
745.27 |
-32.39 |
Nebraska Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
372.48 |
377.30 |
241.58 |
135.72 |
-0.99 |
807.04 |
817.48 |
523.42 |
294.06 |
-2.14 |
Nebraska Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
854.85 |
865.92 |
562.25 |
303.67 |
-4.71 |
1852.18 |
1876.16 |
1218.21 |
657.95 |
-10.21 |
Nebraska Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
838.09 |
848.95 |
517.46 |
331.49 |
-2.48 |
1815.86 |
1839.39 |
1121.16 |
718.23 |
-5.37 |
Nebraska Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Nebraska Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Nebraska Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Nebraska UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Nebraska UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Nebraska UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Nevada Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Nevada Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Nevada Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Nevada Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Nevada Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Nevada Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Nevada Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
328.95 |
330.94 |
241.58 |
89.36 |
-3.82 |
712.73 |
717.04 |
523.42 |
193.62 |
-8.27 |
Nevada Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
753.40 |
757.97 |
562.25 |
195.72 |
-11.21 |
1632.37 |
1642.27 |
1218.21 |
424.06 |
-24.29 |
Nevada Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
738.63 |
743.12 |
517.46 |
225.66 |
-8.85 |
1600.37 |
1610.09 |
1121.16 |
488.93 |
-19.18 |
Nevada Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
417.46 |
488.66 |
241.58 |
247.08 |
65.39 |
904.50 |
1058.76 |
523.42 |
535.34 |
141.68 |
Nevada Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
952.20 |
1114.65 |
562.25 |
552.40 |
146.67 |
2063.10 |
2415.08 |
1218.21 |
1196.87 |
317.79 |
Nevada Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
942.79 |
1103.63 |
517.46 |
586.17 |
147.50 |
2042.71 |
2391.20 |
1121.16 |
1270.04 |
319.59 |
Nevada Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Nevada Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Nevada Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Nevada Health Plan of Nevada, Inc. - High Self |
NM1 |
326.30 |
342.08 |
241.58 |
100.50 |
9.97 |
706.98 |
741.17 |
523.42 |
217.75 |
21.61 |
Nevada Health Plan of Nevada, Inc. - High Self & Family |
NM2 |
773.30 |
810.69 |
562.25 |
248.44 |
21.61 |
1675.48 |
1756.50 |
1218.21 |
538.29 |
46.83 |
Nevada Health Plan of Nevada, Inc. - High Self Plus One |
NM3 |
619.98 |
649.95 |
487.46 |
162.49 |
7.50 |
1343.29 |
1408.23 |
1056.17 |
352.06 |
16.24 |
Nevada UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
WF1 |
241.32 |
287.18 |
215.39 |
71.79 |
11.46 |
522.86 |
622.22 |
466.67 |
155.55 |
24.84 |
Nevada UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
WF2 |
570.64 |
679.17 |
509.38 |
169.79 |
27.13 |
1236.39 |
1471.54 |
1103.66 |
367.88 |
58.78 |
Nevada UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
WF3 |
518.79 |
617.43 |
463.07 |
154.36 |
24.66 |
1124.05 |
1337.77 |
1003.33 |
334.44 |
53.43 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LU1 |
204.85 |
243.77 |
182.83 |
60.94 |
9.73 |
443.84 |
528.17 |
396.13 |
132.04 |
21.08 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LU2 |
471.16 |
560.66 |
420.50 |
140.16 |
22.37 |
1020.85 |
1214.76 |
911.07 |
303.69 |
48.48 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LU3 |
440.43 |
524.10 |
393.08 |
131.02 |
20.91 |
954.27 |
1135.55 |
851.66 |
283.89 |
45.32 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KT1 |
334.51 |
360.98 |
241.58 |
119.40 |
20.66 |
724.77 |
782.12 |
523.42 |
258.70 |
44.77 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KT2 |
836.26 |
902.47 |
562.25 |
340.22 |
50.43 |
1811.90 |
1955.35 |
1218.21 |
737.14 |
109.26 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KT3 |
719.19 |
776.11 |
517.46 |
258.65 |
43.58 |
1558.25 |
1681.57 |
1121.16 |
560.41 |
94.42 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
VD1 |
240.93 |
286.71 |
215.03 |
71.68 |
11.45 |
522.02 |
621.21 |
465.91 |
155.30 |
24.80 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
VD2 |
569.71 |
678.06 |
508.55 |
169.51 |
27.08 |
1234.37 |
1469.13 |
1101.85 |
367.28 |
58.69 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
VD3 |
517.95 |
616.42 |
462.32 |
154.10 |
24.61 |
1122.23 |
1335.58 |
1001.69 |
333.89 |
53.33 |
Nevada UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Nevada UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Nevada UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
New Hampshire Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
New Hampshire Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
New Hampshire Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
New Hampshire Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
New Hampshire Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
New Hampshire Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
350.59 |
387.52 |
241.58 |
145.94 |
31.12 |
759.61 |
839.63 |
523.42 |
316.21 |
67.44 |
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
802.85 |
887.39 |
562.25 |
325.14 |
68.76 |
1739.51 |
1922.68 |
1218.21 |
704.47 |
148.98 |
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
787.10 |
869.98 |
517.46 |
352.52 |
69.54 |
1705.38 |
1884.96 |
1121.16 |
763.80 |
150.68 |
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
496.50 |
519.07 |
241.58 |
277.49 |
16.76 |
1075.75 |
1124.65 |
523.42 |
601.23 |
36.32 |
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
1132.30 |
1183.79 |
562.25 |
621.54 |
35.71 |
2453.32 |
2564.88 |
1218.21 |
1346.67 |
77.37 |
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
1121.09 |
1172.06 |
517.46 |
654.60 |
37.63 |
2429.03 |
2539.46 |
1121.16 |
1418.30 |
81.53 |
New Hampshire Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
New Hampshire Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
New Hampshire Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
New Hampshire UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
New Hampshire UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
New Hampshire UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
New Jersey Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
New Jersey Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
New Jersey Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
New Jersey Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
New Jersey Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
New Jersey Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
New Jersey Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
350.59 |
387.52 |
241.58 |
145.94 |
31.12 |
759.61 |
839.63 |
523.42 |
316.21 |
67.44 |
New Jersey Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
802.85 |
887.39 |
562.25 |
325.14 |
68.76 |
1739.51 |
1922.68 |
1218.21 |
704.47 |
148.98 |
New Jersey Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
787.10 |
869.98 |
517.46 |
352.52 |
69.54 |
1705.38 |
1884.96 |
1121.16 |
763.80 |
150.68 |
New Jersey Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
496.50 |
519.07 |
241.58 |
277.49 |
16.76 |
1075.75 |
1124.65 |
523.42 |
601.23 |
36.32 |
New Jersey Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
1132.30 |
1183.79 |
562.25 |
621.54 |
35.71 |
2453.32 |
2564.88 |
1218.21 |
1346.67 |
77.37 |
New Jersey Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
1121.09 |
1172.06 |
517.46 |
654.60 |
37.63 |
2429.03 |
2539.46 |
1121.16 |
1418.30 |
81.53 |
New Jersey Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
New Jersey Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
New Jersey Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
New Jersey Aetna Open Access - High Self |
JR1 |
712.96 |
764.68 |
241.58 |
523.10 |
45.91 |
1544.75 |
1656.81 |
523.42 |
1133.39 |
99.48 |
New Jersey Aetna Open Access - High Self & Family |
JR2 |
1646.86 |
1766.32 |
562.25 |
1204.07 |
103.68 |
3568.20 |
3827.03 |
1218.21 |
2608.82 |
224.64 |
New Jersey Aetna Open Access - High Self Plus One |
JR3 |
1630.54 |
1748.82 |
517.46 |
1231.36 |
104.94 |
3532.84 |
3789.11 |
1121.16 |
2667.95 |
227.37 |
New Jersey Aetna Open Access - Basic Self |
JR4 |
633.82 |
659.70 |
241.58 |
418.12 |
20.07 |
1373.28 |
1429.35 |
523.42 |
905.93 |
43.49 |
New Jersey Aetna Open Access - Basic Self & Family |
JR5 |
1468.93 |
1528.94 |
562.25 |
966.69 |
44.23 |
3182.68 |
3312.70 |
1218.21 |
2094.49 |
95.83 |
New Jersey Aetna Open Access - Basic Self Plus One |
JR6 |
1454.38 |
1513.79 |
517.46 |
996.33 |
46.07 |
3151.16 |
3279.88 |
1121.16 |
2158.72 |
99.82 |
New Jersey Aetna Open Access - Basic Self |
P34 |
604.65 |
694.86 |
241.58 |
453.28 |
84.40 |
1310.08 |
1505.53 |
523.42 |
982.11 |
182.87 |
New Jersey Aetna Open Access - Basic Self & Family |
P35 |
1403.39 |
1612.77 |
562.25 |
1050.52 |
193.60 |
3040.68 |
3494.34 |
1218.21 |
2276.13 |
419.47 |
New Jersey Aetna Open Access - Basic Self Plus One |
P36 |
1389.48 |
1596.80 |
517.46 |
1079.34 |
193.98 |
3010.54 |
3459.73 |
1121.16 |
2338.57 |
420.29 |
New Jersey Aetna Open Access - High Self |
P31 |
672.28 |
733.03 |
241.58 |
491.45 |
54.94 |
1456.61 |
1588.23 |
523.42 |
1064.81 |
119.04 |
New Jersey Aetna Open Access - High Self & Family |
P32 |
1629.94 |
1777.25 |
562.25 |
1215.00 |
131.53 |
3531.54 |
3850.71 |
1218.21 |
2632.50 |
284.98 |
New Jersey Aetna Open Access - High Self Plus One |
P33 |
1613.79 |
1759.65 |
517.46 |
1242.19 |
132.52 |
3496.55 |
3812.58 |
1121.16 |
2691.42 |
287.13 |
New Jersey GHI Health Plan - Standard Self |
804 |
463.69 |
479.93 |
241.58 |
238.35 |
10.43 |
1004.66 |
1039.85 |
523.42 |
516.43 |
22.61 |
New Jersey GHI Health Plan - Standard Self & Family |
805 |
1124.96 |
1164.33 |
562.25 |
602.08 |
23.59 |
2437.41 |
2522.72 |
1218.21 |
1304.51 |
51.12 |
New Jersey GHI Health Plan - Standard Self Plus One |
806 |
1078.58 |
1116.34 |
517.46 |
598.88 |
24.42 |
2336.92 |
2418.74 |
1121.16 |
1297.58 |
52.92 |
New Jersey UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
New Jersey UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
New Jersey UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
New Mexico Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
New Mexico Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
New Mexico Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
New Mexico Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
New Mexico Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
New Mexico Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
New Mexico Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
328.95 |
330.94 |
241.58 |
89.36 |
-3.82 |
712.73 |
717.04 |
523.42 |
193.62 |
-8.27 |
New Mexico Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
753.40 |
757.97 |
562.25 |
195.72 |
-11.21 |
1632.37 |
1642.27 |
1218.21 |
424.06 |
-24.29 |
New Mexico Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
738.63 |
743.12 |
517.46 |
225.66 |
-8.85 |
1600.37 |
1610.09 |
1121.16 |
488.93 |
-19.18 |
New Mexico Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
417.46 |
488.66 |
241.58 |
247.08 |
65.39 |
904.50 |
1058.76 |
523.42 |
535.34 |
141.68 |
New Mexico Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
952.20 |
1114.65 |
562.25 |
552.40 |
146.67 |
2063.10 |
2415.08 |
1218.21 |
1196.87 |
317.79 |
New Mexico Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
942.79 |
1103.63 |
517.46 |
586.17 |
147.50 |
2042.71 |
2391.20 |
1121.16 |
1270.04 |
319.59 |
New Mexico Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
New Mexico Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
New Mexico Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
New Mexico Presbyterian Health Plan - High Self |
P21 |
388.15 |
390.89 |
241.58 |
149.31 |
-3.07 |
840.99 |
846.93 |
523.42 |
323.51 |
-6.64 |
New Mexico Presbyterian Health Plan - High Self & Family |
P22 |
912.14 |
918.62 |
562.25 |
356.37 |
-9.30 |
1976.30 |
1990.34 |
1218.21 |
772.13 |
-20.15 |
New Mexico Presbyterian Health Plan - High Self Plus One |
P23 |
881.09 |
887.35 |
517.46 |
369.89 |
-7.08 |
1909.03 |
1922.59 |
1121.16 |
801.43 |
-15.34 |
New Mexico Presbyterian Health Plan - Standard Self |
PS4 |
327.82 |
325.99 |
241.58 |
84.41 |
-7.64 |
710.28 |
706.31 |
523.42 |
182.89 |
-16.55 |
New Mexico Presbyterian Health Plan - Standard Self & Family |
PS5 |
770.38 |
766.08 |
562.25 |
203.83 |
-20.08 |
1669.16 |
1659.84 |
1218.21 |
441.63 |
-43.51 |
New Mexico Presbyterian Health Plan - Standard Self Plus One |
PS6 |
744.16 |
740.02 |
517.46 |
222.56 |
-17.48 |
1612.35 |
1603.38 |
1121.16 |
482.22 |
-37.87 |
New Mexico Presbyterian Health Plan - Wellness Self |
PS1 |
286.10 |
291.72 |
218.79 |
72.93 |
1.41 |
619.88 |
632.06 |
474.05 |
158.01 |
3.04 |
New Mexico Presbyterian Health Plan - Wellness Self & Family |
PS2 |
672.35 |
685.55 |
514.16 |
171.39 |
3.30 |
1456.76 |
1485.36 |
1114.02 |
371.34 |
7.15 |
New Mexico Presbyterian Health Plan - Wellness Self Plus One |
PS3 |
649.47 |
662.21 |
496.66 |
165.55 |
3.18 |
1407.19 |
1434.79 |
1076.09 |
358.70 |
6.90 |
New Mexico True Health New Mexico - High Self |
EL1 |
286.23 |
294.96 |
221.22 |
73.74 |
2.18 |
620.17 |
639.08 |
479.31 |
159.77 |
4.73 |
New Mexico True Health New Mexico - High Self & Family |
EL2 |
675.91 |
696.52 |
522.39 |
174.13 |
5.15 |
1464.47 |
1509.13 |
1131.85 |
377.28 |
11.16 |
New Mexico True Health New Mexico - High Self Plus One |
EL3 |
640.63 |
660.16 |
495.12 |
165.04 |
4.88 |
1388.03 |
1430.35 |
1072.76 |
357.59 |
10.58 |
New Mexico UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
New Mexico UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
New Mexico UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
New York Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
New York Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
New York Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
New York Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
New York Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
New York Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
New York Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
350.59 |
387.52 |
241.58 |
145.94 |
31.12 |
759.61 |
839.63 |
523.42 |
316.21 |
67.44 |
New York Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
802.85 |
887.39 |
562.25 |
325.14 |
68.76 |
1739.51 |
1922.68 |
1218.21 |
704.47 |
148.98 |
New York Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
787.10 |
869.98 |
517.46 |
352.52 |
69.54 |
1705.38 |
1884.96 |
1121.16 |
763.80 |
150.68 |
New York Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
496.50 |
519.07 |
241.58 |
277.49 |
16.76 |
1075.75 |
1124.65 |
523.42 |
601.23 |
36.32 |
New York Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
1132.30 |
1183.79 |
562.25 |
621.54 |
35.71 |
2453.32 |
2564.88 |
1218.21 |
1346.67 |
77.37 |
New York Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
1121.09 |
1172.06 |
517.46 |
654.60 |
37.63 |
2429.03 |
2539.46 |
1121.16 |
1418.30 |
81.53 |
New York Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
New York Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
New York Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
New York Aetna Open Access - High Self |
JC1 |
609.40 |
673.65 |
241.58 |
432.07 |
58.44 |
1320.37 |
1459.58 |
523.42 |
936.16 |
126.63 |
New York Aetna Open Access - High Self & Family |
JC2 |
1505.80 |
1664.57 |
562.25 |
1102.32 |
142.99 |
3262.57 |
3606.57 |
1218.21 |
2388.36 |
309.81 |
New York Aetna Open Access - High Self Plus One |
JC3 |
1490.89 |
1648.10 |
517.46 |
1130.64 |
143.87 |
3230.26 |
3570.88 |
1121.16 |
2449.72 |
311.72 |
New York Aetna Open Access - Basic Self |
JC4 |
508.81 |
563.01 |
241.58 |
321.43 |
48.39 |
1102.42 |
1219.86 |
523.42 |
696.44 |
104.86 |
New York Aetna Open Access - Basic Self & Family |
JC5 |
1241.09 |
1373.31 |
562.25 |
811.06 |
116.44 |
2689.03 |
2975.51 |
1218.21 |
1757.30 |
252.29 |
New York Aetna Open Access - Basic Self Plus One |
JC6 |
1228.82 |
1359.72 |
517.46 |
842.26 |
117.56 |
2662.44 |
2946.06 |
1121.16 |
1824.90 |
254.72 |
New York CDPHP - Standard Self |
SG4 |
290.59 |
325.18 |
241.58 |
83.60 |
10.95 |
629.61 |
704.56 |
523.42 |
181.14 |
23.74 |
New York CDPHP - Standard Self & Family |
SG5 |
827.37 |
780.40 |
562.25 |
218.15 |
-62.75 |
1792.64 |
1690.87 |
1218.21 |
472.66 |
-135.96 |
New York CDPHP - Standard Self Plus One |
SG6 |
601.50 |
721.90 |
517.46 |
204.44 |
54.07 |
1303.25 |
1564.12 |
1121.16 |
442.96 |
117.15 |
New York GHI Health Plan - Standard Self |
804 |
463.69 |
479.93 |
241.58 |
238.35 |
10.43 |
1004.66 |
1039.85 |
523.42 |
516.43 |
22.61 |
New York GHI Health Plan - Standard Self & Family |
805 |
1124.96 |
1164.33 |
562.25 |
602.08 |
23.59 |
2437.41 |
2522.72 |
1218.21 |
1304.51 |
51.12 |
New York GHI Health Plan - Standard Self Plus One |
806 |
1078.58 |
1116.34 |
517.46 |
598.88 |
24.42 |
2336.92 |
2418.74 |
1121.16 |
1297.58 |
52.92 |
New York HIP of Greater NY - Standard Self |
YL4 |
375.63 |
415.70 |
241.58 |
174.12 |
34.26 |
813.87 |
900.68 |
523.42 |
377.26 |
74.23 |
New York HIP of Greater NY - Standard Self & Family |
YL5 |
1079.99 |
1208.42 |
562.25 |
646.17 |
112.65 |
2339.98 |
2618.24 |
1218.21 |
1400.03 |
244.07 |
New York HIP of Greater NY - Standard Self Plus One |
YL6 |
683.19 |
759.04 |
517.46 |
241.58 |
62.51 |
1480.25 |
1644.59 |
1121.16 |
523.43 |
135.44 |
New York HIP of Greater NY - High Self |
511 |
494.33 |
484.96 |
241.58 |
243.38 |
-15.18 |
1071.05 |
1050.75 |
523.42 |
527.33 |
-32.88 |
New York HIP of Greater NY - High Self & Family |
512 |
1422.45 |
1409.72 |
562.25 |
847.47 |
-28.51 |
3081.98 |
3054.39 |
1218.21 |
1836.18 |
-61.78 |
New York HIP of Greater NY - High Self Plus One |
513 |
899.33 |
885.52 |
517.46 |
368.06 |
-27.15 |
1948.55 |
1918.63 |
1121.16 |
797.47 |
-58.82 |
New York Independent Health - Standard Self |
C54 |
328.44 |
333.30 |
241.58 |
91.72 |
-0.95 |
711.62 |
722.15 |
523.42 |
198.73 |
-2.05 |
New York Independent Health - Standard Self & Family |
C55 |
886.79 |
899.91 |
562.25 |
337.66 |
-2.66 |
1921.38 |
1949.81 |
1218.21 |
731.60 |
-5.76 |
New York Independent Health - Standard Self Plus One |
C56 |
837.51 |
849.92 |
517.46 |
332.46 |
-0.93 |
1814.61 |
1841.49 |
1121.16 |
720.33 |
-2.02 |
New York Independent Health - High Self |
QA1 |
352.00 |
365.05 |
241.58 |
123.47 |
7.24 |
762.67 |
790.94 |
523.42 |
267.52 |
15.69 |
New York Independent Health - High Self & Family |
QA2 |
950.39 |
985.64 |
562.25 |
423.39 |
19.47 |
2059.18 |
2135.55 |
1218.21 |
917.34 |
42.18 |
New York Independent Health - High Self Plus One |
QA3 |
897.60 |
930.88 |
517.46 |
413.42 |
19.94 |
1944.80 |
2016.91 |
1121.16 |
895.75 |
43.21 |
New York Independent Health - HDHP Self |
QA4 |
273.63 |
276.60 |
207.45 |
69.15 |
0.74 |
592.87 |
599.30 |
449.48 |
149.82 |
1.60 |
New York Independent Health - HDHP Self & Family |
QA5 |
707.60 |
716.01 |
537.01 |
179.00 |
2.10 |
1533.13 |
1551.36 |
1163.52 |
387.84 |
4.56 |
New York Independent Health - HDHP Self Plus One |
QA6 |
659.82 |
681.12 |
510.84 |
170.28 |
5.33 |
1429.61 |
1475.76 |
1106.82 |
368.94 |
11.54 |
New York UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
New York UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
New York UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
North Carolina Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
North Carolina Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
North Carolina Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
North Carolina Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
North Carolina Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
North Carolina Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
North Carolina Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
382.72 |
393.11 |
241.58 |
151.53 |
4.58 |
829.23 |
851.74 |
523.42 |
328.32 |
9.93 |
North Carolina Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
872.64 |
896.32 |
562.25 |
334.07 |
7.90 |
1890.72 |
1942.03 |
1218.21 |
723.82 |
17.12 |
North Carolina Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
864.00 |
887.45 |
517.46 |
369.99 |
10.11 |
1872.00 |
1922.81 |
1121.16 |
801.65 |
21.91 |
North Carolina Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
378.45 |
379.30 |
241.58 |
137.72 |
-4.96 |
819.98 |
821.82 |
523.42 |
298.40 |
-10.74 |
North Carolina Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
866.59 |
868.56 |
562.25 |
306.31 |
-13.81 |
1877.61 |
1881.88 |
1218.21 |
663.67 |
-29.92 |
North Carolina Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
849.59 |
851.52 |
517.46 |
334.06 |
-11.41 |
1840.78 |
1844.96 |
1121.16 |
723.80 |
-24.72 |
North Carolina Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
North Carolina Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
North Carolina Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
North Carolina UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
242.68 |
276.68 |
207.51 |
69.17 |
8.50 |
525.81 |
599.47 |
449.60 |
149.87 |
18.42 |
North Carolina UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
573.86 |
654.35 |
490.76 |
163.59 |
20.13 |
1243.36 |
1417.76 |
1063.32 |
354.44 |
43.60 |
North Carolina UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
521.73 |
594.87 |
446.15 |
148.72 |
18.29 |
1130.42 |
1288.89 |
966.67 |
322.22 |
39.62 |
North Carolina UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LS1 |
209.88 |
224.24 |
168.18 |
56.06 |
3.59 |
454.74 |
485.85 |
364.39 |
121.46 |
7.78 |
North Carolina UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LS2 |
482.73 |
515.77 |
386.83 |
128.94 |
8.26 |
1045.92 |
1117.50 |
838.13 |
279.37 |
17.89 |
North Carolina UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LS3 |
451.25 |
482.12 |
361.59 |
120.53 |
7.72 |
977.71 |
1044.59 |
783.44 |
261.15 |
16.72 |
North Carolina UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KK1 |
329.48 |
354.94 |
241.58 |
113.36 |
19.65 |
713.87 |
769.04 |
523.42 |
245.62 |
42.59 |
North Carolina UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KK2 |
823.71 |
887.37 |
562.25 |
325.12 |
47.88 |
1784.71 |
1922.64 |
1218.21 |
704.43 |
103.74 |
North Carolina UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KK3 |
708.40 |
763.14 |
517.46 |
245.68 |
41.40 |
1534.87 |
1653.47 |
1121.16 |
532.31 |
89.70 |
North Carolina UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
233.88 |
266.18 |
199.64 |
66.54 |
8.07 |
506.74 |
576.72 |
432.54 |
144.18 |
17.50 |
North Carolina UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
553.03 |
629.51 |
472.13 |
157.38 |
19.12 |
1198.23 |
1363.94 |
1022.96 |
340.98 |
41.42 |
North Carolina UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
502.79 |
572.28 |
429.21 |
143.07 |
17.37 |
1089.38 |
1239.94 |
929.96 |
309.98 |
37.64 |
North Carolina UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
North Carolina UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
North Carolina UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
North Dakota Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
North Dakota Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
North Dakota Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
North Dakota Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
North Dakota Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
North Dakota Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
North Dakota Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
382.37 |
381.62 |
241.58 |
140.04 |
-6.56 |
828.47 |
826.84 |
523.42 |
303.42 |
-14.21 |
North Dakota Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
871.59 |
869.88 |
562.25 |
307.63 |
-17.49 |
1888.45 |
1884.74 |
1218.21 |
666.53 |
-37.90 |
North Dakota Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
863.04 |
861.43 |
517.46 |
343.97 |
-14.95 |
1869.92 |
1866.43 |
1121.16 |
745.27 |
-32.39 |
North Dakota Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
372.48 |
377.30 |
241.58 |
135.72 |
-0.99 |
807.04 |
817.48 |
523.42 |
294.06 |
-2.14 |
North Dakota Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
854.85 |
865.92 |
562.25 |
303.67 |
-4.71 |
1852.18 |
1876.16 |
1218.21 |
657.95 |
-10.21 |
North Dakota Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
838.09 |
848.95 |
517.46 |
331.49 |
-2.48 |
1815.86 |
1839.39 |
1121.16 |
718.23 |
-5.37 |
North Dakota Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
North Dakota Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
North Dakota Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
North Dakota HealthPartners - Standard Self |
V34 |
212.27 |
235.11 |
176.33 |
58.78 |
5.71 |
459.92 |
509.41 |
382.06 |
127.35 |
12.37 |
North Dakota HealthPartners - Standard Self & Family |
V35 |
517.11 |
572.74 |
429.56 |
143.18 |
13.90 |
1120.41 |
1240.94 |
930.71 |
310.23 |
30.13 |
North Dakota HealthPartners - Standard Self Plus One |
V36 |
469.13 |
519.60 |
389.70 |
129.90 |
12.62 |
1016.45 |
1125.80 |
844.35 |
281.45 |
27.34 |
North Dakota HealthPartners - High Self |
V31 |
328.76 |
308.34 |
231.26 |
77.08 |
-15.91 |
712.31 |
668.07 |
501.05 |
167.02 |
-34.45 |
North Dakota HealthPartners - High Self & Family |
V32 |
800.86 |
751.10 |
562.25 |
188.85 |
-65.54 |
1735.20 |
1627.38 |
1218.21 |
409.17 |
-142.01 |
North Dakota HealthPartners - High Self Plus One |
V33 |
726.56 |
681.42 |
511.07 |
170.35 |
-52.09 |
1574.21 |
1476.41 |
1107.31 |
369.10 |
-112.85 |
North Dakota UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
North Dakota UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
North Dakota UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Northern Mariana Islands Calvo's SelectCare - Standard Self |
B44 |
183.11 |
198.36 |
148.77 |
49.59 |
3.81 |
396.74 |
429.78 |
322.34 |
107.44 |
8.26 |
Northern Mariana Islands Calvo's SelectCare - Standard Self & Family |
B45 |
532.03 |
576.33 |
432.25 |
144.08 |
11.07 |
1152.73 |
1248.72 |
936.54 |
312.18 |
24.00 |
Northern Mariana Islands Calvo's SelectCare - Standard Self Plus One |
B46 |
360.97 |
391.02 |
293.27 |
97.75 |
7.51 |
782.10 |
847.21 |
635.41 |
211.80 |
16.28 |
Northern Mariana Islands Calvo's SelectCare - High Self |
B41 |
226.87 |
240.78 |
180.59 |
60.19 |
3.47 |
491.55 |
521.69 |
391.27 |
130.42 |
7.53 |
Northern Mariana Islands Calvo's SelectCare - High Self & Family |
B42 |
600.87 |
637.74 |
478.31 |
159.43 |
9.21 |
1301.89 |
1381.77 |
1036.33 |
345.44 |
19.97 |
Northern Mariana Islands Calvo's SelectCare - High Self Plus One |
B43 |
442.72 |
469.88 |
352.41 |
117.47 |
6.79 |
959.23 |
1018.07 |
763.55 |
254.52 |
14.71 |
Northern Mariana Islands TakeCare - HDHP Self |
KX1 |
57.34 |
55.63 |
41.72 |
13.91 |
-0.42 |
124.24 |
120.53 |
90.40 |
30.13 |
-0.93 |
Northern Mariana Islands TakeCare - HDHP Self & Family |
KX2 |
156.61 |
149.15 |
111.86 |
37.29 |
-1.86 |
339.32 |
323.16 |
242.37 |
80.79 |
-4.04 |
Northern Mariana Islands TakeCare - HDHP Self Plus One |
KX3 |
141.28 |
134.28 |
100.71 |
33.57 |
-1.75 |
306.11 |
290.94 |
218.21 |
72.73 |
-3.80 |
Northern Mariana Islands TakeCare - Standard Self |
JK4 |
179.65 |
186.67 |
140.00 |
46.67 |
1.76 |
389.24 |
404.45 |
303.34 |
101.11 |
3.80 |
Northern Mariana Islands TakeCare - Standard Self & Family |
JK5 |
508.76 |
528.64 |
396.48 |
132.16 |
4.97 |
1102.31 |
1145.39 |
859.04 |
286.35 |
10.77 |
Northern Mariana Islands TakeCare - Standard Self Plus One |
JK6 |
354.07 |
367.91 |
275.93 |
91.98 |
3.46 |
767.15 |
797.14 |
597.86 |
199.28 |
7.49 |
Northern Mariana Islands TakeCare - High Self |
JK1 |
227.24 |
229.76 |
172.32 |
57.44 |
0.63 |
492.35 |
497.81 |
373.36 |
124.45 |
1.36 |
Northern Mariana Islands TakeCare - High Self & Family |
JK2 |
542.03 |
548.02 |
411.02 |
137.00 |
1.49 |
1174.40 |
1187.38 |
890.54 |
296.84 |
3.24 |
Northern Mariana Islands TakeCare - High Self Plus One |
JK3 |
448.95 |
453.92 |
340.44 |
113.48 |
1.24 |
972.73 |
983.49 |
737.62 |
245.87 |
2.69 |
Ohio Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Ohio Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Ohio Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Ohio Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Ohio Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Ohio Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Ohio Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
JS4 |
495.45 |
505.19 |
241.58 |
263.61 |
3.93 |
1073.48 |
1094.58 |
523.42 |
571.16 |
8.52 |
Ohio Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
JS5 |
1131.04 |
1153.29 |
562.25 |
591.04 |
6.47 |
2450.59 |
2498.80 |
1218.21 |
1280.59 |
14.02 |
Ohio Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
JS6 |
1119.84 |
1141.88 |
517.46 |
624.42 |
8.70 |
2426.32 |
2474.07 |
1121.16 |
1352.91 |
18.85 |
Ohio Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
JS1 |
463.38 |
466.12 |
241.58 |
224.54 |
-3.07 |
1003.99 |
1009.93 |
523.42 |
486.51 |
-6.64 |
Ohio Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
JS2 |
1056.30 |
1062.53 |
562.25 |
500.28 |
-9.55 |
2288.65 |
2302.15 |
1218.21 |
1083.94 |
-20.69 |
Ohio Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
JS3 |
1045.84 |
1052.00 |
517.46 |
534.54 |
-7.18 |
2265.99 |
2279.33 |
1121.16 |
1158.17 |
-15.56 |
Ohio Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Ohio Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Ohio Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Ohio AultCare Insurance Company - High Self |
3A1 |
388.63 |
404.25 |
241.58 |
162.67 |
9.81 |
842.03 |
875.88 |
523.42 |
352.46 |
21.27 |
Ohio AultCare Insurance Company - High Self & Family |
3A2 |
959.90 |
998.44 |
562.25 |
436.19 |
22.76 |
2079.78 |
2163.29 |
1218.21 |
945.08 |
49.32 |
Ohio AultCare Insurance Company - High Self Plus One |
3A3 |
816.11 |
848.88 |
517.46 |
331.42 |
19.43 |
1768.24 |
1839.24 |
1121.16 |
718.08 |
42.10 |
Ohio AultCare Insurance Company - HDHP Self |
3A4 |
201.98 |
215.02 |
161.27 |
53.75 |
3.26 |
437.62 |
465.88 |
349.41 |
116.47 |
7.07 |
Ohio AultCare Insurance Company - HDHP Self & Family |
3A5 |
646.73 |
688.51 |
516.38 |
172.13 |
10.45 |
1401.25 |
1491.77 |
1118.83 |
372.94 |
22.63 |
Ohio AultCare Insurance Company - HDHP Self Plus One |
3A6 |
383.98 |
408.78 |
306.59 |
102.19 |
6.20 |
831.96 |
885.69 |
664.27 |
221.42 |
13.43 |
Ohio Humana CoverageFirst and Humana Value Plan - Value Self |
X34 |
283.90 |
298.10 |
223.58 |
74.52 |
3.55 |
615.12 |
645.88 |
484.41 |
161.47 |
7.69 |
Ohio Humana CoverageFirst and Humana Value Plan - Value Self & Family |
X35 |
638.79 |
670.73 |
503.05 |
167.68 |
7.98 |
1384.05 |
1453.25 |
1089.94 |
363.31 |
17.30 |
Ohio Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
X36 |
610.40 |
640.92 |
480.69 |
160.23 |
7.63 |
1322.53 |
1388.66 |
1041.50 |
347.16 |
16.53 |
Ohio Humana CoverageFirst and Humana Value Plan - CDHP Self |
X31 |
368.97 |
387.42 |
241.58 |
145.84 |
12.64 |
799.44 |
839.41 |
523.42 |
315.99 |
27.39 |
Ohio Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
X32 |
830.20 |
871.71 |
562.25 |
309.46 |
25.73 |
1798.77 |
1888.71 |
1218.21 |
670.50 |
55.75 |
Ohio Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
X33 |
793.30 |
832.97 |
517.46 |
315.51 |
26.33 |
1718.82 |
1804.77 |
1121.16 |
683.61 |
57.05 |
Ohio Humana Health Plan of Ohio, Inc. - High Self |
A61 |
692.76 |
727.40 |
241.58 |
485.82 |
28.83 |
1500.98 |
1576.03 |
523.42 |
1052.61 |
62.47 |
Ohio Humana Health Plan of Ohio, Inc. - High Self & Family |
A62 |
1558.72 |
1636.66 |
562.25 |
1074.41 |
62.16 |
3377.23 |
3546.10 |
1218.21 |
2327.89 |
134.68 |
Ohio Humana Health Plan of Ohio, Inc. - High Self Plus One |
A63 |
1489.45 |
1563.92 |
517.46 |
1046.46 |
61.13 |
3227.14 |
3388.49 |
1121.16 |
2267.33 |
132.45 |
Ohio Humana Health Plan of Ohio, Inc. - Standard Self |
A64 |
541.00 |
568.05 |
241.58 |
326.47 |
21.24 |
1172.17 |
1230.78 |
523.42 |
707.36 |
46.03 |
Ohio Humana Health Plan of Ohio, Inc. - Standard Self & Family |
A65 |
1217.27 |
1278.14 |
562.25 |
715.89 |
45.09 |
2637.42 |
2769.30 |
1218.21 |
1551.09 |
97.69 |
Ohio Humana Health Plan of Ohio, Inc. - Standard Self Plus One |
A66 |
1163.17 |
1221.32 |
517.46 |
703.86 |
44.81 |
2520.20 |
2646.19 |
1121.16 |
1525.03 |
97.09 |
Ohio Humana Health Plan of Ohio, Inc. - Basic Self |
W61 |
280.90 |
294.95 |
221.21 |
73.74 |
3.52 |
608.62 |
639.06 |
479.30 |
159.76 |
7.61 |
Ohio Humana Health Plan of Ohio, Inc. - Basic Self & Family |
W62 |
632.05 |
663.66 |
497.75 |
165.91 |
7.90 |
1369.44 |
1437.93 |
1078.45 |
359.48 |
17.12 |
Ohio Humana Health Plan of Ohio, Inc. - Basic Self Plus One |
W63 |
603.96 |
634.16 |
475.62 |
158.54 |
7.55 |
1308.58 |
1374.01 |
1030.51 |
343.50 |
16.36 |
Ohio Medical Mutual of Ohio - Basic Self |
YF1 |
203.14 |
191.56 |
143.67 |
47.89 |
-2.89 |
440.14 |
415.05 |
311.29 |
103.76 |
-6.27 |
Ohio Medical Mutual of Ohio - Basic Self & Family |
YF2 |
487.54 |
459.74 |
344.81 |
114.93 |
-6.95 |
1056.34 |
996.10 |
747.08 |
249.02 |
-15.06 |
Ohio Medical Mutual of Ohio - Basic Self Plus One |
YF3 |
446.92 |
421.43 |
316.07 |
105.36 |
-6.37 |
968.33 |
913.10 |
684.83 |
228.27 |
-13.81 |
Ohio Medical Mutual of Ohio - Standard Self |
YF4 |
447.22 |
455.01 |
241.58 |
213.43 |
1.98 |
968.98 |
985.86 |
523.42 |
462.44 |
4.30 |
Ohio Medical Mutual of Ohio - Standard Self & Family |
YF5 |
1073.33 |
1092.02 |
562.25 |
529.77 |
2.91 |
2325.55 |
2366.04 |
1218.21 |
1147.83 |
6.30 |
Ohio Medical Mutual of Ohio - Standard Self Plus One |
YF6 |
983.88 |
1001.02 |
517.46 |
483.56 |
3.80 |
2131.74 |
2168.88 |
1121.16 |
1047.72 |
8.24 |
Ohio Medical Mutual of Ohio - Standard Self |
644 |
474.36 |
434.29 |
241.58 |
192.71 |
-45.88 |
1027.78 |
940.96 |
523.42 |
417.54 |
-99.40 |
Ohio Medical Mutual of Ohio - Standard Self & Family |
645 |
1138.48 |
1042.30 |
562.25 |
480.05 |
-111.96 |
2466.71 |
2258.32 |
1218.21 |
1040.11 |
-242.58 |
Ohio Medical Mutual of Ohio - Standard Self Plus One |
646 |
1043.61 |
955.44 |
517.46 |
437.98 |
-101.51 |
2261.16 |
2070.12 |
1121.16 |
948.96 |
-219.94 |
Ohio Medical Mutual of Ohio - Standard Self |
X64 |
392.04 |
397.54 |
241.58 |
155.96 |
-0.31 |
849.42 |
861.34 |
523.42 |
337.92 |
-0.66 |
Ohio Medical Mutual of Ohio - Standard Self & Family |
X65 |
940.89 |
954.10 |
562.25 |
391.85 |
-2.57 |
2038.60 |
2067.22 |
1218.21 |
849.01 |
-5.57 |
Ohio Medical Mutual of Ohio - Standard Self Plus One |
X66 |
862.48 |
874.59 |
517.46 |
357.13 |
-1.23 |
1868.71 |
1894.95 |
1121.16 |
773.79 |
-2.66 |
Ohio Medical Mutual of Ohio - Basic Self |
X61 |
203.07 |
187.05 |
140.29 |
46.76 |
-4.01 |
439.99 |
405.28 |
303.96 |
101.32 |
-8.68 |
Ohio Medical Mutual of Ohio - Basic Self & Family |
X62 |
487.36 |
448.93 |
336.70 |
112.23 |
-9.61 |
1055.95 |
972.68 |
729.51 |
243.17 |
-20.82 |
Ohio Medical Mutual of Ohio - Basic Self Plus One |
X63 |
446.75 |
411.52 |
308.64 |
102.88 |
-8.81 |
967.96 |
891.63 |
668.72 |
222.91 |
-19.08 |
Ohio Medical Mutual of Ohio - Basic Self |
UX1 |
203.14 |
189.79 |
142.34 |
47.45 |
-3.33 |
440.14 |
411.21 |
308.41 |
102.80 |
-7.23 |
Ohio Medical Mutual of Ohio - Basic Self & Family |
UX2 |
487.54 |
455.50 |
341.63 |
113.87 |
-8.01 |
1056.34 |
986.92 |
740.19 |
246.73 |
-17.35 |
Ohio Medical Mutual of Ohio - Basic Self Plus One |
UX3 |
446.92 |
417.54 |
313.16 |
104.38 |
-7.35 |
968.33 |
904.67 |
678.50 |
226.17 |
-15.91 |
Ohio UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Ohio UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Ohio UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Oklahoma Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Oklahoma Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Oklahoma Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Oklahoma Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Oklahoma Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Oklahoma Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Oklahoma Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
JS4 |
495.45 |
505.19 |
241.58 |
263.61 |
3.93 |
1073.48 |
1094.58 |
523.42 |
571.16 |
8.52 |
Oklahoma Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
JS5 |
1131.04 |
1153.29 |
562.25 |
591.04 |
6.47 |
2450.59 |
2498.80 |
1218.21 |
1280.59 |
14.02 |
Oklahoma Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
JS6 |
1119.84 |
1141.88 |
517.46 |
624.42 |
8.70 |
2426.32 |
2474.07 |
1121.16 |
1352.91 |
18.85 |
Oklahoma Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
JS1 |
463.38 |
466.12 |
241.58 |
224.54 |
-3.07 |
1003.99 |
1009.93 |
523.42 |
486.51 |
-6.64 |
Oklahoma Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
JS2 |
1056.30 |
1062.53 |
562.25 |
500.28 |
-9.55 |
2288.65 |
2302.15 |
1218.21 |
1083.94 |
-20.69 |
Oklahoma Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
JS3 |
1045.84 |
1052.00 |
517.46 |
534.54 |
-7.18 |
2265.99 |
2279.33 |
1121.16 |
1158.17 |
-15.56 |
Oklahoma Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Oklahoma Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Oklahoma Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Oklahoma GlobalHealth - Standard Self |
IM4 |
287.51 |
304.58 |
228.44 |
76.14 |
4.26 |
622.94 |
659.92 |
494.94 |
164.98 |
9.25 |
Oklahoma GlobalHealth - Standard Self & Family |
IM5 |
718.79 |
761.47 |
562.25 |
199.22 |
19.52 |
1557.38 |
1649.85 |
1218.21 |
431.64 |
42.30 |
Oklahoma GlobalHealth - Standard Self Plus One |
IM6 |
575.03 |
609.17 |
456.88 |
152.29 |
8.53 |
1245.90 |
1319.87 |
989.90 |
329.97 |
18.50 |
Oklahoma GlobalHealth - High Self |
IM1 |
304.28 |
322.28 |
241.58 |
80.70 |
4.63 |
659.27 |
698.27 |
523.42 |
174.85 |
10.03 |
Oklahoma GlobalHealth - High Self & Family |
IM2 |
760.69 |
805.69 |
562.25 |
243.44 |
29.22 |
1648.16 |
1745.66 |
1218.21 |
527.45 |
63.31 |
Oklahoma GlobalHealth - High Self Plus One |
IM3 |
608.55 |
644.56 |
483.42 |
161.14 |
9.00 |
1318.53 |
1396.55 |
1047.41 |
349.14 |
19.51 |
Oklahoma UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Oklahoma UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Oklahoma UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Oregon Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Oregon Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Oregon Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Oregon Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Oregon Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Oregon Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Oregon Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
382.37 |
381.62 |
241.58 |
140.04 |
-6.56 |
828.47 |
826.84 |
523.42 |
303.42 |
-14.21 |
Oregon Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
871.59 |
869.88 |
562.25 |
307.63 |
-17.49 |
1888.45 |
1884.74 |
1218.21 |
666.53 |
-37.90 |
Oregon Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
863.04 |
861.43 |
517.46 |
343.97 |
-14.95 |
1869.92 |
1866.43 |
1121.16 |
745.27 |
-32.39 |
Oregon Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
372.48 |
377.30 |
241.58 |
135.72 |
-0.99 |
807.04 |
817.48 |
523.42 |
294.06 |
-2.14 |
Oregon Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
854.85 |
865.92 |
562.25 |
303.67 |
-4.71 |
1852.18 |
1876.16 |
1218.21 |
657.95 |
-10.21 |
Oregon Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
838.09 |
848.95 |
517.46 |
331.49 |
-2.48 |
1815.86 |
1839.39 |
1121.16 |
718.23 |
-5.37 |
Oregon Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Oregon Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Oregon Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Oregon Kaiser Permanente - Northwest - Standard Self |
574 |
299.06 |
317.70 |
238.28 |
79.42 |
4.66 |
647.96 |
688.35 |
516.26 |
172.09 |
10.10 |
Oregon Kaiser Permanente - Northwest - Standard Self & Family |
575 |
687.02 |
729.85 |
547.39 |
182.46 |
10.71 |
1488.54 |
1581.34 |
1186.01 |
395.33 |
23.20 |
Oregon Kaiser Permanente - Northwest - Standard Self Plus One |
576 |
687.02 |
729.85 |
517.46 |
212.39 |
29.49 |
1488.54 |
1581.34 |
1121.16 |
460.18 |
63.90 |
Oregon Kaiser Permanente - Northwest - High Self |
571 |
336.89 |
346.93 |
241.58 |
105.35 |
4.23 |
729.93 |
751.68 |
523.42 |
228.26 |
9.17 |
Oregon Kaiser Permanente - Northwest - High Self & Family |
572 |
760.94 |
783.61 |
562.25 |
221.36 |
6.89 |
1648.70 |
1697.82 |
1218.21 |
479.61 |
14.93 |
Oregon Kaiser Permanente - Northwest - High Self Plus One |
573 |
760.94 |
783.61 |
517.46 |
266.15 |
9.33 |
1648.70 |
1697.82 |
1121.16 |
576.66 |
20.22 |
Oregon Kaiser Permanente - Northwest - Prosper Self |
AM1 |
New Plan |
180.82 |
135.62 |
45.20 |
New Plan |
New Plan |
391.78 |
293.84 |
97.94 |
New Plan |
Oregon Kaiser Permanente - Northwest - Prosper Self & Family |
AM2 |
New Plan |
427.60 |
320.70 |
106.90 |
New Plan |
New Plan |
926.47 |
694.85 |
231.62 |
New Plan |
Oregon Kaiser Permanente - Northwest - Prosper Self Plus One |
AM3 |
New Plan |
388.75 |
291.56 |
97.19 |
New Plan |
New Plan |
842.29 |
631.72 |
210.57 |
New Plan |
Oregon UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
WF1 |
241.32 |
287.18 |
215.39 |
71.79 |
11.46 |
522.86 |
622.22 |
466.67 |
155.55 |
24.84 |
Oregon UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
WF2 |
570.64 |
679.17 |
509.38 |
169.79 |
27.13 |
1236.39 |
1471.54 |
1103.66 |
367.88 |
58.78 |
Oregon UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
WF3 |
518.79 |
617.43 |
463.07 |
154.36 |
24.66 |
1124.05 |
1337.77 |
1003.33 |
334.44 |
53.43 |
Oregon UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LU1 |
204.85 |
243.77 |
182.83 |
60.94 |
9.73 |
443.84 |
528.17 |
396.13 |
132.04 |
21.08 |
Oregon UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LU2 |
471.16 |
560.66 |
420.50 |
140.16 |
22.37 |
1020.85 |
1214.76 |
911.07 |
303.69 |
48.48 |
Oregon UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LU3 |
440.43 |
524.10 |
393.08 |
131.02 |
20.91 |
954.27 |
1135.55 |
851.66 |
283.89 |
45.32 |
Oregon UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KT1 |
334.51 |
360.98 |
241.58 |
119.40 |
20.66 |
724.77 |
782.12 |
523.42 |
258.70 |
44.77 |
Oregon UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KT2 |
836.26 |
902.47 |
562.25 |
340.22 |
50.43 |
1811.90 |
1955.35 |
1218.21 |
737.14 |
109.26 |
Oregon UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KT3 |
719.19 |
776.11 |
517.46 |
258.65 |
43.58 |
1558.25 |
1681.57 |
1121.16 |
560.41 |
94.42 |
Oregon UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
VD1 |
240.93 |
286.71 |
215.03 |
71.68 |
11.45 |
522.02 |
621.21 |
465.91 |
155.30 |
24.80 |
Oregon UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
VD2 |
569.71 |
678.06 |
508.55 |
169.51 |
27.08 |
1234.37 |
1469.13 |
1101.85 |
367.28 |
58.69 |
Oregon UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
VD3 |
517.95 |
616.42 |
462.32 |
154.10 |
24.61 |
1122.23 |
1335.58 |
1001.69 |
333.89 |
53.33 |
Oregon UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Oregon UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Oregon UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Palau Calvo's SelectCare - Standard Self |
B44 |
183.11 |
198.36 |
148.77 |
49.59 |
3.81 |
396.74 |
429.78 |
322.34 |
107.44 |
8.26 |
Palau Calvo's SelectCare - Standard Self & Family |
B45 |
532.03 |
576.33 |
432.25 |
144.08 |
11.07 |
1152.73 |
1248.72 |
936.54 |
312.18 |
24.00 |
Palau Calvo's SelectCare - Standard Self Plus One |
B46 |
360.97 |
391.02 |
293.27 |
97.75 |
7.51 |
782.10 |
847.21 |
635.41 |
211.80 |
16.28 |
Palau Calvo's SelectCare - High Self |
B41 |
226.87 |
240.78 |
180.59 |
60.19 |
3.47 |
491.55 |
521.69 |
391.27 |
130.42 |
7.53 |
Palau Calvo's SelectCare - High Self & Family |
B42 |
600.87 |
637.74 |
478.31 |
159.43 |
9.21 |
1301.89 |
1381.77 |
1036.33 |
345.44 |
19.97 |
Palau Calvo's SelectCare - High Self Plus One |
B43 |
442.72 |
469.88 |
352.41 |
117.47 |
6.79 |
959.23 |
1018.07 |
763.55 |
254.52 |
14.71 |
Palau TakeCare - HDHP Self |
KX1 |
57.34 |
55.63 |
41.72 |
13.91 |
-0.42 |
124.24 |
120.53 |
90.40 |
30.13 |
-0.93 |
Palau TakeCare - HDHP Self & Family |
KX2 |
156.61 |
149.15 |
111.86 |
37.29 |
-1.86 |
339.32 |
323.16 |
242.37 |
80.79 |
-4.04 |
Palau TakeCare - HDHP Self Plus One |
KX3 |
141.28 |
134.28 |
100.71 |
33.57 |
-1.75 |
306.11 |
290.94 |
218.21 |
72.73 |
-3.80 |
Palau TakeCare - Standard Self |
JK4 |
179.65 |
186.67 |
140.00 |
46.67 |
1.76 |
389.24 |
404.45 |
303.34 |
101.11 |
3.80 |
Palau TakeCare - Standard Self & Family |
JK5 |
508.76 |
528.64 |
396.48 |
132.16 |
4.97 |
1102.31 |
1145.39 |
859.04 |
286.35 |
10.77 |
Palau TakeCare - Standard Self Plus One |
JK6 |
354.07 |
367.91 |
275.93 |
91.98 |
3.46 |
767.15 |
797.14 |
597.86 |
199.28 |
7.49 |
Palau TakeCare - High Self |
JK1 |
227.24 |
229.76 |
172.32 |
57.44 |
0.63 |
492.35 |
497.81 |
373.36 |
124.45 |
1.36 |
Palau TakeCare - High Self & Family |
JK2 |
542.03 |
548.02 |
411.02 |
137.00 |
1.49 |
1174.40 |
1187.38 |
890.54 |
296.84 |
3.24 |
Palau TakeCare - High Self Plus One |
JK3 |
448.95 |
453.92 |
340.44 |
113.48 |
1.24 |
972.73 |
983.49 |
737.62 |
245.87 |
2.69 |
Pennsylvania Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Pennsylvania Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Pennsylvania Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Pennsylvania Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Pennsylvania Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Pennsylvania Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Pennsylvania Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
382.37 |
381.62 |
241.58 |
140.04 |
-6.56 |
828.47 |
826.84 |
523.42 |
303.42 |
-14.21 |
Pennsylvania Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
871.59 |
869.88 |
562.25 |
307.63 |
-17.49 |
1888.45 |
1884.74 |
1218.21 |
666.53 |
-37.90 |
Pennsylvania Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
863.04 |
861.43 |
517.46 |
343.97 |
-14.95 |
1869.92 |
1866.43 |
1121.16 |
745.27 |
-32.39 |
Pennsylvania Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
372.48 |
377.30 |
241.58 |
135.72 |
-0.99 |
807.04 |
817.48 |
523.42 |
294.06 |
-2.14 |
Pennsylvania Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
854.85 |
865.92 |
562.25 |
303.67 |
-4.71 |
1852.18 |
1876.16 |
1218.21 |
657.95 |
-10.21 |
Pennsylvania Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
838.09 |
848.95 |
517.46 |
331.49 |
-2.48 |
1815.86 |
1839.39 |
1121.16 |
718.23 |
-5.37 |
Pennsylvania Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Pennsylvania Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Pennsylvania Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Pennsylvania Aetna Open Access - Basic Self |
P34 |
604.65 |
694.86 |
241.58 |
453.28 |
84.40 |
1310.08 |
1505.53 |
523.42 |
982.11 |
182.87 |
Pennsylvania Aetna Open Access - Basic Self & Family |
P35 |
1403.39 |
1612.77 |
562.25 |
1050.52 |
193.60 |
3040.68 |
3494.34 |
1218.21 |
2276.13 |
419.47 |
Pennsylvania Aetna Open Access - Basic Self Plus One |
P36 |
1389.48 |
1596.80 |
517.46 |
1079.34 |
193.98 |
3010.54 |
3459.73 |
1121.16 |
2338.57 |
420.29 |
Pennsylvania Aetna Open Access - High Self |
P31 |
672.28 |
733.03 |
241.58 |
491.45 |
54.94 |
1456.61 |
1588.23 |
523.42 |
1064.81 |
119.04 |
Pennsylvania Aetna Open Access - High Self & Family |
P32 |
1629.94 |
1777.25 |
562.25 |
1215.00 |
131.53 |
3531.54 |
3850.71 |
1218.21 |
2632.50 |
284.98 |
Pennsylvania Aetna Open Access - High Self Plus One |
P33 |
1613.79 |
1759.65 |
517.46 |
1242.19 |
132.52 |
3496.55 |
3812.58 |
1121.16 |
2691.42 |
287.13 |
Pennsylvania Aetna Open Access - High Self |
YE1 |
560.83 |
556.87 |
241.58 |
315.29 |
-9.77 |
1215.13 |
1206.55 |
523.42 |
683.13 |
-21.16 |
Pennsylvania Aetna Open Access - High Self & Family |
YE2 |
1408.24 |
1398.29 |
562.25 |
836.04 |
-25.73 |
3051.19 |
3029.63 |
1218.21 |
1811.42 |
-55.75 |
Pennsylvania Aetna Open Access - High Self Plus One |
YE3 |
1394.30 |
1384.45 |
517.46 |
866.99 |
-23.19 |
3020.98 |
2999.64 |
1121.16 |
1878.48 |
-50.24 |
Pennsylvania Geisinger Health Plan - Standard Self |
GG4 |
379.72 |
421.24 |
241.58 |
179.66 |
35.71 |
822.73 |
912.69 |
523.42 |
389.27 |
77.38 |
Pennsylvania Geisinger Health Plan - Standard Self & Family |
GG5 |
869.39 |
964.44 |
562.25 |
402.19 |
79.27 |
1883.68 |
2089.62 |
1218.21 |
871.41 |
171.75 |
Pennsylvania Geisinger Health Plan - Standard Self Plus One |
GG6 |
820.48 |
910.19 |
517.46 |
392.73 |
76.37 |
1777.71 |
1972.08 |
1121.16 |
850.92 |
165.47 |
Pennsylvania Geisinger Health Plan - Basic Self |
AJ1 |
New Plan |
370.18 |
241.58 |
128.60 |
New Plan |
New Plan |
802.06 |
523.42 |
278.64 |
New Plan |
Pennsylvania Geisinger Health Plan - Basic Self & Family |
AJ2 |
New Plan |
847.53 |
562.25 |
285.28 |
New Plan |
New Plan |
1836.32 |
1218.21 |
618.11 |
New Plan |
Pennsylvania Geisinger Health Plan - Basic Self Plus One |
AJ3 |
New Plan |
799.84 |
517.46 |
282.38 |
New Plan |
New Plan |
1732.99 |
1121.16 |
611.83 |
New Plan |
Pennsylvania UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
242.68 |
276.68 |
207.51 |
69.17 |
8.50 |
525.81 |
599.47 |
449.60 |
149.87 |
18.42 |
Pennsylvania UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
573.86 |
654.35 |
490.76 |
163.59 |
20.13 |
1243.36 |
1417.76 |
1063.32 |
354.44 |
43.60 |
Pennsylvania UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
521.73 |
594.87 |
446.15 |
148.72 |
18.29 |
1130.42 |
1288.89 |
966.67 |
322.22 |
39.62 |
Pennsylvania UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
V41 |
224.57 |
239.96 |
179.97 |
59.99 |
3.85 |
486.57 |
519.91 |
389.93 |
129.98 |
8.34 |
Pennsylvania UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
V42 |
516.51 |
551.91 |
413.93 |
137.98 |
8.85 |
1119.11 |
1195.81 |
896.86 |
298.95 |
19.17 |
Pennsylvania UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
V43 |
482.83 |
515.91 |
386.93 |
128.98 |
8.27 |
1046.13 |
1117.81 |
838.36 |
279.45 |
17.92 |
Pennsylvania UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
LR1 |
329.95 |
355.57 |
241.58 |
113.99 |
19.81 |
714.89 |
770.40 |
523.42 |
246.98 |
42.93 |
Pennsylvania UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
LR2 |
781.98 |
842.69 |
562.25 |
280.44 |
44.93 |
1694.29 |
1825.83 |
1218.21 |
607.62 |
97.35 |
Pennsylvania UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
LR3 |
709.38 |
764.46 |
517.46 |
247.00 |
41.74 |
1536.99 |
1656.33 |
1121.16 |
535.17 |
90.44 |
Pennsylvania UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
233.88 |
266.18 |
199.64 |
66.54 |
8.07 |
506.74 |
576.72 |
432.54 |
144.18 |
17.50 |
Pennsylvania UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
553.03 |
629.51 |
472.13 |
157.38 |
19.12 |
1198.23 |
1363.94 |
1022.96 |
340.98 |
41.42 |
Pennsylvania UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
502.79 |
572.28 |
429.21 |
143.07 |
17.37 |
1089.38 |
1239.94 |
929.96 |
309.98 |
37.64 |
Pennsylvania UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Pennsylvania UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Pennsylvania UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Pennsylvania UPMC Health Plan - Standard Self |
YT4 |
417.27 |
445.99 |
241.58 |
204.41 |
22.91 |
904.09 |
966.31 |
523.42 |
442.89 |
49.64 |
Pennsylvania UPMC Health Plan - Standard Self & Family |
YT5 |
979.37 |
1047.06 |
562.25 |
484.81 |
51.91 |
2121.97 |
2268.63 |
1218.21 |
1050.42 |
112.47 |
Pennsylvania UPMC Health Plan - Standard Self Plus One |
YT6 |
938.06 |
1002.82 |
517.46 |
485.36 |
51.42 |
2032.46 |
2172.78 |
1121.16 |
1051.62 |
111.42 |
Pennsylvania UPMC Health Plan - HDHP Self |
YS4 |
358.06 |
373.13 |
241.58 |
131.55 |
9.26 |
775.80 |
808.45 |
523.42 |
285.03 |
20.07 |
Pennsylvania UPMC Health Plan - HDHP Self & Family |
YS5 |
826.64 |
862.11 |
562.25 |
299.86 |
19.69 |
1791.05 |
1867.91 |
1218.21 |
649.70 |
42.67 |
Pennsylvania UPMC Health Plan - HDHP Self Plus One |
YS6 |
794.64 |
828.60 |
517.46 |
311.14 |
20.62 |
1721.72 |
1795.30 |
1121.16 |
674.14 |
44.68 |
Pennsylvania UPMC Health Plan - HDHP Self |
8W4 |
281.83 |
296.15 |
222.11 |
74.04 |
3.58 |
610.63 |
641.66 |
481.25 |
160.41 |
7.75 |
Pennsylvania UPMC Health Plan - HDHP Self & Family |
8W5 |
648.46 |
681.63 |
511.22 |
170.41 |
8.30 |
1405.00 |
1476.87 |
1107.65 |
369.22 |
17.97 |
Pennsylvania UPMC Health Plan - HDHP Self Plus One |
8W6 |
623.83 |
655.71 |
491.78 |
163.93 |
7.97 |
1351.63 |
1420.71 |
1065.53 |
355.18 |
17.27 |
Pennsylvania UPMC Health Plan - Standard Self |
UW4 |
310.93 |
314.87 |
236.15 |
78.72 |
0.99 |
673.68 |
682.22 |
511.67 |
170.55 |
2.13 |
Pennsylvania UPMC Health Plan - Standard Self & Family |
UW5 |
729.57 |
739.04 |
554.28 |
184.76 |
1.66 |
1580.74 |
1601.25 |
1200.94 |
400.31 |
3.59 |
Pennsylvania UPMC Health Plan - Standard Self Plus One |
UW6 |
698.86 |
707.88 |
517.46 |
190.42 |
-4.32 |
1514.20 |
1533.74 |
1121.16 |
412.58 |
-9.36 |
Puerto Rico Humana Health Plans of Puerto Rico, Inc. - High Self |
ZJ1 |
180.11 |
211.33 |
158.50 |
52.83 |
7.80 |
390.24 |
457.88 |
343.41 |
114.47 |
16.91 |
Puerto Rico Humana Health Plans of Puerto Rico, Inc. - High Self & Family |
ZJ2 |
405.26 |
475.49 |
356.62 |
118.87 |
17.56 |
878.06 |
1030.23 |
772.67 |
257.56 |
38.05 |
Puerto Rico Humana Health Plans of Puerto Rico, Inc. - High Self Plus One |
ZJ3 |
387.24 |
454.36 |
340.77 |
113.59 |
16.78 |
839.02 |
984.45 |
738.34 |
246.11 |
36.36 |
Puerto Rico Triple-S Salud Inc. Puerto Rico - High Self |
891 |
180.02 |
180.02 |
135.02 |
45.00 |
0.00 |
390.04 |
390.04 |
292.53 |
97.51 |
0.00 |
Puerto Rico Triple-S Salud Inc. Puerto Rico - High Self & Family |
892 |
412.25 |
412.25 |
309.19 |
103.06 |
0.00 |
893.21 |
893.21 |
669.91 |
223.30 |
0.00 |
Puerto Rico Triple-S Salud Inc. Puerto Rico - High Self Plus One |
893 |
404.21 |
404.21 |
303.16 |
101.05 |
0.00 |
875.79 |
875.79 |
656.84 |
218.95 |
0.00 |
Rhode Island Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Rhode Island Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Rhode Island Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Rhode Island Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Rhode Island Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Rhode Island Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Rhode Island Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
350.59 |
387.52 |
241.58 |
145.94 |
31.12 |
759.61 |
839.63 |
523.42 |
316.21 |
67.44 |
Rhode Island Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
802.85 |
887.39 |
562.25 |
325.14 |
68.76 |
1739.51 |
1922.68 |
1218.21 |
704.47 |
148.98 |
Rhode Island Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
787.10 |
869.98 |
517.46 |
352.52 |
69.54 |
1705.38 |
1884.96 |
1121.16 |
763.80 |
150.68 |
Rhode Island Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
496.50 |
519.07 |
241.58 |
277.49 |
16.76 |
1075.75 |
1124.65 |
523.42 |
601.23 |
36.32 |
Rhode Island Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
1132.30 |
1183.79 |
562.25 |
621.54 |
35.71 |
2453.32 |
2564.88 |
1218.21 |
1346.67 |
77.37 |
Rhode Island Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
1121.09 |
1172.06 |
517.46 |
654.60 |
37.63 |
2429.03 |
2539.46 |
1121.16 |
1418.30 |
81.53 |
Rhode Island Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Rhode Island Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Rhode Island Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Rhode Island UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Rhode Island UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Rhode Island UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
South Carolina Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
South Carolina Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
South Carolina Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
South Carolina Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
South Carolina Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
South Carolina Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
South Carolina Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
JS4 |
495.45 |
505.19 |
241.58 |
263.61 |
3.93 |
1073.48 |
1094.58 |
523.42 |
571.16 |
8.52 |
South Carolina Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
JS5 |
1131.04 |
1153.29 |
562.25 |
591.04 |
6.47 |
2450.59 |
2498.80 |
1218.21 |
1280.59 |
14.02 |
South Carolina Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
JS6 |
1119.84 |
1141.88 |
517.46 |
624.42 |
8.70 |
2426.32 |
2474.07 |
1121.16 |
1352.91 |
18.85 |
South Carolina Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
JS1 |
463.38 |
466.12 |
241.58 |
224.54 |
-3.07 |
1003.99 |
1009.93 |
523.42 |
486.51 |
-6.64 |
South Carolina Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
JS2 |
1056.30 |
1062.53 |
562.25 |
500.28 |
-9.55 |
2288.65 |
2302.15 |
1218.21 |
1083.94 |
-20.69 |
South Carolina Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
JS3 |
1045.84 |
1052.00 |
517.46 |
534.54 |
-7.18 |
2265.99 |
2279.33 |
1121.16 |
1158.17 |
-15.56 |
South Carolina Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
South Carolina Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
South Carolina Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
South Carolina UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
South Carolina UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
South Carolina UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
South Dakota Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
South Dakota Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
South Dakota Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
South Dakota Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
South Dakota Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
South Dakota Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
South Dakota Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
328.95 |
330.94 |
241.58 |
89.36 |
-3.82 |
712.73 |
717.04 |
523.42 |
193.62 |
-8.27 |
South Dakota Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
753.40 |
757.97 |
562.25 |
195.72 |
-11.21 |
1632.37 |
1642.27 |
1218.21 |
424.06 |
-24.29 |
South Dakota Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
738.63 |
743.12 |
517.46 |
225.66 |
-8.85 |
1600.37 |
1610.09 |
1121.16 |
488.93 |
-19.18 |
South Dakota Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
417.46 |
488.66 |
241.58 |
247.08 |
65.39 |
904.50 |
1058.76 |
523.42 |
535.34 |
141.68 |
South Dakota Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
952.20 |
1114.65 |
562.25 |
552.40 |
146.67 |
2063.10 |
2415.08 |
1218.21 |
1196.87 |
317.79 |
South Dakota Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
942.79 |
1103.63 |
517.46 |
586.17 |
147.50 |
2042.71 |
2391.20 |
1121.16 |
1270.04 |
319.59 |
South Dakota Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
South Dakota Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
South Dakota Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
South Dakota HealthPartners - Standard Self |
V34 |
212.27 |
235.11 |
176.33 |
58.78 |
5.71 |
459.92 |
509.41 |
382.06 |
127.35 |
12.37 |
South Dakota HealthPartners - Standard Self & Family |
V35 |
517.11 |
572.74 |
429.56 |
143.18 |
13.90 |
1120.41 |
1240.94 |
930.71 |
310.23 |
30.13 |
South Dakota HealthPartners - Standard Self Plus One |
V36 |
469.13 |
519.60 |
389.70 |
129.90 |
12.62 |
1016.45 |
1125.80 |
844.35 |
281.45 |
27.34 |
South Dakota HealthPartners - High Self |
V31 |
328.76 |
308.34 |
231.26 |
77.08 |
-15.91 |
712.31 |
668.07 |
501.05 |
167.02 |
-34.45 |
South Dakota HealthPartners - High Self & Family |
V32 |
800.86 |
751.10 |
562.25 |
188.85 |
-65.54 |
1735.20 |
1627.38 |
1218.21 |
409.17 |
-142.01 |
South Dakota HealthPartners - High Self Plus One |
V33 |
726.56 |
681.42 |
511.07 |
170.35 |
-52.09 |
1574.21 |
1476.41 |
1107.31 |
369.10 |
-112.85 |
South Dakota UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
South Dakota UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
South Dakota UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Tennessee Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Tennessee Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Tennessee Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Tennessee Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Tennessee Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Tennessee Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Tennessee Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
382.72 |
393.11 |
241.58 |
151.53 |
4.58 |
829.23 |
851.74 |
523.42 |
328.32 |
9.93 |
Tennessee Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
872.64 |
896.32 |
562.25 |
334.07 |
7.90 |
1890.72 |
1942.03 |
1218.21 |
723.82 |
17.12 |
Tennessee Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
864.00 |
887.45 |
517.46 |
369.99 |
10.11 |
1872.00 |
1922.81 |
1121.16 |
801.65 |
21.91 |
Tennessee Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
378.45 |
379.30 |
241.58 |
137.72 |
-4.96 |
819.98 |
821.82 |
523.42 |
298.40 |
-10.74 |
Tennessee Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
866.59 |
868.56 |
562.25 |
306.31 |
-13.81 |
1877.61 |
1881.88 |
1218.21 |
663.67 |
-29.92 |
Tennessee Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
849.59 |
851.52 |
517.46 |
334.06 |
-11.41 |
1840.78 |
1844.96 |
1121.16 |
723.80 |
-24.72 |
Tennessee Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Tennessee Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Tennessee Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Tennessee Humana CoverageFirst and Humana Value Plan - CDHP Self |
TT1 |
343.99 |
364.62 |
241.58 |
123.04 |
14.82 |
745.31 |
790.01 |
523.42 |
266.59 |
32.12 |
Tennessee Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
TT2 |
773.99 |
820.42 |
562.25 |
258.17 |
30.65 |
1676.98 |
1777.58 |
1218.21 |
559.37 |
66.41 |
Tennessee Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
TT3 |
739.59 |
783.96 |
517.46 |
266.50 |
31.03 |
1602.45 |
1698.58 |
1121.16 |
577.42 |
67.23 |
Tennessee Humana CoverageFirst and Humana Value Plan - Value Self |
TT4 |
315.21 |
334.12 |
241.58 |
92.54 |
13.10 |
682.96 |
723.93 |
523.42 |
200.51 |
28.39 |
Tennessee Humana CoverageFirst and Humana Value Plan - Value Self & Family |
TT5 |
709.21 |
751.75 |
562.25 |
189.50 |
12.20 |
1536.62 |
1628.79 |
1218.21 |
410.58 |
26.43 |
Tennessee Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
TT6 |
677.68 |
718.35 |
517.46 |
200.89 |
27.33 |
1468.31 |
1556.43 |
1121.16 |
435.27 |
59.22 |
Tennessee Humana Health Plan, Inc. - High Self |
GJ1 |
542.67 |
564.38 |
241.58 |
322.80 |
15.90 |
1175.79 |
1222.82 |
523.42 |
699.40 |
34.45 |
Tennessee Humana Health Plan, Inc. - High Self & Family |
GJ2 |
1220.97 |
1269.81 |
562.25 |
707.56 |
33.06 |
2645.44 |
2751.26 |
1218.21 |
1533.05 |
71.63 |
Tennessee Humana Health Plan, Inc. - High Self Plus One |
GJ3 |
1166.70 |
1213.37 |
517.46 |
695.91 |
33.33 |
2527.85 |
2628.97 |
1121.16 |
1507.81 |
72.22 |
Tennessee Humana Health Plan, Inc. - Standard Self |
GJ4 |
401.60 |
417.65 |
241.58 |
176.07 |
10.24 |
870.13 |
904.91 |
523.42 |
381.49 |
22.20 |
Tennessee Humana Health Plan, Inc. - Standard Self & Family |
GJ5 |
903.59 |
939.73 |
562.25 |
377.48 |
20.36 |
1957.78 |
2036.08 |
1218.21 |
817.87 |
44.11 |
Tennessee Humana Health Plan, Inc. - Standard Self Plus One |
GJ6 |
863.43 |
897.97 |
517.46 |
380.51 |
21.20 |
1870.77 |
1945.60 |
1121.16 |
824.44 |
45.93 |
Tennessee UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
242.68 |
276.68 |
207.51 |
69.17 |
8.50 |
525.81 |
599.47 |
449.60 |
149.87 |
18.42 |
Tennessee UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
573.86 |
654.35 |
490.76 |
163.59 |
20.13 |
1243.36 |
1417.76 |
1063.32 |
354.44 |
43.60 |
Tennessee UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
521.73 |
594.87 |
446.15 |
148.72 |
18.29 |
1130.42 |
1288.89 |
966.67 |
322.22 |
39.62 |
Tennessee UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LS1 |
209.88 |
224.24 |
168.18 |
56.06 |
3.59 |
454.74 |
485.85 |
364.39 |
121.46 |
7.78 |
Tennessee UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LS2 |
482.73 |
515.77 |
386.83 |
128.94 |
8.26 |
1045.92 |
1117.50 |
838.13 |
279.37 |
17.89 |
Tennessee UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LS3 |
451.25 |
482.12 |
361.59 |
120.53 |
7.72 |
977.71 |
1044.59 |
783.44 |
261.15 |
16.72 |
Tennessee UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KK1 |
329.48 |
354.94 |
241.58 |
113.36 |
19.65 |
713.87 |
769.04 |
523.42 |
245.62 |
42.59 |
Tennessee UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KK2 |
823.71 |
887.37 |
562.25 |
325.12 |
47.88 |
1784.71 |
1922.64 |
1218.21 |
704.43 |
103.74 |
Tennessee UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KK3 |
708.40 |
763.14 |
517.46 |
245.68 |
41.40 |
1534.87 |
1653.47 |
1121.16 |
532.31 |
89.70 |
Tennessee UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
233.88 |
266.18 |
199.64 |
66.54 |
8.07 |
506.74 |
576.72 |
432.54 |
144.18 |
17.50 |
Tennessee UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
553.03 |
629.51 |
472.13 |
157.38 |
19.12 |
1198.23 |
1363.94 |
1022.96 |
340.98 |
41.42 |
Tennessee UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
502.79 |
572.28 |
429.21 |
143.07 |
17.37 |
1089.38 |
1239.94 |
929.96 |
309.98 |
37.64 |
Tennessee UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Tennessee UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Tennessee UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Texas Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Texas Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Texas Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Texas Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Texas Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Texas Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Texas Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
JS4 |
495.45 |
505.19 |
241.58 |
263.61 |
3.93 |
1073.48 |
1094.58 |
523.42 |
571.16 |
8.52 |
Texas Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
JS5 |
1131.04 |
1153.29 |
562.25 |
591.04 |
6.47 |
2450.59 |
2498.80 |
1218.21 |
1280.59 |
14.02 |
Texas Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
JS6 |
1119.84 |
1141.88 |
517.46 |
624.42 |
8.70 |
2426.32 |
2474.07 |
1121.16 |
1352.91 |
18.85 |
Texas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
JS1 |
463.38 |
466.12 |
241.58 |
224.54 |
-3.07 |
1003.99 |
1009.93 |
523.42 |
486.51 |
-6.64 |
Texas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
JS2 |
1056.30 |
1062.53 |
562.25 |
500.28 |
-9.55 |
2288.65 |
2302.15 |
1218.21 |
1083.94 |
-20.69 |
Texas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
JS3 |
1045.84 |
1052.00 |
517.46 |
534.54 |
-7.18 |
2265.99 |
2279.33 |
1121.16 |
1158.17 |
-15.56 |
Texas Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Texas Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Texas Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Texas Humana CoverageFirst and Humana Value Plan - Value Self |
T34 |
243.77 |
260.82 |
195.62 |
65.20 |
4.26 |
528.17 |
565.11 |
423.83 |
141.28 |
9.24 |
Texas Humana CoverageFirst and Humana Value Plan - Value Self & Family |
T35 |
548.46 |
586.86 |
440.15 |
146.71 |
9.60 |
1188.33 |
1271.53 |
953.65 |
317.88 |
20.80 |
Texas Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
T36 |
524.09 |
560.78 |
420.59 |
140.19 |
9.17 |
1135.53 |
1215.02 |
911.27 |
303.75 |
19.87 |
Texas Humana CoverageFirst and Humana Value Plan - CDHP Self |
T31 |
350.19 |
374.71 |
241.58 |
133.13 |
18.71 |
758.75 |
811.87 |
523.42 |
288.45 |
40.54 |
Texas Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
T32 |
787.92 |
843.08 |
562.25 |
280.83 |
39.38 |
1707.16 |
1826.67 |
1218.21 |
608.46 |
85.32 |
Texas Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
T33 |
752.92 |
805.62 |
517.46 |
288.16 |
39.36 |
1631.33 |
1745.51 |
1121.16 |
624.35 |
85.28 |
Texas Humana CoverageFirst and Humana Value Plan - CDHP Self |
TV1 |
388.63 |
419.72 |
241.58 |
178.14 |
25.28 |
842.03 |
909.39 |
523.42 |
385.97 |
54.78 |
Texas Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
TV2 |
874.43 |
944.38 |
562.25 |
382.13 |
54.17 |
1894.60 |
2046.16 |
1218.21 |
827.95 |
117.37 |
Texas Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
TV3 |
835.57 |
902.42 |
517.46 |
384.96 |
53.51 |
1810.40 |
1955.24 |
1121.16 |
834.08 |
115.94 |
Texas Humana CoverageFirst and Humana Value Plan - Value Self |
TV4 |
307.38 |
331.97 |
241.58 |
90.39 |
13.55 |
665.99 |
719.27 |
523.42 |
195.85 |
29.35 |
Texas Humana CoverageFirst and Humana Value Plan - Value Self & Family |
TV5 |
691.62 |
746.95 |
560.21 |
186.74 |
13.84 |
1498.51 |
1618.39 |
1213.79 |
404.60 |
29.97 |
Texas Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
TV6 |
660.89 |
713.76 |
517.46 |
196.30 |
31.08 |
1431.93 |
1546.48 |
1121.16 |
425.32 |
67.34 |
Texas Humana CoverageFirst and Humana Value Plan - Value Self |
TU4 |
243.56 |
277.21 |
207.91 |
69.30 |
8.41 |
527.71 |
600.62 |
450.47 |
150.15 |
18.22 |
Texas Humana CoverageFirst and Humana Value Plan - Value Self & Family |
TU5 |
548.02 |
623.73 |
467.80 |
155.93 |
18.93 |
1187.38 |
1351.42 |
1013.57 |
337.85 |
41.01 |
Texas Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
TU6 |
523.67 |
596.02 |
447.02 |
149.00 |
18.08 |
1134.62 |
1291.38 |
968.54 |
322.84 |
39.19 |
Texas Humana CoverageFirst and Humana Value Plan - CDHP Self |
TU1 |
298.05 |
336.80 |
241.58 |
95.22 |
20.71 |
645.78 |
729.73 |
523.42 |
206.31 |
44.87 |
Texas Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
TU2 |
670.62 |
757.81 |
562.25 |
195.56 |
27.91 |
1453.01 |
1641.92 |
1218.21 |
423.71 |
60.46 |
Texas Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
TU3 |
640.82 |
724.12 |
517.46 |
206.66 |
46.46 |
1388.44 |
1568.93 |
1121.16 |
447.77 |
100.66 |
Texas Humana CoverageFirst and Humana Value Plan - CDHP Self |
TP1 |
333.05 |
356.37 |
241.58 |
114.79 |
17.51 |
721.61 |
772.14 |
523.42 |
248.72 |
37.95 |
Texas Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
TP2 |
749.36 |
801.82 |
562.25 |
239.57 |
36.68 |
1623.61 |
1737.28 |
1218.21 |
519.07 |
79.48 |
Texas Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
TP3 |
716.07 |
766.19 |
517.46 |
248.73 |
36.78 |
1551.49 |
1660.08 |
1121.16 |
538.92 |
79.69 |
Texas Humana CoverageFirst and Humana Value Plan - Value Self |
TP4 |
195.17 |
208.83 |
156.62 |
52.21 |
3.42 |
422.87 |
452.47 |
339.35 |
113.12 |
7.40 |
Texas Humana CoverageFirst and Humana Value Plan - Value Self & Family |
TP5 |
439.13 |
469.87 |
352.40 |
117.47 |
7.69 |
951.45 |
1018.05 |
763.54 |
254.51 |
16.65 |
Texas Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
TP6 |
419.62 |
448.99 |
336.74 |
112.25 |
7.35 |
909.18 |
972.81 |
729.61 |
243.20 |
15.91 |
Texas Humana Health Plan of Texas - Standard Self |
UC4 |
387.63 |
414.76 |
241.58 |
173.18 |
21.32 |
839.87 |
898.65 |
523.42 |
375.23 |
46.20 |
Texas Humana Health Plan of Texas - Standard Self & Family |
UC5 |
872.15 |
933.21 |
562.25 |
370.96 |
45.28 |
1889.66 |
2021.96 |
1218.21 |
803.75 |
98.11 |
Texas Humana Health Plan of Texas - Standard Self Plus One |
UC6 |
833.39 |
891.73 |
517.46 |
374.27 |
45.00 |
1805.68 |
1932.08 |
1121.16 |
810.92 |
97.50 |
Texas Humana Health Plan of Texas - High Self |
UC1 |
505.51 |
540.90 |
241.58 |
299.32 |
29.58 |
1095.27 |
1171.95 |
523.42 |
648.53 |
64.10 |
Texas Humana Health Plan of Texas - High Self & Family |
UC2 |
1137.42 |
1217.04 |
562.25 |
654.79 |
63.84 |
2464.41 |
2636.92 |
1218.21 |
1418.71 |
138.32 |
Texas Humana Health Plan of Texas - High Self Plus One |
UC3 |
1086.86 |
1162.95 |
517.46 |
645.49 |
62.75 |
2354.86 |
2519.73 |
1121.16 |
1398.57 |
135.97 |
Texas Humana Health Plan of Texas - Basic Self |
QX1 |
345.81 |
377.25 |
241.58 |
135.67 |
25.63 |
749.26 |
817.38 |
523.42 |
293.96 |
55.54 |
Texas Humana Health Plan of Texas - Basic Self & Family |
QX2 |
778.08 |
848.81 |
562.25 |
286.56 |
54.95 |
1685.84 |
1839.09 |
1218.21 |
620.88 |
119.06 |
Texas Humana Health Plan of Texas - Basic Self Plus One |
QX3 |
743.50 |
811.09 |
517.46 |
293.63 |
54.25 |
1610.92 |
1757.36 |
1121.16 |
636.20 |
117.54 |
Texas Humana Health Plan of Texas - Standard Self |
EW4 |
385.81 |
432.11 |
241.58 |
190.53 |
40.49 |
835.92 |
936.24 |
523.42 |
412.82 |
87.74 |
Texas Humana Health Plan of Texas - Standard Self & Family |
EW5 |
868.07 |
972.23 |
562.25 |
409.98 |
88.38 |
1880.82 |
2106.50 |
1218.21 |
888.29 |
191.49 |
Texas Humana Health Plan of Texas - Standard Self Plus One |
EW6 |
829.48 |
929.02 |
517.46 |
411.56 |
86.20 |
1797.21 |
2012.88 |
1121.16 |
891.72 |
186.77 |
Texas Humana Health Plan of Texas - High Self |
EW1 |
522.44 |
585.15 |
241.58 |
343.57 |
56.90 |
1131.95 |
1267.83 |
523.42 |
744.41 |
123.30 |
Texas Humana Health Plan of Texas - High Self & Family |
EW2 |
1175.51 |
1316.58 |
562.25 |
754.33 |
125.29 |
2546.94 |
2852.59 |
1218.21 |
1634.38 |
271.46 |
Texas Humana Health Plan of Texas - High Self Plus One |
EW3 |
1123.27 |
1258.07 |
517.46 |
740.61 |
121.46 |
2433.75 |
2725.82 |
1121.16 |
1604.66 |
263.17 |
Texas Humana Health Plan of Texas - Basic Self |
QY1 |
351.21 |
389.84 |
241.58 |
148.26 |
32.82 |
760.96 |
844.65 |
523.42 |
321.23 |
71.11 |
Texas Humana Health Plan of Texas - Basic Self & Family |
QY2 |
790.21 |
877.14 |
562.25 |
314.89 |
71.15 |
1712.12 |
1900.47 |
1218.21 |
682.26 |
154.16 |
Texas Humana Health Plan of Texas - Basic Self Plus One |
QY3 |
755.10 |
838.17 |
517.46 |
320.71 |
69.73 |
1636.05 |
1816.04 |
1121.16 |
694.88 |
151.09 |
Texas Humana Health Plan of Texas - Basic Self |
Q21 |
339.20 |
362.94 |
241.58 |
121.36 |
17.93 |
734.93 |
786.37 |
523.42 |
262.95 |
38.86 |
Texas Humana Health Plan of Texas - Basic Self & Family |
Q22 |
763.18 |
816.61 |
562.25 |
254.36 |
37.65 |
1653.56 |
1769.32 |
1218.21 |
551.11 |
81.57 |
Texas Humana Health Plan of Texas - Basic Self Plus One |
Q23 |
729.25 |
780.29 |
517.46 |
262.83 |
37.70 |
1580.04 |
1690.63 |
1121.16 |
569.47 |
81.69 |
Texas Humana Health Plan of Texas - Basic Self |
Q61 |
288.12 |
322.69 |
241.58 |
81.11 |
9.08 |
624.26 |
699.16 |
523.42 |
175.74 |
19.68 |
Texas Humana Health Plan of Texas - Basic Self & Family |
Q62 |
648.28 |
726.08 |
544.56 |
181.52 |
19.45 |
1404.61 |
1573.17 |
1179.88 |
393.29 |
42.14 |
Texas Humana Health Plan of Texas - Basic Self Plus One |
Q63 |
619.47 |
693.80 |
517.46 |
176.34 |
21.47 |
1342.19 |
1503.23 |
1121.16 |
382.07 |
46.52 |
Texas Humana Health Plan of Texas - Standard Self |
UU4 |
766.51 |
742.24 |
241.58 |
500.66 |
-30.08 |
1660.77 |
1608.19 |
523.42 |
1084.77 |
-65.16 |
Texas Humana Health Plan of Texas - Standard Self & Family |
UU5 |
1724.64 |
1670.03 |
562.25 |
1107.78 |
-70.39 |
3736.72 |
3618.40 |
1218.21 |
2400.19 |
-152.51 |
Texas Humana Health Plan of Texas - Standard Self Plus One |
UU6 |
1647.98 |
1595.80 |
517.46 |
1078.34 |
-65.52 |
3570.62 |
3457.57 |
1121.16 |
2336.41 |
-141.95 |
Texas Humana Health Plan of Texas - High Self |
UU1 |
712.96 |
748.61 |
241.58 |
507.03 |
29.84 |
1544.75 |
1621.99 |
523.42 |
1098.57 |
64.66 |
Texas Humana Health Plan of Texas - High Self & Family |
UU2 |
1604.15 |
1684.35 |
562.25 |
1122.10 |
64.42 |
3475.66 |
3649.43 |
1218.21 |
2431.22 |
139.58 |
Texas Humana Health Plan of Texas - High Self Plus One |
UU3 |
1532.86 |
1609.50 |
517.46 |
1092.04 |
63.30 |
3321.20 |
3487.25 |
1121.16 |
2366.09 |
137.15 |
Texas Humana Health Plan of Texas - Standard Self |
UR4 |
452.31 |
493.64 |
241.58 |
252.06 |
35.52 |
980.01 |
1069.55 |
523.42 |
546.13 |
76.96 |
Texas Humana Health Plan of Texas - Standard Self & Family |
UR5 |
1017.69 |
1110.67 |
562.25 |
548.42 |
77.20 |
2205.00 |
2406.45 |
1218.21 |
1188.24 |
167.26 |
Texas Humana Health Plan of Texas - Standard Self Plus One |
UR6 |
972.46 |
1061.30 |
517.46 |
543.84 |
75.50 |
2107.00 |
2299.48 |
1121.16 |
1178.32 |
163.58 |
Texas Humana Health Plan of Texas - High Self |
UR1 |
637.98 |
721.73 |
241.58 |
480.15 |
77.94 |
1382.29 |
1563.75 |
523.42 |
1040.33 |
168.88 |
Texas Humana Health Plan of Texas - High Self & Family |
UR2 |
1435.44 |
1623.90 |
562.25 |
1061.65 |
172.68 |
3110.12 |
3518.45 |
1218.21 |
2300.24 |
374.14 |
Texas Humana Health Plan of Texas - High Self Plus One |
UR3 |
1371.65 |
1551.72 |
517.46 |
1034.26 |
166.73 |
2971.91 |
3362.06 |
1121.16 |
2240.90 |
361.25 |
Texas Scott and White Health Plan - Basic Self |
A81 |
303.74 |
270.41 |
202.81 |
67.60 |
-8.33 |
658.10 |
585.89 |
439.42 |
146.47 |
-18.05 |
Texas Scott and White Health Plan - Basic Self & Family |
A82 |
712.71 |
634.40 |
475.80 |
158.60 |
-19.58 |
1544.21 |
1374.53 |
1030.90 |
343.63 |
-42.42 |
Texas Scott and White Health Plan - Basic Self Plus One |
A83 |
673.33 |
599.35 |
449.51 |
149.84 |
-19.37 |
1458.88 |
1298.59 |
973.94 |
324.65 |
-41.97 |
Texas Scott and White Health Plan - Standard Self |
A84 |
362.50 |
397.49 |
241.58 |
155.91 |
29.18 |
785.42 |
861.23 |
523.42 |
337.81 |
63.23 |
Texas Scott and White Health Plan - Standard Self & Family |
A85 |
850.84 |
933.13 |
562.25 |
370.88 |
66.51 |
1843.49 |
2021.78 |
1218.21 |
803.57 |
144.10 |
Texas Scott and White Health Plan - Standard Self Plus One |
A86 |
803.81 |
881.56 |
517.46 |
364.10 |
64.41 |
1741.59 |
1910.05 |
1121.16 |
788.89 |
139.56 |
Texas Scott and White Health Plan - Basic Self |
P81 |
313.09 |
278.74 |
209.06 |
69.68 |
-8.59 |
678.36 |
603.94 |
452.96 |
150.98 |
-18.61 |
Texas Scott and White Health Plan - Basic Self & Family |
P82 |
734.72 |
653.98 |
490.49 |
163.49 |
-24.76 |
1591.89 |
1416.96 |
1062.72 |
354.24 |
-53.63 |
Texas Scott and White Health Plan - Basic Self Plus One |
P83 |
694.12 |
617.85 |
463.39 |
154.46 |
-35.54 |
1503.93 |
1338.68 |
1004.01 |
334.67 |
-77.00 |
Texas Scott and White Health Plan - Standard Self |
P84 |
380.74 |
446.16 |
241.58 |
204.58 |
59.61 |
824.94 |
966.68 |
523.42 |
443.26 |
129.16 |
Texas Scott and White Health Plan - Standard Self & Family |
P85 |
893.68 |
1047.43 |
562.25 |
485.18 |
137.97 |
1936.31 |
2269.43 |
1218.21 |
1051.22 |
298.93 |
Texas Scott and White Health Plan - Standard Self Plus One |
P86 |
844.29 |
989.52 |
517.46 |
472.06 |
131.89 |
1829.30 |
2143.96 |
1121.16 |
1022.80 |
285.76 |
Texas UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
242.68 |
276.68 |
207.51 |
69.17 |
8.50 |
525.81 |
599.47 |
449.60 |
149.87 |
18.42 |
Texas UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
573.86 |
654.35 |
490.76 |
163.59 |
20.13 |
1243.36 |
1417.76 |
1063.32 |
354.44 |
43.60 |
Texas UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
521.73 |
594.87 |
446.15 |
148.72 |
18.29 |
1130.42 |
1288.89 |
966.67 |
322.22 |
39.62 |
Texas UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
L91 |
240.69 |
255.98 |
191.99 |
63.99 |
3.82 |
521.50 |
554.62 |
415.97 |
138.65 |
8.28 |
Texas UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
L92 |
674.89 |
717.76 |
538.32 |
179.44 |
10.72 |
1462.26 |
1555.15 |
1166.36 |
388.79 |
23.23 |
Texas UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self Plus One |
L93 |
470.06 |
499.93 |
374.95 |
124.98 |
7.47 |
1018.46 |
1083.18 |
812.39 |
270.79 |
16.18 |
Texas UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
233.88 |
266.18 |
199.64 |
66.54 |
8.07 |
506.74 |
576.72 |
432.54 |
144.18 |
17.50 |
Texas UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
553.03 |
629.51 |
472.13 |
157.38 |
19.12 |
1198.23 |
1363.94 |
1022.96 |
340.98 |
41.42 |
Texas UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
502.79 |
572.28 |
429.21 |
143.07 |
17.37 |
1089.38 |
1239.94 |
929.96 |
309.98 |
37.64 |
Texas UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Texas UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Texas UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Utah Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Utah Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Utah Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Utah Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Utah Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Utah Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Utah Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
328.95 |
330.94 |
241.58 |
89.36 |
-3.82 |
712.73 |
717.04 |
523.42 |
193.62 |
-8.27 |
Utah Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
753.40 |
757.97 |
562.25 |
195.72 |
-11.21 |
1632.37 |
1642.27 |
1218.21 |
424.06 |
-24.29 |
Utah Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
738.63 |
743.12 |
517.46 |
225.66 |
-8.85 |
1600.37 |
1610.09 |
1121.16 |
488.93 |
-19.18 |
Utah Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
417.46 |
488.66 |
241.58 |
247.08 |
65.39 |
904.50 |
1058.76 |
523.42 |
535.34 |
141.68 |
Utah Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
952.20 |
1114.65 |
562.25 |
552.40 |
146.67 |
2063.10 |
2415.08 |
1218.21 |
1196.87 |
317.79 |
Utah Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
942.79 |
1103.63 |
517.46 |
586.17 |
147.50 |
2042.71 |
2391.20 |
1121.16 |
1270.04 |
319.59 |
Utah Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Utah Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Utah Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Utah Altius Health Plan - High Self |
9K1 |
465.72 |
483.86 |
241.58 |
242.28 |
12.33 |
1009.06 |
1048.36 |
523.42 |
524.94 |
26.72 |
Utah Altius Health Plan - High Self & Family |
9K2 |
1029.93 |
1070.06 |
562.25 |
507.81 |
24.35 |
2231.52 |
2318.46 |
1218.21 |
1100.25 |
52.75 |
Utah Altius Health Plan - High Self Plus One |
9K3 |
1019.73 |
1059.46 |
517.46 |
542.00 |
26.39 |
2209.42 |
2295.50 |
1121.16 |
1174.34 |
57.18 |
Utah Altius Health Plan - HDHP Self |
9K4 |
244.26 |
310.38 |
232.79 |
77.59 |
16.53 |
529.23 |
672.49 |
504.37 |
168.12 |
35.81 |
Utah Altius Health Plan - HDHP Self & Family |
9K5 |
510.48 |
648.66 |
486.50 |
162.16 |
34.54 |
1106.04 |
1405.43 |
1054.07 |
351.36 |
74.85 |
Utah Altius Health Plan - HDHP Self Plus One |
9K6 |
500.48 |
635.93 |
476.95 |
158.98 |
33.86 |
1084.37 |
1377.85 |
1033.39 |
344.46 |
73.37 |
Utah Altius Health Plan - Standard Self |
DK4 |
351.37 |
407.59 |
241.58 |
166.01 |
50.41 |
761.30 |
883.11 |
523.42 |
359.69 |
109.23 |
Utah Altius Health Plan - Standard Self & Family |
DK5 |
775.95 |
900.09 |
562.25 |
337.84 |
108.36 |
1681.23 |
1950.20 |
1218.21 |
731.99 |
234.78 |
Utah Altius Health Plan - Standard Self Plus One |
DK6 |
768.26 |
891.17 |
517.46 |
373.71 |
109.57 |
1664.56 |
1930.87 |
1121.16 |
809.71 |
237.41 |
Utah SelectHealth Plan - Standard Self |
SF4 |
279.23 |
290.13 |
217.60 |
72.53 |
2.72 |
605.00 |
628.62 |
471.47 |
157.15 |
5.90 |
Utah SelectHealth Plan - Standard Self & Family |
SF5 |
636.40 |
725.33 |
544.00 |
181.33 |
22.23 |
1378.87 |
1571.55 |
1178.66 |
392.89 |
48.17 |
Utah SelectHealth Plan - Standard Self Plus One |
SF6 |
636.40 |
638.29 |
478.72 |
159.57 |
0.47 |
1378.87 |
1382.96 |
1037.22 |
345.74 |
1.02 |
Utah SelectHealth Plan - HDHP Self |
WX1 |
243.32 |
248.99 |
186.74 |
62.25 |
1.42 |
527.19 |
539.48 |
404.61 |
134.87 |
3.07 |
Utah SelectHealth Plan - HDHP Self & Family |
WX2 |
554.55 |
622.47 |
466.85 |
155.62 |
16.98 |
1201.53 |
1348.69 |
1011.52 |
337.17 |
36.79 |
Utah SelectHealth Plan - HDHP Self Plus One |
WX3 |
554.55 |
547.77 |
410.83 |
136.94 |
-1.70 |
1201.53 |
1186.84 |
890.13 |
296.71 |
-3.67 |
Utah UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Utah UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Utah UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Vermont Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Vermont Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Vermont Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Vermont Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Vermont Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Vermont Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Vermont Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
350.59 |
387.52 |
241.58 |
145.94 |
31.12 |
759.61 |
839.63 |
523.42 |
316.21 |
67.44 |
Vermont Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
802.85 |
887.39 |
562.25 |
325.14 |
68.76 |
1739.51 |
1922.68 |
1218.21 |
704.47 |
148.98 |
Vermont Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
787.10 |
869.98 |
517.46 |
352.52 |
69.54 |
1705.38 |
1884.96 |
1121.16 |
763.80 |
150.68 |
Vermont Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
496.50 |
519.07 |
241.58 |
277.49 |
16.76 |
1075.75 |
1124.65 |
523.42 |
601.23 |
36.32 |
Vermont Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
1132.30 |
1183.79 |
562.25 |
621.54 |
35.71 |
2453.32 |
2564.88 |
1218.21 |
1346.67 |
77.37 |
Vermont Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
1121.09 |
1172.06 |
517.46 |
654.60 |
37.63 |
2429.03 |
2539.46 |
1121.16 |
1418.30 |
81.53 |
Vermont Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Vermont Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Vermont Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Vermont UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Vermont UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Vermont UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Virgin Islands Triple-S Salud Inc. U.S. Virgin Islands - High Self |
851 |
313.40 |
313.40 |
235.05 |
78.35 |
0.00 |
679.03 |
679.03 |
509.27 |
169.76 |
0.00 |
Virgin Islands Triple-S Salud Inc. U.S. Virgin Islands - High Self & Family |
852 |
717.70 |
717.70 |
538.28 |
179.42 |
0.00 |
1555.02 |
1555.02 |
1166.27 |
388.75 |
0.00 |
Virgin Islands Triple-S Salud Inc. U.S. Virgin Islands - High Self Plus One |
853 |
703.70 |
703.70 |
517.46 |
186.24 |
-13.34 |
1524.68 |
1524.68 |
1121.16 |
403.52 |
-28.90 |
Virginia Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Virginia Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Virginia Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Virginia Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Virginia Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Virginia Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Virginia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
382.72 |
393.11 |
241.58 |
151.53 |
4.58 |
829.23 |
851.74 |
523.42 |
328.32 |
9.93 |
Virginia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
872.64 |
896.32 |
562.25 |
334.07 |
7.90 |
1890.72 |
1942.03 |
1218.21 |
723.82 |
17.12 |
Virginia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
864.00 |
887.45 |
517.46 |
369.99 |
10.11 |
1872.00 |
1922.81 |
1121.16 |
801.65 |
21.91 |
Virginia Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
378.45 |
379.30 |
241.58 |
137.72 |
-4.96 |
819.98 |
821.82 |
523.42 |
298.40 |
-10.74 |
Virginia Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
866.59 |
868.56 |
562.25 |
306.31 |
-13.81 |
1877.61 |
1881.88 |
1218.21 |
663.67 |
-29.92 |
Virginia Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
849.59 |
851.52 |
517.46 |
334.06 |
-11.41 |
1840.78 |
1844.96 |
1121.16 |
723.80 |
-24.72 |
Virginia Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Virginia Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Virginia Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Virginia Aetna Open Access - High Self |
JN1 |
525.03 |
543.03 |
241.58 |
301.45 |
12.19 |
1137.57 |
1176.57 |
523.42 |
653.15 |
26.42 |
Virginia Aetna Open Access - High Self & Family |
JN2 |
1180.35 |
1220.79 |
562.25 |
658.54 |
24.66 |
2557.43 |
2645.05 |
1218.21 |
1426.84 |
53.43 |
Virginia Aetna Open Access - High Self Plus One |
JN3 |
1168.66 |
1208.70 |
517.46 |
691.24 |
26.70 |
2532.10 |
2618.85 |
1121.16 |
1497.69 |
57.85 |
Virginia Aetna Open Access - Basic Self |
JN4 |
321.74 |
329.73 |
241.58 |
88.15 |
2.18 |
697.10 |
714.42 |
523.42 |
191.00 |
4.74 |
Virginia Aetna Open Access - Basic Self & Family |
JN5 |
736.31 |
754.58 |
562.25 |
192.33 |
2.49 |
1595.34 |
1634.92 |
1218.21 |
416.71 |
5.39 |
Virginia Aetna Open Access - Basic Self Plus One |
JN6 |
676.15 |
692.92 |
517.46 |
175.46 |
3.43 |
1464.99 |
1501.33 |
1121.16 |
380.17 |
7.44 |
Virginia Aetna Saver (Open Access) - Saver Self |
QQ4 |
274.71 |
274.71 |
206.03 |
68.68 |
0.00 |
595.21 |
595.21 |
446.41 |
148.80 |
0.00 |
Virginia Aetna Saver (Open Access) - Saver Self & Family |
QQ5 |
628.68 |
628.67 |
471.50 |
157.17 |
0.00 |
1362.14 |
1362.12 |
1021.59 |
340.53 |
0.00 |
Virginia Aetna Saver (Open Access) - Saver Self Plus One |
QQ6 |
577.30 |
577.30 |
432.98 |
144.32 |
0.00 |
1250.82 |
1250.82 |
938.12 |
312.70 |
0.00 |
Virginia CareFirst BlueChoice - Standard Self |
2G4 |
390.25 |
409.76 |
241.58 |
168.18 |
13.70 |
845.54 |
887.81 |
523.42 |
364.39 |
29.69 |
Virginia CareFirst BlueChoice - Standard Self & Family |
2G5 |
927.21 |
973.58 |
562.25 |
411.33 |
30.59 |
2008.96 |
2109.42 |
1218.21 |
891.21 |
66.27 |
Virginia CareFirst BlueChoice - Standard Self Plus One |
2G6 |
780.49 |
819.51 |
517.46 |
302.05 |
25.68 |
1691.06 |
1775.61 |
1121.16 |
654.45 |
55.65 |
Virginia CareFirst BlueChoice - HDHP Self |
B61 |
263.12 |
263.12 |
197.34 |
65.78 |
0.00 |
570.09 |
570.09 |
427.57 |
142.52 |
0.00 |
Virginia CareFirst BlueChoice - HDHP Self & Family |
B62 |
625.16 |
625.16 |
468.87 |
156.29 |
0.00 |
1354.51 |
1354.51 |
1015.88 |
338.63 |
0.00 |
Virginia CareFirst BlueChoice - HDHP Self Plus One |
B63 |
526.23 |
526.23 |
394.67 |
131.56 |
0.00 |
1140.17 |
1140.17 |
855.13 |
285.04 |
0.00 |
Virginia CareFirst BlueChoice - Blue Value Plus Self |
B64 |
325.84 |
334.00 |
241.58 |
92.42 |
2.35 |
705.99 |
723.67 |
523.42 |
200.25 |
5.10 |
Virginia CareFirst BlueChoice - Blue Value Plus Self & Family |
B65 |
774.21 |
793.56 |
562.25 |
231.31 |
3.57 |
1677.46 |
1719.38 |
1218.21 |
501.17 |
7.73 |
Virginia CareFirst BlueChoice - Blue Value Plus Self Plus One |
B66 |
651.70 |
667.98 |
500.99 |
166.99 |
4.07 |
1412.02 |
1447.29 |
1085.47 |
361.82 |
8.82 |
Virginia Kaiser Permanente - Mid-Atlantic States - Basic Self |
T71 |
193.90 |
197.41 |
148.06 |
49.35 |
0.88 |
420.12 |
427.72 |
320.79 |
106.93 |
1.90 |
Virginia Kaiser Permanente - Mid-Atlantic States - Basic Self & Family |
T72 |
473.61 |
507.47 |
380.60 |
126.87 |
8.47 |
1026.16 |
1099.52 |
824.64 |
274.88 |
18.34 |
Virginia Kaiser Permanente - Mid-Atlantic States - Basic Self Plus One |
T73 |
431.49 |
439.31 |
329.48 |
109.83 |
1.96 |
934.90 |
951.84 |
713.88 |
237.96 |
4.24 |
Virginia Kaiser Permanente - Mid-Atlantic States - Standard Self |
E34 |
263.79 |
276.13 |
207.10 |
69.03 |
3.08 |
571.55 |
598.28 |
448.71 |
149.57 |
6.68 |
Virginia Kaiser Permanente - Mid-Atlantic States - Standard Self & Family |
E35 |
606.69 |
635.10 |
476.33 |
158.77 |
7.10 |
1314.50 |
1376.05 |
1032.04 |
344.01 |
15.39 |
Virginia Kaiser Permanente - Mid-Atlantic States - Standard Self Plus One |
E36 |
606.69 |
635.10 |
476.33 |
158.77 |
7.10 |
1314.50 |
1376.05 |
1032.04 |
344.01 |
15.39 |
Virginia Kaiser Permanente - Mid-Atlantic States - High Self |
E31 |
333.61 |
344.42 |
241.58 |
102.84 |
5.00 |
722.82 |
746.24 |
523.42 |
222.82 |
10.84 |
Virginia Kaiser Permanente - Mid-Atlantic States - High Self & Family |
E32 |
767.32 |
792.16 |
562.25 |
229.91 |
9.06 |
1662.53 |
1716.35 |
1218.21 |
498.14 |
19.63 |
Virginia Kaiser Permanente - Mid-Atlantic States - High Self Plus One |
E33 |
767.32 |
792.16 |
517.46 |
274.70 |
11.50 |
1662.53 |
1716.35 |
1121.16 |
595.19 |
24.92 |
Virginia M.D. IPA - High Self |
JP1 |
404.59 |
438.87 |
241.58 |
197.29 |
28.47 |
876.61 |
950.89 |
523.42 |
427.47 |
61.70 |
Virginia M.D. IPA - High Self & Family |
JP2 |
1134.48 |
1230.59 |
562.25 |
668.34 |
80.33 |
2458.04 |
2666.28 |
1218.21 |
1448.07 |
174.05 |
Virginia M.D. IPA - High Self Plus One |
JP3 |
790.17 |
857.12 |
517.46 |
339.66 |
53.61 |
1712.04 |
1857.09 |
1121.16 |
735.93 |
116.15 |
Virginia Optima Health - HDHP Self |
PG4 |
297.42 |
279.27 |
209.45 |
69.82 |
-4.53 |
644.41 |
605.09 |
453.82 |
151.27 |
-9.83 |
Virginia Optima Health - HDHP Self & Family |
PG5 |
656.07 |
616.05 |
462.04 |
154.01 |
-10.01 |
1421.49 |
1334.78 |
1001.09 |
333.69 |
-21.68 |
Virginia Optima Health - HDHP Self Plus One |
PG6 |
643.21 |
603.97 |
452.98 |
150.99 |
-9.81 |
1393.62 |
1308.60 |
981.45 |
327.15 |
-21.25 |
Virginia Optima Health - High Self |
PG1 |
319.43 |
332.10 |
241.58 |
90.52 |
6.86 |
692.10 |
719.55 |
523.42 |
196.13 |
14.87 |
Virginia Optima Health - High Self & Family |
PG2 |
771.86 |
802.47 |
562.25 |
240.22 |
14.83 |
1672.36 |
1738.69 |
1218.21 |
520.48 |
32.14 |
Virginia Optima Health - High Self Plus One |
PG3 |
771.80 |
802.41 |
517.46 |
284.95 |
17.27 |
1672.23 |
1738.56 |
1121.16 |
617.40 |
37.43 |
Virginia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
242.68 |
276.68 |
207.51 |
69.17 |
8.50 |
525.81 |
599.47 |
449.60 |
149.87 |
18.42 |
Virginia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
573.86 |
654.35 |
490.76 |
163.59 |
20.13 |
1243.36 |
1417.76 |
1063.32 |
354.44 |
43.60 |
Virginia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
521.73 |
594.87 |
446.15 |
148.72 |
18.29 |
1130.42 |
1288.89 |
966.67 |
322.22 |
39.62 |
Virginia UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
V41 |
224.57 |
239.96 |
179.97 |
59.99 |
3.85 |
486.57 |
519.91 |
389.93 |
129.98 |
8.34 |
Virginia UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
V42 |
516.51 |
551.91 |
413.93 |
137.98 |
8.85 |
1119.11 |
1195.81 |
896.86 |
298.95 |
19.17 |
Virginia UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
V43 |
482.83 |
515.91 |
386.93 |
128.98 |
8.27 |
1046.13 |
1117.81 |
838.36 |
279.45 |
17.92 |
Virginia UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
LR1 |
329.95 |
355.57 |
241.58 |
113.99 |
19.81 |
714.89 |
770.40 |
523.42 |
246.98 |
42.93 |
Virginia UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
LR2 |
781.98 |
842.69 |
562.25 |
280.44 |
44.93 |
1694.29 |
1825.83 |
1218.21 |
607.62 |
97.35 |
Virginia UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
LR3 |
709.38 |
764.46 |
517.46 |
247.00 |
41.74 |
1536.99 |
1656.33 |
1121.16 |
535.17 |
90.44 |
Virginia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
L91 |
240.69 |
255.98 |
191.99 |
63.99 |
3.82 |
521.50 |
554.62 |
415.97 |
138.65 |
8.28 |
Virginia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
L92 |
674.89 |
717.76 |
538.32 |
179.44 |
10.72 |
1462.26 |
1555.15 |
1166.36 |
388.79 |
23.23 |
Virginia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self Plus One |
L93 |
470.06 |
499.93 |
374.95 |
124.98 |
7.47 |
1018.46 |
1083.18 |
812.39 |
270.79 |
16.18 |
Virginia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
233.88 |
266.18 |
199.64 |
66.54 |
8.07 |
506.74 |
576.72 |
432.54 |
144.18 |
17.50 |
Virginia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
553.03 |
629.51 |
472.13 |
157.38 |
19.12 |
1198.23 |
1363.94 |
1022.96 |
340.98 |
41.42 |
Virginia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
502.79 |
572.28 |
429.21 |
143.07 |
17.37 |
1089.38 |
1239.94 |
929.96 |
309.98 |
37.64 |
Virginia UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Virginia UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Virginia UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Washington Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Washington Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Washington Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Washington Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Washington Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Washington Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Washington Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
328.95 |
330.94 |
241.58 |
89.36 |
-3.82 |
712.73 |
717.04 |
523.42 |
193.62 |
-8.27 |
Washington Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
753.40 |
757.97 |
562.25 |
195.72 |
-11.21 |
1632.37 |
1642.27 |
1218.21 |
424.06 |
-24.29 |
Washington Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
738.63 |
743.12 |
517.46 |
225.66 |
-8.85 |
1600.37 |
1610.09 |
1121.16 |
488.93 |
-19.18 |
Washington Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
417.46 |
488.66 |
241.58 |
247.08 |
65.39 |
904.50 |
1058.76 |
523.42 |
535.34 |
141.68 |
Washington Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
952.20 |
1114.65 |
562.25 |
552.40 |
146.67 |
2063.10 |
2415.08 |
1218.21 |
1196.87 |
317.79 |
Washington Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
942.79 |
1103.63 |
517.46 |
586.17 |
147.50 |
2042.71 |
2391.20 |
1121.16 |
1270.04 |
319.59 |
Washington Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Washington Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Washington Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Washington Kaiser Permanente - Northwest - Standard Self |
574 |
299.06 |
317.70 |
238.28 |
79.42 |
4.66 |
647.96 |
688.35 |
516.26 |
172.09 |
10.10 |
Washington Kaiser Permanente - Northwest - Standard Self & Family |
575 |
687.02 |
729.85 |
547.39 |
182.46 |
10.71 |
1488.54 |
1581.34 |
1186.01 |
395.33 |
23.20 |
Washington Kaiser Permanente - Northwest - Standard Self Plus One |
576 |
687.02 |
729.85 |
517.46 |
212.39 |
29.49 |
1488.54 |
1581.34 |
1121.16 |
460.18 |
63.90 |
Washington Kaiser Permanente - Northwest - High Self |
571 |
336.89 |
346.93 |
241.58 |
105.35 |
4.23 |
729.93 |
751.68 |
523.42 |
228.26 |
9.17 |
Washington Kaiser Permanente - Northwest - High Self & Family |
572 |
760.94 |
783.61 |
562.25 |
221.36 |
6.89 |
1648.70 |
1697.82 |
1218.21 |
479.61 |
14.93 |
Washington Kaiser Permanente - Northwest - High Self Plus One |
573 |
760.94 |
783.61 |
517.46 |
266.15 |
9.33 |
1648.70 |
1697.82 |
1121.16 |
576.66 |
20.22 |
Washington Kaiser Permanente - Northwest - Prosper Self |
AM1 |
New Plan |
180.82 |
135.62 |
45.20 |
New Plan |
New Plan |
391.78 |
293.84 |
97.94 |
New Plan |
Washington Kaiser Permanente - Northwest - Prosper Self & Family |
AM2 |
New Plan |
427.60 |
320.70 |
106.90 |
New Plan |
New Plan |
926.47 |
694.85 |
231.62 |
New Plan |
Washington Kaiser Permanente - Northwest - Prosper Self Plus One |
AM3 |
New Plan |
388.75 |
291.56 |
97.19 |
New Plan |
New Plan |
842.29 |
631.72 |
210.57 |
New Plan |
Washington Kaiser Permanente - Washington Core - Standard Self |
544 |
278.83 |
285.24 |
213.93 |
71.31 |
1.60 |
604.13 |
618.02 |
463.52 |
154.50 |
3.47 |
Washington Kaiser Permanente - Washington Core - Standard Self & Family |
545 |
641.32 |
656.05 |
492.04 |
164.01 |
3.68 |
1389.53 |
1421.44 |
1066.08 |
355.36 |
7.98 |
Washington Kaiser Permanente - Washington Core - Standard Self Plus One |
546 |
641.32 |
656.05 |
492.04 |
164.01 |
3.68 |
1389.53 |
1421.44 |
1066.08 |
355.36 |
7.98 |
Washington Kaiser Permanente - Washington Core - High Self |
541 |
390.34 |
398.66 |
241.58 |
157.08 |
2.51 |
845.74 |
863.76 |
523.42 |
340.34 |
5.44 |
Washington Kaiser Permanente - Washington Core - High Self & Family |
542 |
858.76 |
877.04 |
562.25 |
314.79 |
2.50 |
1860.65 |
1900.25 |
1218.21 |
682.04 |
5.41 |
Washington Kaiser Permanente - Washington Core - High Self Plus One |
543 |
858.76 |
877.04 |
517.46 |
359.58 |
4.94 |
1860.65 |
1900.25 |
1121.16 |
779.09 |
10.70 |
Washington Kaiser Permanente - Washington Core - Prosper Self |
PT4 |
New Plan |
180.00 |
135.00 |
45.00 |
New Plan |
New Plan |
390.00 |
292.50 |
97.50 |
New Plan |
Washington Kaiser Permanente - Washington Core - Prosper Self & Family |
PT5 |
New Plan |
503.99 |
377.99 |
126.00 |
New Plan |
New Plan |
1091.98 |
818.99 |
272.99 |
New Plan |
Washington Kaiser Permanente - Washington Core - Prosper Self Plus One |
PT6 |
New Plan |
436.00 |
327.00 |
109.00 |
New Plan |
New Plan |
944.67 |
708.50 |
236.17 |
New Plan |
Washington Kaiser Permanente Washington Options Federal - Standard Self |
L11 |
335.95 |
343.00 |
241.58 |
101.42 |
1.24 |
727.89 |
743.17 |
523.42 |
219.75 |
2.70 |
Washington Kaiser Permanente Washington Options Federal - Standard Self & Family |
L12 |
745.80 |
761.46 |
562.25 |
199.21 |
-0.12 |
1615.90 |
1649.83 |
1218.21 |
431.62 |
-0.26 |
Washington Kaiser Permanente Washington Options Federal - Standard Self Plus One |
L13 |
745.80 |
761.46 |
517.46 |
244.00 |
2.32 |
1615.90 |
1649.83 |
1121.16 |
528.67 |
5.03 |
Washington Kaiser Permanente Washington Options Federal - HDHP Self |
L14 |
297.96 |
305.41 |
229.06 |
76.35 |
1.86 |
645.58 |
661.72 |
496.29 |
165.43 |
4.04 |
Washington Kaiser Permanente Washington Options Federal - HDHP Self & Family |
L15 |
661.45 |
677.99 |
508.49 |
169.50 |
4.14 |
1433.14 |
1468.98 |
1101.74 |
367.24 |
8.96 |
Washington Kaiser Permanente Washington Options Federal - HDHP Self Plus One |
L16 |
661.45 |
677.99 |
508.49 |
169.50 |
4.14 |
1433.14 |
1468.98 |
1101.74 |
367.24 |
8.96 |
Washington UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
WF1 |
241.32 |
287.18 |
215.39 |
71.79 |
11.46 |
522.86 |
622.22 |
466.67 |
155.55 |
24.84 |
Washington UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
WF2 |
570.64 |
679.17 |
509.38 |
169.79 |
27.13 |
1236.39 |
1471.54 |
1103.66 |
367.88 |
58.78 |
Washington UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
WF3 |
518.79 |
617.43 |
463.07 |
154.36 |
24.66 |
1124.05 |
1337.77 |
1003.33 |
334.44 |
53.43 |
Washington UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LU1 |
204.85 |
243.77 |
182.83 |
60.94 |
9.73 |
443.84 |
528.17 |
396.13 |
132.04 |
21.08 |
Washington UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LU2 |
471.16 |
560.66 |
420.50 |
140.16 |
22.37 |
1020.85 |
1214.76 |
911.07 |
303.69 |
48.48 |
Washington UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LU3 |
440.43 |
524.10 |
393.08 |
131.02 |
20.91 |
954.27 |
1135.55 |
851.66 |
283.89 |
45.32 |
Washington UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KT1 |
334.51 |
360.98 |
241.58 |
119.40 |
20.66 |
724.77 |
782.12 |
523.42 |
258.70 |
44.77 |
Washington UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KT2 |
836.26 |
902.47 |
562.25 |
340.22 |
50.43 |
1811.90 |
1955.35 |
1218.21 |
737.14 |
109.26 |
Washington UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KT3 |
719.19 |
776.11 |
517.46 |
258.65 |
43.58 |
1558.25 |
1681.57 |
1121.16 |
560.41 |
94.42 |
Washington UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
VD1 |
240.93 |
286.71 |
215.03 |
71.68 |
11.45 |
522.02 |
621.21 |
465.91 |
155.30 |
24.80 |
Washington UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
VD2 |
569.71 |
678.06 |
508.55 |
169.51 |
27.08 |
1234.37 |
1469.13 |
1101.85 |
367.28 |
58.69 |
Washington UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
VD3 |
517.95 |
616.42 |
462.32 |
154.10 |
24.61 |
1122.23 |
1335.58 |
1001.69 |
333.89 |
53.33 |
Washington UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Washington UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Washington UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
West Virginia Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
West Virginia Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
West Virginia Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
West Virginia Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
West Virginia Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
West Virginia Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
West Virginia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
382.72 |
393.11 |
241.58 |
151.53 |
4.58 |
829.23 |
851.74 |
523.42 |
328.32 |
9.93 |
West Virginia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
872.64 |
896.32 |
562.25 |
334.07 |
7.90 |
1890.72 |
1942.03 |
1218.21 |
723.82 |
17.12 |
West Virginia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
864.00 |
887.45 |
517.46 |
369.99 |
10.11 |
1872.00 |
1922.81 |
1121.16 |
801.65 |
21.91 |
West Virginia Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
378.45 |
379.30 |
241.58 |
137.72 |
-4.96 |
819.98 |
821.82 |
523.42 |
298.40 |
-10.74 |
West Virginia Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
866.59 |
868.56 |
562.25 |
306.31 |
-13.81 |
1877.61 |
1881.88 |
1218.21 |
663.67 |
-29.92 |
West Virginia Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
849.59 |
851.52 |
517.46 |
334.06 |
-11.41 |
1840.78 |
1844.96 |
1121.16 |
723.80 |
-24.72 |
West Virginia Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
West Virginia Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
West Virginia Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
West Virginia UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
West Virginia UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
West Virginia UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Wisconsin Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Wisconsin Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Wisconsin Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Wisconsin Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Wisconsin Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Wisconsin Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Wisconsin Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
JS4 |
495.45 |
505.19 |
241.58 |
263.61 |
3.93 |
1073.48 |
1094.58 |
523.42 |
571.16 |
8.52 |
Wisconsin Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
JS5 |
1131.04 |
1153.29 |
562.25 |
591.04 |
6.47 |
2450.59 |
2498.80 |
1218.21 |
1280.59 |
14.02 |
Wisconsin Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
JS6 |
1119.84 |
1141.88 |
517.46 |
624.42 |
8.70 |
2426.32 |
2474.07 |
1121.16 |
1352.91 |
18.85 |
Wisconsin Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
JS1 |
463.38 |
466.12 |
241.58 |
224.54 |
-3.07 |
1003.99 |
1009.93 |
523.42 |
486.51 |
-6.64 |
Wisconsin Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
JS2 |
1056.30 |
1062.53 |
562.25 |
500.28 |
-9.55 |
2288.65 |
2302.15 |
1218.21 |
1083.94 |
-20.69 |
Wisconsin Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
JS3 |
1045.84 |
1052.00 |
517.46 |
534.54 |
-7.18 |
2265.99 |
2279.33 |
1121.16 |
1158.17 |
-15.56 |
Wisconsin Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Wisconsin Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Wisconsin Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Wisconsin Dean Health Plan, Inc. - High Self |
WD1 |
529.42 |
581.94 |
241.58 |
340.36 |
46.71 |
1147.08 |
1260.87 |
523.42 |
737.45 |
101.21 |
Wisconsin Dean Health Plan, Inc. - High Self & Family |
WD2 |
1217.66 |
1338.48 |
562.25 |
776.23 |
105.04 |
2638.26 |
2900.04 |
1218.21 |
1681.83 |
227.59 |
Wisconsin Dean Health Plan, Inc. - High Self Plus One |
WD3 |
1111.78 |
1222.09 |
517.46 |
704.63 |
96.97 |
2408.86 |
2647.86 |
1121.16 |
1526.70 |
210.10 |
Wisconsin Dean Health Plan, Inc. - Standard Self |
WD4 |
314.57 |
316.21 |
237.16 |
79.05 |
0.25 |
681.57 |
685.12 |
513.84 |
171.28 |
0.55 |
Wisconsin Dean Health Plan, Inc. - Standard Self & Family |
WD5 |
754.97 |
758.89 |
562.25 |
196.64 |
-11.86 |
1635.77 |
1644.26 |
1218.21 |
426.05 |
-25.70 |
Wisconsin Dean Health Plan, Inc. - Standard Self Plus One |
WD6 |
692.06 |
695.66 |
517.46 |
178.20 |
-9.74 |
1499.46 |
1507.26 |
1121.16 |
386.10 |
-21.10 |
Wisconsin Dean Health Plan, Inc. - Basic Self |
AG1 |
New Plan |
210.03 |
157.52 |
52.51 |
New Plan |
New Plan |
455.07 |
341.30 |
113.77 |
New Plan |
Wisconsin Dean Health Plan, Inc. - Basic Self & Family |
AG2 |
New Plan |
472.57 |
354.43 |
118.14 |
New Plan |
New Plan |
1023.90 |
767.93 |
255.97 |
New Plan |
Wisconsin Dean Health Plan, Inc. - Basic Self Plus One |
AG3 |
New Plan |
441.06 |
330.80 |
110.26 |
New Plan |
New Plan |
955.63 |
716.72 |
238.91 |
New Plan |
Wisconsin Group Health Cooperative of South Central Wisconsin - High Self |
WJ1 |
395.98 |
410.32 |
241.58 |
168.74 |
8.53 |
857.96 |
889.03 |
523.42 |
365.61 |
18.49 |
Wisconsin Group Health Cooperative of South Central Wisconsin - High Self & Family |
WJ2 |
1029.58 |
1066.85 |
562.25 |
504.60 |
21.49 |
2230.76 |
2311.51 |
1218.21 |
1093.30 |
46.56 |
Wisconsin Group Health Cooperative of South Central Wisconsin - High Self Plus One |
WJ3 |
871.18 |
902.72 |
517.46 |
385.26 |
18.20 |
1887.56 |
1955.89 |
1121.16 |
834.73 |
39.43 |
Wisconsin Group Health Cooperative of South Central Wisconsin - Standard Self |
WJ4 |
New Plan |
285.62 |
214.22 |
71.40 |
New Plan |
New Plan |
618.84 |
464.13 |
154.71 |
New Plan |
Wisconsin Group Health Cooperative of South Central Wisconsin - Standard Self & Family |
WJ5 |
New Plan |
742.62 |
556.97 |
185.65 |
New Plan |
New Plan |
1609.01 |
1206.76 |
402.25 |
New Plan |
Wisconsin Group Health Cooperative of South Central Wisconsin - Standard Self Plus One |
WJ6 |
New Plan |
628.37 |
471.28 |
157.09 |
New Plan |
New Plan |
1361.47 |
1021.10 |
340.37 |
New Plan |
Wisconsin HealthPartners - Standard Self |
V34 |
212.27 |
235.11 |
176.33 |
58.78 |
5.71 |
459.92 |
509.41 |
382.06 |
127.35 |
12.37 |
Wisconsin HealthPartners - Standard Self & Family |
V35 |
517.11 |
572.74 |
429.56 |
143.18 |
13.90 |
1120.41 |
1240.94 |
930.71 |
310.23 |
30.13 |
Wisconsin HealthPartners - Standard Self Plus One |
V36 |
469.13 |
519.60 |
389.70 |
129.90 |
12.62 |
1016.45 |
1125.80 |
844.35 |
281.45 |
27.34 |
Wisconsin HealthPartners - High Self |
V31 |
328.76 |
308.34 |
231.26 |
77.08 |
-15.91 |
712.31 |
668.07 |
501.05 |
167.02 |
-34.45 |
Wisconsin HealthPartners - High Self & Family |
V32 |
800.86 |
751.10 |
562.25 |
188.85 |
-65.54 |
1735.20 |
1627.38 |
1218.21 |
409.17 |
-142.01 |
Wisconsin HealthPartners - High Self Plus One |
V33 |
726.56 |
681.42 |
511.07 |
170.35 |
-52.09 |
1574.21 |
1476.41 |
1107.31 |
369.10 |
-112.85 |
Wisconsin Quartz Health Benefit Plans Corporation - High Self |
TF1 |
466.32 |
509.45 |
241.58 |
267.87 |
37.32 |
1010.36 |
1103.81 |
523.42 |
580.39 |
80.87 |
Wisconsin Quartz Health Benefit Plans Corporation - High Self & Family |
TF2 |
1119.18 |
1222.70 |
562.25 |
660.45 |
87.74 |
2424.89 |
2649.18 |
1218.21 |
1430.97 |
190.10 |
Wisconsin Quartz Health Benefit Plans Corporation - High Self Plus One |
TF3 |
1049.24 |
1146.29 |
517.46 |
628.83 |
83.71 |
2273.35 |
2483.63 |
1121.16 |
1362.47 |
181.38 |
Wisconsin Quartz Health Benefit Plans Corporation - Standard Self |
TF4 |
283.51 |
295.57 |
221.68 |
73.89 |
3.01 |
614.27 |
640.40 |
480.30 |
160.10 |
6.53 |
Wisconsin Quartz Health Benefit Plans Corporation - Standard Self & Family |
TF5 |
680.44 |
709.36 |
532.02 |
177.34 |
7.23 |
1474.29 |
1536.95 |
1152.71 |
384.24 |
15.67 |
Wisconsin Quartz Health Benefit Plans Corporation - Standard Self Plus One |
TF6 |
623.74 |
650.24 |
487.68 |
162.56 |
6.63 |
1351.44 |
1408.85 |
1056.64 |
352.21 |
14.35 |
Wisconsin UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Wisconsin UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Wisconsin UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |
Wyoming Aetna Advantage - Advantage Self |
Z24 |
214.08 |
230.78 |
173.09 |
57.69 |
4.17 |
463.84 |
500.02 |
375.02 |
125.00 |
9.04 |
Wyoming Aetna Advantage - Advantage Self & Family |
Z25 |
567.31 |
611.54 |
458.66 |
152.88 |
11.05 |
1229.17 |
1325.00 |
993.75 |
331.25 |
23.96 |
Wyoming Aetna Advantage - Advantage Self Plus One |
Z26 |
470.97 |
507.70 |
380.78 |
126.92 |
9.18 |
1020.44 |
1100.02 |
825.02 |
275.00 |
19.89 |
Wyoming Aetna Direct - CDHP Self |
N61 |
282.76 |
284.23 |
213.17 |
71.06 |
0.37 |
612.65 |
615.83 |
461.87 |
153.96 |
0.80 |
Wyoming Aetna Direct - CDHP Self & Family |
N62 |
713.08 |
716.80 |
537.60 |
179.20 |
0.93 |
1545.01 |
1553.07 |
1164.80 |
388.27 |
2.02 |
Wyoming Aetna Direct - CDHP Self Plus One |
N63 |
620.10 |
623.33 |
467.50 |
155.83 |
0.81 |
1343.55 |
1350.55 |
1012.91 |
337.64 |
1.75 |
Wyoming Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
382.37 |
381.62 |
241.58 |
140.04 |
-6.56 |
828.47 |
826.84 |
523.42 |
303.42 |
-14.21 |
Wyoming Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
871.59 |
869.88 |
562.25 |
307.63 |
-17.49 |
1888.45 |
1884.74 |
1218.21 |
666.53 |
-37.90 |
Wyoming Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
863.04 |
861.43 |
517.46 |
343.97 |
-14.95 |
1869.92 |
1866.43 |
1121.16 |
745.27 |
-32.39 |
Wyoming Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
372.48 |
377.30 |
241.58 |
135.72 |
-0.99 |
807.04 |
817.48 |
523.42 |
294.06 |
-2.14 |
Wyoming Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
854.85 |
865.92 |
562.25 |
303.67 |
-4.71 |
1852.18 |
1876.16 |
1218.21 |
657.95 |
-10.21 |
Wyoming Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
838.09 |
848.95 |
517.46 |
331.49 |
-2.48 |
1815.86 |
1839.39 |
1121.16 |
718.23 |
-5.37 |
Wyoming Aetna HealthFund HDHP - HDHP Self |
224 |
336.37 |
362.78 |
241.58 |
121.20 |
20.60 |
728.80 |
786.02 |
523.42 |
262.60 |
44.64 |
Wyoming Aetna HealthFund HDHP - HDHP Self & Family |
225 |
741.97 |
800.23 |
562.25 |
237.98 |
42.48 |
1607.60 |
1733.83 |
1218.21 |
515.62 |
92.04 |
Wyoming Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
727.43 |
784.56 |
517.46 |
267.10 |
43.79 |
1576.10 |
1699.88 |
1121.16 |
578.72 |
94.88 |
Wyoming Altius Health Plan - High Self |
9K1 |
465.72 |
483.86 |
241.58 |
242.28 |
12.33 |
1009.06 |
1048.36 |
523.42 |
524.94 |
26.72 |
Wyoming Altius Health Plan - High Self & Family |
9K2 |
1029.93 |
1070.06 |
562.25 |
507.81 |
24.35 |
2231.52 |
2318.46 |
1218.21 |
1100.25 |
52.75 |
Wyoming Altius Health Plan - High Self Plus One |
9K3 |
1019.73 |
1059.46 |
517.46 |
542.00 |
26.39 |
2209.42 |
2295.50 |
1121.16 |
1174.34 |
57.18 |
Wyoming Altius Health Plan - HDHP Self |
9K4 |
244.26 |
310.38 |
232.79 |
77.59 |
16.53 |
529.23 |
672.49 |
504.37 |
168.12 |
35.81 |
Wyoming Altius Health Plan - HDHP Self & Family |
9K5 |
510.48 |
648.66 |
486.50 |
162.16 |
34.54 |
1106.04 |
1405.43 |
1054.07 |
351.36 |
74.85 |
Wyoming Altius Health Plan - HDHP Self Plus One |
9K6 |
500.48 |
635.93 |
476.95 |
158.98 |
33.86 |
1084.37 |
1377.85 |
1033.39 |
344.46 |
73.37 |
Wyoming Altius Health Plan - Standard Self |
DK4 |
351.37 |
407.59 |
241.58 |
166.01 |
50.41 |
761.30 |
883.11 |
523.42 |
359.69 |
109.23 |
Wyoming Altius Health Plan - Standard Self & Family |
DK5 |
775.95 |
900.09 |
562.25 |
337.84 |
108.36 |
1681.23 |
1950.20 |
1218.21 |
731.99 |
234.78 |
Wyoming Altius Health Plan - Standard Self Plus One |
DK6 |
768.26 |
891.17 |
517.46 |
373.71 |
109.57 |
1664.56 |
1930.87 |
1121.16 |
809.71 |
237.41 |
Wyoming UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self |
Y51 |
New Plan |
190.03 |
142.52 |
47.51 |
New Plan |
New Plan |
411.73 |
308.80 |
102.93 |
New Plan |
Wyoming UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self & Family |
Y52 |
New Plan |
503.57 |
377.68 |
125.89 |
New Plan |
New Plan |
1091.07 |
818.30 |
272.77 |
New Plan |
Wyoming UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan - High Self Plus One |
Y53 |
New Plan |
418.06 |
313.55 |
104.51 |
New Plan |
New Plan |
905.80 |
679.35 |
226.45 |
New Plan |