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Healthcare

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

FFS (Fee-for-Service/Nationwide Plans)

Plan - Option Enrollment Code 2021 TCC Premium 2022 TCC Monthly Premiums - Total Premium 2022 TCC Monthly Premiums - Government Pays 2022 TCC Monthly Premiums - Employee Pays 2022 TCC Monthly Premiums - Change in Employee Payment 2021 Former Spouse Premium 2022 Former Spouse Monthly Premiums - Total Premium 2022 Former Spouse Monthly Premiums - Government Pays 2022 Former Spouse Monthly Premiums - Employee Pays 2022 Former Spouse Monthly Premiums - Change in Employee Payment
Nationwide APWU Health Plan - CDHP Self 474 615.73 615.73 0.00 615.73 0.00 603.66 603.66 0.00 603.66 0.00
Nationwide APWU Health Plan - CDHP Self & Family 475 1459.89 1459.89 0.00 1459.89 0.00 1431.26 1431.26 0.00 1431.26 0.00
Nationwide APWU Health Plan - CDHP Self Plus One 476 1338.22 1338.22 0.00 1338.22 0.00 1311.98 1311.98 0.00 1311.98 0.00
Nationwide APWU Health Plan - High Self 471 762.98 776.26 0.00 776.26 13.28 748.02 761.04 0.00 761.04 13.02
Nationwide APWU Health Plan - High Self & Family 472 1831.09 1862.94 0.00 1862.94 31.85 1795.19 1826.41 0.00 1826.41 31.22
Nationwide APWU Health Plan - High Self Plus One 473 1602.19 1630.07 0.00 1630.07 27.88 1570.77 1598.11 0.00 1598.11 27.34
Nationwide Blue Cross and Blue Shield Service Benefit Plan Basic Option - Basic Self 111 694.86 708.84 0.00 708.84 13.98 681.24 694.94 0.00 694.94 13.70
Nationwide Blue Cross and Blue Shield Service Benefit Plan Basic Option - Basic Self & Family 112 1687.38 1737.99 0.00 1737.99 50.61 1654.29 1703.91 0.00 1703.91 49.62
Nationwide Blue Cross and Blue Shield Service Benefit Plan Basic Option - Basic Self Plus One 113 1561.65 1592.88 0.00 1592.88 31.23 1531.03 1561.65 0.00 1561.65 30.62
Nationwide Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - FEP Blue Focus Self 131 469.80 469.80 0.00 469.80 0.00 460.59 460.59 0.00 460.59 0.00
Nationwide Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - FEP Blue Focus Self & Family 132 1110.96 1110.96 0.00 1110.96 0.00 1089.18 1089.18 0.00 1089.18 0.00
Nationwide Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - FEP Blue Focus Self Plus One 133 1010.01 1010.01 0.00 1010.01 0.00 990.21 990.21 0.00 990.21 0.00
Nationwide Blue Cross and Blue Shield Service Benefit Plan Standard Option - Standard Self 104 806.72 822.85 0.00 822.85 16.13 790.90 806.72 0.00 806.72 15.82
Nationwide Blue Cross and Blue Shield Service Benefit Plan Standard Option - Standard Self & Family 105 1905.84 1963.01 0.00 1963.01 57.17 1868.47 1924.52 0.00 1924.52 56.05
Nationwide Blue Cross and Blue Shield Service Benefit Plan Standard Option - Standard Self Plus One 106 1764.18 1799.47 0.00 1799.47 35.29 1729.59 1764.19 0.00 1764.19 34.60
Nationwide Compass Rose Health Plan - High Self 421 768.09 775.75 0.00 775.75 7.66 753.03 760.54 0.00 760.54 7.51
Nationwide Compass Rose Health Plan - High Self & Family 422 1843.43 1861.86 0.00 1861.86 18.43 1807.28 1825.35 0.00 1825.35 18.07
Nationwide Compass Rose Health Plan - High Self Plus One 423 1689.81 1706.69 0.00 1706.69 16.88 1656.68 1673.23 0.00 1673.23 16.55
Nationwide Foreign Service Benefit Plan - High Self 401 634.32 647.00 0.00 647.00 12.68 621.88 634.31 0.00 634.31 12.43
Nationwide Foreign Service Benefit Plan - High Self & Family 402 1569.15 1600.52 0.00 1600.52 31.37 1538.38 1569.14 0.00 1569.14 30.76
Nationwide Foreign Service Benefit Plan - High Self Plus One 403 1538.58 1569.34 0.00 1569.34 30.76 1508.41 1538.57 0.00 1538.57 30.16
Nationwide GEHA Benefit Plan - High Self 311 772.88 772.88 0.00 772.88 0.00 757.73 757.73 0.00 757.73 0.00
Nationwide GEHA Benefit Plan - High Self & Family 312 1936.80 1936.80 0.00 1936.80 0.00 1898.82 1898.82 0.00 1898.82 0.00
Nationwide GEHA Benefit Plan - High Self Plus One 313 1700.35 1700.35 0.00 1700.35 0.00 1667.01 1667.01 0.00 1667.01 0.00
Nationwide GEHA Benefit Plan - Standard Self 314 553.96 553.96 0.00 553.96 0.00 543.10 543.10 0.00 543.10 0.00
Nationwide GEHA Benefit Plan - Standard Self & Family 315 1457.27 1457.27 0.00 1457.27 0.00 1428.70 1428.70 0.00 1428.70 0.00
Nationwide GEHA Benefit Plan - Standard Self Plus One 316 1191.05 1191.05 0.00 1191.05 0.00 1167.70 1167.70 0.00 1167.70 0.00
Nationwide GEHA HDHP - HDHP Self 341 542.49 558.76 0.00 558.76 16.27 531.85 547.80 0.00 547.80 15.95
Nationwide GEHA HDHP - HDHP Self & Family 342 1405.96 1476.26 0.00 1476.26 70.30 1378.39 1447.31 0.00 1447.31 68.92
Nationwide GEHA HDHP - HDHP Self Plus One 343 1166.35 1201.34 0.00 1201.34 34.99 1143.48 1177.78 0.00 1177.78 34.30
Nationwide GEHA Indemnity Benefit Plan - Elevate Plus Self 251 666.18 699.49 0.00 699.49 33.31 653.12 685.77 0.00 685.77 32.65
Nationwide GEHA Indemnity Benefit Plan - Elevate Plus Self & Family 252 1652.13 1685.19 0.00 1685.19 33.06 1619.74 1652.15 0.00 1652.15 32.41
Nationwide GEHA Indemnity Benefit Plan - Elevate Plus Self Plus One 253 1532.13 1562.78 0.00 1562.78 30.65 1502.09 1532.14 0.00 1532.14 30.05
Nationwide GEHA Indemnity Benefit Plan - Elevate Self 254 418.33 430.89 0.00 430.89 12.56 410.13 422.44 0.00 422.44 12.31
Nationwide GEHA Indemnity Benefit Plan - Elevate Self & Family 255 1171.37 1206.51 0.00 1206.51 35.14 1148.40 1182.85 0.00 1182.85 34.45
Nationwide GEHA Indemnity Benefit Plan - Elevate Self Plus One 256 962.19 991.05 0.00 991.05 28.86 943.32 971.62 0.00 971.62 28.30
Nationwide MHBP Consumer Option - HDHP Self 481 643.20 675.35 0.00 675.35 32.15 630.59 662.11 0.00 662.11 31.52
Nationwide MHBP Consumer Option - HDHP Self & Family 482 1494.58 1569.30 0.00 1569.30 74.72 1465.27 1538.53 0.00 1538.53 73.26
Nationwide MHBP Consumer Option - HDHP Self Plus One 483 1423.42 1494.58 0.00 1494.58 71.16 1395.51 1465.27 0.00 1465.27 69.76
Nationwide MHBP Standard Option - Standard Self 454 634.70 691.82 0.00 691.82 57.12 622.25 678.25 0.00 678.25 56.00
Nationwide MHBP Standard Option - Standard Self & Family 455 1474.98 1607.73 0.00 1607.73 132.75 1446.06 1576.21 0.00 1576.21 130.15
Nationwide MHBP Standard Option - Standard Self Plus One 456 1460.95 1592.41 0.00 1592.41 131.46 1432.30 1561.19 0.00 1561.19 128.89
Nationwide MHBP Value Plan - Value Self 414 471.64 494.75 0.00 494.75 23.11 462.39 485.05 0.00 485.05 22.66
Nationwide MHBP Value Plan - Value Self & Family 415 1139.81 1195.65 0.00 1195.65 55.84 1117.46 1172.21 0.00 1172.21 54.75
Nationwide MHBP Value Plan - Value Self Plus One 416 1117.49 1172.26 0.00 1172.26 54.77 1095.58 1149.27 0.00 1149.27 53.69
Nationwide NALC Health Benefit Plan - CDHP Self 324 483.00 483.00 0.00 483.00 0.00 473.53 473.53 0.00 473.53 0.00
Nationwide NALC Health Benefit Plan - CDHP Self & Family 325 1121.93 1133.14 0.00 1133.14 11.21 1099.93 1110.92 0.00 1110.92 10.99
Nationwide NALC Health Benefit Plan - CDHP Self Plus One 326 1065.57 1065.57 0.00 1065.57 0.00 1044.68 1044.68 0.00 1044.68 0.00
Nationwide NALC Health Benefit Plan - High Self 321 743.47 758.34 0.00 758.34 14.87 728.89 743.47 0.00 743.47 14.58
Nationwide NALC Health Benefit Plan - High Self & Family 322 1681.67 1715.29 0.00 1715.29 33.62 1648.70 1681.66 0.00 1681.66 32.96
Nationwide NALC Health Benefit Plan - High Self Plus One 323 1644.46 1677.35 0.00 1677.35 32.89 1612.22 1644.46 0.00 1644.46 32.24
Nationwide NALC Health Benefit Plan - Value Self KM1 396.41 396.41 0.00 396.41 0.00 388.64 388.64 0.00 388.64 0.00
Nationwide NALC Health Benefit Plan - Value Self & Family KM2 921.17 930.39 0.00 930.39 9.22 903.11 912.15 0.00 912.15 9.04
Nationwide NALC Health Benefit Plan - Value Self Plus One KM3 874.50 874.50 0.00 874.50 0.00 857.35 857.35 0.00 857.35 0.00
Nationwide Panama Canal Area Benefit Plan - High Self 431 673.17 720.28 0.00 720.28 47.11 659.97 706.16 0.00 706.16 46.19
Nationwide Panama Canal Area Benefit Plan - High Self & Family 432 1405.14 1517.57 0.00 1517.57 112.43 1377.59 1487.81 0.00 1487.81 110.22
Nationwide Panama Canal Area Benefit Plan - High Self Plus One 433 1343.54 1451.02 0.00 1451.02 107.48 1317.20 1422.57 0.00 1422.57 105.37
Nationwide Rural Carrier Benefit Plan - High Self 381 813.94 830.23 0.00 830.23 16.29 797.98 813.95 0.00 813.95 15.97
Nationwide Rural Carrier Benefit Plan - High Self & Family 382 1727.58 1792.35 0.00 1792.35 64.77 1693.71 1757.21 0.00 1757.21 63.50
Nationwide Rural Carrier Benefit Plan - High Self Plus One 383 1644.71 1706.39 0.00 1706.39 61.68 1612.46 1672.93 0.00 1672.93 60.47
Nationwide SAMBA Health Benefit Plan - High Self 441 892.17 892.17 0.00 892.17 0.00 874.68 874.68 0.00 874.68 0.00
Nationwide SAMBA Health Benefit Plan - High Self & Family 442 2141.20 2141.20 0.00 2141.20 0.00 2099.22 2099.22 0.00 2099.22 0.00
Nationwide SAMBA Health Benefit Plan - High Self Plus One 443 1962.79 1962.79 0.00 1962.79 0.00 1924.30 1924.30 0.00 1924.30 0.00
Nationwide SAMBA Health Benefit Plan - Standard Self 444 714.94 722.10 0.00 722.10 7.16 700.92 707.94 0.00 707.94 7.02
Nationwide SAMBA Health Benefit Plan - Standard Self & Family 445 1631.11 1647.42 0.00 1647.42 16.31 1599.13 1615.12 0.00 1615.12 15.99
Nationwide SAMBA Health Benefit Plan - Standard Self Plus One 446 1538.78 1554.18 0.00 1554.18 15.40 1508.61 1523.71 0.00 1523.71 15.10
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