2020 Plan Information for New York
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Location Specific Rates
| Contract | Enrollment Code | Enrollment Type | Option/Enrollment Type | Payment Period | Employee Payment |
|---|---|---|---|---|---|
| Aetna Direct | 224 | Non-Postal | HDHP Self | Monthly | 217.96 |
| Aetna Direct | 225 | Non-Postal | HDHP Self & Family | Monthly | 423.58 |
| Aetna Direct | 226 | Non-Postal | HDHP Self Plus One | Monthly | 483.84 |
| Aetna Direct | N61 | Non-Postal | CDHP Self | Monthly | 153.16 |
| Aetna Direct | N62 | Non-Postal | CDHP Self & Family | Monthly | 386.25 |
| Aetna Direct | N63 | Non-Postal | CDHP Self Plus One | Monthly | 335.89 |
| Aetna Direct | Z24 | Non-Postal | Advantage Self | Monthly | 115.96 |
| Aetna Direct | Z25 | Non-Postal | Advantage Self & Family | Monthly | 307.29 |
| Aetna Direct | Z26 | Non-Postal | Advantage Self Plus One | Monthly | 255.11 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP1 | Non-Postal | CDHP Self | Monthly | 564.91 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP2 | Non-Postal | CDHP Self & Family | Monthly | 1269.3 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP3 | Non-Postal | CDHP Self Plus One | Monthly | 1336.77 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP4 | Non-Postal | Value Self | Monthly | 248.77 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP5 | Non-Postal | Value Self & Family | Monthly | 555.49 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP6 | Non-Postal | Value Self Plus One | Monthly | 613.12 |
| Aetna Open Access | JC1 | Non-Postal | High Self | Monthly | 809.53 |
| Aetna Open Access | JC2 | Non-Postal | High Self & Family | Monthly | 2078.55 |
| Aetna Open Access | JC3 | Non-Postal | High Self Plus One | Monthly | 2138 |
| Aetna Open Access | JC4 | Non-Postal | Basic Self | Monthly | 591.58 |
| Aetna Open Access | JC5 | Non-Postal | Basic Self & Family | Monthly | 1505.01 |
| Aetna Open Access | JC6 | Non-Postal | Basic Self Plus One | Monthly | 1570.18 |
| CDPHP Universal Benefits, Inc. | SG1 | Non-Postal | High Self | Monthly | 480.41 |
| CDPHP Universal Benefits, Inc. | SG2 | Non-Postal | High Self & Family | Monthly | 1641.03 |
| CDPHP Universal Benefits, Inc. | SG3 | Non-Postal | High Self Plus One | Monthly | 959.62 |
| CDPHP Universal Benefits, Inc. | SG4 | Non-Postal | Standard Self | Monthly | 157.4 |
| CDPHP Universal Benefits, Inc. | SG5 | Non-Postal | Standard Self & Family | Monthly | 608.62 |
| CDPHP Universal Benefits, Inc. | SG6 | Non-Postal | Standard Self Plus One | Monthly | 325.81 |
| EmblemHealth Plan | 804 | Non-Postal | Standard Self | Monthly | 493.82 |
| EmblemHealth Plan | 805 | Non-Postal | Standard Self & Family | Monthly | 1253.39 |
| EmblemHealth Plan | 806 | Non-Postal | Standard Self Plus One | Monthly | 1244.66 |
| EmblemHealth Plan | 811 | Non-Postal | HDHP Self | Monthly | 169.09 |
| EmblemHealth Plan | 812 | Non-Postal | HDHP Self & Family | Monthly | 369.68 |
| EmblemHealth Plan | 813 | Non-Postal | HDHP Self Plus One | Monthly | 362.52 |
| HIP of Greater New York | 511 | Non-Postal | High Self | Monthly | 560.21 |
| HIP of Greater New York | 512 | Non-Postal | High Self & Family | Monthly | 1897.96 |
| HIP of Greater New York | 513 | Non-Postal | High Self Plus One | Monthly | 856.29 |
| HIP of Greater New York | YL4 | Non-Postal | Standard Self | Monthly | 303.03 |
| HIP of Greater New York | YL5 | Non-Postal | Standard Self & Family | Monthly | 1155.96 |
| HIP of Greater New York | YL6 | Non-Postal | Standard Self Plus One | Monthly | 387.99 |
| Independent Health Assoc | C54 | Non-Postal | Standard Self | Monthly | 200.78 |
| Independent Health Assoc | C55 | Non-Postal | Standard Self & Family | Monthly | 737.36 |
| Independent Health Assoc | C56 | Non-Postal | Standard Self Plus One | Monthly | 722.35 |
| Independent Health Assoc | QA1 | Non-Postal | High Self | Monthly | 251.83 |
| Independent Health Assoc | QA2 | Non-Postal | High Self & Family | Monthly | 875.16 |
| Independent Health Assoc | QA3 | Non-Postal | High Self Plus One | Monthly | 852.54 |
| Independent Health Assoc | QA4 | Non-Postal | HDHP Self | Monthly | 148.22 |
| Independent Health Assoc | QA5 | Non-Postal | HDHP Self & Family | Monthly | 383.28 |
| Independent Health Assoc | QA6 | Non-Postal | HDHP Self Plus One | Monthly | 357.4 |