Non-Postal Premium Rates for the Federal Employees Health Benefits Program

Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Gov't
Pays

Empl.
Pays

Alabama Aetna Direct

N61
210.05
218.45 163.84 54.61
CDHP Self
N62
474.42
550.93 413.20 137.73
CDHP Self & Family
N63
479.08 359.31 119.77
CDHP Self Plus One
Alabama Aetna HealthFund CDHP and Value Plan
F51
272.01
298.88 213.37 85.51
CDHP Self
F52
617.70
681.47 488.50 192.97
CDHP Self & Family
F53
674.72 461.02 213.70
CDHP Self Plus One
F54
243.50
250.64 187.98 62.66
Basic Self
F55
552.96
573.93 430.45 143.48
Basic Self & Family
F56
562.68 422.01 140.67
Basic Self Plus One
Alabama Aetna HealthFund HDHP
224
226.86
240.15 180.11 60.04
HDHP Self
225
496.83
529.73 397.30 132.43
HDHP Self & Family
226
519.34 389.51 129.83
HDHP Self Plus One
Alabama United Healthcare Insurance Company, Inc. (Choice HMO)
KK1
New Plan 245.00 183.75 61.25
High Self
KK2
New Plan 686.98 488.50 198.48
High Self & Family
KK3
New Plan 478.48 358.86 119.62
High Self Plus One
Alabama United Healthcare Insurance Company, Inc. (HDHP Choice Plus)
LS1
New Plan 234.69 176.02 58.67
HDHP Self
LS2
New Plan 658.05 488.50 169.55
HDHP Self & Family
LS3
New Plan 458.33 343.75 114.58
HDHP Self Plus One
Alaska Aetna Direct
N61
210.05
218.45 163.84 54.61
CDHP Self
N62
474.42
550.93 413.20 137.73
CDHP Self & Family
N63
479.08 359.31 119.77
CDHP Self Plus One

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

354.98
895.26
778.51

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

118.33
298.42
259.50

4.55
41.44
-

15.51
23.84
1.79
5.24
-

589.36
1338.35
527.58
1198.08
-

647.57 462.30 185.27

1476.52 1058.42 418.10
1461.89 998.88 463.01
543.05 407.29 135.76
1243.52 932.64 310.88
1219.14 914.36 304.78

33.60
51.65
3.87
11.36
-

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

7.20
17.82
-

390.25
860.81
843.93

130.08
286.94
281.31

New Plan New Plan 530.83 398.12 132.71

New Plan New Plan 1488.46 1058.42 430.04
New Plan New Plan 1036.71 777.53 259.18

New Plan
New Plan
New Plan

New Plan New Plan 508.50 381.38 127.12

New Plan New Plan 1425.78 1058.42 367.36
New Plan New Plan 993.05 744.79 248.26

New Plan
New Plan
New Plan

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

354.98
895.26
778.51

118.33
298.42
259.50

4.55
41.44
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Alaska Aetna HealthFund CDHP and Value Plan

JS1
340.51
CDHP Self
JS2
773.27
CDHP Self & Family
JS3
CDHP Self Plus One
JS4
279.09
Basic Self
JS5
633.78
Basic Self & Family
JS6
Basic Self Plus One
Alaska Aetna HealthFund HDHP
224
226.86
HDHP Self
225
496.83
HDHP Self & Family
226
HDHP Self Plus One
Arizona Aetna Direct
N61
210.05
CDHP Self
N62
474.42
CDHP Self & Family
N63
CDHP Self Plus One
Arizona Aetna HealthFund CDHP and Value Plan
G51
289.47
CDHP Self
G52
657.36
CDHP Self & Family
G53
CDHP Self Plus One
G54
239.10
Basic Self
G55
542.96
Basic Self & Family
G56
Basic Self Plus One
Arizona Aetna HealthFund HDHP
224
226.86
HDHP Self
225
496.83
HDHP Self & Family
226
HDHP Self Plus One

Total
Premium

Gov't
Pays

Empl.
Pays

403.55
919.90
910.79
301.31
687.86
681.04

213.37
488.50
461.02
213.37
488.50
461.02

190.18
431.40
449.77
87.94
199.36
220.02

240.15
529.73
519.34

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

51.68
106.70
10.86
14.15
-

737.77
1675.42
604.70
1373.19
-

874.36 462.30 412.06

1993.12 1058.42 934.70
1973.38 998.88 974.50
652.84 462.30 190.54
1490.36 1058.42 431.94
1475.59 998.88 476.71

111.98
231.18
23.53
30.65
-

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

390.25
860.81
843.93

130.08
286.94
281.31

7.20
17.82
-

218.45
550.93
479.08

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

354.98
895.26
778.51

118.33
298.42
259.50

4.55
41.44
-

321.78
733.96
726.69
246.85
565.39
554.30

213.37
488.50
461.02
185.14
424.04
415.73

108.41
245.46
265.67
61.71
141.35
138.57

20.95
36.67
1.94
5.61
-

627.19
1424.28
518.05
1176.41
-

697.19 462.30 234.89

1590.25 1058.42 531.83
1574.50 998.88 575.62
534.84 401.13 133.71
1225.01 918.76 306.25
1200.98 900.74 300.24

45.39
79.45
4.20
12.15
-

240.15
529.73
519.34

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

7.20
17.82
-

390.25
860.81
843.93

130.08
286.94
281.31

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

Arizona Aetna Open Access

WQ1
High Self
WQ2
High Self & Family
WQ3
High Self Plus One
Arizona Health Net of Arizona, Inc.
A71
High Self
A72
High Self & Family
A73
High Self Plus One
A74
Standard Self
A75
Standard Self & Family
A76
Standard Self Plus One
Arizona Humana Health Plan, Inc.
BF1
High Self
BF2
High Self & Family
BF3
High Self Plus One
BF4
Standard Self
BF5
Standard Self & Family
BF6
Standard Self Plus One
Arizona Humana Health Plan, Inc.
C71
High Self
C72
High Self & Family
C73
High Self Plus One
C74
Standard Self
C75
Standard Self & Family
C76
Standard Self Plus One

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

376.27
909.88
-

405.62
984.84
975.08

213.37 192.25
488.50 496.34
461.02 514.06

17.99
35.03
-

815.25
1971.41
-

878.84 462.30 416.54

2133.82 1058.42 1075.40
2112.67 998.88 1113.79

38.98
75.89
-

331.53
839.45
302.58
766.16
-

363.05
919.28
919.28
315.62
799.12
799.12

213.37
488.50
461.02
213.37
488.50
461.02

149.68
430.78
458.26
102.25
310.62
338.10

20.16
39.90
1.68
-6.97
-

718.32
1818.81
655.59
1660.01
-

786.61 462.30 324.31

1991.77 1058.42 933.35
1991.77 998.88 992.89
683.84 462.30 221.54
1731.43 1058.42 673.01
1731.43 998.88 732.55

43.68
86.44
3.64
-15.10
-

275.35
612.64
261.58
582.02
-

349.02
785.30
750.40
304.14
684.31
653.89

213.37
488.50
461.02
213.37
488.50
461.02

135.65
296.80
289.38
90.77
195.81
192.87

62.31
132.73
25.38
50.31
-

596.59
1327.39
566.76
1261.04
-

756.21 462.30 293.91

1701.48 1058.42 643.06
1625.87 998.88 626.99
658.97 462.30 196.67
1482.67 1058.42 424.25
1416.76 998.88 417.88

135.01
287.57
54.98
108.99
-

275.35
612.64
261.58
582.02
-

310.24
698.05
667.02
289.46
651.30
622.35

213.37
488.50
461.02
213.37
488.48
461.02

96.87
209.55
206.00
76.09
162.82
161.33

23.53
45.48
10.70
17.32
-

596.59
1327.39
566.76
1261.04
-

672.19 462.30 209.89

1512.44 1058.42 454.02
1445.21 998.88 446.33
627.16 462.30 164.86
1411.15 1058.36 352.79
1348.43 998.88 349.55

50.99
98.53
23.17
37.53
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Gov't
Pays

Empl.
Pays

Arizona United Healthcare Insurance Company, Inc. (Choice HMO)

KT1
New Plan 244.98 183.74 61.24
High Self
KT2
New Plan 686.93 488.50 198.43
High Self & Family
KT3
New Plan 478.45 358.84 119.61
High Self Plus One
Arizona United Healthcare Insurance Company, Inc. (HDHP Choice Plus)
LU1
New Plan 236.75 177.56 59.19
HDHP Self
LU2
New Plan 663.82 488.50 175.32
HDHP Self & Family
LU3
New Plan 462.35 346.76 115.59
HDHP Self Plus One
Arkansas Aetna Direct
N61
210.05
218.45 163.84 54.61
CDHP Self
N62
474.42
550.93 413.20 137.73
CDHP Self & Family
N63
479.08 359.31 119.77
CDHP Self Plus One
Arkansas Aetna HealthFund CDHP and Value Plan
F51
272.01
298.88 213.37 85.51
CDHP Self
F52
617.70
681.47 488.50 192.97
CDHP Self & Family
F53
674.72 461.02 213.70
CDHP Self Plus One
F54
243.50
250.64 187.98 62.66
Basic Self
F55
552.96
573.93 430.45 143.48
Basic Self & Family
F56
562.68 422.01 140.67
Basic Self Plus One
Arkansas Aetna HealthFund HDHP
224
226.86
240.15 180.11 60.04
HDHP Self
225
496.83
529.73 397.30 132.43
HDHP Self & Family
226
519.34 389.51 129.83
HDHP Self Plus One

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

New Plan New Plan 530.79 398.09 132.70

New Plan New Plan 1488.35 1058.42 429.93
New Plan New Plan 1036.64 777.48 259.16

New Plan
New Plan
New Plan

New Plan New Plan 512.96 384.72 128.24

New Plan New Plan 1438.28 1058.42 379.86
New Plan New Plan 1001.76 751.32 250.44

New Plan
New Plan
New Plan

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

354.98
895.26
778.51

118.33
298.42
259.50

4.55
41.44
-

15.51
23.84
1.79
5.24
-

589.36
1338.35
527.58
1198.08
-

647.57 462.30 185.27

1476.52 1058.42 418.10
1461.89 998.88 463.01
543.05 407.29 135.76
1243.52 932.64 310.88
1219.14 914.36 304.78

33.60
51.65
3.87
11.36
-

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

7.20
17.82
-

390.25
860.81
843.93

130.08
286.94
281.31

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Gov't
Pays

Empl.
Pays

Arkansas QualChoice
DH1
271.99
312.81 213.37 99.44
High Self
DH2
636.95
815.90 488.50 327.40
High Self & Family
DH3
607.64 455.73 151.91
High Self Plus One
DH4
231.48
243.98 182.99 60.99
Standard Self
DH5
542.08
636.37 477.28 159.09
Standard Self & Family
DH6
473.93 355.45 118.48
Standard Self Plus One
Arkansas United Healthcare Insurance Company, Inc. (Choice HMO)
KK1
New Plan 245.00 183.75 61.25
High Self
KK2
New Plan 686.98 488.50 198.48
High Self & Family
KK3
New Plan 478.48 358.86 119.62
High Self Plus One
Arkansas United Healthcare Insurance Company, Inc. (HDHP Choice Plus)
LS1
New Plan 234.69 176.02 58.67
HDHP Self
LS2
New Plan 658.05 488.50 169.55
HDHP Self & Family
LS3
New Plan 458.33 343.75 114.58
HDHP Self Plus One
California Aetna Direct
N61
210.05
218.45 163.84 54.61
CDHP Self
N62
474.42
550.93 413.20 137.73
CDHP Self & Family
N63
479.08 359.31 119.77
CDHP Self Plus One
California Aetna HealthFund CDHP and Value Plan
JS1
340.51
403.55 213.37 190.18
CDHP Self
JS2
773.27
919.90 488.50 431.40
CDHP Self & Family
JS3
910.79 461.02 449.77
CDHP Self Plus One
JS4
279.09
301.31 213.37 87.94
Basic Self
JS5
633.78
687.86 488.50 199.36
Basic Self & Family
JS6
681.04 461.02 220.02
Basic Self Plus One

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

29.46
139.02
3.12
23.57
-

589.31
1380.06
501.54
1174.51
-

Gov't
Pays

Empl.
Pays

677.76 462.30 215.46

1767.78 1058.42 709.36
1316.55 987.41 329.14
528.62 396.47 132.15
1378.80 1034.10 344.70
1026.85 770.14 256.71

Change in
empl.
payment

63.84
301.20
6.77
51.07
-

New Plan New Plan 530.83 398.12 132.71

New Plan New Plan 1488.46 1058.42 430.04
New Plan New Plan 1036.71 777.53 259.18

New Plan
New Plan
New Plan

New Plan New Plan 508.50 381.38 127.12

New Plan New Plan 1425.78 1058.42 367.36
New Plan New Plan 993.05 744.79 248.26

New Plan
New Plan
New Plan

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

354.98
895.26
778.51

118.33
298.42
259.50

4.55
41.44
-

51.68
106.70
10.86
14.15
-

737.77
1675.42
604.70
1373.19
-

874.36 462.30 412.06

1993.12 1058.42 934.70
1973.38 998.88 974.50
652.84 462.30 190.54
1490.36 1058.42 431.94
1475.59 998.88 476.71

111.98
231.18
23.53
30.65
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

California Aetna HealthFund HDHP

224
226.86
HDHP Self
225
496.83
HDHP Self & Family
226
HDHP Self Plus One
California Aetna Open Access
2X1
279.15
High Self
2X2
651.14
High Self & Family
2X3
High Self Plus One
California Anthem Blue Cross Select HMO
B31
322.76
High Self
B32
693.93
High Self & Family
B33
High Self Plus One
California Blue Shield of CA Access+HMO
SI1
309.25
High Self
SI2
695.83
High Self & Family
SI3
High Self Plus One
California Health Net of California
LB1
585.00
High Self
LB2
1352.56
High Self & Family
LB3
High Self Plus One
LB4
557.14
Standard Self
LB5
1288.14
Standard Self & Family
LB6
Standard Self Plus One

Total
Premium

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

390.25
860.81
843.93

240.15
529.73
519.34

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

130.08
286.94
281.31

7.20
17.82
-

288.61
677.55
664.27

213.37 75.24
488.50 189.05
461.02 203.25

-1.90
-13.52
-

604.83
1410.80
-

625.32 462.30 163.02

1468.03 1058.42 409.61
1439.25 998.88 440.37

-4.12
-29.29
-

337.07
715.63
674.21

213.37 123.70
488.50 227.13
461.02 213.19

2.95
-18.23
-

699.31
1503.52
-

730.32 462.30 268.02

1550.53 1058.42 492.11
1460.79 998.88 461.91

6.40
-39.51
-

331.36
745.57
729.00

213.37 117.99
488.50 257.07
461.02 267.98

10.75
9.81
-

670.04
1507.63
-

717.95 462.30 255.65

1615.40 1058.42 556.98
1579.50 998.88 580.62

23.30
21.25
-

600.60
1441.45
1321.33
570.43
1369.04
1254.95

213.37
488.50
461.02
213.37
488.50
461.02

4.24
48.96
1.93
40.97
-

1267.50
2930.55
1207.14
2790.97
-

1301.30 462.30 839.00

3123.14 1058.42 2064.72
2862.88 998.88 1864.00
1235.93 462.30 773.63
2966.25 1058.42 1907.83
2719.06 998.88 1720.18

9.19
106.07
4.18
88.76
-

387.23
952.95
860.31
357.06
880.54
793.93

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

California Health Net of California

LP1
344.22
High Self
LP2
795.88
High Self & Family
LP3
High Self Plus One
LP4
327.38
Standard Self
LP5
756.94
Standard Self & Family
LP6
Standard Self Plus One
California Health Net of California
P61
New Plan
Basic Self
P62
New Plan
Basic Self & Family
P63
New Plan
Basic Self Plus One
California Kaiser Foundation Health Plan
591
359.81
High Self
592
858.89
High Self & Family
593
High Self Plus One
594
301.78
Standard Self
595
706.16
Standard Self & Family
596
Standard Self Plus One
California Kaiser Foundation Health Plan
621
266.38
High Self
622
615.65
High Self & Family
623
High Self Plus One
624
172.81
Standard Self
625
399.39
Standard Self & Family
626
Standard Self Plus One

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

350.22
840.52
770.47
332.20
797.30
730.85

213.37
488.50
461.02
213.37
488.50
461.02

136.85
352.02
309.45
118.83
308.80
269.83

132.81
318.73
292.17

99.61
239.05
219.13

33.20
79.68
73.04

377.23
900.50
900.50
315.31
737.83
737.83

213.37
488.50
461.02
213.37
488.50
461.02

163.86
412.00
439.48
101.94
249.33
276.81

6.06
1.68
2.17
-8.26
-

779.59
1860.93
653.86
1530.01
-

817.33 462.30 355.03

1951.08 1058.42 892.66
1951.08 998.88 952.20
683.17 462.30 220.87
1598.63 1058.42 540.21
1598.63 998.88 599.75

13.13
3.63
4.70
-17.90
-

275.88
637.61
637.61
178.91
413.50
413.50

206.91
478.21
461.02
134.18
310.13
310.13

68.97
159.40
176.59
44.73
103.37
103.37

2.38
-7.68
1.53
3.52
-

577.16
1333.91
374.42
865.35
-

597.74 448.31 149.43

1381.49 1036.12 345.37
1381.49 998.88 382.61
387.64 290.73 96.91
895.92 671.94 223.98
895.92 671.94 223.98

5.14
-16.64
3.31
7.64
-

-5.36
4.71
-6.54
0.43
-

745.81
1724.41
709.32
1640.04
-

New Plan New Plan

New Plan New Plan
New Plan New Plan

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

Total
Premium

758.81 462.30 296.51

1821.13 1058.42 762.71
1669.35 998.88 670.47
719.77 462.30 257.47
1727.48 1058.42 669.06
1583.51 998.88 584.63
287.76
690.58
633.04

215.82
517.94
474.78

71.94
172.64
158.26

-11.61
10.20
-14.16
0.92
New Plan
New Plan
New Plan

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

California Kaiser Foundation Health Plan

KC1
281.11
Basic Self
KC2
657.80
Basic Self & Family
KC3
Basic Self Plus One
California Kaiser Foundation Health Plan
NZ1
266.38
High Self
NZ2
615.65
High Self & Family
NZ3
High Self Plus One
NZ4
172.81
Standard Self
NZ5
399.39
Standard Self & Family
NZ6
Standard Self Plus One
California UnitedHealthcare of California
CY1
297.25
High Self
CY2
679.23
High Self & Family
CY3
High Self Plus One
CY4
251.45
Standard Self
CY5
576.15
Standard Self & Family
CY6
Standard Self Plus One
Colorado Aetna Direct
N61
210.05
CDHP Self
N62
474.42
CDHP Self & Family
N63
CDHP Self Plus One

Total
Premium

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

281.33
658.31
658.31

211.00 70.33
488.50 169.81
461.02 197.29

-8.77
-39.42
-

609.07
1425.23
-

609.55 457.16 152.39

1426.34 1058.42 367.92
1426.34 998.88 427.46

-18.99
-85.41
-

279.39
645.73
645.73
181.26
418.94
418.94

209.54
484.30
461.02
135.95
314.21
314.21

69.85
161.43
184.71
45.31
104.73
104.73

3.26
-5.65
2.11
4.88
-

577.16
1333.91
374.42
865.35
-

605.35 454.01 151.34

1399.08 1049.31 349.77
1399.08 998.88 400.20
392.73 294.55 98.18
907.70 680.78 226.92
907.70 680.78 226.92

7.05
-12.24
4.58
10.58
-

286.34
802.88
559.21
257.47
721.97
502.85

213.37
488.50
419.41
193.10
488.50
377.14

72.97
314.38
139.80
64.37
233.47
125.71

-22.27
83.72
1.51
89.43
-

644.04
1471.67
544.81
1248.33
-

620.40 462.30 158.10

1739.57 1058.42 681.15
1211.62 908.72 302.90
557.85 418.39 139.46
1564.27 1058.42 505.85
1089.51 817.13 272.38

-48.25
181.38
3.26
193.77
-

218.45
550.93
479.08

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

4.55
41.44
-

354.98
895.26
778.51

118.33
298.42
259.50

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Colorado Aetna HealthFund CDHP and Value Plan

G51
289.47
CDHP Self
G52
657.36
CDHP Self & Family
G53
CDHP Self Plus One
G54
239.10
Basic Self
G55
542.96
Basic Self & Family
G56
Basic Self Plus One
Colorado Aetna HealthFund HDHP
224
226.86
HDHP Self
225
496.83
HDHP Self & Family
226
HDHP Self Plus One
Colorado Humana Health Plan, Inc.
NR1
209.27
High Self
NR2
465.62
High Self & Family
NR3
High Self Plus One
NR4
188.34
Standard Self
NR5
419.06
Standard Self & Family
NR6
Standard Self Plus One
Colorado Humana Health Plan, Inc.
NT1
220.28
High Self
NT2
490.13
High Self & Family
NT3
High Self Plus One
NT4
198.26
Standard Self
NT5
441.12
Standard Self & Family
NT6
Standard Self Plus One

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

Total
Premium

Gov't
Pays

Empl.
Pays

321.78
733.96
726.69
246.85
565.39
554.30

213.37
488.50
461.02
185.14
424.04
415.73

108.41
245.46
265.67
61.71
141.35
138.57

20.95
36.67
1.94
5.61
-

627.19
1424.28
518.05
1176.41
-

697.19 462.30 234.89

1590.25 1058.42 531.83
1574.50 998.88 575.62
534.84 401.13 133.71
1225.01 918.76 306.25
1200.98 900.74 300.24

45.39
79.45
4.20
12.15
-

240.15
529.73
519.34

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

390.25
860.81
843.93

130.08
286.94
281.31

7.20
17.82
-

247.70
557.32
532.54
227.47
511.80
489.06

185.78
417.99
399.41
170.60
383.85
366.80

61.92
139.33
133.13
56.87
127.95
122.26

9.60
22.93
9.79
23.19
-

453.42
1008.84
408.07
907.96
-

536.68
1207.53
1153.84
492.85
1108.90
1059.63

402.51
905.65
865.38
369.64
831.68
794.72

134.17
301.88
288.46
123.21
277.22
264.91

20.82
49.67
21.19
50.23
-

263.00
591.74
565.45
238.80
537.32
513.44

197.25
443.81
424.09
179.10
402.99
385.08

65.75
147.93
141.36
59.70
134.33
128.36

10.68
25.40
10.14
24.05
-

477.27
1061.95
429.56
955.76
-

569.83
1282.10
1225.14
517.40
1164.19
1112.45

427.37
961.58
918.86
388.05
873.14
834.34

142.46
320.52
306.28
129.35
291.05
278.11

23.14
55.03
21.96
52.11
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Gov't
Pays

Empl.
Pays

Colorado Kaiser Foundation Health Plan of Colorado

651
315.92
318.22 213.37 104.85
High Self
652
713.98
719.18 488.50 230.68
High Self & Family
653
719.18 461.02 258.16
High Self Plus One
654
201.14
214.90 161.18 53.72
Standard Self
655
454.58
485.66 364.25 121.41
Standard Self & Family
656
485.66 364.25 121.41
Standard Self Plus One
Colorado Kaiser Foundation Health Plan of Colorado
N41
143.68
162.00 121.50 40.50
Basic Self
N42
324.71
366.12 274.59 91.53
Basic Self & Family
N43
366.12 274.59 91.53
Basic Self Plus One
Colorado United Healthcare Insurance Company, Inc. (Choice HMO)
KT1
New Plan 244.98 183.74 61.24
High Self
KT2
New Plan 686.93 488.50 198.43
High Self & Family
KT3
New Plan 478.45 358.84 119.61
High Self Plus One
Colorado United Healthcare Insurance Company, Inc. (HDHP Choice Plus)
LU1
New Plan 236.75 177.56 59.19
HDHP Self
LU2
New Plan 663.82 488.50 175.32
HDHP Self & Family
LU3
New Plan 462.35 346.76 115.59
HDHP Self Plus One
Connecticut Aetna Direct
N61
210.05
218.45 163.84 54.61
CDHP Self
N62
474.42
550.93 413.20 137.73
CDHP Self & Family
N63
479.08 359.31 119.77
CDHP Self Plus One

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

-9.06
-34.73
3.44
7.77
-

684.49
1546.96
435.80
984.92
-

689.48 462.30 227.18

1558.22 1058.42 499.80
1558.22 998.88 559.34
465.62 349.22 116.40
1052.26 789.20 263.06
1052.26 789.20 263.06

-19.62
-75.26
7.45
16.83
-

4.58
10.35
-

311.31
703.54
-

351.00
793.26
793.26

9.92
22.43
-

263.25
594.95
594.95

87.75
198.31
198.31

New Plan New Plan 530.79 398.09 132.70

New Plan New Plan 1488.35 1058.42 429.93
New Plan New Plan 1036.64 777.48 259.16

New Plan
New Plan
New Plan

New Plan New Plan 512.96 384.72 128.24

New Plan New Plan 1438.28 1058.42 379.86
New Plan New Plan 1001.76 751.32 250.44

New Plan
New Plan
New Plan

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

354.98
895.26
778.51

118.33
298.42
259.50

4.55
41.44
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Connecticut Aetna HealthFund CDHP and Value Plan

EP1
296.95
353.14
CDHP Self
EP2
674.38
805.37
CDHP Self & Family
EP3
797.39
CDHP Self Plus One
EP4
236.69
243.00
Basic Self
EP5
537.52
556.47
Basic Self & Family
EP6
545.55
Basic Self Plus One
Connecticut Aetna HealthFund HDHP
224
226.86
240.15
HDHP Self
225
496.83
529.73
HDHP Self & Family
226
519.34
HDHP Self Plus One
Delaware Aetna Direct
N61
210.05
218.45
CDHP Self
N62
474.42
550.93
CDHP Self & Family
N63
479.08
CDHP Self Plus One
Delaware Aetna HealthFund CDHP and Value Plan
EP1
296.95
353.14
CDHP Self
EP2
674.38
805.37
CDHP Self & Family
EP3
797.39
CDHP Self Plus One
EP4
236.69
243.00
Basic Self
EP5
537.52
556.47
Basic Self & Family
EP6
545.55
Basic Self Plus One
Delaware Aetna HealthFund HDHP
224
226.86
240.15
HDHP Self
225
496.83
529.73
HDHP Self & Family
226
519.34
HDHP Self Plus One

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

213.37
488.50
461.02
182.25
417.35
409.16

139.77
316.87
336.37
60.75
139.12
136.39

44.83
91.06
1.58
4.74
-

643.39
1461.16
512.83
1164.63
-

765.14 462.30 302.84

1744.97 1058.42 686.55
1727.68 998.88 728.80
526.50 394.88 131.62
1205.69 904.27 301.42
1182.03 886.52 295.51

97.14
197.29
3.41
10.26
-

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

390.25
860.81
843.93

130.08
286.94
281.31

7.20
17.82
-

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

354.98
895.26
778.51

118.33
298.42
259.50

4.55
41.44
-

213.37
488.50
461.02
182.25
417.35
409.16

139.77
316.87
336.37
60.75
139.12
136.39

44.83
91.06
1.58
4.74
-

643.39
1461.16
512.83
1164.63
-

765.14 462.30 302.84

1744.97 1058.42 686.55
1727.68 998.88 728.80
526.50 394.88 131.62
1205.69 904.27 301.42
1182.03 886.52 295.51

97.14
197.29
3.41
10.26
-

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

7.20
17.82
-

390.25
860.81
843.93

Empl.
Pays

Change in
empl.
payment

Gov't
Pays

130.08
286.94
281.31

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Delaware Aetna Open Access

P31
557.69
631.25
High Self
P32
1345.62 1530.47
High Self & Family
P33
1515.32
High Self Plus One
P34
483.10
508.42
Basic Self
P35
1115.54 1180.07
Basic Self & Family
P36
1168.39
Basic Self Plus One
District of Columbia Aetna Direct
N61
210.05
218.45
CDHP Self
N62
474.42
550.93
CDHP Self & Family
N63
479.08
CDHP Self Plus One
District of Columbia Aetna HealthFund CDHP and Value Plan
F51
272.01
298.88
CDHP Self
F52
617.70
681.47
CDHP Self & Family
F53
674.72
CDHP Self Plus One
F54
243.50
250.64
Basic Self
F55
552.96
573.93
Basic Self & Family
F56
562.68
Basic Self Plus One
District of Columbia Aetna HealthFund HDHP
224
226.86
240.15
HDHP Self
225
496.83
529.73
HDHP Self & Family
226
519.34
HDHP Self Plus One

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

213.37
488.50
461.02
213.37
488.50
461.02

417.88
1041.97
1054.30
295.05
691.57
707.37

62.20
144.92
13.96
24.60
-

1208.33
2915.51
1046.72
2417.00
-

1367.71 462.30 905.41

3316.02 1058.42 2257.60
3283.19 998.88 2284.31
1101.58 462.30 639.28
2556.82 1058.42 1498.40
2531.51 998.88 1532.63

134.77
313.99
30.25
53.30
-

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

118.33
298.42
259.50

4.55
41.44
-

213.37
488.50
461.02
187.98
430.45
422.01

85.51
192.97
213.70
62.66
143.48
140.67

15.51
23.84
1.79
5.24
-

589.36
1338.35
527.58
1198.08
-

647.57 462.30 185.27

1476.52 1058.42 418.10
1461.89 998.88 463.01
543.05 407.29 135.76
1243.52 932.64 310.88
1219.14 914.36 304.78

33.60
51.65
3.87
11.36
-

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

7.20
17.82
-

354.98
895.26
778.51

390.25
860.81
843.93

Empl.
Pays

Change in
empl.
payment

Gov't
Pays

130.08
286.94
281.31

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Gov't
Pays

Empl.
Pays

District of Columbia Aetna Open Access

JN1
426.78
442.85 213.37 229.48
High Self
JN2
955.97
995.60 488.50 507.10
High Self & Family
JN3
985.75 461.02 524.73
High Self Plus One
JN4
265.88
275.96 206.97 68.99
Basic Self
JN5
594.52
621.16 465.87 155.29
Basic Self & Family
JN6
608.98 456.74 152.24
Basic Self Plus One
District of Columbia CareFirst BlueChoice
2G1
309.39
321.77 213.37 108.40
High Self
2G2
696.01
764.50 488.50 276.00
High Self & Family
2G3
643.53 461.02 182.51
High Self Plus One
2G4
276.57
287.63 213.37 74.26
Standard Self
2G5
622.18
683.40 488.50 194.90
Standard Self & Family
2G6
575.27 431.45 143.82
Standard Self Plus One
District of Columbia CareFirst BlueChoice
B61
267.85
273.21 204.91 68.30
HDHP Self
B62
597.46
649.15 486.86 162.29
HDHP Self & Family
B63
546.43 409.82 136.61
HDHP Self Plus One
District of Columbia Kaiser Foundation Health Plan Mid-Atlantic States
E31
279.94
285.48 213.37 72.11
High Self
E32
643.87
668.01 488.50 179.51
High Self & Family
E33
645.17 461.02 184.15
High Self Plus One
E34
181.53
214.96 161.22 53.74
Standard Self
E35
417.50
503.01 377.26 125.75
Standard Self & Family
E36
485.80 364.35 121.45
Standard Self Plus One

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

4.71
-0.30
2.52
6.66
-

924.69
2071.27
576.07
1288.13
-

959.51 462.30 497.21

2157.13 1058.42 1098.71
2135.79 998.88 1136.91
597.91 448.43 149.48
1345.85 1009.39 336.46
1319.46 989.60 329.86

10.21
-0.66
5.46
14.43
-

1.02
28.56
-0.30
21.29
-

670.35
1508.02
599.24
1348.06
-

697.17 462.30 234.87

1656.42 1058.42 598.00
1394.32 998.88 395.44
623.20 462.30 160.90
1480.70 1058.42 422.28
1246.42 934.82 311.60

2.21
61.88
-0.65
46.12
-

1.34
12.93
-

580.34
1294.50
-

591.96 443.97 147.99

1406.49 1054.87 351.62
1183.93 887.95 295.98

2.91
28.00
-

-5.82
-15.79
8.36
21.38
-

606.54
1395.05
393.32
904.58
-

618.54 462.30 156.24

1447.36 1058.42 388.94
1397.87 998.88 398.99
465.75 349.31 116.44
1089.86 817.40 272.46
1052.57 789.43 263.14

-12.61
-34.21
18.11
46.32
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

District of Columbia M.D. IPA

JP1
314.55
295.87 213.37 82.50
-30.04
681.53
High Self
JP2
725.30
829.62 488.50 341.12
64.39
1571.48
High Self & Family
JP3
577.83 433.37 144.46
High Self Plus One
District of Columbia United Healthcare Insurance Company, Inc. (Choice HMO)
LR1
New Plan 245.13 183.85 61.28 New Plan New Plan
High Self
LR2
New Plan 687.35 488.50 198.85 New Plan New Plan
High Self & Family
LR3
New Plan 478.74 359.06 119.68 New Plan New Plan
High Self Plus One
District of Columbia UnitedHealthcare Insurance Company
L91
244.32
212.71 159.53 53.18
-7.90
529.36
Basic Self
L92
543.61
596.45 447.34 149.11
13.21
1177.82
Basic Self & Family
L93
415.43 311.57 103.86
Basic Self Plus One
Florida Aetna Direct
N61
210.05
218.45 163.84 54.61
2.10
455.11
CDHP Self
N62
474.42
550.93 413.20 137.73
19.13
1027.91
CDHP Self & Family
N63
479.08 359.31 119.77
CDHP Self Plus One
Florida Aetna HealthFund CDHP and Value Plan
F51
272.01
298.88 213.37 85.51
15.51
589.36
CDHP Self
F52
617.70
681.47 488.50 192.97
23.84
1338.35
CDHP Self & Family
F53
674.72 461.02 213.70
CDHP Self Plus One
F54
243.50
250.64 187.98 62.66
1.79
527.58
Basic Self
F55
552.96
573.93
430.45
143.48
5.24
1198.08
Basic Self & Family
F56
562.68 422.01 140.67
Basic Self Plus One
Florida Aetna HealthFund HDHP
224
226.86
240.15 180.11 60.04
3.33
491.53
HDHP Self
225
496.83
529.73 397.30 132.43
8.22
1076.47
HDHP Self & Family
226
519.34 389.51 129.83
HDHP Self Plus One

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

641.05 462.30 178.75

1797.51 1058.42 739.09
1251.97 938.98 312.99

-65.09
139.51
-

531.12 398.34 132.78

1489.26 1058.42 430.84
1037.27 777.95 259.32

New Plan
New Plan
New Plan

460.87
1292.31
900.10

345.65
969.23
675.08

115.22
323.08
225.02

-17.12
28.63
-

473.31
1193.68
1038.01

354.98
895.26
778.51

118.33
298.42
259.50

4.55
41.44
-

647.57 462.30 185.27

1476.52 1058.42 418.10
1461.89 998.88 463.01
543.05 407.29 135.76
1243.52 932.64 310.88
1219.14 914.36 304.78

33.60
51.65
3.87
11.36
-

520.33
1147.75
1125.24

7.20
17.82
-

390.25
860.81
843.93

130.08
286.94
281.31

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Florida AvMed Health Plans

ML1
299.98
High Self
ML2
719.99
High Self & Family
ML3
High Self Plus One
ML4
241.87
Standard Self
ML5
580.55
Standard Self & Family
ML6
Standard Self Plus One
Florida Capital Health Plan
EA1
237.30
High Self
EA2
628.85
High Self & Family
EA3
High Self Plus One
Florida Humana CoverageFirst and Value Plan
MJ1
272.07
CDHP Self
MJ2
605.37
CDHP Self & Family
MJ3
CDHP Self Plus One
MJ4
198.87
Basic Self
MJ5
442.49
Basic Self & Family
MJ6
Basic Self Plus One
Florida Humana CoverageFirst and Value Plan
QP1
233.21
CDHP Self
QP2
518.89
CDHP Self & Family
QP3
CDHP Self Plus One
QP4
198.87
Basic Self
QP5
442.49
Basic Self & Family
QP6
Basic Self Plus One

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Gov't
Pays

Empl.
Pays

347.11
899.12
694.22
272.83
706.74
545.69

213.37
488.50
461.02
204.62
488.50
409.27

133.74
410.62
233.20
68.21
218.24
136.42

35.77
139.20
7.74
73.10
-

649.96
1559.98
524.05
1257.86
-

752.07 462.30 289.77

1948.09 1058.42 889.67
1504.14 998.88 505.26
591.13 443.35 147.78
1531.27 1058.42 472.85
1182.33 886.75 295.58

77.50
301.59
16.77
158.39
-

254.52
687.19
509.03

190.89 63.63
488.50 198.69
381.77 127.26

4.31
18.41
-

514.15
1362.51
-

551.46 413.60 137.86

1488.91 1058.42 430.49
1102.90 827.18 275.72

9.32
39.88
-

305.78
688.02
657.45
215.28
484.37
462.84

213.37
488.50
461.02
161.46
363.28
347.13

92.41
199.52
196.43
53.82
121.09
115.71

22.35
42.72
4.10
10.47
-

589.49
1311.64
430.89
958.73
-

662.52 462.30 200.22

1490.71 1058.42 432.29
1424.48 998.88 425.60
466.44 349.83 116.61
1049.47 787.10 262.37
1002.82 752.12 250.70

48.42
92.55
8.89
22.69
-

266.44
599.47
572.83
215.28
484.37
462.84

199.83
449.60
429.62
161.46
363.28
347.13

66.61
149.87
143.21
53.82
121.09
115.71

8.31
20.15
4.10
10.47
-

505.29
1124.26
430.89
958.73
-

577.29
1298.85
1241.13
466.44
1049.47
1002.82

18.00
43.65
8.89
22.69
-

432.97
974.14
930.85
349.83
787.10
752.12

Empl.
Pays

Change in
empl.
payment

Total
Premium

144.32
324.71
310.28
116.61
262.37
250.70

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

Florida Humana Medical Plan, Inc.

E21
High Self
E22
High Self & Family
E23
High Self Plus One
E24
Standard Self
E25
Standard Self & Family
E26
Standard Self Plus One
Florida Humana Medical Plan, Inc.
EE1
High Self
EE2
High Self & Family
EE3
High Self Plus One
EE4
Standard Self
EE5
Standard Self & Family
EE6
Standard Self Plus One
Florida Humana Medical Plan, Inc.
EX1
High Self
EX2
High Self & Family
EX3
High Self Plus One
EX4
Standard Self
EX5
Standard Self & Family
EX6
Standard Self Plus One

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

Total
Premium

Gov't
Pays

Empl.
Pays

244.75
544.58
220.28
490.12
-

277.58
624.54
596.78
262.86
591.43
565.15

208.19
468.41
447.59
197.15
443.57
423.86

69.39
156.13
149.19
65.71
147.86
141.29

8.20
19.99
10.64
25.33
-

530.29
1179.92
477.27
1061.93
-

601.42 451.07 150.35

1353.17 1014.88 338.29
1293.02 969.77 323.25
569.53 427.15 142.38
1281.43 961.07 320.36
1224.49 918.37 306.12

17.78
43.31
23.06
54.88
-

321.70
715.78
275.32
612.59
-

389.81
877.08
838.10
313.98
706.44
675.04

213.37
488.50
461.02
213.37
488.50
461.02

176.44
388.58
377.08
100.61
217.94
214.02

56.75
121.37
27.30
53.92
-

697.02
1550.86
596.53
1327.28
-

844.59 462.30 382.29

1900.34 1058.42 841.92
1815.88 998.88 817.00
680.29 462.30 217.99
1530.62 1058.42 472.20
1462.59 998.88 463.71

122.96
262.96
59.15
116.82
-

260.05
578.61
234.05
520.76
-

299.88
674.74
644.75
273.72
615.87
588.49

213.37
488.50
461.02
205.29
461.90
441.37

86.51
186.24
183.73
68.43
153.97
147.12

21.50
41.59
9.92
23.78
-

563.44
1253.66
507.11
1128.31
-

649.74 462.30 187.44

1461.94 1058.42 403.52
1396.96 998.88 398.08
593.06 444.80 148.26
1334.39 1000.79 333.60
1275.06 956.30 318.76

46.58
90.11
21.48
51.52
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Florida Humana Medical Plan, Inc.

LL1
472.12
High Self
LL2
1050.46
High Self & Family
LL3
High Self Plus One
LL4
275.35
Standard Self
LL5
612.65
Standard Self & Family
LL6
Standard Self Plus One
Florida UnitedHealthcare Insurance Company
LV1
254.82
Basic Self
LV2
566.98
Basic Self & Family
LV3
Basic Self Plus One
Georgia Aetna Direct
N61
210.05
CDHP Self
N62
474.42
CDHP Self & Family
N63
CDHP Self Plus One
Georgia Aetna HealthFund CDHP and Value Plan
F51
272.01
CDHP Self
F52
617.70
CDHP Self & Family
F53
CDHP Self Plus One
F54
243.50
Basic Self
F55
552.96
Basic Self & Family
F56
Basic Self Plus One
Georgia Aetna HealthFund HDHP
224
226.86
HDHP Self
225
496.83
HDHP Self & Family
226
HDHP Self Plus One

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Gov't
Pays

Empl.
Pays

606.75
1365.20
1304.51
319.76
719.45
687.49

213.37
488.50
461.02
213.37
488.50
461.02

393.38
876.70
843.49
106.39
230.95
226.47

123.27
274.81
33.05
66.87
-

1022.93
2276.00
596.59
1327.41
-

1314.63 462.30 852.33

2957.93 1058.42 1899.51
2826.44 998.88 1827.56
692.81 462.30 230.51
1558.81 1058.42 500.39
1489.56 998.88 490.68

267.09
595.41
71.61
144.88
-

242.80
680.83
474.20

182.10 60.70
488.50 192.33
355.65 118.55

-3.00
50.59
-

552.11
1228.46
-

526.07 394.55 131.52

1475.13 1058.42 416.71
1027.43 770.57 256.86

-6.51
109.60
-

218.45
550.93
479.08

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

118.33
298.42
259.50

4.55
41.44
-

298.88
681.47
674.72
250.64
573.93
562.68

213.37
488.50
461.02
187.98
430.45
422.01

85.51
192.97
213.70
62.66
143.48
140.67

15.51
23.84
1.79
5.24
-

589.36
1338.35
527.58
1198.08
-

647.57 462.30 185.27

1476.52 1058.42 418.10
1461.89 998.88 463.01
543.05 407.29 135.76
1243.52 932.64 310.88
1219.14 914.36 304.78

33.60
51.65
3.87
11.36
-

240.15
529.73
519.34

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

7.20
17.82
-

354.98
895.26
778.51

390.25
860.81
843.93

Empl.
Pays

Change in
empl.
payment

Total
Premium

130.08
286.94
281.31

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Georgia Aetna Open Access

2U1
446.24
505.45
High Self
2U2
1023.98 1164.27
High Self & Family
2U3
1152.74
High Self Plus One
Georgia Humana CoverageFirst and Value Plan
AD1
259.13
283.43
CDHP Self
AD2
576.54
637.72
CDHP Self & Family
AD3
609.37
CDHP Self Plus One
AD4
198.87
215.28
Basic Self
AD5
442.49
484.37
Basic Self & Family
AD6
462.84
Basic Self Plus One
Georgia Humana CoverageFirst and Value Plan
LM1
259.13
272.15
CDHP Self
LM2
576.54
612.33
CDHP Self & Family
LM3
585.11
CDHP Self Plus One
LM4
198.87
215.28
Basic Self
LM5
442.49
484.37
Basic Self & Family
LM6
462.84
Basic Self Plus One
Georgia Humana Employers Health of Georgia, Inc.
CB1
275.35
314.30
High Self
CB2
612.64
707.17
High Self & Family
CB3
675.74
High Self Plus One
CB4
261.58
298.36
Standard Self
CB5
582.02
671.31
Standard Self & Family
CB6
641.47
Standard Self Plus One

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

213.37 292.08
488.50 675.77
461.02 691.72

47.85
100.36
-

966.85
2218.62
-

1095.14 462.30 632.84

2522.59 1058.42 1464.17
2497.60 998.88 1498.72

103.68
217.45
-

212.57
478.29
457.03
161.46
363.28
347.13

70.86
159.43
152.34
53.82
121.09
115.71

6.08
15.30
4.10
10.47
-

561.45
1249.17
430.89
958.73
-

614.10 460.58 153.52

1381.73 1036.30 345.43
1320.30 990.23 330.07
466.44 349.83 116.61
1049.47 787.10 262.37
1002.82 752.12 250.70

13.16
33.14
8.89
22.69
-

204.11
459.25
438.83
161.46
363.28
347.13

68.04
153.08
146.28
53.82
121.09
115.71

3.26
8.95
4.10
10.47
-

561.45
1249.17
430.89
958.73
-

589.66
1326.72
1267.74
466.44
1049.47
1002.82

147.41
331.68
316.93
116.61
262.37
250.70

7.05
19.39
8.89
22.69
-

213.37
488.50
461.02
213.37
488.50
461.02

100.93
218.67
214.72
84.99
182.81
180.45

27.59
54.60
19.60
37.31
-

596.59
1327.39
566.76
1261.04
-

680.98 462.30 218.68

1532.20 1058.42 473.78
1464.10 998.88 465.22
646.45 462.30 184.15
1454.51 1058.42 396.09
1389.85 998.88 390.97

59.78
118.29
42.46
80.83
-

442.25
995.04
950.81
349.83
787.10
752.12

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Georgia Humana Employers Health of Georgia, Inc.

DG1
298.01
High Self
DG2
663.07
High Self & Family
DG3
High Self Plus One
DG4
275.35
Standard Self
DG5
612.65
Standard Self & Family
DG6
Standard Self Plus One
Georgia Humana Employers Health of Georgia, Inc.
DN1
275.35
High Self
DN2
612.64
High Self & Family
DN3
High Self Plus One
DN4
261.58
Standard Self
DN5
582.02
Standard Self & Family
DN6
Standard Self Plus One
Georgia Kaiser Foundation Health Plan of Georgia
F81
271.66
High Self
F82
620.76
High Self & Family
F83
High Self Plus One
F84
200.69
Standard Self
F85
458.58
Standard Self & Family
F86
Standard Self Plus One
Georgia UnitedHealthcare Insurance Company
LV1
254.82
Basic Self
LV2
566.98
Basic Self & Family
LV3
Basic Self Plus One

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

Total
Premium

Gov't
Pays

Empl.
Pays

374.12
841.78
804.35
312.03
702.07
670.87

213.37
488.50
461.02
213.37
488.50
461.02

160.75
353.28
343.33
98.66
213.57
209.85

64.75
138.78
25.32
49.49
-

645.69
1436.65
596.59
1327.41
-

810.59 462.30 348.29

1823.86 1058.42 765.44
1742.76 998.88 743.88
676.07 462.30 213.77
1521.15 1058.42 462.73
1453.55 998.88 454.67

140.29
300.69
54.87
107.22
-

311.03
699.84
668.73
297.80
670.05
640.27

213.37
488.50
461.02
213.37
488.50
461.02

97.66
211.34
207.71
84.43
181.55
179.25

24.32
47.27
19.04
36.05
-

596.59
1327.39
566.76
1261.04
-

673.90 462.30 211.60

1516.32 1058.42 457.90
1448.92 998.88 450.04
645.23 462.30 182.93
1451.78 1058.42 393.36
1387.25 998.88 388.37

52.70
102.41
41.24
78.10
-

287.15
656.17
637.51
214.72
493.83
478.81

213.37
488.50
461.02
161.04
370.37
359.11

73.78
167.67
176.49
53.68
123.46
119.70

4.13
-4.52
3.51
8.82
-

588.60
1344.98
434.83
993.59
-

622.16 462.30 159.86

1421.70 1058.42 363.28
1381.27 998.88 382.39
465.23 348.92 116.31
1069.97 802.48 267.49
1037.42 778.07 259.35

8.95
-9.80
7.60
19.09
-

242.80
680.83
474.20

182.10 60.70
488.50 192.33
355.65 118.55

-3.00
50.59
-

552.11
1228.46
-

526.07 394.55 131.52

1475.13 1058.42 416.71
1027.43 770.57 256.86

-6.51
109.60
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)

2016 Biweekly premium rates

Plan - Option - Enrollment Code

Guam Calvos Selectcare

High Self
High Self & Family
High Self Plus One
Standard Self
Standard Self & Family
Standard Self Plus One
Guam TakeCare
High Self
High Self & Family
High Self Plus One
Standard Self
Standard Self & Family
Standard Self Plus One
Guam TakeCare
HDHP Self
HDHP Self & Family
HDHP Self Plus One
Hawaii Aetna Direct
CDHP Self
CDHP Self & Family
CDHP Self Plus One

2015 Total
Biweekly
Premium

Total
Premium

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

290.54
776.75
566.95
267.36
714.83
521.74

B41
B42
B43
B44
B45
B46

195.03
532.08
168.73
460.00
-

178.79
478.00
348.89
164.53
439.89
321.07

134.09 44.70
358.50 119.50
261.67 87.22
123.40 41.13
329.92 109.97
240.80 80.27

-4.06
-13.52
-1.05
-5.03
-

422.57
1152.84
365.58
996.67
-

387.38
1035.67
755.93
356.48
953.10
695.65

96.84
258.92
188.98
89.12
238.27
173.91

-8.80
-29.29
-2.27
-10.90
-

JK1
JK2
JK3
JK4
JK5
JK6

205.73
540.62
171.92
454.01
-

243.00
728.99
485.99
167.22
500.01
332.78

182.25 60.75
488.50 240.49
364.49 121.50
125.42 41.80
375.01 125.00
249.59 83.19

9.32
105.34
-1.18
11.50
-

445.75
1171.34
372.49
983.69
-

526.50 394.88 131.62

1579.48 1058.42 521.06
1052.98 789.74 263.24
362.31 271.73 90.58
1083.36 812.52 270.84
721.02 540.77 180.25

20.18
228.23
-2.54
24.92
-

KX1
KX2
KX3

89.04
233.54
-

76.38
223.94
159.48

57.29
167.96
119.61

19.09
55.98
39.87

-3.17
-2.40
-

192.92
506.00
-

165.49
485.20
345.54

124.12
363.90
259.16

41.37
121.30
86.38

-6.86
-5.20
-

N61
N62
N63

210.05
474.42
-

218.45
550.93
479.08

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

354.98
895.26
778.51

118.33
298.42
259.50

4.55
41.44
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Hawaii Aetna HealthFund CDHP and Value Plan

JS1
340.51
CDHP Self
JS2
773.27
CDHP Self & Family
JS3
CDHP Self Plus One
JS4
279.09
Basic Self
JS5
633.78
Basic Self & Family
JS6
Basic Self Plus One
Hawaii Aetna HealthFund HDHP
224
226.86
HDHP Self
225
496.83
HDHP Self & Family
226
HDHP Self Plus One
Hawaii HMSA
871
230.00
High Self
872
511.96
High Self & Family
873
High Self Plus One
Hawaii Kaiser Foundation Health Plan of Hawaii
631
243.84
High Self
632
543.75
High Self & Family
633
High Self Plus One
634
168.28
Standard Self
635
375.26
Standard Self & Family
636
Standard Self Plus One
Idaho Aetna Direct
N61
210.05
CDHP Self
N62
474.42
CDHP Self & Family
N63
CDHP Self Plus One

Total
Premium

Gov't
Pays

Empl.
Pays

403.55
919.90
910.79
301.31
687.86
681.04

213.37
488.50
461.02
213.37
488.50
461.02

190.18
431.40
449.77
87.94
199.36
220.02

240.15
529.73
519.34

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

51.68
106.70
10.86
14.15
-

737.77
1675.42
604.70
1373.19
-

874.36 462.30 412.06

1993.12 1058.42 934.70
1973.38 998.88 974.50
652.84 462.30 190.54
1490.36 1058.42 431.94
1475.59 998.88 476.71

111.98
231.18
23.53
30.65
-

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

390.25
860.81
843.93

130.08
286.94
281.31

7.20
17.82
-

259.39
583.10
568.32

194.54 64.85
437.33 145.77
426.24 142.08

7.35
17.78
-

498.33
1109.25
-

562.01
1263.38
1231.36

421.51
947.54
923.52

140.50
315.84
307.84

15.92
38.53
-

263.95
588.62
588.62
181.20
404.08
404.08

197.96
441.47
441.47
135.90
303.06
303.06

65.99
147.15
147.15
45.30
101.02
101.02

5.03
11.21
3.23
7.21
-

528.32
1178.13
364.61
813.06
-

571.89
1275.34
1275.34
392.60
875.51
875.51

428.92
956.51
956.51
294.45
656.63
656.63

142.97
318.83
318.83
98.15
218.88
218.88

10.89
24.30
7.00
15.62
-

218.45
550.93
479.08

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

354.98
895.26
778.51

118.33
298.42
259.50

4.55
41.44
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Idaho Aetna Health of Utah, Inc. dba Altius Health Plans

9K1
299.68
314.79
High Self
9K2
659.33
696.14
High Self & Family
9K3
689.25
High Self Plus One
9K4
168.74
170.28
HDHP Self
9K5
349.58
355.88
HDHP Self & Family
9K6
348.90
HDHP Self Plus One
Idaho Aetna Health of Utah, Inc. dba Altius Health Plans
DK4
225.43
229.98
Standard Self
DK5
495.93
507.85
Standard Self & Family
DK6
502.83
Standard Self Plus One
Idaho Aetna HealthFund CDHP and Value Plan
H41
276.95
312.68
CDHP Self
H42
628.94
712.76
CDHP Self & Family
H43
705.70
CDHP Self Plus One
H44
244.12
247.72
Basic Self
H45
554.39
568.54
Basic Self & Family
H46
557.39
Basic Self Plus One
Idaho Aetna HealthFund HDHP
224
226.86
240.15
HDHP Self
225
496.83
529.73
HDHP Self & Family
226
519.34
HDHP Self Plus One

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

213.37 101.42
488.50 207.64
461.02 228.23
127.71 42.57
266.91 88.97
261.68 87.22

3.75
-3.12
0.39
1.58
-

649.31
1428.55
365.60
757.42
-

682.05 462.30 219.75

1508.30 1058.42 449.88
1493.38 998.88 494.50
368.94 276.71 92.23
771.07 578.30 192.77
755.95 566.96 188.99

8.13
-6.77
0.83
3.42
-

172.49 57.49
380.89 126.96
377.12 125.71

1.13
2.98
-

488.43
1074.52
-

498.29
1100.34
1089.47

124.57
275.08
272.37

2.46
6.45
-

213.37
488.50
461.02
185.79
426.41
418.04

99.31
224.26
244.68
61.93
142.13
139.35

24.37
43.89
0.90
3.53
-

600.06
1362.70
528.93
1201.18
-

677.47 462.30 215.17

1544.31 1058.42 485.89
1529.02 998.88 530.14
536.73 402.55 134.18
1231.84 923.88 307.96
1207.68 905.76 301.92

52.80
95.09
1.95
7.67
-

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

7.20
17.82
-

373.72
825.26
817.10

390.25
860.81
843.93

130.08
286.94
281.31

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

Idaho Group Health Cooperative

541
High Self
542
High Self & Family
543
High Self Plus One
544
Standard Self
545
Standard Self & Family
546
Standard Self Plus One
Idaho Group Health Cooperative
PT1
HDHP Self
PT2
HDHP Self & Family
PT3
HDHP Self Plus One
Idaho SelectHealth
SF1
High Self
SF2
High Self & Family
SF3
High Self Plus One
SF4
Standard Self
SF5
Standard Self & Family
SF6
Standard Self Plus One
Illinois Aetna Direct
N61
CDHP Self
N62
CDHP Self & Family
N63
CDHP Self Plus One

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

324.42
697.50
222.70
502.76
-

327.13
883.24
654.25
234.07
632.01
468.15

213.37
488.50
461.02
175.55
474.01
351.11

113.76
394.74
193.23
58.52
158.00
117.04

New Plan
New Plan
New Plan

218.70
590.50
437.40

164.03 54.67
442.88 147.62
328.05 109.35

293.90
655.62
229.58
512.14
-

317.43
708.06
708.06
236.46
525.08
525.08

213.37
488.50
461.02
177.35
393.81
393.81

104.06
219.56
247.04
59.11
131.27
131.27

12.17
12.51
1.72
3.24
-

636.78
1420.51
497.42
1109.64
-

687.77 462.30 225.47

1534.13 1058.42 475.71
1534.13 998.88 535.25
512.33 384.25 128.08
1137.67 853.25 284.42
1137.67 853.25 284.42

26.38
27.10
3.73
7.01
-

210.05
474.42
-

218.45
550.93
479.08

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

4.55
41.44
-

-8.65
145.81
2.85
32.31
-

702.91
1511.25
482.52
1089.31
-

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

Total
Premium

708.78 462.30 246.48

1913.69 1058.42 855.27
1417.54 998.88 418.66
507.15 380.36 126.79
1369.36 1027.02 342.34
1014.33 760.75 253.58

New Plan New Plan 473.85

New Plan New Plan 1279.42
New Plan New Plan 947.70

355.39
959.57
710.78

354.98
895.26
778.51

118.46
319.85
236.92

118.33
298.42
259.50

-18.74
315.92
6.16
70.01
New Plan
New Plan
New Plan

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Illinois Aetna HealthFund CDHP and Value Plan

H41
276.95
CDHP Self
H42
628.94
CDHP Self & Family
H43
CDHP Self Plus One
H44
244.12
Basic Self
H45
554.39
Basic Self & Family
H46
Basic Self Plus One
Illinois Aetna HealthFund HDHP
224
226.86
HDHP Self
225
496.83
HDHP Self & Family
226
HDHP Self Plus One
Illinois Blue Cross and Blue Shield of Illinois
A21
355.07
High Self
A22
806.05
High Self & Family
A23
High Self Plus One
Illinois Blue Preferred Plus POS
9G1
401.19
High Self
9G2
802.39
High Self & Family
9G3
High Self Plus One
Illinois Health Alliance HMO
FX1
341.84
High Self
FX2
796.84
High Self & Family
FX3
High Self Plus One
Illinois Health Alliance HMO
K84
290.48
Standard Self
K85
677.12
Standard Self & Family
K86
Standard Self Plus One

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Gov't
Pays

Empl.
Pays

312.68
712.76
705.70
247.72
568.54
557.39

213.37
488.50
461.02
185.79
426.41
418.04

99.31
224.26
244.68
61.93
142.13
139.35

24.37
43.89
0.90
3.53
-

600.06
1362.70
528.93
1201.18
-

677.47 462.30 215.17

1544.31 1058.42 485.89
1529.02 998.88 530.14
536.73 402.55 134.18
1231.84 923.88 307.96
1207.68 905.76 301.92

52.80
95.09
1.95
7.67
-

240.15
529.73
519.34

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

130.08
286.94
281.31

7.20
17.82
-

337.21
836.02
728.89

213.37 123.84
488.50 347.52
461.02 267.87

-29.22
-9.96
-

769.32
1746.44
-

730.62 462.30 268.32

1811.38 1058.42 752.96
1579.26 998.88 580.38

-63.31
-21.58
-

311.98
665.10
623.97

213.37 98.61
488.50 176.60
461.02 162.95

-100.57
-177.22
-

869.25
1738.51
-

675.96 462.30 213.66

1441.05 1058.42 382.63
1351.94 998.88 353.06

-217.90
-383.98
-

351.45
994.51
738.04

213.37 138.08
488.50 506.01
461.02 277.02

-1.75
157.74
-

740.65
1726.49
-

761.48 462.30 299.18

2154.77 1058.42 1096.35
1599.09 998.88 600.21

-3.78
341.76
-

288.42
800.36
605.69

213.37 75.05
488.50 311.86
454.27 151.42

-13.42
83.31
-

629.37
1467.09
-

624.91 462.30 162.61

1734.11 1058.42 675.69
1312.33 984.25 328.08

-29.07
180.50
-

390.25
860.81
843.93

Empl.
Pays

Change in
empl.
payment

Total
Premium

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Illinois Humana CoverageFirst and Value Plan

GB1
259.13
CDHP Self
GB2
576.54
CDHP Self & Family
GB3
CDHP Self Plus One
GB4
198.87
Basic Self
GB5
442.49
Basic Self & Family
GB6
Basic Self Plus One
Illinois Humana CoverageFirst and Value Plan
MW1
259.13
CDHP Self
MW2
576.54
CDHP Self & Family
MW3
CDHP Self Plus One
MW4
198.87
Basic Self
MW5
442.49
Basic Self & Family
MW6
Basic Self Plus One
Illinois Humana Health Plan, Inc.
751
449.90
High Self
752
1001.04
High Self & Family
753
High Self Plus One
754
275.35
Standard Self
755
612.65
Standard Self & Family
756
Standard Self Plus One
Illinois Humana Health Plan, Inc.
9F1
541.68
High Self
9F2
1205.24
High Self & Family
9F3
High Self Plus One

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

Total
Premium

Gov't
Pays

Empl.
Pays

291.97
656.92
627.72
215.28
484.37
462.84

213.37
488.50
461.02
161.46
363.28
347.13

78.60
168.42
166.70
53.82
121.09
115.71

13.82
24.29
4.10
10.47
-

561.45
1249.17
430.89
958.73
-

632.60 462.30 170.30

1423.33 1058.42 364.91
1360.06 998.88 361.18
466.44 349.83 116.61
1049.47 787.10 262.37
1002.82 752.12 250.70

29.94
52.62
8.89
22.69
-

308.79
694.77
663.89
215.28
484.37
462.84

213.37
488.50
461.02
161.46
363.28
347.13

95.42
206.27
202.87
53.82
121.09
115.71

30.64
62.14
4.10
10.47
-

561.45
1249.17
430.89
958.73
-

669.05 462.30 206.75

1505.34 1058.42 446.92
1438.43 998.88 439.55
466.44 349.83 116.61
1049.47 787.10 262.37
1002.82 752.12 250.70

66.39
134.63
8.89
22.69
-

554.20
1246.96
1191.53
344.87
775.96
741.48

213.37
488.50
461.02
213.37
488.50
461.02

340.83
758.46
730.51
131.50
287.46
280.46

92.94
205.99
58.16
123.38
-

974.78
2168.92
596.59
1327.41
-

1200.77 462.30 738.47

2701.75 1058.42 1643.33
2581.65 998.88 1582.77
747.22 462.30 284.92
1681.25 1058.42 622.83
1606.54 998.88 607.66

201.38
446.31
126.02
267.32
-

688.02 213.37 474.65

1548.06 488.50 1059.56
1479.25 461.02 1018.23

134.98
302.89
-

1173.64
2611.35
-

1490.71 462.30 1028.41

3354.13 1058.42 2295.71
3205.04 998.88 2206.16

292.46
656.26
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Illinois Humana Health Plan, Inc.

AB4
281.14
361.84
Standard Self
AB5
625.55
814.15
Standard Self & Family
AB6
777.95
Standard Self Plus One
Illinois Union Health Service
761
257.46
275.92
High Self
762
597.92
685.76
High Self & Family
763
603.48
High Self Plus One
Illinois UnitedHealthcare Insurance Company
L91
244.32
212.71
Basic Self
L92
543.61
596.45
Basic Self & Family
L93
415.43
Basic Self Plus One
Illinois UnitedHealthcare Plan of the River Valley Inc.
YH1
269.36
288.17
High Self
YH2
636.34
808.04
High Self & Family
YH3
562.81
High Self Plus One
Indiana Aetna Direct
N61
210.05
218.45
CDHP Self
N62
474.42
550.93
CDHP Self & Family
N63
479.08
CDHP Self Plus One
Indiana Aetna HealthFund CDHP and Value Plan
JS1
340.51
403.55
CDHP Self
JS2
773.27
919.90
CDHP Self & Family
JS3
910.79
CDHP Self Plus One
JS4
279.09
301.31
Basic Self
JS5
633.78
687.86
Basic Self & Family
JS6
681.04
Basic Self Plus One

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

213.37 148.47
488.50 325.65
461.02 316.93

69.34
148.67
-

609.14
1355.36
-

783.99 462.30 321.69

1763.99 1058.42 705.57
1685.56 998.88 686.68

150.24
322.11
-

206.94 68.98
488.50 197.26
452.61 150.87

4.62
47.78
-

557.83
1295.49
-

597.83 448.37 149.46

1485.81 1058.42 427.39
1307.54 980.66 326.88

10.00
103.52
-

159.53 53.18
447.34 149.11
311.57 103.86

-7.90
13.21
-

529.36
1177.82
-

460.87
1292.31
900.10

115.22
323.08
225.02

-17.12
28.63
-

213.37 74.80
488.50 319.54
422.11 140.70

7.45
131.77
-

583.61
1378.74
-

624.37 462.30 162.07

1750.75 1058.42 692.33
1219.42 914.57 304.85

16.15
285.49
-

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

118.33
298.42
259.50

4.55
41.44
-

213.37
488.50
461.02
213.37
488.50
461.02

51.68
106.70
10.86
14.15
-

737.77
1675.42
604.70
1373.19
-

874.36 462.30 412.06

1993.12 1058.42 934.70
1973.38 998.88 974.50
652.84 462.30 190.54
1490.36 1058.42 431.94
1475.59 998.88 476.71

111.98
231.18
23.53
30.65
-

190.18
431.40
449.77
87.94
199.36
220.02

345.65
969.23
675.08

354.98
895.26
778.51

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Indiana Aetna HealthFund HDHP

224
226.86
HDHP Self
225
496.83
HDHP Self & Family
226
HDHP Self Plus One
Indiana Health Alliance HMO
FX1
341.84
High Self
FX2
796.84
High Self & Family
FX3
High Self Plus One
Indiana Health Alliance HMO
K84
290.48
Standard Self
K85
677.12
Standard Self & Family
K86
Standard Self Plus One
Indiana Humana CoverageFirst and Value Plan
MW1
259.13
CDHP Self
MW2
576.54
CDHP Self & Family
MW3
CDHP Self Plus One
MW4
198.87
Basic Self
MW5
442.49
Basic Self & Family
MW6
Basic Self Plus One
Indiana Humana Health Plan of Ohio
A61
275.35
High Self
A62
612.64
High Self & Family
A63
High Self Plus One
A64
261.58
Standard Self
A65
582.02
Standard Self & Family
A66
Standard Self Plus One

Total
Premium

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

390.25
860.81
843.93

240.15
529.73
519.34

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

130.08
286.94
281.31

7.20
17.82
-

351.45
994.51
738.04

213.37 138.08
488.50 506.01
461.02 277.02

-1.75
157.74
-

740.65
1726.49
-

761.48 462.30 299.18

2154.77 1058.42 1096.35
1599.09 998.88 600.21

-3.78
341.76
-

288.42
800.36
605.69

213.37 75.05
488.50 311.86
454.27 151.42

-13.42
83.31
-

629.37
1467.09
-

624.91 462.30 162.61

1734.11 1058.42 675.69
1312.33 984.25 328.08

-29.07
180.50
-

308.79
694.77
663.89
215.28
484.37
462.84

213.37
488.50
461.02
161.46
363.28
347.13

95.42
206.27
202.87
53.82
121.09
115.71

30.64
62.14
4.10
10.47
-

561.45
1249.17
430.89
958.73
-

669.05 462.30 206.75

1505.34 1058.42 446.92
1438.43 998.88 439.55
466.44 349.83 116.61
1049.47 787.10 262.37
1002.82 752.12 250.70

66.39
134.63
8.89
22.69
-

349.02
785.30
750.40
294.73
663.14
633.66

213.37
488.50
461.02
213.37
488.50
461.02

135.65
296.80
289.38
81.36
174.64
172.64

62.31
132.73
15.97
29.14
-

596.59
1327.39
566.76
1261.04
-

756.21 462.30 293.91

1701.48 1058.42 643.06
1625.87 998.88 626.99
638.58 462.30 176.28
1436.80 1058.42 378.38
1372.93 998.88 374.05

135.01
287.57
34.59
63.12
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Indiana Humana Health Plan, Inc.

751
449.90
High Self
752
1001.04
High Self & Family
753
High Self Plus One
754
275.35
Standard Self
755
612.65
Standard Self & Family
756
Standard Self Plus One
Indiana Humana Health Plan, Inc.
MH1
275.35
High Self
MH2
612.64
High Self & Family
MH3
High Self Plus One
MH4
261.58
Standard Self
MH5
582.02
Standard Self & Family
MH6
Standard Self Plus One
Iowa Aetna Direct
N61
210.05
CDHP Self
N62
474.42
CDHP Self & Family
N63
CDHP Self Plus One
Iowa Aetna HealthFund CDHP and Value Plan
H41
276.95
CDHP Self
H42
628.94
CDHP Self & Family
H43
CDHP Self Plus One
H44
244.12
Basic Self
H45
554.39
Basic Self & Family
H46
Basic Self Plus One

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

554.20
1246.96
1191.53
344.87
775.96
741.48

213.37
488.50
461.02
213.37
488.50
461.02

340.83
758.46
730.51
131.50
287.46
280.46

92.94
205.99
58.16
123.38
-

974.78
2168.92
596.59
1327.41
-

1200.77 462.30 738.47

2701.75 1058.42 1643.33
2581.65 998.88 1582.77
747.22 462.30 284.92
1681.25 1058.42 622.83
1606.54 998.88 607.66

201.38
446.31
126.02
267.32
-

318.52
716.67
684.83
289.46
651.30
622.35

213.37
488.50
461.02
213.37
488.48
461.02

105.15
228.17
223.81
76.09
162.82
161.33

31.81
64.10
10.70
17.32
-

596.59
1327.39
566.76
1261.04
-

690.13 462.30 227.83

1552.79 1058.42 494.37
1483.80 998.88 484.92
627.16 462.30 164.86
1411.15 1058.36 352.79
1348.43 998.88 349.55

68.93
138.88
23.17
37.53
-

218.45
550.93
479.08

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

118.33
298.42
259.50

4.55
41.44
-

312.68
712.76
705.70
247.72
568.54
557.39

213.37
488.50
461.02
185.79
426.41
418.04

24.37
43.89
0.90
3.53
-

600.06
1362.70
528.93
1201.18
-

677.47 462.30 215.17

1544.31 1058.42 485.89
1529.02 998.88 530.14
536.73 402.55 134.18
1231.84 923.88 307.96
1207.68 905.76 301.92

52.80
95.09
1.95
7.67
-

99.31
224.26
244.68
61.93
142.13
139.35

Gov't
Pays

354.98
895.26
778.51

Empl.
Pays

Change in
empl.
payment

Total
Premium

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Iowa Aetna HealthFund HDHP

224
226.86
HDHP Self
225
496.83
HDHP Self & Family
226
HDHP Self Plus One
Iowa Health Alliance HMO
FX1
341.84
High Self
FX2
796.84
High Self & Family
FX3
High Self Plus One
Iowa Health Alliance HMO
K84
290.48
Standard Self
K85
677.12
Standard Self & Family
K86
Standard Self Plus One
Iowa HealthPartners High and Standard Option
V31
304.64
High Self
V32
700.68
High Self & Family
V33
High Self Plus One
V34
169.19
Standard Self
V35
389.14
Standard Self & Family
V36
Standard Self Plus One
Iowa Sanford Health Plan
AU1
340.19
High Self
AU2
782.74
High Self & Family
AU3
High Self Plus One
AU4
326.45
Standard Self
AU5
750.86
Standard Self & Family
AU6
Standard Self Plus One

Total
Premium

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

390.25
860.81
843.93

240.15
529.73
519.34

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

130.08
286.94
281.31

7.20
17.82
-

351.45
994.51
738.04

213.37 138.08
488.50 506.01
461.02 277.02

-1.75
157.74
-

740.65
1726.49
-

761.48 462.30 299.18

2154.77 1058.42 1096.35
1599.09 998.88 600.21

-3.78
341.76
-

288.42
800.36
605.69

213.37 75.05
488.50 311.86
454.27 151.42

-13.42
83.31
-

629.37
1467.09
-

624.91 462.30 162.61

1734.11 1058.42 675.69
1312.33 984.25 328.08

-29.07
180.50
-

315.60
768.79
697.47
179.23
436.61
396.10

213.37
488.50
461.02
134.42
327.46
297.08

102.23
280.29
236.45
44.81
109.15
99.02

-0.40
28.18
2.51
11.87
-

660.05
1518.14
366.58
843.14
-

683.80 462.30 221.50

1665.71 1058.42 607.29
1511.19 998.88 512.31
388.33 291.25 97.08
945.99 709.49 236.50
858.22 643.67 214.55

-0.86
61.05
5.44
25.72
-

337.07
943.80
606.73
326.78
914.97
588.19

213.37
488.50
455.05
213.37
488.50
441.14

123.70
455.30
151.68
113.41
426.47
147.05

-14.48
121.13
-11.03
124.18
-

737.08
1695.94
707.31
1626.86
-

730.32 462.30 268.02

2044.90 1058.42 986.48
1314.58 985.94 328.64
708.02 462.30 245.72
1982.44 1058.42 924.02
1274.41 955.81 318.60

-31.37
262.44
-23.90
269.06
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Gov't
Pays

Iowa United Healthcare Insurance Company, Inc. (Choice HMO)

LJ1
New Plan 245.23 183.92
High Self
LJ2
New Plan 687.63 488.50
High Self & Family
LJ3
New Plan 478.94 359.21
High Self Plus One
Iowa United Healthcare Insurance Company, Inc. (HDHP Choice Plus)
N71 New Plan 236.63 177.47
HDHP Self
N72 New Plan 663.52 488.50
HDHP Self & Family
N73 New Plan 462.14 346.61
HDHP Self Plus One
Iowa UnitedHealthcare Plan of the River Valley Inc.
YH1
269.36
288.17 213.37
High Self
YH2
636.34
808.04 488.50
High Self & Family
YH3
562.81 422.11
High Self Plus One
Kansas Aetna Direct
N61
210.05
218.45 163.84
CDHP Self
N62
474.42
550.93 413.20
CDHP Self & Family
N63
479.08 359.31
CDHP Self Plus One
Kansas Aetna HealthFund CDHP and Value Plan
G51
289.47
321.78 213.37
CDHP Self
G52
657.36
733.96 488.50
CDHP Self & Family
G53
726.69 461.02
CDHP Self Plus One
G54
239.10
246.85 185.14
Basic Self
G55
542.96
565.39 424.04
Basic Self & Family
G56
554.30 415.73
Basic Self Plus One
Kansas Aetna HealthFund HDHP
224
226.86
240.15 180.11
HDHP Self
225
496.83
529.73 397.30
HDHP Self & Family
226
519.34 389.51
HDHP Self Plus One

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

61.31
199.13
119.73

New Plan New Plan 531.33 398.50 132.83

New Plan New Plan 1489.87 1058.42 431.45
New Plan New Plan 1037.70 778.28 259.42

New Plan
New Plan
New Plan

59.16
175.02
115.53

New Plan New Plan 512.70 384.53 128.17

New Plan New Plan 1437.63 1058.42 379.21
New Plan New Plan 1001.30 750.98 250.32

New Plan
New Plan
New Plan

74.80
319.54
140.70

7.45
131.77
-

583.61
1378.74
-

624.37 462.30 162.07

1750.75 1058.42 692.33
1219.42 914.57 304.85

16.15
285.49
-

54.61
137.73
119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

118.33
298.42
259.50

4.55
41.44
-

108.41
245.46
265.67
61.71
141.35
138.57

20.95
36.67
1.94
5.61
-

627.19
1424.28
518.05
1176.41
-

697.19 462.30 234.89

1590.25 1058.42 531.83
1574.50 998.88 575.62
534.84 401.13 133.71
1225.01 918.76 306.25
1200.98 900.74 300.24

45.39
79.45
4.20
12.15
-

60.04
132.43
129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

7.20
17.82
-

354.98
895.26
778.51

390.25
860.81
843.93

130.08
286.94
281.31

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Kansas Aetna Open Access

HA1
244.44
High Self
HA2
574.46
High Self & Family
HA3
High Self Plus One
HA4
261.53
Standard Self
HA5
614.60
Standard Self & Family
HA6
Standard Self Plus One
Kansas Humana CoverageFirst and Value Plan
PH1
233.21
CDHP Self
PH2
518.89
CDHP Self & Family
PH3
CDHP Self Plus One
PH4
198.87
Basic Self
PH5
442.49
Basic Self & Family
PH6
Basic Self Plus One
Kansas Humana Health Plan, Inc.
MS1
587.03
High Self
MS2
1306.13
High Self & Family
MS3
High Self Plus One
MS4
275.35
Standard Self
MS5
612.65
Standard Self & Family
MS6
Standard Self Plus One
Kentucky Aetna Direct
N61
210.05
CDHP Self
N62
474.42
CDHP Self & Family
CDHP Self Plus One
N63

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Gov't
Pays

Empl.
Pays

289.24
683.26
676.50
281.30
664.00
657.43

213.37
488.50
461.02
210.98
488.50
461.02

75.87
194.76
215.48
70.32
175.50
196.41

14.76
51.15
4.94
9.47
-

529.62
1244.66
566.65
1331.63
-

626.69 462.30 164.39

1480.40 1058.42 421.98
1465.75 998.88 466.87
609.48 457.11 152.37
1438.67 1058.42 380.25
1424.43 998.88 425.55

31.99
110.82
10.71
20.52
-

280.80
631.82
603.74
215.28
484.37
462.84

210.60
473.87
452.81
161.46
363.28
347.13

70.20
157.95
150.93
53.82
121.09
115.71

11.90
28.23
4.10
10.47
-

505.29
1124.26
430.89
958.73
-

608.40 456.30 152.10

1368.94 1026.71 342.23
1308.10 981.08 327.02
466.44 349.83 116.61
1049.47 787.10 262.37
1002.82 752.12 250.70

25.78
61.17
8.89
22.69
-

675.19
1519.17
1451.64
336.66
757.47
723.81

213.37
488.50
461.02
213.37
488.50
461.02

461.82
1030.67
990.62
123.29
268.97
262.79

76.80
173.11
49.95
104.89
-

1271.90
2829.95
596.59
1327.41
-

1462.91 462.30 1000.61

3291.54 1058.42 2233.12
3145.22 998.88 2146.34
729.43 462.30 267.13
1641.19 1058.42 582.77
1568.26 998.88 569.38

166.40
375.07
108.23
227.26
-

218.45
550.93
479.08

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

4.55
41.44
-

354.98
895.26
778.51

Empl.
Pays

Change in
empl.
payment

Total
Premium

118.33
298.42
259.50

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Kentucky Aetna HealthFund CDHP and Value Plan

276.95
CDHP Self
H41
628.94
CDHP Self & Family
H42
CDHP Self Plus One
H43
244.12
Basic Self
H44
554.39
Basic Self & Family
H45
Basic Self Plus One
H46
Kentucky Aetna HealthFund HDHP
226.86
HDHP Self
224
496.83
HDHP Self & Family
225
HDHP Self Plus One
226
Kentucky Humana CoverageFirst and Value Plan
233.21
CDHP Self
6N1
518.89
CDHP Self & Family
6N2
CDHP Self Plus One
6N3
Kentucky Humana Health Plan of Ohio
275.35
High Self
A61
612.64
High Self & Family
A62
High Self Plus One
A63
261.58
Standard Self
A64
582.02
Standard Self & Family
A65
Standard Self Plus One
A66

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

312.68
712.76
705.70
247.72
568.54
557.39

213.37
488.50
461.02
185.79
426.41
418.04

99.31
224.26
244.68
61.93
142.13
139.35

24.37
43.89
0.90
3.53
-

600.06
1362.70
528.93
1201.18
-

677.47 462.30 215.17

1544.31 1058.42 485.89
1529.02 998.88 530.14
536.73 402.55 134.18
1231.84 923.88 307.96
1207.68 905.76 301.92

52.80
95.09
1.95
7.67
-

240.15
529.73
519.34

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

390.25
860.81
843.93

130.08
286.94
281.31

7.20
17.82
-

255.65
575.21
549.65

191.74 63.91
431.41 143.80
412.24 137.41

5.61
14.08
-

505.29
1124.26
-

553.91
1246.29
1190.91

415.43
934.72
893.18

138.48
311.57
297.73

12.16
30.51
-

349.02
785.30
750.40
294.73
663.14
633.66

213.37
488.50
461.02
213.37
488.50
461.02

62.31
132.73
15.97
29.14
-

596.59
1327.39
566.76
1261.04
-

756.21 462.30 293.91

1701.48 1058.42 643.06
1625.87 998.88 626.99
638.58 462.30 176.28
1436.80 1058.42 378.38
1372.93 998.88 374.05

135.01
287.57
34.59
63.12
-

135.65
296.80
289.38
81.36
174.64
172.64

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

Total
Premium

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Gov't
Pays

Empl.
Pays

Kentucky Humana Health Plan, Inc.

275.35
High Self
MH1
318.52 213.37 105.15
612.64
High Self & Family
MH2
716.67 488.50 228.17
High Self Plus One
MH3
684.83 461.02 223.81
261.58
Standard Self
MH4
289.46 213.37 76.09
582.02
Standard Self & Family
MH5
651.30 488.48 162.82
Standard Self Plus One
MH6
622.35 461.02 161.33
Kentucky Humana Health Plan, Inc.
275.35
High Self
MI1
315.02 213.37 101.65
612.65
High Self & Family
MI2
708.79 488.50 220.29
High Self Plus One
MI3
677.29 461.02 216.27
261.58
Standard Self
MI4
299.16 213.37 85.79
582.02
Standard Self & Family
MI5
673.11 488.50 184.61
Standard Self Plus One
MI6
643.19 461.02 182.17
Kentucky United Healthcare Insurance Company, Inc. (Choice HMO)
New Plan 245.23 183.92 61.31
High Self
LJ1
New Plan 687.63 488.50 199.13
High Self & Family
LJ2
New Plan 478.94 359.21 119.73
High Self Plus One
LJ3
Kentucky United Healthcare Insurance Company, Inc. (HDHP Choice Plus)
HDHP Self
N71 New Plan 236.63 177.47 59.16
HDHP Self & Family
N72 New Plan 663.52 488.50 175.02
HDHP Self Plus One
N73 New Plan 462.14 346.61 115.53
Louisiana Aetna Direct
210.05
CDHP Self
N61
218.45 163.84 54.61
474.42
CDHP Self & Family
N62
550.93 413.20 137.73
CDHP Self Plus One
N63
479.08 359.31 119.77

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

31.81
64.10
10.70
17.32
-

596.59
1327.39
566.76
1261.04
-

690.13 462.30 227.83

1552.79 1058.42 494.37
1483.80 998.88 484.92
627.16 462.30 164.86
1411.15 1058.36 352.79
1348.43 998.88 349.55

68.93
138.88
23.17
37.53
-

28.31
56.21
20.40
39.11
-

596.59
1327.41
566.76
1261.04
-

682.54 462.30 220.24

1535.71 1058.42 477.29
1467.46 998.88 468.58
648.18 462.30 185.88
1458.41 1058.42 399.99
1393.58 998.88 394.70

61.34
121.78
44.19
84.73
-

New Plan New Plan 531.33 398.50 132.83

New Plan New Plan 1489.87 1058.42 431.45
New Plan New Plan 1037.70 778.28 259.42

New Plan
New Plan
New Plan

New Plan New Plan 512.70 384.53 128.17

New Plan New Plan 1437.63 1058.42 379.21
New Plan New Plan 1001.30 750.98 250.32

New Plan
New Plan
New Plan

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

354.98
895.26
778.51

118.33
298.42
259.50

4.55
41.44
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Louisiana Aetna HealthFund CDHP and Value Plan

272.01
CDHP Self
F51
298.88
617.70
CDHP Self & Family
F52
681.47
CDHP Self Plus One
F53
674.72
243.50
Basic Self
F54
250.64
552.96
Basic Self & Family
F55
573.93
Basic Self Plus One
F56
562.68
Louisiana Aetna HealthFund HDHP
226.86
HDHP Self
224
240.15
496.83
HDHP Self & Family
225
529.73
HDHP Self Plus One
226
519.34
Louisiana Humana Health Benefit Plan of Louisiana, Inc.
275.35
High Self
AE1
314.07
612.65
High Self & Family
AE2
706.66
High Self Plus One
AE3
675.25
247.81
Standard Self
AE4
298.06
551.39
Standard Self & Family
AE5
671.12
Standard Self Plus One
AE6
641.30
Louisiana Humana Health Benefit Plan of Louisiana, Inc.
260.05
High Self
BC1
296.73
578.61
High Self & Family
BC2
667.64
High Self Plus One
BC3
637.97
234.05
Standard Self
BC4
264.57
520.76
Standard Self & Family
BC5
595.28
Standard Self Plus One
BC6
568.82

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

213.37
488.50
461.02
187.98
430.45
422.01

85.51
192.97
213.70
62.66
143.48
140.67

15.51
23.84
1.79
5.24
-

589.36
1338.35
527.58
1198.08
-

647.57 462.30 185.27

1476.52 1058.42 418.10
1461.89 998.88 463.01
543.05 407.29 135.76
1243.52 932.64 310.88
1219.14 914.36 304.78

33.60
51.65
3.87
11.36
-

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

130.08
286.94
281.31

7.20
17.82
-

213.37
488.50
461.02
213.37
488.50
461.02

100.70
218.16
214.23
84.69
182.62
180.28

27.36
54.08
22.74
44.77
-

596.59
1327.41
536.92
1194.68
-

680.49 462.30 218.19

1531.10 1058.42 472.68
1463.04 998.88 464.16
645.80 462.30 183.50
1454.09 1058.42 395.67
1389.48 998.88 390.60

59.29
117.17
49.27
97.00
-

213.37
488.50
461.02
198.43
446.46
426.62

83.36
179.14
176.95
66.14
148.82
142.20

18.35
34.49
7.63
18.63
-

563.44
1253.66
507.11
1128.31
-

642.92 462.30 180.62

1446.55 1058.42 388.13
1382.27 998.88 383.39
573.24 429.93 143.31
1289.77 967.33 322.44
1232.44 924.33 308.11

39.76
74.72
16.53
40.36
-

390.25
860.81
843.93

Empl.
Pays

Change in
empl.
payment

Gov't
Pays

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Gov't
Pays

Empl.
Pays

Louisiana United Healthcare Insurance Company, Inc. (Choice HMO)

High Self
KK1 New Plan 245.00 183.75 61.25
High Self & Family
KK2 New Plan 686.98 488.50 198.48
High Self Plus One
KK3 New Plan 478.48 358.86 119.62
Louisiana United Healthcare Insurance Company, Inc. (HDHP Choice Plus)
New Plan 234.69 176.02 58.67
HDHP Self
LS1
New Plan 658.05 488.50 169.55
HDHP Self & Family
LS2
New Plan 458.33 343.75 114.58
HDHP Self Plus One
LS3
Maine Aetna Direct
210.05
CDHP Self
N61
218.45 163.84 54.61
474.42
CDHP Self & Family
N62
550.93 413.20 137.73
CDHP Self Plus One
N63
479.08 359.31 119.77
Maine Aetna HealthFund CDHP and Value Plan
296.95
CDHP Self
EP1
353.14 213.37 139.77
674.38
CDHP Self & Family
EP2
805.37 488.50 316.87
CDHP Self Plus One
EP3
797.39 461.02 336.37
236.69
Basic Self
EP4
243.00 182.25 60.75
537.52
Basic Self & Family
EP5
556.47 417.35 139.12
Basic Self Plus One
EP6
545.55 409.16 136.39
Maine Aetna HealthFund HDHP
226.86
HDHP Self
224
240.15 180.11 60.04
496.83
HDHP Self & Family
225
529.73 397.30 132.43
HDHP Self Plus One
226
519.34 389.51 129.83
Maryland Aetna Direct
210.05
CDHP Self
N61
218.45 163.84 54.61
474.42
CDHP Self & Family
N62
550.93 413.20 137.73
CDHP Self Plus One
N63
479.08 359.31 119.77

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

New Plan New Plan 530.83 398.12 132.71

New Plan New Plan 1488.46 1058.42 430.04
New Plan New Plan 1036.71 777.53 259.18

New Plan
New Plan
New Plan

New Plan New Plan 508.50 381.38 127.12

New Plan New Plan 1425.78 1058.42 367.36
New Plan New Plan 993.05 744.79 248.26

New Plan
New Plan
New Plan

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

118.33
298.42
259.50

4.55
41.44
-

44.83
91.06
1.58
4.74
-

643.39
1461.16
512.83
1164.63
-

765.14 462.30 302.84

1744.97 1058.42 686.55
1727.68 998.88 728.80
526.50 394.88 131.62
1205.69 904.27 301.42
1182.03 886.52 295.51

97.14
197.29
3.41
10.26
-

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

390.25
860.81
843.93

130.08
286.94
281.31

7.20
17.82
-

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

354.98
895.26
778.51

118.33
298.42
259.50

4.55
41.44
-

354.98
895.26
778.51

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Maryland Aetna HealthFund CDHP and Value Plan

272.01
CDHP Self
F51
617.70
CDHP Self & Family
F52
CDHP Self Plus One
F53
243.50
Basic Self
F54
552.96
Basic Self & Family
F55
Basic Self Plus One
F56
Maryland Aetna HealthFund HDHP
226.86
HDHP Self
224
496.83
HDHP Self & Family
225
HDHP Self Plus One
226
Maryland Aetna Open Access
426.78
High Self
JN1
955.97
High Self & Family
JN2
High Self Plus One
JN3
265.88
Basic Self
JN4
594.52
Basic Self & Family
JN5
Basic Self Plus One
JN6
Maryland CareFirst BlueChoice
309.39
High Self
2G1
696.01
High Self & Family
2G2
High Self Plus One
2G3
276.57
Standard Self
2G4
622.18
Standard Self & Family
2G5
Standard Self Plus One
2G6

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Gov't
Pays

Empl.
Pays

298.88
681.47
674.72
250.64
573.93
562.68

213.37
488.50
461.02
187.98
430.45
422.01

85.51
192.97
213.70
62.66
143.48
140.67

15.51
23.84
1.79
5.24
-

589.36
1338.35
527.58
1198.08
-

647.57 462.30 185.27

1476.52 1058.42 418.10
1461.89 998.88 463.01
543.05 407.29 135.76
1243.52 932.64 310.88
1219.14 914.36 304.78

33.60
51.65
3.87
11.36
-

240.15
529.73
519.34

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

130.08
286.94
281.31

7.20
17.82
-

442.85
995.60
985.75
275.96
621.16
608.98

213.37
488.50
461.02
206.97
465.87
456.74

229.48
507.10
524.73
68.99
155.29
152.24

4.71
-0.30
2.52
6.66
-

924.69
2071.27
576.07
1288.13
-

959.51 462.30 497.21

2157.13 1058.42 1098.71
2135.79 998.88 1136.91
597.91 448.43 149.48
1345.85 1009.39 336.46
1319.46 989.60 329.86

10.21
-0.66
5.46
14.43
-

321.77
764.50
643.53
287.63
683.40
575.27

213.37
488.50
461.02
213.37
488.50
431.45

108.40
276.00
182.51
74.26
194.90
143.82

1.02
28.56
-0.30
21.29
-

670.35
1508.02
599.24
1348.06
-

697.17 462.30 234.87

1656.42 1058.42 598.00
1394.32 998.88 395.44
623.20 462.30 160.90
1480.70 1058.42 422.28
1246.42 934.82 311.60

2.21
61.88
-0.65
46.12
-

390.25
860.81
843.93

Empl.
Pays

Change in
empl.
payment

Total
Premium

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Gov't
Pays

Maryland CareFirst BlueChoice

267.85
HDHP Self
B61
273.21 204.91
597.46
HDHP Self & Family
B62
649.15 486.86
HDHP Self Plus One
B63
546.43 409.82
Maryland Kaiser Foundation Health Plan Mid-Atlantic States
279.94
High Self
E31
285.48 213.37
643.87
High Self & Family
E32
668.01 488.50
High Self Plus One
E33
645.17 461.02
181.53
Standard Self
E34
214.96 161.22
417.50
Standard Self & Family
E35
503.01 377.26
Standard Self Plus One
E36
485.80 364.35
Maryland M.D. IPA
314.55
High Self
JP1
295.87 213.37
725.30
High Self & Family
JP2
829.62 488.50
High Self Plus One
JP3
577.83 433.37
Maryland United Healthcare Insurance Company, Inc. (Choice HMO)
New Plan 245.13 183.85
High Self
LR1
New Plan 687.35 488.50
High Self & Family
LR2
New Plan 478.74 359.06
High Self Plus One
LR3
Maryland UnitedHealthcare Insurance Company
244.32
Basic Self
L91
212.71 159.53
543.61
Basic Self & Family
L92
596.45 447.34
Basic Self Plus One
L93
415.43 311.57
Massachusetts Aetna Direct
210.05
CDHP Self
N61
218.45 163.84
474.42
CDHP Self & Family
N62
550.93 413.20
CDHP Self Plus One
N63
479.08 359.31

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

68.30
162.29
136.61

1.34
12.93
-

580.34
1294.50
-

591.96 443.97 147.99

1406.49 1054.87 351.62
1183.93 887.95 295.98

2.91
28.00
-

72.11
179.51
184.15
53.74
125.75
121.45

-5.82
-15.79
8.36
21.38
-

606.54
1395.05
393.32
904.58
-

618.54 462.30 156.24

1447.36 1058.42 388.94
1397.87 998.88 398.99
465.75 349.31 116.44
1089.86 817.40 272.46
1052.57 789.43 263.14

-12.61
-34.21
18.11
46.32
-

82.50
341.12
144.46

-30.04
64.39
-

681.53
1571.48
-

641.05 462.30 178.75

1797.51 1058.42 739.09
1251.97 938.98 312.99

-65.09
139.51
-

61.28
198.85
119.68

New Plan New Plan 531.12 398.34 132.78

New Plan New Plan 1489.26 1058.42 430.84
New Plan New Plan 1037.27 777.95 259.32

New Plan
New Plan
New Plan

53.18
149.11
103.86

-7.90
13.21
-

529.36
1177.82
-

460.87
1292.31
900.10

345.65
969.23
675.08

115.22
323.08
225.02

-17.12
28.63
-

54.61
137.73
119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

354.98
895.26
778.51

118.33
298.42
259.50

4.55
41.44
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Massachusetts Aetna HealthFund CDHP and Value Plan

296.95
CDHP Self
EP1
353.14
674.38
CDHP Self & Family
EP2
805.37
CDHP Self Plus One
EP3
797.39
236.69
Basic Self
EP4
243.00
537.52
Basic Self & Family
EP5
556.47
Basic Self Plus One
EP6
545.55
Massachusetts Aetna HealthFund HDHP
226.86
HDHP Self
224
240.15
496.83
HDHP Self & Family
225
529.73
HDHP Self Plus One
226
519.34
Michigan Aetna Direct
210.05
CDHP Self
N61
218.45
474.42
CDHP Self & Family
N62
550.93
CDHP Self Plus One
N63
479.08
Michigan Aetna HealthFund CDHP and Value Plan
289.47
CDHP Self
G51
321.78
657.36
CDHP Self & Family
G52
733.96
CDHP Self Plus One
G53
726.69
239.10
Basic Self
G54
246.85
542.96
Basic Self & Family
G55
565.39
Basic Self Plus One
G56
554.30
Michigan Aetna HealthFund HDHP
226.86
HDHP Self
224
240.15
496.83
HDHP Self & Family
225
529.73
HDHP Self Plus One
226
519.34

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

213.37
488.50
461.02
182.25
417.35
409.16

139.77
316.87
336.37
60.75
139.12
136.39

44.83
91.06
1.58
4.74
-

643.39
1461.16
512.83
1164.63
-

765.14 462.30 302.84

1744.97 1058.42 686.55
1727.68 998.88 728.80
526.50 394.88 131.62
1205.69 904.27 301.42
1182.03 886.52 295.51

97.14
197.29
3.41
10.26
-

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

390.25
860.81
843.93

130.08
286.94
281.31

7.20
17.82
-

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

354.98
895.26
778.51

118.33
298.42
259.50

4.55
41.44
-

213.37
488.50
461.02
185.14
424.04
415.73

108.41
245.46
265.67
61.71
141.35
138.57

20.95
36.67
1.94
5.61
-

627.19
1424.28
518.05
1176.41
-

697.19 462.30 234.89

1590.25 1058.42 531.83
1574.50 998.88 575.62
534.84 401.13 133.71
1225.01 918.76 306.25
1200.98 900.74 300.24

45.39
79.45
4.20
12.15
-

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

7.20
17.82
-

390.25
860.81
843.93

Empl.
Pays

Change in
empl.
payment

Gov't
Pays

130.08
286.94
281.31

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

Michigan Bluecare Network of MI

High Self
K51
High Self & Family
K52
High Self Plus One
K53
Michigan Bluecare Network of MI
High Self
LX1
High Self & Family
LX2
High Self Plus One
LX3
Michigan Grand Valley Health Plan
High Self
RL1
High Self & Family
RL2
High Self Plus One
RL3
Standard Self
RL4
Standard Self & Family
RL5
Standard Self Plus One
RL6
Michigan Health Alliance Plan
High Self
521
High Self & Family
522
High Self Plus One
523
Michigan Health Alliance Plan
Standard Self
GY4
Standard Self & Family
GY5
Standard Self Plus One
GY6
Michigan HealthPlus of MI
High Self
X51
High Self & Family
X52
High Self Plus One
X53

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

316.70
722.04
-

327.06
798.66
752.38

213.37 113.69
488.50 310.16
461.02 291.36

-1.00
36.69
-

686.18
1564.42
-

708.63 462.30 246.33

1730.43 1058.42 672.01
1630.16 998.88 631.28

-2.16
79.49
-

280.24
672.39
-

285.20
696.52
656.05

213.37 71.83
488.50 208.02
461.02 195.03

-6.40
-15.80
-

607.19
1456.85
-

617.93 462.30 155.63

1509.13 1058.42 450.71
1421.44 998.88 422.56

-13.87
-34.24
-

310.23
725.93
290.06
678.70
-

280.33
658.78
621.98
265.93
624.94
585.04

210.25
488.50
461.02
199.45
468.71
438.78

70.08
170.28
160.96
66.48
156.23
146.26

-38.14
-107.08
-21.57
-73.90
-

672.17
1572.85
628.46
1470.52
-

607.38 455.54 151.84

1427.36 1058.42 368.94
1347.62 998.88 348.74
576.18 432.14 144.04
1354.04 1015.53 338.51
1267.59 950.69 316.90

-82.64
-232.01
-46.73
-160.11
-

313.42
736.55
-

318.54
756.63
740.60

213.37 105.17
488.50 268.13
461.02 279.58

-6.24
-19.85
-

679.08
1595.86
-

690.17 462.30 227.87

1639.37 1058.42 580.95
1604.63 998.88 605.75

-13.52
-43.01
-

266.53
626.35
-

266.61
633.21
619.89

199.96 66.65
474.91 158.30
461.02 158.87

0.02
-19.48
-

577.48
1357.09
-

577.66 433.25 144.41

1371.96 1028.97 342.99
1343.10 998.88 344.22

0.04
-42.20
-

295.96
710.14
-

303.60
819.70
683.08

213.37 90.23
488.50 331.20
461.02 222.06

-3.72
69.63
-

641.25
1538.64
-

657.80 462.30 195.50

1776.02 1058.42 717.60
1480.01 998.88 481.13

-8.06
150.86
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Michigan Priority Health

315.06
High Self
LE1
294.73
756.14
High Self & Family
LE2
736.82
High Self Plus One
LE3
648.39
267.98
Standard Self
LE4
230.80
643.14
Standard Self & Family
LE5
577.00
Standard Self Plus One
LE6
507.76
Minnesota Aetna Direct
210.05
CDHP Self
N61
218.45
474.42
CDHP Self & Family
N62
550.93
CDHP Self Plus One
N63
479.08
Minnesota Aetna HealthFund CDHP and Value Plan
276.95
CDHP Self
H41
312.68
628.94
CDHP Self & Family
H42
712.76
CDHP Self Plus One
H43
705.70
244.12
Basic Self
H44
247.72
554.39
Basic Self & Family
H45
568.54
Basic Self Plus One
H46
557.39
Minnesota Aetna HealthFund HDHP
226.86
HDHP Self
224
240.15
496.83
HDHP Self & Family
225
529.73
HDHP Self Plus One
226
519.34

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

213.37
488.50
461.02
173.10
432.75
380.82

81.36
248.32
187.37
57.70
144.25
126.94

-31.69
-59.25
-9.29
-50.32
-

682.63
1638.30
580.62
1393.47
-

638.58 462.30 176.28

1596.44 1058.42 538.02
1404.85 998.88 405.97
500.07 375.05 125.02
1250.17 937.63 312.54
1100.15 825.11 275.04

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

118.33
298.42
259.50

4.55
41.44
-

213.37
488.50
461.02
185.79
426.41
418.04

99.31
224.26
244.68
61.93
142.13
139.35

24.37
43.89
0.90
3.53
-

600.06
1362.70
528.93
1201.18
-

677.47 462.30 215.17

1544.31 1058.42 485.89
1529.02 998.88 530.14
536.73 402.55 134.18
1231.84 923.88 307.96
1207.68 905.76 301.92

52.80
95.09
1.95
7.67
-

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

7.20
17.82
-

354.98
895.26
778.51

390.25
860.81
843.93

Empl.
Pays

Change in
empl.
payment

Gov't
Pays

130.08
286.94
281.31

-68.66
-128.38
-20.13
-109.03
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Gov't
Pays

Minnesota HealthPartners High and Standard Option

304.64
High Self
V31
315.60 213.37
700.68
High Self & Family
V32
768.79 488.50
High Self Plus One
V33
697.47 461.02
169.19
Standard Self
V34
179.23 134.42
389.14
Standard Self & Family
V35
436.61 327.46
Standard Self Plus One
V36
396.10 297.08
Mississippi Aetna Direct
210.05
CDHP Self
N61
218.45 163.84
474.42
CDHP Self & Family
N62
550.93 413.20
CDHP Self Plus One
N63
479.08 359.31
Mississippi Aetna HealthFund CDHP and Value Plan
276.95
CDHP Self
H41
312.68 213.37
628.94
CDHP Self & Family
H42
712.76 488.50
CDHP Self Plus One
H43
705.70 461.02
244.12
Basic Self
H44
247.72 185.79
554.39
Basic Self & Family
H45
568.54 426.41
Basic Self Plus One
H46
557.39 418.04
Mississippi Aetna HealthFund HDHP
226.86
HDHP Self
224
240.15 180.11
496.83
HDHP Self & Family
225
529.73 397.30
HDHP Self Plus One
226
519.34 389.51
Mississippi United Healthcare Insurance Company, Inc. (Choice HMO)
High Self
KK1 New Plan 245.00 183.75
High Self & Family
KK2 New Plan 686.98 488.50
High Self Plus One
KK3 New Plan 478.48 358.86

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

102.23
280.29
236.45
44.81
109.15
99.02

-0.40
28.18
2.51
11.87
-

660.05
1518.14
366.58
843.14
-

683.80 462.30 221.50

1665.71 1058.42 607.29
1511.19 998.88 512.31
388.33 291.25 97.08
945.99 709.49 236.50
858.22 643.67 214.55

-0.86
61.05
5.44
25.72
-

54.61
137.73
119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

118.33
298.42
259.50

4.55
41.44
-

99.31
224.26
244.68
61.93
142.13
139.35

24.37
43.89
0.90
3.53
-

600.06
1362.70
528.93
1201.18
-

677.47 462.30 215.17

1544.31 1058.42 485.89
1529.02 998.88 530.14
536.73 402.55 134.18
1231.84 923.88 307.96
1207.68 905.76 301.92

52.80
95.09
1.95
7.67
-

60.04
132.43
129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

7.20
17.82
-

61.25
198.48
119.62

354.98
895.26
778.51

390.25
860.81
843.93

130.08
286.94
281.31

New Plan New Plan 530.83 398.12 132.71

New Plan New Plan 1488.46 1058.42 430.04
New Plan New Plan 1036.71 777.53 259.18

New Plan
New Plan
New Plan

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Gov't
Pays

Empl.
Pays

Mississippi United Healthcare Insurance Company, Inc. (HDHP Choice Plus)

New Plan 234.69 176.02 58.67
HDHP Self
LS1
New Plan 658.05 488.50 169.55
HDHP Self & Family
LS2
New Plan 458.33 343.75 114.58
HDHP Self Plus One
LS3
Missouri Aetna Direct
210.05
CDHP Self
N61
218.45 163.84 54.61
474.42
CDHP Self & Family
N62
550.93 413.20 137.73
CDHP Self Plus One
N63
479.08 359.31 119.77
Missouri Aetna HealthFund CDHP and Value Plan
289.47
CDHP Self
G51
321.78 213.37 108.41
657.36
CDHP Self & Family
G52
733.96 488.50 245.46
CDHP Self Plus One
G53
726.69 461.02 265.67
239.10
Basic Self
G54
246.85 185.14 61.71
542.96
Basic Self & Family
G55
565.39 424.04 141.35
Basic Self Plus One
G56
554.30 415.73 138.57
Missouri Aetna HealthFund HDHP
226.86
HDHP Self
224
240.15 180.11 60.04
496.83
HDHP Self & Family
225
529.73 397.30 132.43
HDHP Self Plus One
226
519.34 389.51 129.83
Missouri Aetna Open Access
244.44
High Self
HA1
289.24 213.37 75.87
574.46
High Self & Family
HA2
683.26 488.50 194.76
High Self Plus One
HA3
676.50 461.02 215.48
261.53
Standard Self
HA4
281.30 210.98 70.32
614.60
Standard Self & Family
HA5
664.00 488.50 175.50
Standard Self Plus One
HA6
657.43 461.02 196.41

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

New Plan New Plan 508.50 381.38 127.12

New Plan New Plan 1425.78 1058.42 367.36
New Plan New Plan 993.05 744.79 248.26

Change in
empl.
payment

New Plan
New Plan
New Plan

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

118.33
298.42
259.50

4.55
41.44
-

20.95
36.67
1.94
5.61
-

627.19
1424.28
518.05
1176.41
-

697.19 462.30 234.89

1590.25 1058.42 531.83
1574.50 998.88 575.62
534.84 401.13 133.71
1225.01 918.76 306.25
1200.98 900.74 300.24

45.39
79.45
4.20
12.15
-

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

130.08
286.94
281.31

7.20
17.82
-

14.76
51.15
4.94
9.47
-

529.62
1244.66
566.65
1331.63
-

626.69 462.30 164.39

1480.40 1058.42 421.98
1465.75 998.88 466.87
609.48 457.11 152.37
1438.67 1058.42 380.25
1424.43 998.88 425.55

31.99
110.82
10.71
20.52
-

354.98
895.26
778.51

390.25
860.81
843.93

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Missouri Blue Preferred Plus POS

401.19
High Self
9G1
802.39
High Self & Family
9G2
High Self Plus One
9G3
Missouri Humana CoverageFirst and Value Plan
233.21
CDHP Self
PH1
518.89
CDHP Self & Family
PH2
CDHP Self Plus One
PH3
198.87
Basic Self
PH4
442.49
Basic Self & Family
PH5
Basic Self Plus One
PH6
Missouri Humana Health Plan, Inc.
587.03
High Self
MS1
1306.13
High Self & Family
MS2
High Self Plus One
MS3
275.35
Standard Self
MS4
612.65
Standard Self & Family
MS5
Standard Self Plus One
MS6
Montana Aetna Direct
210.05
CDHP Self
N61
474.42
CDHP Self & Family
N62
CDHP Self Plus One
N63

Total
Premium

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

-100.57
-177.22
-

869.25
1738.51
-

675.96 462.30 213.66

1441.05 1058.42 382.63
1351.94 998.88 353.06

-217.90
-383.98
-

70.20
157.95
150.93
53.82
121.09
115.71

11.90
28.23
4.10
10.47
-

505.29
1124.26
430.89
958.73
-

608.40 456.30 152.10

1368.94 1026.71 342.23
1308.10 981.08 327.02
466.44 349.83 116.61
1049.47 787.10 262.37
1002.82 752.12 250.70

25.78
61.17
8.89
22.69
-

461.82
1030.67
990.62
123.29
268.97
262.79

76.80
173.11
49.95
104.89
-

1271.90
2829.95
596.59
1327.41
-

1462.91 462.30 1000.61

3291.54 1058.42 2233.12
3145.22 998.88 2146.34
729.43 462.30 267.13
1641.19 1058.42 582.77
1568.26 998.88 569.38

166.40
375.07
108.23
227.26
-

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

4.55
41.44
-

311.98
665.10
623.97

213.37 98.61
488.50 176.60
461.02 162.95

280.80
631.82
603.74
215.28
484.37
462.84

210.60
473.87
452.81
161.46
363.28
347.13

675.19
1519.17
1451.64
336.66
757.47
723.81

213.37
488.50
461.02
213.37
488.50
461.02

218.45
550.93
479.08

354.98
895.26
778.51

118.33
298.42
259.50

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Montana Aetna HealthFund CDHP and Value Plan

276.95
CDHP Self
H41
628.94
CDHP Self & Family
H42
CDHP Self Plus One
H43
244.12
Basic Self
H44
554.39
Basic Self & Family
H45
Basic Self Plus One
H46
Montana Aetna HealthFund HDHP
226.86
HDHP Self
224
496.83
HDHP Self & Family
225
HDHP Self Plus One
226
Nebraska Aetna Direct
210.05
CDHP Self
N61
474.42
CDHP Self & Family
N62
CDHP Self Plus One
N63
Nebraska Aetna HealthFund CDHP and Value Plan
276.95
CDHP Self
H41
628.94
CDHP Self & Family
H42
CDHP Self Plus One
H43
244.12
Basic Self
H44
554.39
Basic Self & Family
H45
Basic Self Plus One
H46
Nebraska Aetna HealthFund HDHP
226.86
HDHP Self
224
496.83
HDHP Self & Family
225
HDHP Self Plus One
226

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Gov't
Pays

Empl.
Pays

312.68
712.76
705.70
247.72
568.54
557.39

213.37
488.50
461.02
185.79
426.41
418.04

99.31
224.26
244.68
61.93
142.13
139.35

24.37
43.89
0.90
3.53
-

600.06
1362.70
528.93
1201.18
-

677.47 462.30 215.17

1544.31 1058.42 485.89
1529.02 998.88 530.14
536.73 402.55 134.18
1231.84 923.88 307.96
1207.68 905.76 301.92

52.80
95.09
1.95
7.67
-

240.15
529.73
519.34

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

390.25
860.81
843.93

130.08
286.94
281.31

7.20
17.82
-

218.45
550.93
479.08

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

354.98
895.26
778.51

118.33
298.42
259.50

4.55
41.44
-

312.68
712.76
705.70
247.72
568.54
557.39

213.37
488.50
461.02
185.79
426.41
418.04

99.31
224.26
244.68
61.93
142.13
139.35

24.37
43.89
0.90
3.53
-

600.06
1362.70
528.93
1201.18
-

677.47 462.30 215.17

1544.31 1058.42 485.89
1529.02 998.88 530.14
536.73 402.55 134.18
1231.84 923.88 307.96
1207.68 905.76 301.92

52.80
95.09
1.95
7.67
-

240.15
529.73
519.34

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

7.20
17.82
-

390.25
860.81
843.93

Empl.
Pays

Change in
empl.
payment

Total
Premium

130.08
286.94
281.31

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Nevada Aetna Direct

210.05
CDHP Self
N61
474.42
CDHP Self & Family
N62
CDHP Self Plus One
N63
Nevada Aetna HealthFund CDHP and Value Plan
289.47
CDHP Self
G51
657.36
CDHP Self & Family
G52
CDHP Self Plus One
G53
239.10
Basic Self
G54
542.96
Basic Self & Family
G55
Basic Self Plus One
G56
Nevada Aetna HealthFund HDHP
226.86
HDHP Self
224
496.83
HDHP Self & Family
225
HDHP Self Plus One
226
Nevada Health Plan of Nevada
207.02
High Self
NM1
488.17
High Self & Family
NM2
High Self Plus One
NM3
New Hampshire Aetna Direct
210.05
CDHP Self
N61
474.42
CDHP Self & Family
N62
CDHP Self Plus One
N63

Total
Premium

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

354.98
895.26
778.51

218.45
550.93
479.08

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

118.33
298.42
259.50

4.55
41.44
-

321.78
733.96
726.69
246.85
565.39
554.30

213.37
488.50
461.02
185.14
424.04
415.73

108.41
245.46
265.67
61.71
141.35
138.57

20.95
36.67
1.94
5.61
-

627.19
1424.28
518.05
1176.41
-

697.19 462.30 234.89

1590.25 1058.42 531.83
1574.50 998.88 575.62
534.84 401.13 133.71
1225.01 918.76 306.25
1200.98 900.74 300.24

45.39
79.45
4.20
12.15
-

240.15
529.73
519.34

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

390.25
860.81
843.93

130.08
286.94
281.31

7.20
17.82
-

233.53
553.48
443.72

175.15 58.38
415.11 138.37
332.79 110.93

6.63
16.33
-

448.54
1057.70
-

505.98
1199.21
961.39

379.49
899.41
721.04

126.49
299.80
240.35

14.36
35.38
-

218.45
550.93
479.08

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

354.98
895.26
778.51

118.33
298.42
259.50

4.55
41.44
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

New Hampshire Aetna HealthFund CDHP and Value Plan

296.95
CDHP Self
EP1
353.14
674.38
CDHP Self & Family
EP2
805.37
CDHP Self Plus One
EP3
797.39
236.69
Basic Self
EP4
243.00
537.52
Basic Self & Family
EP5
556.47
Basic Self Plus One
EP6
545.55
New Hampshire Aetna HealthFund HDHP
226.86
HDHP Self
224
240.15
496.83
HDHP Self & Family
225
529.73
HDHP Self Plus One
226
519.34
New Jersey Aetna Direct
210.05
CDHP Self
N61
218.45
474.42
CDHP Self & Family
N62
550.93
CDHP Self Plus One
N63
479.08
New Jersey Aetna HealthFund CDHP and Value Plan
296.95
CDHP Self
EP1
353.14
674.38
CDHP Self & Family
EP2
805.37
CDHP Self Plus One
EP3
797.39
236.69
Basic Self
EP4
243.00
537.52
Basic Self & Family
EP5
556.47
Basic Self Plus One
EP6
545.55
New Jersey Aetna HealthFund HDHP
226.86
HDHP Self
224
240.15
496.83
HDHP Self & Family
225
529.73
HDHP Self Plus One
226
519.34

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

213.37
488.50
461.02
182.25
417.35
409.16

139.77
316.87
336.37
60.75
139.12
136.39

44.83
91.06
1.58
4.74
-

643.39
1461.16
512.83
1164.63
-

765.14 462.30 302.84

1744.97 1058.42 686.55
1727.68 998.88 728.80
526.50 394.88 131.62
1205.69 904.27 301.42
1182.03 886.52 295.51

97.14
197.29
3.41
10.26
-

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

390.25
860.81
843.93

130.08
286.94
281.31

7.20
17.82
-

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

354.98
895.26
778.51

118.33
298.42
259.50

4.55
41.44
-

213.37
488.50
461.02
182.25
417.35
409.16

139.77
316.87
336.37
60.75
139.12
136.39

44.83
91.06
1.58
4.74
-

643.39
1461.16
512.83
1164.63
-

765.14 462.30 302.84

1744.97 1058.42 686.55
1727.68 998.88 728.80
526.50 394.88 131.62
1205.69 904.27 301.42
1182.03 886.52 295.51

97.14
197.29
3.41
10.26
-

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

7.20
17.82
-

390.25
860.81
843.93

Empl.
Pays

Change in
empl.
payment

Gov't
Pays

130.08
286.94
281.31

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

New Jersey Aetna Open Access

High Self
JR1
High Self & Family
JR2
High Self Plus One
JR3
Basic Self
JR4
Basic Self & Family
JR5
Basic Self Plus One
JR6
New Jersey Aetna Open Access
High Self
P31
High Self & Family
P32
High Self Plus One
P33
Basic Self
P34
Basic Self & Family
P35
Basic Self Plus One
P36
New Jersey GHI Health Plan
High Self
801
High Self & Family
802
High Self Plus One
803
Standard Self
804
Standard Self & Family
805
Standard Self Plus One
806
New Mexico Aetna Direct
CDHP Self
N61
CDHP Self & Family
N62
CDHP Self Plus One
N63

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Gov't
Pays

Empl.
Pays

534.78
1230.15
394.52
910.70
-

633.17
1462.59
1448.11
502.07
1163.56
1152.04

213.37
488.50
461.02
213.37
488.50
461.02

419.80
974.09
987.09
288.70
675.06
691.02

87.03
192.51
96.19
212.93
-

1158.69
2665.33
854.79
1973.18
-

1371.87 462.30 909.57

3168.95 1058.42 2110.53
3137.57 998.88 2138.69
1087.82 462.30 625.52
2521.05 1058.42 1462.63
2496.09 998.88 1497.21

188.57
417.10
208.42
461.35
-

557.69
1345.62
483.10
1115.54
-

631.25
1530.47
1515.32
508.42
1180.07
1168.39

213.37
488.50
461.02
213.37
488.50
461.02

417.88
1041.97
1054.30
295.05
691.57
707.37

62.20
144.92
13.96
24.60
-

1208.33
2915.51
1046.72
2417.00
-

1367.71 462.30 905.41

3316.02 1058.42 2257.60
3283.19 998.88 2284.31
1101.58 462.30 639.28
2556.82 1058.42 1498.40
2531.51 998.88 1532.63

134.77
313.99
30.25
53.30
-

359.25
898.21
270.09
613.31
-

393.81
1163.42
754.55
303.85
822.81
499.88

213.37
488.50
461.02
213.37
488.50
374.91

180.44
674.92
293.53
90.48
334.31
124.97

23.20
225.28
22.40
169.57
-

778.38
1946.12
585.20
1328.84
-

853.26 462.30 390.96

2520.74 1058.42 1462.32
1634.86 998.88 635.98
658.34 462.30 196.04
1782.76 1058.42 724.34
1083.07 812.30 270.77

50.27
488.10
48.53
367.40
-

210.05
474.42
-

218.45
550.93
479.08

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

4.55
41.44
-

354.98
895.26
778.51

Empl.
Pays

Change in
empl.
payment

Total
Premium

118.33
298.42
259.50

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

New Mexico Aetna HealthFund CDHP and Value Plan

289.47
CDHP Self
G51
321.78
657.36
CDHP Self & Family
G52
733.96
CDHP Self Plus One
G53
726.69
239.10
Basic Self
G54
246.85
542.96
Basic Self & Family
G55
565.39
Basic Self Plus One
G56
554.30
New Mexico Aetna HealthFund HDHP
226.86
HDHP Self
224
240.15
496.83
HDHP Self & Family
225
529.73
HDHP Self Plus One
226
519.34
New Mexico New Mexico BlueHMO Preferred
277.36
High Self
Q11
323.66
651.81
High Self & Family
Q12
798.13
High Self Plus One
Q13
695.85
New Mexico Presbyterian Health Plan
317.02
High Self
P21
313.76
719.98
High Self & Family
P22
737.34
High Self Plus One
P23
712.24
New Mexico Presbyterian Health Plan
New Plan 266.31
Standard Self
PS4
New Plan 625.82
Standard Self & Family
PS5
New Plan 604.52
Standard Self Plus One
PS6
New York Aetna Direct
210.05
CDHP Self
N61
218.45
474.42
CDHP Self & Family
N62
550.93
CDHP Self Plus One
N63
479.08

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Empl.
Pays

213.37
488.50
461.02
185.14
424.04
415.73

108.41
245.46
265.67
61.71
141.35
138.57

20.95
36.67
1.94
5.61
-

627.19
1424.28
518.05
1176.41
-

697.19 462.30 234.89

1590.25 1058.42 531.83
1574.50 998.88 575.62
534.84 401.13 133.71
1225.01 918.76 306.25
1200.98 900.74 300.24

45.39
79.45
4.20
12.15
-

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

130.08
286.94
281.31

7.20
17.82
-

213.37 110.29
488.50 309.63
461.02 234.83

34.94
106.39
-

600.95
1412.26
-

701.26 462.30 238.96

1729.28 1058.42 670.86
1507.68 998.88 508.80

75.70
230.50
-

213.37 100.39
488.50 248.84
461.02 251.22

-14.62
-22.57
-

686.88
1559.96
-

679.81 462.30 217.51

1597.57 1058.42 539.15
1543.19 998.88 544.31

-31.68
-48.91
-

199.73 66.58
469.37 156.45
453.39 151.13
163.84 54.61
413.20 137.73
359.31 119.77

Gov't
Pays

390.25
860.81
843.93

Empl.
Pays

Change in
empl.
payment

Gov't
Pays

New Plan New Plan 577.01 432.76 144.25

New Plan New Plan 1355.94 1016.96 338.98
New Plan New Plan 1309.79 982.34 327.45
2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

354.98
895.26
778.51

118.33
298.42
259.50

New Plan
New Plan
New Plan
4.55
41.44
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

New York Aetna HealthFund CDHP and Value Plan

296.95
CDHP Self
EP1
674.38
CDHP Self & Family
EP2
CDHP Self Plus One
EP3
236.69
Basic Self
EP4
537.52
Basic Self & Family
EP5
Basic Self Plus One
EP6
New York Aetna HealthFund HDHP
226.86
HDHP Self
224
496.83
HDHP Self & Family
225
HDHP Self Plus One
226
New York Aetna Open Access
417.25
High Self
JC1
1027.10
High Self & Family
JC2
High Self Plus One
JC3
323.42
Basic Self
JC4
785.86
Basic Self & Family
JC5
Basic Self Plus One
JC6
New York CDPHP Universal Benefits, Inc.
317.74
High Self
SG1
804.71
High Self & Family
SG2
High Self Plus One
SG3
242.27
Standard Self
SG4
585.56
Standard Self & Family
SG5
Standard Self Plus One
SG6

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Gov't
Pays

Empl.
Pays

353.14
805.37
797.39
243.00
556.47
545.55

213.37
488.50
461.02
182.25
417.35
409.16

139.77
316.87
336.37
60.75
139.12
136.39

44.83
91.06
1.58
4.74
-

643.39
1461.16
512.83
1164.63
-

765.14 462.30 302.84

1744.97 1058.42 686.55
1727.68 998.88 728.80
526.50 394.88 131.62
1205.69 904.27 301.42
1182.03 886.52 295.51

97.14
197.29
3.41
10.26
-

240.15
529.73
519.34

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

130.08
286.94
281.31

7.20
17.82
-

480.22
1186.65
1174.90
346.30
844.69
836.33

213.37
488.50
461.02
213.37
488.50
461.02

266.85
698.15
713.88
132.93
356.19
375.31

51.61
119.62
11.52
18.90
-

904.04
2225.38
700.74
1702.70
-

1040.48 462.30 578.18

2571.08 1058.42 1512.66
2545.62 998.88 1546.74
750.32 462.30 288.02
1830.16 1058.42 771.74
1812.05 998.88 813.17

111.83
259.18
24.97
40.94
-

345.92
1037.75
691.85
244.54
733.57
489.06

213.37
488.50
461.02
183.41
488.50
366.80

132.55
549.25
230.83
61.13
245.07
122.26

16.82
193.11
0.56
98.68
-

688.44
1743.54
524.92
1268.71
-

749.49 462.30 287.19

2248.46 1058.42 1190.04
1499.01 998.88 500.13
529.84 397.38 132.46
1589.40 1058.42 530.98
1059.63 794.72 264.91

36.44
418.40
1.23
213.80
-

390.25
860.81
843.93

Empl.
Pays

Change in
empl.
payment

Total
Premium

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

New York GHI Health Plan

359.25
High Self
801
898.21
High Self & Family
802
High Self Plus One
803
270.09
Standard Self
804
613.31
Standard Self & Family
805
Standard Self Plus One
806
New York HIP Health of Greater New York
294.68
High Self
511
780.92
High Self & Family
512
High Self Plus One
513
New York Independent Health Assoc
297.69
High Self
QA1
714.44
High Self & Family
QA2
High Self Plus One
QA3
212.93
HDHP Self
QA4
512.09
HDHP Self & Family
QA5
HDHP Self Plus One
QA6
New York Independent Health Association
293.11
Standard Self
C54
703.47
Standard Self & Family
C55
Standard Self Plus One
C56

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

Total
Premium

Gov't
Pays

Empl.
Pays

393.81
1163.42
754.55
303.85
822.81
499.88

213.37
488.50
461.02
213.37
488.50
374.91

180.44
674.92
293.53
90.48
334.31
124.97

23.20
225.28
22.40
169.57
-

778.38
1946.12
585.20
1328.84
-

853.26 462.30 390.96

2520.74 1058.42 1462.32
1634.86 998.88 635.98
658.34 462.30 196.04
1782.76 1058.42 724.34
1083.07 812.30 270.77

50.27
488.10
48.53
367.40
-

303.08
869.28
537.96

213.37 89.71
488.50 380.78
403.47 134.49

-2.96
48.43
-

638.47
1691.99
-

656.67 462.30 194.37

1883.44 1058.42 825.02
1165.58 874.19 291.39

-6.41
104.93
-

286.19
772.70
729.77
207.21
549.19
507.55

213.37
488.50
461.02
155.41
411.89
380.66

72.82
284.20
268.75
51.80
137.30
126.89

-22.86
18.33
-1.43
9.28
-

645.00
1547.95
461.35
1109.53
-

620.08 462.30 157.78

1674.18 1058.42 615.76
1581.17 998.88 582.29
448.96 336.72 112.24
1189.91 892.43 297.48
1099.69 824.77 274.92

-49.53
39.71
-3.10
20.10
-

274.15
740.22
699.10

205.61 68.54
488.50 251.72
461.02 238.08

-22.56
-3.18
-

635.07
1524.19
-

593.99 445.49 148.50

1603.81 1058.42 545.39
1514.72 998.88 515.84

-48.88
-6.90
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)

2016 Biweekly premium rates

Plan - Option - Enrollment Code

New York MVP Health Care

High Self
High Self & Family
High Self Plus One
Standard Self
Standard Self & Family
Standard Self Plus One
New York MVP Health Care
High Self
High Self & Family
High Self Plus One
Standard Self
Standard Self & Family
Standard Self Plus One
New York MVP Health Care
High Self
High Self & Family
High Self Plus One
Standard Self
Standard Self & Family
Standard Self Plus One

2015 Total
Biweekly
Premium

Total
Premium

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

GA1
GA2
GA3
GA4
GA5
GA6

299.86
751.24
278.81
700.50
-

313.35
768.85
721.34
285.99
699.39
661.51

213.37
488.50
461.02
213.37
488.50
461.02

99.98
280.35
260.32
72.62
210.89
200.49

2.13
-22.32
-4.18
-41.04
-

649.70
1627.69
604.09
1517.75
-

678.93 462.30 216.63

1665.84 1058.42 607.42
1562.90 998.88 564.02
619.65 462.30 157.35
1515.35 1058.42 456.93
1433.27 998.88 434.39

4.62
-48.37
-9.05
-88.92
-

GV1
GV2
GV3
GV4
GV5
GV6

276.62
692.22
247.83
620.16
-

293.39
719.54
674.84
259.58
636.58
597.03

213.37
488.50
461.02
194.69
477.44
447.77

80.02
231.04
213.82
64.89
159.14
149.26

5.41
-12.61
2.93
-12.45
-

599.34
1499.81
536.97
1343.68
-

635.68 462.30 173.38

1559.00 1058.42 500.58
1462.15 998.88 463.27
562.42 421.82 140.60
1379.26 1034.45 344.81
1293.57 970.18 323.39

11.73
-27.33
6.36
-26.97
-

M91
M92
M93
M94
M95
M96

297.43
745.43
279.45
698.02
-

311.50
764.42
718.85
296.13
727.26
682.74

213.37
488.50
461.02
213.37
488.50
461.02

98.13
275.92
257.83
82.76
238.76
221.72

2.71
-20.94
5.32
-10.69
-

644.43
1615.10
605.48
1512.38
-

674.92 462.30 212.62

1656.24 1058.42 597.82
1557.51 998.88 558.63
641.62 462.30 179.32
1575.73 1058.42 517.31
1479.27 998.88 480.39

5.88
-45.38
11.53
-23.17
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

New York MVP Health Care

338.83
High Self
MF1
356.52
847.90
High Self & Family
MF2
874.34
High Self Plus One
MF3
820.01
322.59
Standard Self
MF4
344.02
807.25
Standard Self & Family
MF5
843.67
Standard Self Plus One
MF6
791.23
New York MVP Health Care
304.31
High Self
MX1
332.71
761.26
High Self & Family
MX2
815.68
High Self Plus One
MX3
764.62
286.84
Standard Self
MX4
316.09
719.50
Standard Self & Family
MX5
775.14
Standard Self Plus One
MX6
730.32
North Carolina Aetna Direct
210.05
CDHP Self
N61
218.45
474.42
CDHP Self & Family
N62
550.93
CDHP Self Plus One
N63
479.08
North Carolina Aetna HealthFund CDHP and Value Plan
272.01
CDHP Self
F51
298.88
617.70
CDHP Self & Family
F52
681.47
CDHP Self Plus One
F53
674.72
243.50
Basic Self
F54
250.64
552.96
Basic Self & Family
F55
573.93
Basic Self Plus One
F56
562.68

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Empl.
Pays

213.37
488.50
461.02
213.37
488.50
461.02

143.15
385.84
358.99
130.65
355.17
330.21

6.33
-13.49
10.07
-3.51
-

734.13
1837.12
698.95
1749.04
-

772.46 462.30 310.16

1894.40 1058.42 835.98
1776.69 998.88 777.81
745.38 462.30 283.08
1827.95 1058.42 769.53
1714.33 998.88 715.45

13.72
-29.24
21.82
-7.61
-

213.37
488.50
461.02
213.37
488.50
461.02

119.34
327.18
303.60
102.72
286.64
269.30

17.04
14.49
17.89
15.71
-

659.34
1649.40
621.49
1558.92
-

720.87 462.30 258.57

1767.31 1058.42 708.89
1656.68 998.88 657.80
684.86 462.30 222.56
1679.47 1058.42 621.05
1582.36 998.88 583.48

36.92
31.39
38.76
34.03
-

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

118.33
298.42
259.50

4.55
41.44
-

213.37
488.50
461.02
187.98
430.45
422.01

15.51
23.84
1.79
5.24
-

589.36
1338.35
527.58
1198.08
-

647.57 462.30 185.27

1476.52 1058.42 418.10
1461.89 998.88 463.01
543.05 407.29 135.76
1243.52 932.64 310.88
1219.14 914.36 304.78

33.60
51.65
3.87
11.36
-

85.51
192.97
213.70
62.66
143.48
140.67

Gov't
Pays

354.98
895.26
778.51

Empl.
Pays

Change in
empl.
payment

Gov't
Pays

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

North Carolina Aetna HealthFund HDHP

226.86
HDHP Self
224
240.15
496.83
HDHP Self & Family
225
529.73
HDHP Self Plus One
226
519.34
North Dakota Aetna Direct
210.05
CDHP Self
N61
218.45
474.42
CDHP Self & Family
N62
550.93
CDHP Self Plus One
N63
479.08
North Dakota Aetna HealthFund CDHP and Value Plan
276.95
CDHP Self
H41
312.68
628.94
CDHP Self & Family
H42
712.76
CDHP Self Plus One
H43
705.70
244.12
Basic Self
H44
247.72
554.39
Basic Self & Family
H45
568.54
Basic Self Plus One
H46
557.39
North Dakota Aetna HealthFund HDHP
226.86
HDHP Self
224
240.15
496.83
HDHP Self & Family
225
529.73
HDHP Self Plus One
226
519.34
North Dakota HealthPartners High and Standard Option
304.64
High Self
V31
315.60
700.68
High Self & Family
V32
768.79
High Self Plus One
V33
697.47
169.19
Standard Self
V34
179.23
389.14
Standard Self & Family
V35
436.61
Standard Self Plus One
V36
396.10

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

390.25
860.81
843.93

130.08
286.94
281.31

7.20
17.82
-

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

354.98
895.26
778.51

118.33
298.42
259.50

4.55
41.44
-

213.37
488.50
461.02
185.79
426.41
418.04

99.31
224.26
244.68
61.93
142.13
139.35

24.37
43.89
0.90
3.53
-

600.06
1362.70
528.93
1201.18
-

677.47 462.30 215.17

1544.31 1058.42 485.89
1529.02 998.88 530.14
536.73 402.55 134.18
1231.84 923.88 307.96
1207.68 905.76 301.92

52.80
95.09
1.95
7.67
-

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

130.08
286.94
281.31

7.20
17.82
-

213.37
488.50
461.02
134.42
327.46
297.08

-0.40
28.18
2.51
11.87
-

660.05
1518.14
366.58
843.14
-

683.80 462.30 221.50

1665.71 1058.42 607.29
1511.19 998.88 512.31
388.33 291.25 97.08
945.99 709.49 236.50
858.22 643.67 214.55

-0.86
61.05
5.44
25.72
-

102.23
280.29
236.45
44.81
109.15
99.02

390.25
860.81
843.93

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

North Dakota Sanford Health Plan

329.47
High Self
C91
757.79
High Self & Family
C92
High Self Plus One
C93
293.11
Standard Self
C94
728.73
Standard Self & Family
C95
Standard Self Plus One
C96
Ohio Aetna Direct
210.05
CDHP Self
N61
474.42
CDHP Self & Family
N62
CDHP Self Plus One
N63
Ohio Aetna HealthFund CDHP and Value Plan
340.51
CDHP Self
JS1
773.27
CDHP Self & Family
JS2
CDHP Self Plus One
JS3
279.09
Basic Self
JS4
633.78
Basic Self & Family
JS5
Basic Self Plus One
JS6
Ohio Aetna HealthFund HDHP
226.86
HDHP Self
224
496.83
HDHP Self & Family
225
HDHP Self Plus One
226

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

399.12
1117.54
718.42
370.96
1038.68
667.72

213.37
488.50
461.02
213.37
488.50
461.02

185.75
629.04
257.40
157.59
550.18
206.70

58.29
319.82
66.49
270.02
-

713.85
1641.88
635.07
1578.92
-

864.76 462.30 402.46

2421.34 1058.42 1362.92
1556.58 998.88 557.70
803.75 462.30 341.45
2250.47 1058.42 1192.05
1446.73 998.88 447.85

126.30
692.94
144.07
585.03
-

218.45
550.93
479.08

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

118.33
298.42
259.50

4.55
41.44
-

403.55
919.90
910.79
301.31
687.86
681.04

213.37
488.50
461.02
213.37
488.50
461.02

51.68
106.70
10.86
14.15
-

737.77
1675.42
604.70
1373.19
-

874.36 462.30 412.06

1993.12 1058.42 934.70
1973.38 998.88 974.50
652.84 462.30 190.54
1490.36 1058.42 431.94
1475.59 998.88 476.71

111.98
231.18
23.53
30.65
-

240.15
529.73
519.34

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

7.20
17.82
-

190.18
431.40
449.77
87.94
199.36
220.02

Gov't
Pays

354.98
895.26
778.51

390.25
860.81
843.93

Empl.
Pays

Change in
empl.
payment

Total
Premium

130.08
286.94
281.31

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

Ohio AultCare HMO

High Self
3A1
High Self & Family
3A2
High Self Plus One
3A3
HDHP Self
3A4
HDHP Self & Family
3A5
HDHP Self Plus One
3A6
Ohio HealthSpan Integrated Care
High Self
641
High Self & Family
642
High Self Plus One
643
Standard Self
644
Standard Self & Family
645
Standard Self Plus One
646
Ohio Humana Health Plan of Ohio
High Self
A61
High Self & Family
A62
High Self Plus One
A63
Standard Self
A64
Standard Self & Family
A65
Standard Self Plus One
A66
Ohio Paramount Health Care
High Self
N81
High Self & Family
N82
High Self Plus One
N83

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

Total
Premium

Gov't
Pays

Empl.
Pays

275.30
675.85
164.36
331.83
-

317.69
1016.58
603.60
145.49
465.52
276.41

213.37
488.50
452.70
109.12
349.14
207.31

104.32
528.08
150.90
36.37
116.38
69.10

31.03
300.80
-4.72
33.42
-

596.48
1464.34
356.11
718.97
-

688.33 462.30 226.03

2202.59 1058.42 1144.17
1307.80 980.85 326.95
315.23 236.42 78.81
1008.63 756.47 252.16
598.89 449.17 149.72

67.24
651.73
-10.22
72.42
-

340.53
783.22
249.82
574.57
-

364.04
873.69
800.89
265.94
638.26
585.06

213.37
488.50
461.02
199.46
478.70
438.80

150.67
385.19
339.87
66.48
159.56
146.26

12.15
50.54
4.03
15.92
-

737.82
1696.98
541.28
1244.90
-

788.75 462.30 326.45

1893.00 1058.42 834.58
1735.26 998.88 736.38
576.20 432.15 144.05
1382.90 1037.18 345.72
1267.63 950.72 316.91

26.32
109.50
8.73
34.50
-

275.35
612.64
261.58
582.02
-

349.02
785.30
750.40
294.73
663.14
633.66

213.37
488.50
461.02
213.37
488.50
461.02

135.65
296.80
289.38
81.36
174.64
172.64

62.31
132.73
15.97
29.14
-

596.59
1327.39
566.76
1261.04
-

756.21 462.30 293.91

1701.48 1058.42 643.06
1625.87 998.88 626.99
638.58 462.30 176.28
1436.80 1058.42 378.38
1372.93 998.88 374.05

135.01
287.57
34.59
63.12
-

New Plan
New Plan
New Plan

267.45
703.39
534.90

200.59 66.86
488.50 214.89
401.18 133.72

New Plan New Plan 579.48 434.61 144.87

New Plan New Plan 1524.01 1058.42 465.59
New Plan New Plan 1158.95 869.21 289.74

New Plan
New Plan
New Plan

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Oklahoma Aetna Direct

210.05
CDHP Self
N61
474.42
CDHP Self & Family
N62
CDHP Self Plus One
N63
Oklahoma Aetna HealthFund CDHP and Value Plan
340.51
CDHP Self
JS1
773.27
CDHP Self & Family
JS2
CDHP Self Plus One
JS3
279.09
Basic Self
JS4
633.78
Basic Self & Family
JS5
Basic Self Plus One
JS6
Oklahoma Aetna HealthFund HDHP
226.86
HDHP Self
224
496.83
HDHP Self & Family
225
HDHP Self Plus One
226
Oklahoma Globalhealth, Inc.
251.82
High Self
IM1
606.88
High Self & Family
IM2
High Self Plus One
IM3
Oregon Aetna Direct
210.05
CDHP Self
N61
474.42
CDHP Self & Family
N62
CDHP Self Plus One
N63

Total
Premium

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

354.98
895.26
778.51

218.45
550.93
479.08

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

118.33
298.42
259.50

4.55
41.44
-

403.55
919.90
910.79
301.31
687.86
681.04

213.37
488.50
461.02
213.37
488.50
461.02

51.68
106.70
10.86
14.15
-

737.77
1675.42
604.70
1373.19
-

874.36 462.30 412.06

1993.12 1058.42 934.70
1973.38 998.88 974.50
652.84 462.30 190.54
1490.36 1058.42 431.94
1475.59 998.88 476.71

111.98
231.18
23.53
30.65
-

240.15
529.73
519.34

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

130.08
286.94
281.31

7.20
17.82
-

276.33
690.84
552.67

207.25 69.08
488.50 202.34
414.50 138.17

6.13
44.03
-

545.61
1314.91
-

598.72 449.04 149.68

1496.82 1058.42 438.40
1197.45 898.09 299.36

13.28
95.39
-

218.45
550.93
479.08

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

4.55
41.44
-

190.18
431.40
449.77
87.94
199.36
220.02

390.25
860.81
843.93

354.98
895.26
778.51

118.33
298.42
259.50

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Oregon Aetna HealthFund CDHP and Value Plan

276.95
CDHP Self
H41
312.68
628.94
CDHP Self & Family
H42
712.76
CDHP Self Plus One
H43
705.70
244.12
Basic Self
H44
247.72
554.39
Basic Self & Family
H45
568.54
Basic Self Plus One
H46
557.39
Oregon Aetna HealthFund HDHP
226.86
HDHP Self
224
240.15
496.83
HDHP Self & Family
225
529.73
HDHP Self Plus One
226
519.34
Oregon Kaiser Foundation Health Plan of Northwest
288.33
High Self
571
298.94
651.28
High Self & Family
572
675.21
High Self Plus One
573
675.21
243.47
Standard Self
574
261.22
570.13
Standard Self & Family
575
600.10
Standard Self Plus One
576
600.10
Pennsylvania Aetna Direct
210.05
CDHP Self
N61
218.45
474.42
CDHP Self & Family
N62
550.93
CDHP Self Plus One
N63
479.08

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Empl.
Pays

213.37
488.50
461.02
185.79
426.41
418.04

99.31
224.26
244.68
61.93
142.13
139.35

24.37
43.89
0.90
3.53
-

600.06
1362.70
528.93
1201.18
-

677.47 462.30 215.17

1544.31 1058.42 485.89
1529.02 998.88 530.14
536.73 402.55 134.18
1231.84 923.88 307.96
1207.68 905.76 301.92

52.80
95.09
1.95
7.67
-

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

130.08
286.94
281.31

7.20
17.82
-

85.57
186.71
214.19
65.30
150.02
150.02

-0.75
-16.00
4.43
7.49
-

624.72
1411.11
527.52
1235.28
-

647.70 462.30 185.40

1462.96 1058.42 404.54
1462.96 998.88 464.08
565.98 424.49 141.49
1300.22 975.17 325.05
1300.22 975.17 325.05

-1.63
-34.67
9.61
16.23
-

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

4.55
41.44
-

213.37
488.50
461.02
195.92
450.08
450.08

Gov't
Pays

390.25
860.81
843.93

354.98
895.26
778.51

Empl.
Pays

Change in
empl.
payment

Gov't
Pays

118.33
298.42
259.50

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Pennsylvania Aetna HealthFund CDHP and Value Plan

276.95
CDHP Self
H41
312.68
628.94
CDHP Self & Family
H42
712.76
CDHP Self Plus One
H43
705.70
244.12
Basic Self
H44
247.72
554.39
Basic Self & Family
H45
568.54
Basic Self Plus One
H46
557.39
Pennsylvania Aetna HealthFund HDHP
226.86
HDHP Self
224
240.15
496.83
HDHP Self & Family
225
529.73
HDHP Self Plus One
226
519.34
Pennsylvania Aetna Open Access
557.69
High Self
P31
631.25
1345.62 1530.47
High Self & Family
P32
High Self Plus One
P33
1515.32
483.10
Basic Self
P34
508.42
1115.54 1180.07
Basic Self & Family
P35
Basic Self Plus One
P36
1168.39
Pennsylvania Aetna Open Access
320.33
High Self
YE1
327.62
801.24
High Self & Family
YE2
822.65
High Self Plus One
YE3
814.52
Pennsylvania Geisinger Health Plan
292.09
Standard Self
GG4
299.25
671.81
Standard Self & Family
GG5
688.29
Standard Self Plus One
GG6
688.29

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Empl.
Pays

213.37
488.50
461.02
185.79
426.41
418.04

99.31
224.26
244.68
61.93
142.13
139.35

24.37
43.89
0.90
3.53
-

600.06
1362.70
528.93
1201.18
-

677.47 462.30 215.17

1544.31 1058.42 485.89
1529.02 998.88 530.14
536.73 402.55 134.18
1231.84 923.88 307.96
1207.68 905.76 301.92

52.80
95.09
1.95
7.67
-

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

130.08
286.94
281.31

7.20
17.82
-

417.88
1041.97
1054.30
295.05
691.57
707.37

62.20
144.92
13.96
24.60
-

1208.33
2915.51
1046.72
2417.00
-

1367.71 462.30 905.41

3316.02 1058.42 2257.60
3283.19 998.88 2284.31
1101.58 462.30 639.28
2556.82 1058.42 1498.40
2531.51 998.88 1532.63

134.77
313.99
30.25
53.30
-

213.37 114.25
488.50 334.15
461.02 353.50

-4.07
-18.52
-

694.05
1736.02
-

709.84 462.30 247.54

1782.41 1058.42 723.99
1764.79 998.88 765.91

-8.82
-40.13
-

213.37 85.88
488.50 199.79
461.02 227.27

-4.20
-23.45
-

632.86
1455.59
-

648.38 462.30 186.08

1491.30 1058.42 432.88
1491.30 998.88 492.42

-9.09
-50.81
-

213.37
488.50
461.02
213.37
488.50
461.02

Gov't
Pays

390.25
860.81
843.93

Empl.
Pays

Change in
empl.
payment

Gov't
Pays

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Pennsylvania Keystone Health Plan West

204.93
High Self
NP1
252.23
479.54
High Self & Family
NP2
572.17
High Self Plus One
NP3
474.68
Pennsylvania UPMC Health Plan
305.67
High Self
8W1
356.35
703.01
High Self & Family
8W2
837.39
High Self Plus One
8W3
801.78
229.55
HDHP Self
8W4
236.77
518.14
HDHP Self & Family
8W5
545.81
HDHP Self Plus One
8W6
524.87
Pennsylvania UPMC Health Plan
250.98
Standard Self
UW4
267.50
577.28
Standard Self & Family
UW5
628.58
Standard Self Plus One
UW6
601.85
Puerto Rico Humana Health Plans of Puerto Rico, Inc.
151.99
High Self
ZJ1
161.83
338.17
High Self & Family
ZJ2
364.14
High Self Plus One
ZJ3
347.95
Puerto Rico Triple-S Salud, Inc.
179.99
High Self
891
179.99
412.18
High Self & Family
892
412.18
High Self Plus One
893
404.14
Rhode Island Aetna Direct
210.05
CDHP Self
N61
218.45
474.42
CDHP Self & Family
N62
550.93
CDHP Self Plus One
N63
479.08

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

409.88
929.78
771.35

189.17 63.06
429.13 143.04
356.01 118.67

11.83
23.16
-

444.02
1039.00
-

546.50
1239.70
1028.47

136.62
309.92
257.12

25.62
50.17
-

213.37
488.50
461.02
177.58
409.36
393.65

142.98
348.89
340.76
59.19
136.45
131.22

39.32
94.45
1.80
6.92
-

662.29
1523.19
497.36
1122.64
-

772.09 462.30 309.79

1814.35 1058.42 755.93
1737.19 998.88 738.31
513.00 384.75 128.25
1182.59 886.94 295.65
1137.22 852.92 284.30

85.19
204.64
3.91
14.99
-

200.63 66.87
471.44 157.14
451.39 150.46

4.13
12.82
-

543.79
1250.77
-

579.58 434.69 144.89

1361.92 1021.44 340.48
1304.01 978.01 326.00

8.94
27.79
-

121.37
273.11
260.96

40.46
91.03
86.99

2.46
6.49
-

329.31
732.70
-

350.63
788.97
753.89

262.97
591.73
565.42

87.66
197.24
188.47

5.33
14.07
-

134.99 45.00
309.14 103.04
303.11 101.03

0.00
0.00
-

389.98
893.06
-

389.98
893.06
875.64

292.49
669.80
656.73

97.49
223.26
218.91

0.00
0.00
-

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

354.98
895.26
778.51

118.33
298.42
259.50

4.55
41.44
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Rhode Island Aetna HealthFund CDHP and Value Plan

296.95
CDHP Self
EP1
353.14
674.38
CDHP Self & Family
EP2
805.37
CDHP Self Plus One
EP3
797.39
236.69
Basic Self
EP4
243.00
537.52
Basic Self & Family
EP5
556.47
Basic Self Plus One
EP6
545.55
Rhode Island Aetna HealthFund HDHP
226.86
HDHP Self
224
240.15
496.83
HDHP Self & Family
225
529.73
HDHP Self Plus One
226
519.34
South Carolina Aetna Direct
210.05
CDHP Self
N61
218.45
474.42
CDHP Self & Family
N62
550.93
CDHP Self Plus One
N63
479.08
South Carolina Aetna HealthFund CDHP and Value Plan
340.51
CDHP Self
JS1
403.55
773.27
CDHP Self & Family
JS2
919.90
CDHP Self Plus One
JS3
910.79
279.09
Basic Self
JS4
301.31
633.78
Basic Self & Family
JS5
687.86
Basic Self Plus One
JS6
681.04
South Carolina Aetna HealthFund HDHP
226.86
HDHP Self
224
240.15
496.83
HDHP Self & Family
225
529.73
HDHP Self Plus One
226
519.34

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Empl.
Pays

213.37
488.50
461.02
182.25
417.35
409.16

139.77
316.87
336.37
60.75
139.12
136.39

44.83
91.06
1.58
4.74
-

643.39
1461.16
512.83
1164.63
-

765.14 462.30 302.84

1744.97 1058.42 686.55
1727.68 998.88 728.80
526.50 394.88 131.62
1205.69 904.27 301.42
1182.03 886.52 295.51

97.14
197.29
3.41
10.26
-

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

390.25
860.81
843.93

130.08
286.94
281.31

7.20
17.82
-

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

354.98
895.26
778.51

118.33
298.42
259.50

4.55
41.44
-

213.37
488.50
461.02
213.37
488.50
461.02

51.68
106.70
10.86
14.15
-

737.77
1675.42
604.70
1373.19
-

874.36 462.30 412.06

1993.12 1058.42 934.70
1973.38 998.88 974.50
652.84 462.30 190.54
1490.36 1058.42 431.94
1475.59 998.88 476.71

111.98
231.18
23.53
30.65
-

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

7.20
17.82
-

190.18
431.40
449.77
87.94
199.36
220.02

180.11 60.04
397.30 132.43
389.51 129.83

Gov't
Pays

390.25
860.81
843.93

Empl.
Pays

Change in
empl.
payment

Gov't
Pays

130.08
286.94
281.31

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

South Dakota Aetna Direct

210.05
CDHP Self
N61
218.45
474.42
CDHP Self & Family
N62
550.93
CDHP Self Plus One
N63
479.08
South Dakota Aetna HealthFund CDHP and Value Plan
289.47
CDHP Self
G51
321.78
657.36
CDHP Self & Family
G52
733.96
CDHP Self Plus One
G53
726.69
239.10
Basic Self
G54
246.85
542.96
Basic Self & Family
G55
565.39
Basic Self Plus One
G56
554.30
South Dakota Aetna HealthFund HDHP
226.86
HDHP Self
224
240.15
496.83
HDHP Self & Family
225
529.73
HDHP Self Plus One
226
519.34
South Dakota HealthPartners High and Standard Option
304.64
High Self
V31
315.60
700.68
High Self & Family
V32
768.79
High Self Plus One
V33
697.47
169.19
Standard Self
V34
179.23
389.14
Standard Self & Family
V35
436.61
Standard Self Plus One
V36
396.10

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

354.98
895.26
778.51

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

118.33
298.42
259.50

4.55
41.44
-

213.37
488.50
461.02
185.14
424.04
415.73

108.41
245.46
265.67
61.71
141.35
138.57

20.95
36.67
1.94
5.61
-

627.19
1424.28
518.05
1176.41
-

697.19 462.30 234.89

1590.25 1058.42 531.83
1574.50 998.88 575.62
534.84 401.13 133.71
1225.01 918.76 306.25
1200.98 900.74 300.24

45.39
79.45
4.20
12.15
-

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

130.08
286.94
281.31

7.20
17.82
-

213.37
488.50
461.02
134.42
327.46
297.08

-0.40
28.18
2.51
11.87
-

660.05
1518.14
366.58
843.14
-

683.80 462.30 221.50

1665.71 1058.42 607.29
1511.19 998.88 512.31
388.33 291.25 97.08
945.99 709.49 236.50
858.22 643.67 214.55

-0.86
61.05
5.44
25.72
-

102.23
280.29
236.45
44.81
109.15
99.02

390.25
860.81
843.93

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

South Dakota Sanford Health Plan

340.19
High Self
AU1
782.74
High Self & Family
AU2
High Self Plus One
AU3
326.45
Standard Self
AU4
750.86
Standard Self & Family
AU5
Standard Self Plus One
AU6
Tennessee Aetna Direct
210.05
CDHP Self
N61
474.42
CDHP Self & Family
N62
CDHP Self Plus One
N63
Tennessee Aetna HealthFund CDHP and Value Plan
272.01
CDHP Self
F51
617.70
CDHP Self & Family
F52
CDHP Self Plus One
F53
243.50
Basic Self
F54
552.96
Basic Self & Family
F55
Basic Self Plus One
F56
Tennessee Aetna HealthFund HDHP
226.86
HDHP Self
224
496.83
HDHP Self & Family
225
HDHP Self Plus One
226
Tennessee Aetna Open Access
343.29
High Self
UB1
875.33
High Self & Family
UB2
High Self Plus One
UB3

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Gov't
Pays

Empl.
Pays

337.07
943.80
606.73
326.78
914.97
588.19

213.37
488.50
455.05
213.37
488.50
441.14

123.70
455.30
151.68
113.41
426.47
147.05

-14.48
121.13
-11.03
124.18
-

737.08
1695.94
707.31
1626.86
-

730.32 462.30 268.02

2044.90 1058.42 986.48
1314.58 985.94 328.64
708.02 462.30 245.72
1982.44 1058.42 924.02
1274.41 955.81 318.60

-31.37
262.44
-23.90
269.06
-

218.45
550.93
479.08

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

118.33
298.42
259.50

4.55
41.44
-

298.88
681.47
674.72
250.64
573.93
562.68

213.37
488.50
461.02
187.98
430.45
422.01

85.51
192.97
213.70
62.66
143.48
140.67

15.51
23.84
1.79
5.24
-

589.36
1338.35
527.58
1198.08
-

647.57 462.30 185.27

1476.52 1058.42 418.10
1461.89 998.88 463.01
543.05 407.29 135.76
1243.52 932.64 310.88
1219.14 914.36 304.78

33.60
51.65
3.87
11.36
-

240.15
529.73
519.34

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

130.08
286.94
281.31

7.20
17.82
-

383.54
982.84
973.11

213.37 170.17
488.50 494.34
461.02 512.09

28.89
67.58
-

743.80
1896.55
-

831.00 462.30 368.70

2129.49 1058.42 1071.07
2108.41 998.88 1109.53

62.59
146.42
-

354.98
895.26
778.51

390.25
860.81
843.93

Empl.
Pays

Change in
empl.
payment

Total
Premium

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Gov't
Pays

Empl.
Pays

Tennessee Humana Health Plan, Inc.

260.05
High Self
GJ1
296.48 213.37 83.11
578.61
High Self & Family
GJ2
667.09 488.50 178.59
High Self Plus One
GJ3
637.45 461.02 176.43
234.05
Standard Self
GJ4
270.49 202.87 67.62
520.76
Standard Self & Family
GJ5
608.61 456.46 152.15
Standard Self Plus One
GJ6
581.56 436.17 145.39
Tennessee United Healthcare Insurance Company, Inc. (Choice HMO)
High Self
KK1 New Plan 245.00 183.75 61.25
High Self & Family
KK2 New Plan 686.98 488.50 198.48
High Self Plus One
KK3 New Plan 478.48 358.86 119.62
Tennessee United Healthcare Insurance Company, Inc. (HDHP Choice Plus)
New Plan 234.69 176.02 58.67
HDHP Self
LS1
New Plan 658.05 488.50 169.55
HDHP Self & Family
LS2
New Plan 458.33 343.75 114.58
HDHP Self Plus One
LS3
Texas Aetna Direct
210.05
CDHP Self
N61
218.45 163.84 54.61
474.42
CDHP Self & Family
N62
550.93 413.20 137.73
CDHP Self Plus One
N63
479.08 359.31 119.77
Texas Aetna HealthFund CDHP and Value Plan
340.51
CDHP Self
JS1
403.55 213.37 190.18
773.27
CDHP Self & Family
JS2
919.90 488.50 431.40
CDHP Self Plus One
JS3
910.79 461.02 449.77
279.09
Basic Self
JS4
301.31 213.37 87.94
633.78
Basic Self & Family
JS5
687.86 488.50 199.36
Basic Self Plus One
JS6
681.04 461.02 220.02

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

18.10
33.94
9.11
21.96
-

563.44
1253.66
507.11
1128.31
-

Gov't
Pays

Empl.
Pays

642.37 462.30 180.07

1445.36 1058.42 386.94
1381.14 998.88 382.26
586.06 439.55 146.51
1318.66 989.00 329.66
1260.05 945.04 315.01

Change in
empl.
payment

39.21
73.53
19.73
47.58
-

New Plan New Plan 530.83 398.12 132.71

New Plan New Plan 1488.46 1058.42 430.04
New Plan New Plan 1036.71 777.53 259.18

New Plan
New Plan
New Plan

New Plan New Plan 508.50 381.38 127.12

New Plan New Plan 1425.78 1058.42 367.36
New Plan New Plan 993.05 744.79 248.26

New Plan
New Plan
New Plan

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

118.33
298.42
259.50

4.55
41.44
-

51.68
106.70
10.86
14.15
-

737.77
1675.42
604.70
1373.19
-

874.36 462.30 412.06

1993.12 1058.42 934.70
1973.38 998.88 974.50
652.84 462.30 190.54
1490.36 1058.42 431.94
1475.59 998.88 476.71

111.98
231.18
23.53
30.65
-

354.98
895.26
778.51

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Texas Aetna HealthFund HDHP

226.86
HDHP Self
224
496.83
HDHP Self & Family
225
HDHP Self Plus One
226
Texas Aetna Whole Health
243.73
Basic Self
ES1
642.48
Basic Self & Family
ES2
Basic Self Plus One
ES3
Texas Firstcare
239.65
High Self
CK1
551.18
High Self & Family
CK2
High Self Plus One
CK3
Texas Humana CoverageFirst and Value Plan
261.85
CDHP Self
TP1
582.62
CDHP Self & Family
TP2
CDHP Self Plus One
TP3
198.87
Basic Self
TP4
442.49
Basic Self & Family
TP5
Basic Self Plus One
TP6
Texas Humana CoverageFirst and Value Plan
259.00
CDHP Self
TU1
576.27
CDHP Self & Family
TU2
CDHP Self Plus One
TU3
198.87
Basic Self
TU4
442.49
Basic Self & Family
TU5
Basic Self Plus One
TU6

Total
Premium

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

390.25
860.81
843.93

240.15
529.73
519.34

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

130.08
286.94
281.31

7.20
17.82
-

254.88
674.81
668.14

191.16 63.72
488.50 186.31
461.02 207.12

2.79
-7.60
-

528.08
1392.04
-

552.24 414.18 138.06

1462.09 1058.42 403.67
1447.64 998.88 448.76

6.04
-16.47
-

257.10
591.30
488.49

192.83 64.27
443.48 147.82
366.37 122.12

4.36
10.03
-

519.24
1194.22
-

557.05
1281.15
1058.40

139.26
320.29
264.60

9.45
21.74
-

295.84
665.64
636.05
215.28
484.37
462.84

213.37
488.50
461.02
161.46
363.28
347.13

82.47
177.14
175.03
53.82
121.09
115.71

17.01
31.49
4.10
10.47
-

567.34
1262.34
430.89
958.73
-

640.99 462.30 178.69

1442.22 1058.42 383.80
1378.11 998.88 379.23
466.44 349.83 116.61
1049.47 787.10 262.37
1002.82 752.12 250.70

36.86
68.22
8.89
22.69
-

290.09
652.69
623.69
215.28
484.37
462.84

213.37
488.50
461.02
161.46
363.28
347.13

76.72
164.19
162.67
53.82
121.09
115.71

11.97
20.12
4.10
10.47
-

561.17
1248.59
430.89
958.73
-

628.53 462.30 166.23

1414.16 1058.42 355.74
1351.33 998.88 352.45
466.44 349.83 116.61
1049.47 787.10 262.37
1002.82 752.12 250.70

25.94
43.59
8.89
22.69
-

417.79
960.86
793.80

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Texas Humana CoverageFirst and Value Plan

272.17
CDHP Self
TV1
605.59
CDHP Self & Family
TV2
CDHP Self Plus One
TV3
198.87
Basic Self
TV4
442.49
Basic Self & Family
TV5
Basic Self Plus One
TV6
Texas Humana Health Plan of Texas
260.05
High Self
EW1
578.61
High Self & Family
EW2
High Self Plus One
EW3
234.05
Standard Self
EW4
520.76
Standard Self & Family
EW5
Standard Self Plus One
EW6
Texas Humana Health Plan of Texas
275.35
High Self
UC1
612.65
High Self & Family
UC2
High Self Plus One
UC3
261.58
Standard Self
UC4
582.02
Standard Self & Family
UC5
Standard Self Plus One
UC6

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

Total
Premium

Gov't
Pays

Empl.
Pays

300.33
675.74
645.70
215.28
484.37
462.84

213.37
488.50
461.02
161.46
363.28
347.13

86.96
187.24
184.68
53.82
121.09
115.71

16.80
30.22
4.10
10.47
-

589.70
1312.11
430.89
958.73
-

650.72 462.30 188.42

1464.10 1058.42 405.68
1399.02 998.88 400.14
466.44 349.83 116.61
1049.47 787.10 262.37
1002.82 752.12 250.70

36.41
65.47
8.89
22.69
-

299.70
674.30
644.34
273.37
615.09
587.75

213.37
488.50
461.02
205.03
461.32
440.81

86.33
185.80
183.32
68.34
153.77
146.94

21.32
41.15
9.83
23.58
-

563.44
1253.66
507.11
1128.31
-

649.35 462.30 187.05

1460.98 1058.42 402.56
1396.07 998.88 397.19
592.30 444.23 148.07
1332.70 999.53 333.17
1273.46 955.10 318.36

46.19
89.15
21.29
51.09
-

314.51
707.64
676.18
297.24
668.79
639.07

213.37
488.50
461.02
213.37
488.50
461.02

101.14
219.14
215.16
83.87
180.29
178.05

27.80
55.06
18.48
34.79
-

596.59
1327.41
566.76
1261.04
-

681.44 462.30 219.14

1533.22 1058.42 474.80
1465.06 998.88 466.18
644.02 462.30 181.72
1449.05 1058.42 390.63
1384.65 998.88 385.77

60.24
119.29
40.03
75.37
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Texas Humana Health Plan of Texas

482.16
High Self
UR1
1072.80
High Self & Family
UR2
High Self Plus One
UR3
275.35
Standard Self
UR4
612.65
Standard Self & Family
UR5
Standard Self Plus One
UR6
Texas Humana Health Plan of Texas
355.47
High Self
UU1
790.92
High Self & Family
UU2
High Self Plus One
UU3
275.35
Standard Self
UU4
612.65
Standard Self & Family
UU5
Standard Self Plus One
UU6
Texas Scott & White Health Plan
260.56
Standard Self
A84
598.27
Standard Self & Family
A85
Standard Self Plus One
A86
Texas UnitedHealthcare Benefits of Texas, Inc.
365.53
High Self
GF1
841.89
High Self & Family
GF2
High Self Plus One
GF3
Texas UnitedHealthcare Insurance Company
244.32
Basic Self
L91
543.61
Basic Self & Family
L92
Basic Self Plus One
L93

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

603.57
1358.03
1297.67
313.84
706.14
674.75

213.37
488.50
461.02
213.37
488.50
461.02

390.20
869.53
836.65
100.47
217.64
213.73

110.05
245.30
27.13
53.56
-

1044.68
2324.40
596.59
1327.41
-

1307.74 462.30 845.44

2942.40 1058.42 1883.98
2811.62 998.88 1812.74
679.99 462.30 217.69
1529.97 1058.42 471.55
1461.96 998.88 463.08

238.45
531.48
58.79
116.04
-

502.52
1130.66
1080.40
350.56
788.79
753.73

213.37
488.50
461.02
213.37
488.50
461.02

289.15
642.16
619.38
137.19
300.29
292.71

135.69
299.81
63.85
136.21
-

770.19
1713.66
596.59
1327.41
-

1088.79 462.30 626.49

2449.76 1058.42 1391.34
2340.87 998.88 1341.99
759.55 462.30 297.25
1709.05 1058.42 650.63
1633.08 998.88 634.20

293.99
649.58
138.35
295.12
-

272.01
638.18
570.37

204.01 68.00
478.64 159.54
427.78 142.59

2.86
9.84
-

564.55
1296.25
-

589.36 442.02 147.34

1382.72 1037.04 345.68
1235.80 926.85 308.95

6.20
21.33
-

396.27 213.37 182.90

1111.14 488.50 622.64
773.91 461.02 312.89

19.38
229.32
-

791.98
1824.10
-

858.59 462.30 396.29

2407.47 1058.42 1349.05
1676.81 998.88 677.93

42.00
496.85
-

212.71
596.45
415.43

-7.90
13.21
-

529.36
1177.82
-

460.87
1292.31
900.10

-17.12
28.63
-

159.53 53.18
447.34 149.11
311.57 103.86

Gov't
Pays

345.65
969.23
675.08

Empl.
Pays

Change in
empl.
payment

Total
Premium

115.22
323.08
225.02

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Utah Aetna Direct

210.05
CDHP Self
N61
218.45
474.42
CDHP Self & Family
N62
550.93
CDHP Self Plus One
N63
479.08
Utah Aetna Health of Utah, Inc. dba Altius Health Plans
299.68
High Self
9K1
314.79
659.33
High Self & Family
9K2
696.14
High Self Plus One
9K3
689.25
168.74
HDHP Self
9K4
170.28
349.58
HDHP Self & Family
9K5
355.88
HDHP Self Plus One
9K6
348.90
Utah Aetna Health of Utah, Inc. dba Altius Health Plans
225.43
Standard Self
DK4
229.98
495.93
Standard Self & Family
DK5
507.85
Standard Self Plus One
DK6
502.83
Utah Aetna HealthFund CDHP and Value Plan
289.47
CDHP Self
G51
321.78
657.36
CDHP Self & Family
G52
733.96
CDHP Self Plus One
G53
726.69
239.10
Basic Self
G54
246.85
542.96
Basic Self & Family
G55
565.39
Basic Self Plus One
G56
554.30
Utah Aetna HealthFund HDHP
226.86
HDHP Self
224
240.15
496.83
HDHP Self & Family
225
529.73
HDHP Self Plus One
226
519.34

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

354.98
895.26
778.51

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

118.33
298.42
259.50

4.55
41.44
-

213.37 101.42
488.50 207.64
461.02 228.23
127.71 42.57
266.91 88.97
261.68 87.22

3.75
-3.12
0.39
1.58
-

649.31
1428.55
365.60
757.42
-

682.05 462.30 219.75

1508.30 1058.42 449.88
1493.38 998.88 494.50
368.94 276.71 92.23
771.07 578.30 192.77
755.95 566.96 188.99

8.13
-6.77
0.83
3.42
-

172.49 57.49
380.89 126.96
377.12 125.71

1.13
2.98
-

488.43
1074.52
-

498.29
1100.34
1089.47

124.57
275.08
272.37

2.46
6.45
-

213.37
488.50
461.02
185.14
424.04
415.73

108.41
245.46
265.67
61.71
141.35
138.57

20.95
36.67
1.94
5.61
-

627.19
1424.28
518.05
1176.41
-

697.19 462.30 234.89

1590.25 1058.42 531.83
1574.50 998.88 575.62
534.84 401.13 133.71
1225.01 918.76 306.25
1200.98 900.74 300.24

45.39
79.45
4.20
12.15
-

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

7.20
17.82
-

373.72
825.26
817.10

390.25
860.81
843.93

130.08
286.94
281.31

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Utah SelectHealth
293.90
High Self
SF1
655.62
High Self & Family
SF2
High Self Plus One
SF3
229.58
Standard Self
SF4
512.14
Standard Self & Family
SF5
Standard Self Plus One
SF6
Vermont Aetna Direct
210.05
CDHP Self
N61
474.42
CDHP Self & Family
N62
CDHP Self Plus One
N63
Vermont Aetna HealthFund CDHP and Value Plan
296.95
CDHP Self
EP1
674.38
CDHP Self & Family
EP2
CDHP Self Plus One
EP3
236.69
Basic Self
EP4
537.52
Basic Self & Family
EP5
Basic Self Plus One
EP6
Vermont Aetna HealthFund HDHP
226.86
HDHP Self
224
496.83
HDHP Self & Family
225
HDHP Self Plus One
226
Virgin Islands Triple-S Salud, Inc.
227.85
High Self
851
521.80
High Self & Family
852
High Self Plus One
853

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Gov't
Pays

Empl.
Pays

317.43
708.06
708.06
236.46
525.08
525.08

213.37
488.50
461.02
177.35
393.81
393.81

104.06
219.56
247.04
59.11
131.27
131.27

12.17
12.51
1.72
3.24
-

636.78
1420.51
497.42
1109.64
-

687.77 462.30 225.47

1534.13 1058.42 475.71
1534.13 998.88 535.25
512.33 384.25 128.08
1137.67 853.25 284.42
1137.67 853.25 284.42

26.38
27.10
3.73
7.01
-

218.45
550.93
479.08

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

118.33
298.42
259.50

4.55
41.44
-

353.14
805.37
797.39
243.00
556.47
545.55

213.37
488.50
461.02
182.25
417.35
409.16

139.77
316.87
336.37
60.75
139.12
136.39

44.83
91.06
1.58
4.74
-

643.39
1461.16
512.83
1164.63
-

765.14 462.30 302.84

1744.97 1058.42 686.55
1727.68 998.88 728.80
526.50 394.88 131.62
1205.69 904.27 301.42
1182.03 886.52 295.51

97.14
197.29
3.41
10.26
-

240.15
529.73
519.34

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

390.25
860.81
843.93

130.08
286.94
281.31

7.20
17.82
-

227.85
521.80
511.62

170.89 56.96
391.35 130.45
383.72 127.90

0.00
0.00
-

493.68
1130.57
-

493.68
1130.57
1108.51

370.26
847.93
831.38

123.42
282.64
277.13

0.00
0.00
-

354.98
895.26
778.51

Empl.
Pays

Change in
empl.
payment

Total
Premium

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Virginia Aetna Direct

210.05
CDHP Self
N61
474.42
CDHP Self & Family
N62
CDHP Self Plus One
N63
Virginia Aetna HealthFund CDHP and Value Plan
272.01
CDHP Self
F51
617.70
CDHP Self & Family
F52
CDHP Self Plus One
F53
243.50
Basic Self
F54
552.96
Basic Self & Family
F55
Basic Self Plus One
F56
Virginia Aetna HealthFund HDHP
226.86
HDHP Self
224
496.83
HDHP Self & Family
225
HDHP Self Plus One
226
Virginia Aetna Open Access
426.78
High Self
JN1
955.97
High Self & Family
JN2
High Self Plus One
JN3
265.88
Basic Self
JN4
594.52
Basic Self & Family
JN5
Basic Self Plus One
JN6
Virginia Aetna Whole Health
230.81
Basic Self
D91
642.48
Basic Self & Family
D92
Basic Self Plus One
D93

Total
Premium

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

354.98
895.26
778.51

218.45
550.93
479.08

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

118.33
298.42
259.50

4.55
41.44
-

298.88
681.47
674.72
250.64
573.93
562.68

213.37
488.50
461.02
187.98
430.45
422.01

85.51
192.97
213.70
62.66
143.48
140.67

15.51
23.84
1.79
5.24
-

589.36
1338.35
527.58
1198.08
-

647.57 462.30 185.27

1476.52 1058.42 418.10
1461.89 998.88 463.01
543.05 407.29 135.76
1243.52 932.64 310.88
1219.14 914.36 304.78

33.60
51.65
3.87
11.36
-

240.15
529.73
519.34

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

130.08
286.94
281.31

7.20
17.82
-

442.85
995.60
985.75
275.96
621.16
608.98

213.37
488.50
461.02
206.97
465.87
456.74

229.48
507.10
524.73
68.99
155.29
152.24

4.71
-0.30
2.52
6.66
-

924.69
2071.27
576.07
1288.13
-

959.51 462.30 497.21

2157.13 1058.42 1098.71
2135.79 998.88 1136.91
597.91 448.43 149.48
1345.85 1009.39 336.46
1319.46 989.60 329.86

10.21
-0.66
5.46
14.43
-

242.20
679.76
673.04

181.65 60.55
488.50 191.26
461.02 212.02

2.85
-2.65
-

500.09
1392.04
-

524.77 393.58 131.19

1472.81 1058.42 414.39
1458.25 998.88 459.37

6.17
-5.75
-

390.25
860.81
843.93

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Virginia Aetna Whole Health

214.50
Basic Self
J91
257.40
558.39
Basic Self & Family
J92
673.06
Basic Self Plus One
J93
666.39
Virginia CareFirst BlueChoice
309.39
High Self
2G1
321.77
696.01
High Self & Family
2G2
764.50
High Self Plus One
2G3
643.53
276.57
Standard Self
2G4
287.63
622.18
Standard Self & Family
2G5
683.40
Standard Self Plus One
2G6
575.27
Virginia CareFirst BlueChoice
267.85
HDHP Self
B61
273.21
597.46
HDHP Self & Family
B62
649.15
HDHP Self Plus One
B63
546.43
Virginia Innovation Health Plan
240.93
High Self
LQ1
252.97
564.46
High Self & Family
LQ2
595.32
High Self Plus One
LQ3
589.42
Virginia Kaiser Foundation Health Plan Mid-Atlantic States
279.94
High Self
E31
285.48
643.87
High Self & Family
E32
668.01
High Self Plus One
E33
645.17
181.53
Standard Self
E34
214.96
417.50
Standard Self & Family
E35
503.01
Standard Self Plus One
E36
485.80

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

193.05 64.35
488.50 184.56
461.02 205.37

10.73
44.96
-

464.75
1209.85
-

557.70 418.28 139.42

1458.30 1058.42 399.88
1443.85 998.88 444.97

23.23
97.42
-

213.37
488.50
461.02
213.37
488.50
431.45

108.40
276.00
182.51
74.26
194.90
143.82

1.02
28.56
-0.30
21.29
-

670.35
1508.02
599.24
1348.06
-

697.17 462.30 234.87

1656.42 1058.42 598.00
1394.32 998.88 395.44
623.20 462.30 160.90
1480.70 1058.42 422.28
1246.42 934.82 311.60

2.21
61.88
-0.65
46.12
-

204.91 68.30
486.86 162.29
409.82 136.61

1.34
12.93
-

580.34
1294.50
-

591.96 443.97 147.99

1406.49 1054.87 351.62
1183.93 887.95 295.98

2.91
28.00
-

189.73 63.24
446.49 148.83
442.07 147.35

3.01
7.72
-

522.02
1223.00
-

548.10
1289.86
1277.08

137.02
322.46
319.27

6.52
16.71
-

-5.82
-15.79
8.36
21.38
-

606.54
1395.05
393.32
904.58
-

618.54 462.30 156.24

1447.36 1058.42 388.94
1397.87 998.88 398.99
465.75 349.31 116.44
1089.86 817.40 272.46
1052.57 789.43 263.14

-12.61
-34.21
18.11
46.32
-

213.37
488.50
461.02
161.22
377.26
364.35

72.11
179.51
184.15
53.74
125.75
121.45

411.08
967.40
957.81

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Gov't
Pays

Virginia M.D. IPA

314.55
High Self
JP1
295.87 213.37
725.30
High Self & Family
JP2
829.62 488.50
High Self Plus One
JP3
577.83 433.37
Virginia Optima Health Plan
High Self
PG1 New Plan 240.85 180.64
High Self & Family
PG2 New Plan 629.57 472.18
High Self Plus One
PG3 New Plan 598.09 448.57
Virginia United Healthcare Insurance Company, Inc. (Choice HMO)
New Plan 245.13 183.85
High Self
LR1
New Plan 687.35 488.50
High Self & Family
LR2
New Plan 478.74 359.06
High Self Plus One
LR3
Virginia UnitedHealthcare Insurance Company
244.32
Basic Self
L91
212.71 159.53
543.61
Basic Self & Family
L92
596.45 447.34
Basic Self Plus One
L93
415.43 311.57
Washington Aetna Direct
210.05
CDHP Self
N61
218.45 163.84
474.42
CDHP Self & Family
N62
550.93 413.20
CDHP Self Plus One
N63
479.08 359.31
Washington Aetna HealthFund CDHP and Value Plan
289.47
CDHP Self
G51
321.78 213.37
657.36
CDHP Self & Family
G52
733.96 488.50
CDHP Self Plus One
G53
726.69 461.02
239.10
Basic Self
G54
246.85 185.14
542.96
Basic Self & Family
G55
565.39 424.04
Basic Self Plus One
G56
554.30 415.73

Empl.
Pays

82.50
341.12
144.46

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

-30.04
64.39
-

681.53
1571.48
-

Gov't
Pays

Empl.
Pays

641.05 462.30 178.75

1797.51 1058.42 739.09
1251.97 938.98 312.99

Change in
empl.
payment

-65.09
139.51
-

60.21
157.39
149.52

New Plan New Plan 521.84 391.38 130.46

New Plan New Plan 1364.07 1023.05 341.02
New Plan New Plan 1295.86 971.90 323.96

New Plan
New Plan
New Plan

61.28
198.85
119.68

New Plan New Plan 531.12 398.34 132.78

New Plan New Plan 1489.26 1058.42 430.84
New Plan New Plan 1037.27 777.95 259.32

New Plan
New Plan
New Plan

53.18
149.11
103.86

-7.90
13.21
-

529.36
1177.82
-

460.87
1292.31
900.10

345.65
969.23
675.08

115.22
323.08
225.02

-17.12
28.63
-

54.61
137.73
119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

354.98
895.26
778.51

118.33
298.42
259.50

4.55
41.44
-

108.41
245.46
265.67
61.71
141.35
138.57

20.95
36.67
1.94
5.61
-

627.19
1424.28
518.05
1176.41
-

697.19 462.30 234.89

1590.25 1058.42 531.83
1574.50 998.88 575.62
534.84 401.13 133.71
1225.01 918.76 306.25
1200.98 900.74 300.24

45.39
79.45
4.20
12.15
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Washington Aetna HealthFund HDHP

226.86
HDHP Self
224
240.15
496.83
HDHP Self & Family
225
529.73
HDHP Self Plus One
226
519.34
Washington Aetna Open Access
278.88
High Self
C31
305.02
761.29
High Self & Family
C32
836.39
High Self Plus One
C33
828.11
Washington Group Health Cooperative
324.42
High Self
541
327.13
697.50
High Self & Family
542
883.24
High Self Plus One
543
654.25
222.70
Standard Self
544
234.07
502.76
Standard Self & Family
545
632.01
Standard Self Plus One
546
468.15
Washington Group Health Cooperative
New Plan 218.70
HDHP Self
PT1
New Plan 590.50
HDHP Self & Family
PT2
New Plan 437.40
HDHP Self Plus One
PT3
Washington Kaiser Foundation Health Plan of Northwest
288.33
High Self
571
298.94
651.28
High Self & Family
572
675.21
High Self Plus One
573
675.21
243.47
Standard Self
574
261.22
570.13
Standard Self & Family
575
600.10
Standard Self Plus One
576
600.10

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

390.25
860.81
843.93

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

130.08
286.94
281.31

7.20
17.82
-

213.37 91.65
488.50 347.89
461.02 367.09

14.78
35.17
-

604.24
1649.46
-

660.88 462.30 198.58

1812.18 1058.42 753.76
1794.24 998.88 795.36

32.03
76.20
-

213.37
488.50
461.02
175.55
474.01
351.11

-8.65
145.81
2.85
32.31
-

702.91
1511.25
482.52
1089.31
-

708.78 462.30 246.48

1913.69 1058.42 855.27
1417.54 998.88 418.66
507.15 380.36 126.79
1369.36 1027.02 342.34
1014.33 760.75 253.58

-18.74
315.92
6.16
70.01
-

113.76
394.74
193.23
58.52
158.00
117.04

164.03 54.67
442.88 147.62
328.05 109.35
213.37
488.50
461.02
195.92
450.08
450.08

85.57
186.71
214.19
65.30
150.02
150.02

New Plan New Plan 473.85

New Plan New Plan 1279.42
New Plan New Plan 947.70
-0.75
-16.00
4.43
7.49
-

624.72
1411.11
527.52
1235.28
-

355.39
959.57
710.78

118.46
319.85
236.92

647.70 462.30 185.40

1462.96 1058.42 404.54
1462.96 998.88 464.08
565.98 424.49 141.49
1300.22 975.17 325.05
1300.22 975.17 325.05

New Plan
New Plan
New Plan
-1.63
-34.67
9.61
16.23
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Washington KPS Health Plans

268.40
Standard Self
L11
285.33
579.35
Standard Self & Family
L12
684.80
Standard Self Plus One
L13
599.21
216.02
HDHP Self
L14
224.81
472.06
HDHP Self & Family
L15
526.79
HDHP Self Plus One
L16
468.92
Washington KPS Health Plans
332.48
High Self
VT1
395.49
726.50
High Self & Family
VT2
949.17
High Self Plus One
VT3
830.52
West Virginia Aetna Direct
210.05
CDHP Self
N61
218.45
474.42
CDHP Self & Family
N62
550.93
CDHP Self Plus One
N63
479.08
West Virginia Aetna HealthFund CDHP and Value Plan
272.01
CDHP Self
F51
298.88
617.70
CDHP Self & Family
F52
681.47
CDHP Self Plus One
F53
674.72
243.50
Basic Self
F54
250.64
552.96
Basic Self & Family
F55
573.93
Basic Self Plus One
F56
562.68
West Virginia Aetna HealthFund HDHP
226.86
HDHP Self
224
240.15
496.83
HDHP Self & Family
225
529.73
HDHP Self Plus One
226
519.34

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

213.37
488.50
449.41
168.61
395.09
351.69

71.96
196.30
149.80
56.20
131.70
117.23

4.86
51.46
2.20
13.69
-

581.53
1255.26
468.04
1022.80
-

618.22 462.30 155.92

1483.73 1058.42 425.31
1298.29 973.72 324.57
487.09 365.32 121.77
1141.38 856.04 285.34
1015.99 761.99 254.00

10.54
111.50
4.76
29.64
-

213.37 182.12
488.50 460.67
461.02 369.50

51.65
182.74
-

720.37
1574.08
-

856.90 462.30 394.60

2056.54 1058.42 998.12
1799.46 998.88 800.58

111.92
395.94
-

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

118.33
298.42
259.50

4.55
41.44
-

213.37
488.50
461.02
187.98
430.45
422.01

85.51
192.97
213.70
62.66
143.48
140.67

15.51
23.84
1.79
5.24
-

589.36
1338.35
527.58
1198.08
-

647.57 462.30 185.27

1476.52 1058.42 418.10
1461.89 998.88 463.01
543.05 407.29 135.76
1243.52 932.64 310.88
1219.14 914.36 304.78

33.60
51.65
3.87
11.36
-

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

7.20
17.82
-

354.98
895.26
778.51

390.25
860.81
843.93

Empl.
Pays

Change in
empl.
payment

Gov't
Pays

130.08
286.94
281.31

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Wisconsin Aetna Direct

210.05
CDHP Self
N61
474.42
CDHP Self & Family
N62
CDHP Self Plus One
N63
Wisconsin Aetna HealthFund CDHP and Value Plan
340.51
CDHP Self
JS1
773.27
CDHP Self & Family
JS2
CDHP Self Plus One
JS3
279.09
Basic Self
JS4
633.78
Basic Self & Family
JS5
Basic Self Plus One
JS6
Wisconsin Aetna HealthFund HDHP
226.86
HDHP Self
224
496.83
HDHP Self & Family
225
HDHP Self Plus One
226
Wisconsin Aetna Whole Health
201.56
Basic Self
F71
555.41
Basic Self & Family
F72
Basic Self Plus One
F73
Wisconsin Dean Health Plan
358.21
High Self
WD1
895.51
High Self & Family
WD2
High Self Plus One
WD3
240.46
Standard Self
WD4
601.15
Standard Self & Family
WD5
Standard Self Plus One
WD6

Total
Premium

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

354.98
895.26
778.51

218.45
550.93
479.08

163.84 54.61
413.20 137.73
359.31 119.77

2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

118.33
298.42
259.50

4.55
41.44
-

403.55
919.90
910.79
301.31
687.86
681.04

213.37
488.50
461.02
213.37
488.50
461.02

51.68
106.70
10.86
14.15
-

737.77
1675.42
604.70
1373.19
-

874.36 462.30 412.06

1993.12 1058.42 934.70
1973.38 998.88 974.50
652.84 462.30 190.54
1490.36 1058.42 431.94
1475.59 998.88 476.71

111.98
231.18
23.53
30.65
-

240.15
529.73
519.34

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

390.25
860.81
843.93

130.08
286.94
281.31

7.20
17.82
-

211.64
585.61
579.82

158.73 52.91
439.21 146.40
434.87 144.95

2.52
7.55
-

436.71
1203.39
-

458.55
1268.82
1256.28

343.91
951.62
942.21

114.64
317.20
314.07

5.46
16.35
-

388.82
894.31
816.55
270.30
648.71
594.65

213.37
488.50
461.02
202.73
486.53
445.99

19.25
-41.13
7.46
9.60
-

776.12
1940.27
521.00
1302.49
-

842.44 462.30 380.14

1937.67 1058.42 879.25
1769.19 998.88 770.31
585.65 439.24 146.41
1405.54 1054.16 351.38
1288.41 966.31 322.10

41.71
-89.12
16.16
20.79
-

190.18
431.40
449.77
87.94
199.36
220.02

175.45
405.81
355.53
67.57
162.18
148.66

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Wisconsin Group Health Cooperative

275.75
High Self
WJ1
295.88
689.54
High Self & Family
WJ2
881.73
High Self Plus One
WJ3
585.85
Wisconsin HealthPartners High and Standard Option
304.64
High Self
V31
315.60
700.68
High Self & Family
V32
768.79
High Self Plus One
V33
697.47
169.19
Standard Self
V34
179.23
389.14
Standard Self & Family
V35
436.61
Standard Self Plus One
V36
396.10
Wisconsin MercyCare HMO
299.71
High Self
EY1
305.61
749.61
High Self & Family
EY2
916.84
High Self Plus One
EY3
611.23
Wisconsin Physicians Plus
299.78
High Self
LW1
303.20
763.85
High Self & Family
LW2
772.58
High Self Plus One
LW3
725.11
Standard Self
LW4 New Plan 268.65
Standard Self & Family
LW5 New Plan 684.55
Standard Self Plus One
LW6 New Plan 642.48
Wyoming Aetna Direct
210.05
CDHP Self
N61
218.45
474.42
CDHP Self & Family
N62
550.93
CDHP Self Plus One
N63
479.08

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

213.37 82.51
488.50 393.23
439.39 146.46

8.77
152.26
-

597.46
1494.00
-

641.07 462.30 178.77

1910.42 1058.42 852.00
1269.34 952.01 317.33

19.00
329.90
-

213.37
488.50
461.02
134.42
327.46
297.08

102.23
280.29
236.45
44.81
109.15
99.02

-0.40
28.18
2.51
11.87
-

660.05
1518.14
366.58
843.14
-

683.80 462.30 221.50

1665.71 1058.42 607.29
1511.19 998.88 512.31
388.33 291.25 97.08
945.99 709.49 236.50
858.22 643.67 214.55

-0.86
61.05
5.44
25.72
-

213.37 92.24
488.50 428.34
458.42 152.81

-5.46
127.30
-

649.37
1624.16
-

662.16 462.30 199.86

1986.49 1058.42 928.07
1324.33 993.25 331.08

-11.82
275.81
-

213.37
488.50
461.02
201.49
488.50
461.02

89.83
284.08
264.09
67.16
196.05
181.46

163.84 54.61
413.20 137.73
359.31 119.77

-7.94
649.52
656.93 462.30 194.63
-31.20
1655.01 1673.92 1058.42 615.50
1571.07 998.88 572.19
New Plan New Plan 582.08 436.56 145.52
New Plan New Plan 1483.19 1058.42 424.77
New Plan New Plan 1392.04 998.88 393.16
2.10
19.13
-

455.11
1027.91
-

473.31
1193.68
1038.01

354.98
895.26
778.51

118.33
298.42
259.50

-17.20
-67.61
New Plan
New Plan
New Plan
4.55
41.44
-

Non-Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code

2016 Biweekly premium rates

2015 Total
Biweekly
Premium

Total
Premium

Wyoming Aetna Health of Utah, Inc. dba Altius Health Plans

299.68
High Self
9K1
314.79
659.33
High Self & Family
9K2
696.14
High Self Plus One
9K3
689.25
168.74
HDHP Self
9K4
170.28
349.58
HDHP Self & Family
9K5
355.88
HDHP Self Plus One
9K6
348.90
Wyoming Aetna Health of Utah, Inc. dba Altius Health Plans
225.43
Standard Self
DK4
229.98
495.93
Standard Self & Family
DK5
507.85
Standard Self Plus One
DK6
502.83
Wyoming Aetna HealthFund CDHP and Value Plan
276.95
CDHP Self
H41
312.68
628.94
CDHP Self & Family
H42
712.76
CDHP Self Plus One
H43
705.70
244.12
Basic Self
H44
247.72
554.39
Basic Self & Family
H45
568.54
Basic Self Plus One
H46
557.39
Wyoming Aetna HealthFund HDHP
226.86
HDHP Self
224
240.15
496.83
HDHP Self & Family
225
529.73
HDHP Self Plus One
226
519.34

Gov't
Pays

Empl.
Pays

2016 Monthly premium rates

2015 Total
Change in Monthly
Total
Premium
empl.
Premium
payment

Gov't
Pays

Empl.
Pays

Change in
empl.
payment

213.37 101.42
488.50 207.64
461.02 228.23
127.71 42.57
266.91 88.97
261.68 87.22

3.75
-3.12
0.39
1.58
-

649.31
1428.55
365.60
757.42
-

682.05 462.30 219.75

1508.30 1058.42 449.88
1493.38 998.88 494.50
368.94 276.71 92.23
771.07 578.30 192.77
755.95 566.96 188.99

8.13
-6.77
0.83
3.42
-

172.49 57.49
380.89 126.96
377.12 125.71

1.13
2.98
-

488.43
1074.52
-

498.29
1100.34
1089.47

124.57
275.08
272.37

2.46
6.45
-

213.37
488.50
461.02
185.79
426.41
418.04

99.31
224.26
244.68
61.93
142.13
139.35

24.37
43.89
0.90
3.53
-

600.06
1362.70
528.93
1201.18
-

677.47 462.30 215.17

1544.31 1058.42 485.89
1529.02 998.88 530.14
536.73 402.55 134.18
1231.84 923.88 307.96
1207.68 905.76 301.92

52.80
95.09
1.95
7.67
-

180.11 60.04
397.30 132.43
389.51 129.83

3.33
8.22
-

491.53
1076.47
-

520.33
1147.75
1125.24

7.20
17.82
-

373.72
825.26
817.10

390.25
860.81
843.93

130.08
286.94
281.31