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TABLE 1
PLANS LEAVING THE FEHB PROGRAM
Enrollees in these terminating plans must make a positive election into another
FEHB plan during Open Season or they will be enrolled in the GEHA Indemnity
Benefit Plan - Elevate option (Plan Codes 254, 256, 255) (the lowest-cost nationwide
plan option for 2020 as determined by OPM).
New York MVP Health GA4, GA6, GA5 Albany, Broome, Cayuga, Chenango,
Care MX4, MX6, MX5 Clinton, Columbia, Cortland,
M94, M96, M95 Delaware, Dutchess, Essex,
MF4, MF6, MF5 Franklin, Fulton, Genesee, Greene,
GV4, GV6, GV5 Hamilton, Herkimer, Jefferson,
Lewis, Livingston, Madison, Monroe,
Montgomery, Oneida, Onondaga,
Ontario, Orange, Orleans, Oswego,
Otsego, Putnam, Rensselaer,
Rockland, Saratoga, Schenectady,
Schoharie, Seneca, St. Lawrence,
Steuben, Sullivan, Tioga, Tompkins,
Ulster, Warren, Washington, Wayne,
Westchester, Wyoming and
Yates counties
1
TABLE 2
PLANS REDUCING SERVICE AREAS
WITHOUT TERMINATING ENROLLMENT CODES
Enrollees in the areas being dropped who do not change health plans during Open
Season will only have emergency services where they live and they will have to
travel to their plan’s remaining service area to obtain medical care in order to
receive full benefits from the plan in 2020.
Colorado Kaiser Foundation Health 651, 653, 652 Eagle, Garfield, Grand, Routt, and
Plan of Colorado 654, 656, 655 Summit counties
N41, N43, N42
Zip codes: 80423, 80424, 80426,
80435, 80443, 80463, 80497, 80498,
81620, 81631, 81632, 81637, 81645,
81649, 81655, 81657, 81658
Washington Kaiser Foundation Health 541, 543, 542 San Juan County
Plan of Washington 544, 546, 545
TABLE 3
PLAN TERMINATING OPTION AND ENROLLMENT CODES
Enrollees in the plan’s terminating option will be automatically enrolled into the
plan option that is identified in the table below unless they enroll in another plan
during Open Season.
Utah SelectHealth Plan High SF1, SF3, SF2 Standard - SF4, SF6, SF5
2
TABLE 4
PLANS ADDING NEW OPTIONS AND ENROLLMENT CODES
All States Aetna Advantage Advantage Z24, Z26, Z25 Portions of all 50 States
and DC
Georgia Kaiser Foundation Basic LA1, LA3, LA2 Barrow, Bartow, Bibb,
Health Plan of Bleckley, Bryan, Bulloch,
Georgia, Inc. Butts, Carroll, Chatham,
Chattahoochee, Cherokee,
Clarke, Clayton, Cobb,
Coweta, Crawford, Dawson,
DeKalb, Douglas,
Effingham, Evans, Fayette,
Forsyth, Fulton, Gwinnett,
Hall, Haralson, Harris,
Heard, Henry, Houston,
Jones, Lamar, Laurens,
Liberty, Madison, Marion,
Meriwether, Monroe,
Muscogee, Newton, Oconee,
Oglethorpe, Paulding, Peach,
Pickens, Pike, Pulaski,
Rockdale, Spalding, Twiggs,
and Walton counties
Hawaii HMSA Plan Standard 874, 876, 875 Entire state of Hawaii
Illinois MercyCare Health Standard EY4, EY6, EY5 Boone and Winnebago
Plans counties
3
Maryland Aetna Open Saver QQ4, QQ6, QQ5 Entire state of Maryland
Access and Aetna
Saver Plan
Maryland CareFirst Blue Value Plus B64, B66, B65 Entire state of Maryland
BlueChoice
Michigan Priority Health Value Y41, Y43, Y42 Alcona, Allegan, Alpena,
Antrim, Arenac, Barry, Bay,
Benzie, Berrien, Branch,
Calhoun, Cass, Charlevoix,
Cheboygan, Clare, Clinton,
Crawford, Eaton, Emmet,
Genesee, Gladwin, Grand
Traverse, Gratiot, Hillsdale,
Huron, Ingham, Ionia, Iosco,
Isabella, Jackson,
Kalamazoo, Kalkaska, Kent,
Lake, Lapeer, Leelanau,
Livingston, Macomb,
Manistee, Mason, Mecosta,
Midland, Missaukee,
Montcalm, Monroe,
Montmorency, Muskegon,
Newaygo, Oakland, Oceana,
Ogemaw, Osceola, Oscoda,
Otsego, Ottawa, Presque
Isle, Roscommon, Saginaw,
Sanilac, Shiawassee, St.
Clair, St. Joseph, Tuscola,
Van Buren, Washtenaw,
Wayne, and Wexford
counties
New GHI Health Plan HDHP 811, 813, 812 Bergen, Essex, Hudson,
Jersey Middlesex, Monmouth,
Morris, Passaic, Somerset,
Sussex, and Union counties
New Presbyterian Wellness PS1, PS3, PS2 Entire state of New Mexico
Mexico Health Plan
4
New York GHI Health Plan HDHP 811, 813, 812 Boroughs of Manhattan,
Brooklyn, Bronx, Queens,
and Staten Island, Nassau,
Suffolk, Rockland,
Westchester Broome,
Cayuga, Chemung,
Columbia, Cortland,
Delaware, Dutchess,
Franklin, Greene, Hamilton,
Herimer, Jefferson, Lewis,
Madison, Oneida,
Onondaga, Orange, Oswego,
Otsego, Putnam, St.
Lawrence, Schuyler,
Steuben, Sullivan, Tioga,
Tompkins, and Ulster
counties
Virginia Aetna Open Saver QQ4, QQ6, QQ5 Arlington, Caroline, Clarke,
Access and Aetna Fairfax, Fauquier, Greene,
Saver Plan King George, Loudoun,
Madison, Orange, Prince
William, Rappahannock,
Spotsylvania, Stafford, and
Westmoreland counties
Cities of Alexandria,
Fairfax, Falls Church,
Fredericksburg, Manassas,
and Manassas Park
Virginia CareFirst Blue Value Plus B64, B66, B65 Cities of Alexandria and
BlueChoice Fairfax; Arlington County;
town of Vienna; Counties of
Fairfax, and Prince William
(east of route 123)
Wisconsin MercyCare Health Standard EY4, EY6, EY5 Green, Jefferson, Rock, and
Plan Walworth counties
TABLE 5
5
SERVICE AREA EXPANSIONS WITHOUT NEW ENROLLMENT CODES
Colorado Kaiser Foundation High 651, 653, 652 Clear Creek County
Health Plan of Colorado Standard 654, 656, 655 Zip codes: 80436, 80444
Basic N41, N43, N42
Larimer County
Zip code: 82070
Michigan Health Alliance Plan High 521, 523, 522 Lenawee County
(HAP) Standard GY4, GY6, GY5
Ohio Medical Mutual of Ohio Standard YF4, YF6, YF5 Adams, Miami, and
Basic YF1, YF3, YF2 Warren counties
Virginia Kaiser Foundation High E31, E33, E32 Fauquier County Zip
Health Plan of the Mid- Standard E34, E36 ,E35 codes:
Atlantic States, Inc. Basic T71, T73, T72 20115, 20137, 20144,
20117, 20184, 20186,
20187, 20198, 22639,
22642, 22643
TABLE 6
SERVICE AREA EXPANSIONS ADDING
NEW ENROLLMENT CODES
Pennsylvania UPMC Health Plan High YS1, YS3, YS2 Berks, Clinton, Cumberland,
Standard YT4, YT6, YT5 Dauphin, Juniata, Lackawanna,
HDHP YS4, YS6, YS5 Lancaster, Lehigh, Luzerne,
Lycoming, Mifflin, Northampton,
Northumberland, Perry, Schuylkill,
Snyder, Sullivan, Susquehanna,
Tioga, Union, and Wayne counties
TABLE 7
6
NEW PLAN ENTERING THE FEHB PROGRAM
All States GEHA Indemnity Elevate Plus 251, 253, 252 Nationwide
Benefit Plan Elevate 254, 256, 255
Arizona UnitedHealthcare High VD1, VD3, VD2 Maricopa, Mohave, Pima, Pinal, and
Insurance Co., Inc. Yavapai counties
Choice Primary
Advantage
Arizona UnitedHealthcare High WF1, WF3, WF2 Maricopa, Mohave, Pima, Pinal, and
Insurance Co., Inc. Yavapai counties
Choice Plus
Primary
Advantage
7
District of UnitedHealthcare High Y81, Y83, Y82 Washington, DC
Columbia Insurance Co., Inc.
Choice Primary
Advantage
Georgia UnitedHealthcare High Y81, Y83, Y82 Butts, Carroll, Cherokee, Clayton,
Insurance Co., Inc. Cobb, Coweta, Dawson, DeKalb,
Choice Primary Douglas, Fayette, Forsythe, Fulton,
Advantage Gwinnett, Haralson, Heard, Henry,
Jasper, Morgan, Newton, Paulding,
Putnam, Rockdale, Spaulding, and
Walton counties
Georgia UnitedHealthcare High AS1, AS3, AS2 Butts, Carroll, Cherokee, Clayton,
Insurance, Co., Cobb, Coweta, Dawson, DeKalb,
Inc. Choice Plus Douglas, Fayette, Forsythe, Fulton,
Primary Gwinnett, Haralson, Heard, Henry,
Advantage Jasper, Morgan, Newton, Paulding,
Putnam, Rockdale, Spaulding, and
Walton counties
8
Illinois UnitedHealthcare High AS1, AS3, AS2 Entire state of Illinois
Insurance Co., Inc.
Choice Plus
Primary
Advantage
9
Maryland UnitedHealthcare High AS1, AS3, AS2 Entire state of Maryland
Insurance Co., Inc.
Choice Plus
Primary
Advantage
Missouri UnitedHealthcare High Y81, Y83, Y82 Bollinger, Butler, Cape Girardeau,
Insurance Co., Inc. Clark, Clinton, Crawford, Dent,
Choice Primary Dunklin, Franklin, Gasconade,
Advantage Greene, Howell, Iron, Jefferson,
Lewis, Lincoln, Madison, Marion,
Mississippi, Monroe, Montgomery,
New Madrid, Oregon, Pemiscot,
Perry, Phelps, Pike, Ralls, Randolph,
Reynolds, Ripley, Scott, Shannon,
St. Charles, St. Clair, St. Francois,
St. Louis, St. Louis City, Ste.
Genevieve, Stoddard, Texas,
Warren, Washington, Wayne, and
Williamson counties
10
Missouri UnitedHealthcare High AS1, AS3, AS2 Bollinger, Butler, Cape Girardeau,
Insurance, Co., Clark, Clinton, Crawford, Dent,
Inc. Choice Plus Dunklin, Franklin, Gasconade,
Primary Greene, Howell, Iron, Jefferson,
Advantage Lewis, Lincoln, Madison, Marion,
Mississippi, Monroe, Montgomery,
New Madrid, Oregon, Pemiscot,
Perry, Phelps, Pike, Ralls, Randolph,
Reynolds, Ripley, Scott, Shannon,
St. Charles, St. Clair, St. Francois,
St. Louis, St. Louis City, Ste.
Genevieve, Stoddard, Texas,
Warren, Washington, Wayne, and
Williamson counties
New Mexico True Health New High EL1, EL3, EL2 Entire state of New Mexico
Mexico
North Carolina UnitedHealthcare High Y81, Y83, Y82 Entire state of North Carolina
Insurance Co., Inc.
Choice Primary
Advantage
North Carolina UnitedHealthcare High AS1, AS3, AS2 Entire state of North Carolina
Insurance Co., Inc.
Choice Plus
Primary
Advantage
11
Pennsylvania UnitedHealthcare High Y81, Y83, Y82 Entire state of Pennsylvania
Insurance Co., Inc.
Choice Primary
Advantage
12
Virginia UnitedHealthcare High Y81, Y83, Y82 Entire state of Virginia
Insurance Co., Inc.
Choice Primary
Advantage
Wisconsin Quartz Health High TF1, TF3, TF2 Adams, Buffalo, Columbia,
Benefit Plans Standard TF4, TF6, TF5 Crawford, Dane, Dodge, Fond du
Corporation Lac, Grant, Green, Green Lake,
Iowa, Jackson, Jefferson, Juneau,
La Crosse, Lafayette, Rock, Sauk,
Trempealeau, Vernon, Walworth,
Waukesha, and Waushara counties
13