2021 FEHB Postal Rates HMO

Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management Organizations 2021 Biweekly Postal Premium Rates 2021 Biweekly Postal Premium Rates
(HMO) 2020 Total Category 1 2020 Total Category 2
Biweekly Biweekly
Change in Change in
Premium Total Government Employee Premium Total Government Employee
Plan - Option - Enrollment Code employee employment
Premium Pays Pays Premium Pays Pays
payment payment
Alabama Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Advantage Self & Family Z25 567.31 611.54 464.77 146.77 10.62 567.31 611.54 484.65 126.89 9.17
Advantage Self Plus One Z26 470.97 507.70 385.85 121.85 8.82 470.97 507.70 402.35 105.35 7.62
Alabama Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
CDHP Self & Family N62 713.08 716.80 544.77 172.03 0.89 713.08 716.80 568.06 148.74 0.78
CDHP Self Plus One N63 620.10 623.33 473.73 149.60 0.78 620.10 623.33 493.99 129.34 0.67
Alabama Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self F51 382.72 393.11 244.94 148.17 4.50 382.72 393.11 255.00 138.11 4.26
CDHP Self & Family F52 872.64 896.32 570.06 326.26 7.68 872.64 896.32 593.48 302.84 7.02
CDHP Self Plus One F53 864.00 887.45 524.65 362.80 9.92 864.00 887.45 546.21 341.24 9.37
Value Self F54 378.45 379.30 244.94 134.36 ‐5.04 378.45 379.30 255.00 124.30 ‐5.28
Value Self & Family F55 866.59 868.56 570.06 298.50 ‐14.03 866.59 868.56 593.48 275.08 ‐14.69
Value Self Plus One F56 849.59 851.52 524.65 326.87 ‐11.60 849.59 851.52 546.21 305.31 ‐12.15
Alabama Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
HDHP Self Plus One 226 727.43 784.56 524.65 259.91 43.60 727.43 784.56 546.21 238.35 43.05
Alabama UnitedHealthcare Insurance Company, Inc. ‐ Choice Plus Primary
High Self AS1 242.68 276.68 210.28 66.40 8.16 242.68 276.68 219.27 57.41 7.05
High Self & Family AS2 573.86 654.35 497.31 157.04 19.31 573.86 654.35 518.57 135.78 16.70
High Self Plus One AS3 521.73 594.87 452.10 142.77 17.55 521.73 594.87 471.43 123.44 15.18
Alabama UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self LS1 209.88 224.24 170.42 53.82 3.45 209.88 224.24 177.71 46.53 2.98
HDHP Self & Family LS2 482.73 515.77 391.99 123.78 7.92 482.73 515.77 408.75 107.02 6.85
HDHP Self Plus One LS3 451.25 482.12 366.41 115.71 7.41 451.25 482.12 382.08 100.04 6.41
Alabama UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self KK1 329.48 354.94 244.94 110.00 19.57 329.48 354.94 255.00 99.94 19.33
High Self & Family KK2 823.71 887.37 570.06 317.31 47.66 823.71 887.37 593.48 293.89 47.00
High Self Plus One KK3 708.40 763.14 524.65 238.49 41.21 708.40 763.14 546.21 216.93 40.66
Biweekly Biweekly
Change in Change in
payment payment
Alabama UnitedHealthcare Insurance Company, Inc. Choice Primary
High Self Y81 233.88 266.18 202.30 63.88 7.75 233.88 266.18 210.95 55.23 6.70
High Self & Family Y82 553.03 629.51 478.43 151.08 18.35 553.03 629.51 498.89 130.62 15.87
High Self Plus One Y83 502.79 572.28 434.93 137.35 16.68 502.79 572.28 453.53 118.75 14.42
Alabama UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
High Self Y51 New Plan 190.03 144.42 45.61 New Plan New Plan 190.03 150.60 39.43 New Plan
High Self & Family Y52 New Plan 503.57 382.71 120.86 New Plan New Plan 503.57 399.08 104.49 New Plan
High Self Plus One Y53 New Plan 418.06 317.73 100.33 New Plan New Plan 418.06 331.31 86.75 New Plan
Alaska Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Alaska Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Alaska Aetna HealthFund CDHP and Aetna Value Plan
Value Self JS4 495.45 505.19 244.94 260.25 3.85 495.45 505.19 255.00 250.19 3.61
Value Self & Family JS5 1131.04 1153.29 570.06 583.23 6.25 1131.04 1153.29 593.48 559.81 5.59
Value Self Plus One JS6 1119.84 1141.88 524.65 617.23 8.51 1119.84 1141.88 546.21 595.67 7.96
CDHP Self JS1 463.38 466.12 244.94 221.18 ‐3.15 463.38 466.12 255.00 211.12 ‐3.39
CDHP Self & Family JS2 1056.30 1062.53 570.06 492.47 ‐9.77 1056.30 1062.53 593.48 469.05 ‐10.43
CDHP Self Plus One JS3 1045.84 1052.00 524.65 527.35 ‐7.37 1045.84 1052.00 546.21 505.79 ‐7.92
Alaska Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Arizona Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Biweekly Biweekly
Change in Change in
payment payment
Arizona Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Arizona Aetna HealthFund CDHP and Aetna Value Plan
Value Self G54 328.95 330.94 244.94 86.00 ‐3.90 328.95 330.94 255.00 75.94 ‐4.14
Value Self & Family G55 753.40 757.97 570.06 187.91 ‐11.43 753.40 757.97 593.48 164.49 ‐12.09
Value Self Plus One G56 738.63 743.12 524.65 218.47 ‐9.04 738.63 743.12 546.21 196.91 ‐9.59
CDHP Self G51 417.46 488.66 244.94 243.72 65.31 417.46 488.66 255.00 233.66 65.07
CDHP Self & Family G52 952.20 1114.65 570.06 544.59 146.45 952.20 1114.65 593.48 521.17 145.79
CDHP Self Plus One G53 942.79 1103.63 524.65 578.98 147.31 942.79 1103.63 546.21 557.42 146.76
Arizona Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Arizona Aetna Open Access
High Self WQ1 535.92 621.08 244.94 376.14 79.27 535.92 621.08 255.00 366.08 79.03
High Self & Family WQ2 1301.20 1507.96 570.06 937.90 190.76 1301.20 1507.96 593.48 914.48 190.10
High Self Plus One WQ3 1288.31 1493.01 524.65 968.36 191.17 1288.31 1493.01 546.21 946.80 190.62
Arizona Humana CoverageFirst and Humana Value Plan
CDHP Self R61 331.75 374.88 244.94 129.94 37.24 331.75 374.88 255.00 119.88 37.00
CDHP Self & Family R62 746.43 843.46 570.06 273.40 81.03 746.43 843.46 593.48 249.98 80.37
CDHP Self Plus One R63 713.25 805.98 524.65 281.33 79.20 713.25 805.98 546.21 259.77 78.65
Value Self R64 265.17 299.64 227.73 71.91 8.27 265.17 299.64 237.46 62.18 7.16
Value Self & Family R65 596.62 674.18 512.38 161.80 18.61 596.62 674.18 534.29 139.89 16.09
Value Self Plus One R66 570.11 644.22 489.61 154.61 17.78 570.11 644.22 510.54 133.68 15.38
Arizona Humana CoverageFirst and Humana Value Plan
Value Self R94 241.76 263.52 200.28 63.24 5.22 241.76 263.52 208.84 54.68 4.51
Value Self & Family R95 543.95 592.90 450.60 142.30 11.75 543.95 592.90 469.87 123.03 10.16
Value Self Plus One R96 519.78 566.56 430.59 135.97 11.22 519.78 566.56 449.00 117.56 9.71
CDHP Self R91 303.64 330.96 244.94 86.02 13.15 303.64 330.96 255.00 75.96 12.95
CDHP Self & Family R92 683.17 744.65 565.93 178.72 14.76 683.17 744.65 590.14 154.51 12.75
CDHP Self Plus One R93 652.80 711.55 524.65 186.90 30.23 652.80 711.55 546.21 165.34 29.88
Biweekly Biweekly
Change in Change in
payment payment
Arizona Humana Health Plan, Inc.
Standard Self C74 361.89 412.55 244.94 167.61 44.77 361.89 412.55 255.00 157.55 44.53
Standard Self & Family C75 814.24 928.23 570.06 358.17 97.99 814.24 928.23 593.48 334.75 97.33
Standard Self Plus One C76 778.03 886.95 524.65 362.30 95.39 778.03 886.95 546.21 340.74 94.84
High Self C71 469.79 535.56 244.94 290.62 59.88 469.79 535.56 255.00 280.56 59.64
High Self & Family C72 1057.01 1205.00 570.06 634.94 131.99 1057.01 1205.00 593.48 611.52 131.33
High Self Plus One C73 1010.03 1151.44 524.65 626.79 127.88 1010.03 1151.44 546.21 605.23 127.33
Arizona Humana Health Plan, Inc.
High Self BF1 659.77 679.56 244.94 434.62 13.90 659.77 679.56 255.00 424.56 13.66
High Self & Family BF2 1484.43 1528.97 570.06 958.91 28.54 1484.43 1528.97 593.48 935.49 27.88
High Self Plus One BF3 1418.47 1461.01 524.65 936.36 29.01 1418.47 1461.01 546.21 914.80 28.46
Standard Self BF4 532.73 575.35 244.94 330.41 36.73 532.73 575.35 255.00 320.35 36.49
Standard Self & Family BF5 1198.65 1294.54 570.06 724.48 79.89 1198.65 1294.54 593.48 701.06 79.23
Standard Self Plus One BF6 1145.38 1237.02 524.65 712.37 78.11 1145.38 1237.02 546.21 690.81 77.56
Arizona UnitedHealthcare Insurance Company, Inc. ‐ Choice Plus Primary
High Self WF1 241.32 287.18 218.26 68.92 11.00 241.32 287.18 227.59 59.59 9.52
High Self & Family WF2 570.64 679.17 516.17 163.00 26.05 570.64 679.17 538.24 140.93 22.52
High Self Plus One WF3 518.79 617.43 469.25 148.18 23.67 518.79 617.43 489.31 128.12 20.47
Arizona UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self LU1 204.85 243.77 185.27 58.50 9.34 204.85 243.77 193.19 50.58 8.07
HDHP Self & Family LU2 471.16 560.66 426.10 134.56 21.48 471.16 560.66 444.32 116.34 18.57
HDHP Self Plus One LU3 440.43 524.10 398.32 125.78 20.08 440.43 524.10 415.35 108.75 17.36
Arizona UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self KT1 334.51 360.98 244.94 116.04 20.58 334.51 360.98 255.00 105.98 20.34
High Self & Family KT2 836.26 902.47 570.06 332.41 50.21 836.26 902.47 593.48 308.99 49.55
High Self Plus One KT3 719.19 776.11 524.65 251.46 43.39 719.19 776.11 546.21 229.90 42.84
Arizona UnitedHealthcare Insurance Company, Inc. Choice Primary
High Self VD1 240.93 286.71 217.90 68.81 10.99 240.93 286.71 227.22 59.49 9.50
High Self & Family VD2 569.71 678.06 515.33 162.73 26.00 569.71 678.06 537.36 140.70 22.49
High Self Plus One VD3 517.95 616.42 468.48 147.94 23.63 517.95 616.42 488.51 127.91 20.44
Arizona UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Biweekly Biweekly
Change in Change in
payment payment
Arkansas Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Arkansas Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Arkansas Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self F51 382.72 393.11 244.94 148.17 4.50 382.72 393.11 255.00 138.11 4.26
Value Self F54 378.45 379.30 244.94 134.36 ‐5.04 378.45 379.30 255.00 124.30 ‐5.28
Arkansas Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Arkansas QualChoice
High Self DH1 347.17 354.12 244.94 109.18 1.06 347.17 354.12 255.00 99.12 0.82
High Self & Family DH2 905.52 923.63 570.06 353.57 2.11 905.52 923.63 593.48 330.15 1.45
High Self Plus One DH3 674.39 687.89 522.80 165.09 1.82 674.39 687.89 545.15 142.74 0.48
Standard Self DH4 271.04 276.46 210.11 66.35 1.30 271.04 276.46 219.09 57.37 1.13
Standard Self & Family DH5 706.96 721.12 548.05 173.07 3.40 706.96 721.12 571.49 149.63 2.94
Standard Self Plus One DH6 526.51 537.06 408.17 128.89 2.53 526.51 537.06 425.62 111.44 2.19
Arkansas UnitedHealthcare Insurance Company, Inc. ‐ Choice Plus Primary
High Self AS1 242.68 276.68 210.28 66.40 8.16 242.68 276.68 219.27 57.41 7.05
Arkansas UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self LS1 209.88 224.24 170.42 53.82 3.45 209.88 224.24 177.71 46.53 2.98
Biweekly Biweekly
Change in Change in
payment payment
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self KK1 329.48 354.94 244.94 110.00 19.57 329.48 354.94 255.00 99.94 19.33
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Primary
High Self Y81 233.88 266.18 202.30 63.88 7.75 233.88 266.18 210.95 55.23 6.70
Arkansas UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
California Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
California Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
California Aetna HealthFund CDHP and Aetna Value Plan
Value Self JS4 495.45 505.19 244.94 260.25 3.85 495.45 505.19 255.00 250.19 3.61
CDHP Self JS1 463.38 466.12 244.94 221.18 ‐3.15 463.38 466.12 255.00 211.12 ‐3.39
California Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Biweekly Biweekly
Change in Change in
payment payment
California Aetna Open Access
High Self 2X1 406.40 432.31 244.94 187.37 20.02 406.40 432.31 255.00 177.31 19.78
High Self & Family 2X2 954.11 1014.93 570.06 444.87 44.82 954.11 1014.93 593.48 421.45 44.16
High Self Plus One 2X3 935.40 995.03 524.65 470.38 46.10 935.40 995.03 546.21 448.82 45.55
California Anthem Blue Cross Select HMO
High Self B31 357.29 357.29 244.94 112.35 ‐5.89 357.29 357.29 255.00 102.29 ‐6.13
High Self & Family B32 816.42 816.42 570.06 246.36 ‐16.00 816.42 816.42 593.48 222.94 ‐16.66
High Self Plus One B33 757.46 757.46 524.65 232.81 ‐13.53 757.46 757.46 546.21 211.25 ‐14.08
California Blue Shield of California
Access + HMO Self SI1 384.85 396.40 244.94 151.46 5.66 384.85 396.40 255.00 141.40 5.42
Access + HMO Self & Family SI2 885.16 911.72 570.06 341.66 10.56 885.16 911.72 593.48 318.24 9.90
Access + HMO Self Plus One SI3 846.67 872.07 524.65 347.42 11.87 846.67 872.07 546.21 325.86 11.32
California Health Net of California
Basic Self P61 149.71 168.02 127.70 40.32 4.39 149.71 168.02 133.16 34.86 3.80
Basic Self & Family P62 359.29 403.26 306.48 96.78 10.55 359.29 403.26 319.58 83.68 9.13
Basic Self Plus One P63 329.35 369.66 280.94 88.72 9.68 329.35 369.66 292.96 76.70 8.36
High Self LP1 483.86 467.53 244.94 222.59 ‐22.22 483.86 467.53 255.00 212.53 ‐22.46
High Self & Family LP2 1161.26 1122.08 570.06 552.02 ‐55.18 1161.26 1122.08 593.48 528.60 ‐55.84
High Self Plus One LP3 1064.49 1028.57 524.65 503.92 ‐49.45 1064.49 1028.57 546.21 482.36 ‐50.00
High Self LB1 697.18 715.68 244.94 470.74 12.61 697.18 715.68 255.00 460.68 12.37
High Self & Family LB2 1673.25 1717.61 570.06 1147.55 28.36 1673.25 1717.61 593.48 1124.13 27.70
High Self Plus One LB3 1533.81 1574.47 524.65 1049.82 27.13 1533.81 1574.47 546.21 1028.26 26.58
Standard Self LB4 618.71 676.68 244.94 431.74 52.08 618.71 676.68 255.00 421.68 51.84
Standard Self & Family LB5 1484.90 1624.02 570.06 1053.96 123.12 1484.90 1624.02 593.48 1030.54 122.46
Standard Self Plus One LB6 1361.16 1488.69 524.65 964.04 114.00 1361.16 1488.69 546.21 942.48 113.45
Basic Self T41 407.00 412.70 244.94 167.76 ‐0.19 407.00 412.70 255.00 157.70 ‐0.43
Basic Self & Family T42 976.80 990.48 570.06 420.42 ‐2.32 976.80 990.48 593.48 397.00 ‐2.98
Basic Self Plus One T43 895.41 907.94 524.65 383.29 ‐1.00 895.41 907.94 546.21 361.73 ‐1.55
Biweekly Biweekly
Change in Change in
payment payment
California Kaiser Permanente ‐ Fresno California
Standard Self NZ4 261.60 272.36 206.99 65.37 2.59 261.60 272.36 215.85 56.51 2.23
Standard Self & Family NZ5 604.59 629.48 478.40 151.08 5.98 604.59 629.48 498.86 130.62 5.17
Standard Self Plus One NZ6 604.59 629.48 478.40 151.08 5.98 604.59 629.48 498.86 130.62 5.17
High Self NZ1 358.58 370.61 244.94 125.67 6.14 358.58 370.61 255.00 115.61 5.90
High Self & Family NZ2 828.77 856.55 570.06 286.49 11.78 828.77 856.55 593.48 263.07 11.12
High Self Plus One NZ3 828.77 856.55 524.65 331.90 14.25 828.77 856.55 546.21 310.34 13.70
California Kaiser Permanente ‐ Northern California
Basic Self KC1 300.96 300.96 228.73 72.23 0.00 300.96 300.96 238.51 62.45 0.00
Basic Self & Family KC2 704.24 704.24 535.22 169.02 0.00 704.24 704.24 558.11 146.13 0.00
Basic Self Plus One KC3 704.24 704.24 524.65 179.59 ‐13.53 704.24 704.24 546.21 158.03 ‐14.08
California Kaiser Permanente ‐ Northern California
High Self 591 461.75 468.25 244.94 223.31 0.61 461.75 468.25 255.00 213.25 0.37
High Self & Family 592 1102.25 1117.78 570.06 547.72 ‐0.47 1102.25 1117.78 593.48 524.30 ‐1.13
High Self Plus One 593 1102.25 1117.78 524.65 593.13 2.00 1102.25 1117.78 546.21 571.57 1.45
Standard Self 594 373.79 379.70 244.94 134.76 0.02 373.79 379.70 255.00 124.70 ‐0.22
Standard Self & Family 595 874.65 888.51 570.06 318.45 ‐2.14 874.65 888.51 593.48 295.03 ‐2.80
Standard Self Plus One 596 874.65 888.51 524.65 363.86 0.33 874.65 888.51 546.21 342.30 ‐0.22
California Kaiser Permanente ‐ Southern California
Standard Self 624 215.22 218.51 166.07 52.44 0.79 215.22 218.51 173.17 45.34 0.68
Standard Self & Family 625 497.40 505.02 383.82 121.20 1.82 497.40 505.02 400.23 104.79 1.58
Standard Self Plus One 626 497.40 505.02 383.82 121.20 1.82 497.40 505.02 400.23 104.79 1.58
High Self 621 339.42 346.24 244.94 101.30 0.93 339.42 346.24 255.00 91.24 0.69
High Self & Family 622 784.46 800.23 570.06 230.17 ‐0.23 784.46 800.23 593.48 206.75 ‐0.89
California UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Colorado Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Biweekly Biweekly
Change in Change in
payment payment
Colorado Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Colorado Aetna HealthFund CDHP and Aetna Value Plan
Value Self G54 328.95 330.94 244.94 86.00 ‐3.90 328.95 330.94 255.00 75.94 ‐4.14
CDHP Self G51 417.46 488.66 244.94 243.72 65.31 417.46 488.66 255.00 233.66 65.07
Colorado Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Colorado BlueAdvantageHMO on the Pathway HMO Network
High Self WW1 293.70 293.70 223.21 70.49 0.00 293.70 293.70 232.76 60.94 0.00
High Self & Family WW2 715.15 715.15 543.51 171.64 0.00 715.15 715.15 566.76 148.39 0.00
High Self Plus One WW3 668.15 668.15 507.79 160.36 0.00 668.15 668.15 529.51 138.64 0.00
Colorado Humana Health Plan, Inc.
High Self NR1 379.16 443.62 244.94 198.68 58.57 379.16 443.62 255.00 188.62 58.33
High Self & Family NR2 853.11 998.14 570.06 428.08 129.03 853.11 998.14 593.48 404.66 128.37
High Self Plus One NR3 815.20 953.78 524.65 429.13 125.05 815.20 953.78 546.21 407.57 124.50
Standard Self NR4 262.76 307.42 233.64 73.78 10.72 262.76 307.42 243.63 63.79 9.27
Standard Self & Family NR5 591.22 691.72 525.71 166.01 24.12 591.22 691.72 548.19 143.53 20.85
Standard Self Plus One NR6 564.93 660.96 502.33 158.63 23.05 564.93 660.96 523.81 137.15 19.93
Basic Self RZ1 240.83 245.65 186.69 58.96 1.16 240.83 245.65 194.68 50.97 1.00
Basic Self & Family RZ2 541.86 552.70 420.05 132.65 2.60 541.86 552.70 438.01 114.69 2.25
Basic Self Plus One RZ3 517.80 528.15 401.39 126.76 2.49 517.80 528.15 418.56 109.59 2.15
Biweekly Biweekly
Change in Change in
payment payment
High Self NT1 352.97 384.74 244.94 139.80 25.88 352.97 384.74 255.00 129.74 25.64
High Self & Family NT2 794.21 865.69 570.06 295.63 55.48 794.21 865.69 593.48 272.21 54.82
High Self Plus One NT3 758.90 827.20 524.65 302.55 54.77 758.90 827.20 546.21 280.99 54.22
Standard Self NT4 249.93 272.43 207.05 65.38 5.40 249.93 272.43 215.90 56.53 4.67
Standard Self & Family NT5 562.36 612.98 465.86 147.12 12.15 562.36 612.98 485.79 127.19 10.50
Standard Self Plus One NT6 537.39 585.75 445.17 140.58 11.61 537.39 585.75 464.21 121.54 10.03
Basic Self R21 245.13 286.80 217.97 68.83 10.00 245.13 286.80 227.29 59.51 8.65
Basic Self & Family R22 551.54 645.31 490.44 154.87 22.50 551.54 645.31 511.41 133.90 19.46
Basic Self Plus One R23 527.03 616.63 468.64 147.99 21.50 527.03 616.63 488.68 127.95 18.59
Colorado Kaiser Permanente ‐ Colorado
Standard Self 654 309.83 305.00 231.80 73.20 ‐1.16 309.83 305.00 241.71 63.29 ‐1.00
Standard Self Plus One 656 700.21 689.29 523.86 165.43 ‐23.66 700.21 689.29 546.21 143.08 ‐25.00
High Self 651 364.23 356.72 244.94 111.78 ‐13.40 364.23 356.72 255.00 101.72 ‐13.64
High Self & Family 652 823.16 806.19 570.06 236.13 ‐32.97 823.16 806.19 593.48 212.71 ‐33.63
High Self Plus One 653 823.16 806.19 524.65 281.54 ‐30.50 823.16 806.19 546.21 259.98 ‐31.05
Colorado Kaiser Permanente ‐ Colorado
Basic Self N41 223.74 205.62 156.27 49.35 ‐4.35 223.74 205.62 162.95 42.67 ‐3.76
Basic Self & Family N42 505.66 505.82 384.42 121.40 0.04 505.66 505.82 400.86 104.96 0.04
Basic Self Plus One N43 505.66 464.70 353.17 111.53 ‐9.83 505.66 464.70 368.27 96.43 ‐8.49
Colorado UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self LU1 204.85 243.77 185.27 58.50 9.34 204.85 243.77 193.19 50.58 8.07
Colorado UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self KT1 334.51 360.98 244.94 116.04 20.58 334.51 360.98 255.00 105.98 20.34
Biweekly Biweekly
Change in Change in
payment payment
Colorado UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Connecticut Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Connecticut Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Connecticut Aetna HealthFund CDHP and Aetna Value Plan
Value Self EP4 350.59 387.52 244.94 142.58 31.04 350.59 387.52 255.00 132.52 30.80
Value Self & Family EP5 802.85 887.39 570.06 317.33 68.54 802.85 887.39 593.48 293.91 67.88
Value Self Plus One EP6 787.10 869.98 524.65 345.33 69.35 787.10 869.98 546.21 323.77 68.80
CDHP Self EP1 496.50 519.07 244.94 274.13 16.68 496.50 519.07 255.00 264.07 16.44
CDHP Self & Family EP2 1132.30 1183.79 570.06 613.73 35.49 1132.30 1183.79 593.48 590.31 34.83
CDHP Self Plus One EP3 1121.09 1172.06 524.65 647.41 37.44 1121.09 1172.06 546.21 625.85 36.89
Connecticut Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Connecticut UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Delaware Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Biweekly Biweekly
Change in Change in
payment payment
Delaware Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Delaware Aetna HealthFund CDHP and Aetna Value Plan
Value Self EP4 350.59 387.52 244.94 142.58 31.04 350.59 387.52 255.00 132.52 30.80
CDHP Self EP1 496.50 519.07 244.94 274.13 16.68 496.50 519.07 255.00 264.07 16.44
Delaware Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Delaware Aetna Open Access
Basic Self P34 604.65 694.86 244.94 449.92 84.32 604.65 694.86 255.00 439.86 84.08
High Self P31 672.28 733.03 244.94 488.09 54.86 672.28 733.03 255.00 478.03 54.62
High Self & Family P32 1629.94 1777.25 570.06 1207.19 131.31 1629.94 1777.25 593.48 1183.77 130.65
High Self Plus One P33 1613.79 1759.65 524.65 1235.00 132.33 1613.79 1759.65 546.21 1213.44 131.78
Delaware UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
District Of Columbia Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
District Of Columbia Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Biweekly Biweekly
Change in Change in
payment payment
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self F51 382.72 393.11 244.94 148.17 4.50 382.72 393.11 255.00 138.11 4.26
Value Self F54 378.45 379.30 244.94 134.36 ‐5.04 378.45 379.30 255.00 124.30 ‐5.28
District Of Columbia Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
District Of Columbia Aetna Open Access
High Self JN1 525.03 543.03 244.94 298.09 12.11 525.03 543.03 255.00 288.03 11.87
High Self & Family JN2 1180.35 1220.79 570.06 650.73 24.44 1180.35 1220.79 593.48 627.31 23.78
High Self Plus One JN3 1168.66 1208.70 524.65 684.05 26.51 1168.66 1208.70 546.21 662.49 25.96
Basic Self JN4 321.74 329.73 244.94 84.79 2.10 321.74 329.73 255.00 74.73 1.86
Basic Self & Family JN5 736.31 754.58 570.06 184.52 2.27 736.31 754.58 593.48 161.10 1.61
Basic Self Plus One JN6 676.15 692.92 524.65 168.27 3.24 676.15 692.92 546.21 146.71 2.69
District Of Columbia Aetna Saver (Open Access)
Saver Self QQ4 274.71 274.71 208.78 65.93 0.00 274.71 274.71 217.71 57.00 0.00
Saver Self & Family QQ5 628.68 628.67 477.79 150.88 0.00 628.68 628.67 498.22 130.45 0.00
Saver Self Plus One QQ6 577.30 577.30 438.75 138.55 0.00 577.30 577.30 457.51 119.79 0.00
District Of Columbia CareFirst BlueChoice
Standard Self 2G4 390.25 409.76 244.94 164.82 13.62 390.25 409.76 255.00 154.76 13.38
Standard Self & Family 2G5 927.21 973.58 570.06 403.52 30.37 927.21 973.58 593.48 380.10 29.71
Standard Self Plus One 2G6 780.49 819.51 524.65 294.86 25.49 780.49 819.51 546.21 273.30 24.94
District Of Columbia CareFirst BlueChoice
HDHP Self B61 263.12 263.12 199.97 63.15 0.00 263.12 263.12 208.52 54.60 0.00
HDHP Self & Family B62 625.16 625.16 475.12 150.04 0.00 625.16 625.16 495.44 129.72 0.00
HDHP Self Plus One B63 526.23 526.23 399.93 126.30 0.00 526.23 526.23 417.04 109.19 0.00
Blue Value Plus Self B64 325.84 334.00 244.94 89.06 2.27 325.84 334.00 255.00 79.00 2.03
Blue Value Plus Self & Famil B65 774.21 793.56 570.06 223.50 3.35 774.21 793.56 593.48 200.08 2.69
Blue Value Plus Self Plus On B66 651.70 667.98 507.66 160.32 3.91 651.70 667.98 529.37 138.61 3.38
Biweekly Biweekly
Change in Change in
payment payment
District Of Columbia Kaiser Permanente ‐ Mid‐Atlantic States
Basic Self T71 193.90 197.41 150.03 47.38 0.84 193.90 197.41 156.45 40.96 0.73
Basic Self & Family T72 473.61 507.47 385.68 121.79 8.12 473.61 507.47 402.17 105.30 7.03
Basic Self Plus One T73 431.49 439.31 333.88 105.43 1.87 431.49 439.31 348.15 91.16 1.63
District Of Columbia Kaiser Permanente ‐ Mid‐Atlantic States
Standard Self E34 263.79 276.13 209.86 66.27 2.96 263.79 276.13 218.83 57.30 2.56
Standard Self & Family E35 606.69 635.10 482.68 152.42 6.81 606.69 635.10 503.32 131.78 5.89
Standard Self Plus One E36 606.69 635.10 482.68 152.42 6.81 606.69 635.10 503.32 131.78 5.89
High Self E31 333.61 344.42 244.94 99.48 4.92 333.61 344.42 255.00 89.42 4.68
High Self & Family E32 767.32 792.16 570.06 222.10 8.84 767.32 792.16 593.48 198.68 8.18
High Self Plus One E33 767.32 792.16 524.65 267.51 11.31 767.32 792.16 546.21 245.95 10.76
District Of Columbia M.D. IPA
High Self JP1 404.59 438.87 244.94 193.93 28.39 404.59 438.87 255.00 183.87 28.15
High Self & Family JP2 1134.48 1230.59 570.06 660.53 80.11 1134.48 1230.59 593.48 637.11 79.45
High Self Plus One JP3 790.17 857.12 524.65 332.47 53.42 790.17 857.12 546.21 310.91 52.87
District Of Columbia UnitedHealthcare Insurance Company, Inc. ‐ Choice Plus Primary
High Self AS1 242.68 276.68 210.28 66.40 8.16 242.68 276.68 219.27 57.41 7.05
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self V41 224.57 239.96 182.37 57.59 3.69 224.57 239.96 190.17 49.79 3.19
HDHP Self & Family V42 516.51 551.91 419.45 132.46 8.50 516.51 551.91 437.39 114.52 7.34
HDHP Self Plus One V43 482.83 515.91 392.09 123.82 7.94 482.83 515.91 408.86 107.05 6.86
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self LR1 329.95 355.57 244.94 110.63 19.73 329.95 355.57 255.00 100.57 19.49
High Self & Family LR2 781.98 842.69 570.06 272.63 44.71 781.98 842.69 593.48 249.21 44.05
High Self Plus One LR3 709.38 764.46 524.65 239.81 41.55 709.38 764.46 546.21 218.25 41.00
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced
Value Self L91 240.69 255.98 194.54 61.44 3.67 240.69 255.98 202.86 53.12 3.18
Value Self & Family L92 674.89 717.76 545.50 172.26 10.29 674.89 717.76 568.82 148.94 8.90
Value Self Plus One L93 470.06 499.93 379.95 119.98 7.17 470.06 499.93 396.19 103.74 6.20
Biweekly Biweekly
Change in Change in
payment payment
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Primary
High Self Y81 233.88 266.18 202.30 63.88 7.75 233.88 266.18 210.95 55.23 6.70
District Of Columbia UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Florida Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Florida Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Florida Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self F51 382.72 393.11 244.94 148.17 4.50 382.72 393.11 255.00 138.11 4.26
Value Self F54 378.45 379.30 244.94 134.36 ‐5.04 378.45 379.30 255.00 124.30 ‐5.28
Florida Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Florida AvMed
HDHP Self WZ1 371.61 351.73 244.94 106.79 ‐25.77 371.61 351.73 255.00 96.73 ‐26.01
HDHP Self & Family WZ2 863.70 813.23 570.06 243.17 ‐66.47 863.70 813.23 593.48 219.75 ‐67.13
HDHP Self Plus One WZ3 748.77 705.54 524.65 180.89 ‐56.76 748.77 705.54 546.21 159.33 ‐57.31
Biweekly Biweekly
Change in Change in
payment payment
Florida AvMed
Standard Self ML4 327.34 378.91 244.94 133.97 45.68 327.34 378.91 255.00 123.91 45.44
Standard Self & Family ML5 796.99 922.58 570.06 352.52 109.59 796.99 922.58 593.48 329.10 108.93
Standard Self Plus One ML6 687.40 795.72 524.65 271.07 94.79 687.40 795.72 546.21 249.51 94.24
Florida Capital Health Plan
High Self EA1 314.13 318.68 242.20 76.48 1.09 314.13 318.68 252.55 66.13 0.87
High Self & Family EA2 728.00 738.55 561.30 177.25 2.53 728.00 738.55 585.30 153.25 2.07
High Self Plus One EA3 686.96 696.92 524.65 172.27 ‐3.57 686.96 696.92 546.21 150.71 ‐4.12
Florida Humana CoverageFirst and Humana Value Plan
Value Self W94 237.04 270.22 205.37 64.85 7.96 237.04 270.22 214.15 56.07 6.88
Value Self & Family W95 533.34 608.00 462.08 145.92 17.92 533.34 608.00 481.84 126.16 15.49
Value Self Plus One W96 509.63 580.98 441.54 139.44 17.13 509.63 580.98 460.43 120.55 14.80
CDHP Self W91 280.20 319.43 242.77 76.66 9.41 280.20 319.43 253.15 66.28 8.14
CDHP Self & Family W92 630.44 718.70 546.21 172.49 21.18 630.44 718.70 569.57 149.13 18.31
CDHP Self Plus One W93 602.43 686.76 521.94 164.82 20.24 602.43 686.76 544.26 142.50 17.50
CDHP Self QP1 334.64 354.72 244.94 109.78 14.19 334.64 354.72 255.00 99.72 13.95
CDHP Self & Family QP2 753.94 799.18 570.06 229.12 29.24 753.94 799.18 593.48 205.70 28.58
CDHP Self Plus One QP3 720.43 763.65 524.65 239.00 29.69 720.43 763.65 546.21 217.44 29.14
Value Self QP4 239.70 254.08 193.10 60.98 3.45 239.70 254.08 201.36 52.72 2.98
Value Self & Family QP5 539.30 571.66 434.46 137.20 7.77 539.30 571.66 453.04 118.62 6.72
Value Self Plus One QP6 515.34 546.26 415.16 131.10 7.42 515.34 546.26 432.91 113.35 6.42
Value Self MJ4 239.82 259.01 196.85 62.16 4.60 239.82 259.01 205.27 53.74 3.98
Value Self & Family MJ5 539.60 582.77 442.91 139.86 10.36 539.60 582.77 461.85 120.92 8.95
Value Self Plus One MJ6 515.62 556.87 423.22 133.65 9.90 515.62 556.87 441.32 115.55 8.56
CDHP Self MJ1 437.57 472.58 244.94 227.64 29.12 437.57 472.58 255.00 217.58 28.88
CDHP Self & Family MJ2 984.53 1063.29 570.06 493.23 62.76 984.53 1063.29 593.48 469.81 62.10
CDHP Self Plus One MJ3 940.78 1016.05 524.65 491.40 61.74 940.78 1016.05 546.21 469.84 61.19
Biweekly Biweekly
Change in Change in
payment payment
Value Self X24 227.62 236.72 179.91 56.81 2.18 227.62 236.72 187.60 49.12 1.89
Value Self & Family X25 512.15 532.64 404.81 127.83 4.91 512.15 532.64 422.12 110.52 4.25
Value Self Plus One X26 489.39 508.97 386.82 122.15 4.70 489.39 508.97 403.36 105.61 4.06
CDHP Self X21 269.07 279.83 212.67 67.16 2.58 269.07 279.83 221.77 58.06 2.23
CDHP Self & Family X22 605.42 629.64 478.53 151.11 5.81 605.42 629.64 498.99 130.65 5.03
CDHP Self Plus One X23 578.51 601.65 457.25 144.40 5.56 578.51 601.65 476.81 124.84 4.80
Florida Humana Medical Plan, Inc.
Standard Self LL4 496.13 550.71 244.94 305.77 48.69 496.13 550.71 255.00 295.71 48.45
Standard Self & Family LL5 1116.28 1239.07 570.06 669.01 106.79 1116.28 1239.07 593.48 645.59 106.13
Standard Self Plus One LL6 1066.67 1184.00 524.65 659.35 103.80 1066.67 1184.00 546.21 637.79 103.25
High Self LL1 765.76 788.74 244.94 543.80 17.09 765.76 788.74 255.00 533.74 16.85
High Self & Family LL2 1722.95 1774.64 570.06 1204.58 35.69 1722.95 1774.64 593.48 1181.16 35.03
High Self Plus One LL3 1646.37 1695.76 524.65 1171.11 35.86 1646.37 1695.76 546.21 1149.55 35.31
High Self EE1 514.68 576.43 244.94 331.49 55.86 514.68 576.43 255.00 321.43 55.62
High Self & Family EE2 1158.03 1296.99 570.06 726.93 122.96 1158.03 1296.99 593.48 703.51 122.30
High Self Plus One EE3 1106.58 1239.37 524.65 714.72 119.26 1106.58 1239.37 546.21 693.16 118.71
Standard Self EE4 460.21 515.43 244.94 270.49 49.33 460.21 515.43 255.00 260.43 49.09
Standard Self & Family EE5 1035.46 1159.71 570.06 589.65 108.25 1035.46 1159.71 593.48 566.23 107.59
Standard Self Plus One EE6 989.44 1108.17 524.65 583.52 105.20 989.44 1108.17 546.21 561.96 104.65
Standard Self E24 330.47 353.60 244.94 108.66 17.24 330.47 353.60 255.00 98.60 17.00
High Self E21 555.07 593.92 244.94 348.98 32.96 555.07 593.92 255.00 338.92 32.72
Biweekly Biweekly
Change in Change in
payment payment
High Self EX1 412.34 470.07 244.94 225.13 51.84 412.34 470.07 255.00 215.07 51.60
High Self & Family EX2 927.74 1057.63 570.06 487.57 113.89 927.74 1057.63 593.48 464.15 113.23
High Self Plus One EX3 886.51 1010.62 524.65 485.97 110.58 886.51 1010.62 546.21 464.41 110.03
Standard Self EX4 337.95 385.26 244.94 140.32 41.42 337.95 385.26 255.00 130.26 41.18
Standard Self & Family EX5 760.39 866.84 570.06 296.78 90.45 760.39 866.84 593.48 273.36 89.79
Standard Self Plus One EX6 726.59 828.31 524.65 303.66 88.19 726.59 828.31 546.21 282.10 87.64
Florida UnitedHealthcare Insurance Company, Inc. ‐ Choice Plus Primary
High Self AS1 242.68 276.68 210.28 66.40 8.16 242.68 276.68 219.27 57.41 7.05
Florida UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self LS1 209.88 224.24 170.42 53.82 3.45 209.88 224.24 177.71 46.53 2.98
Florida UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self KK1 329.48 354.94 244.94 110.00 19.57 329.48 354.94 255.00 99.94 19.33
Florida UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced
Value Self LV1 323.74 346.44 244.94 101.50 16.81 323.74 346.44 255.00 91.44 16.57
Value Self & Family LV2 971.21 1039.34 570.06 469.28 52.13 971.21 1039.34 593.48 445.86 51.47
Value Self Plus One LV3 696.03 744.87 524.65 220.22 35.31 696.03 744.87 546.21 198.66 34.76
Florida UnitedHealthcare Insurance Company, Inc. Choice Primary
High Self Y81 233.88 266.18 202.30 63.88 7.75 233.88 266.18 210.95 55.23 6.70
Florida UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Biweekly Biweekly
Change in Change in
payment payment
Georgia Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Georgia Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Georgia Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self F51 382.72 393.11 244.94 148.17 4.50 382.72 393.11 255.00 138.11 4.26
Value Self F54 378.45 379.30 244.94 134.36 ‐5.04 378.45 379.30 255.00 124.30 ‐5.28
Georgia Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Georgia Aetna Open Access
High Self 2U1 800.01 833.47 244.94 588.53 27.57 800.01 833.47 255.00 578.47 27.33
High Self & Family 2U2 1842.78 1919.87 570.06 1349.81 61.09 1842.78 1919.87 593.48 1326.39 60.43
High Self Plus One 2U3 1824.53 1900.86 524.65 1376.21 62.80 1824.53 1900.86 546.21 1354.65 62.25
Georgia Blue Open Access POS
High Self QM1 288.54 302.96 230.25 72.71 3.46 288.54 302.96 240.10 62.86 2.99
High Self & Family QM2 757.14 779.85 570.06 209.79 6.71 757.14 779.85 593.48 186.37 6.05
High Self Plus One QM3 635.88 667.67 507.43 160.24 7.63 635.88 667.67 529.13 138.54 6.59
Georgia Humana CoverageFirst and Humana Value Plan
Value Self S94 254.72 282.74 214.88 67.86 6.73 254.72 282.74 224.07 58.67 5.82
Value Self & Family S95 573.11 636.16 483.48 152.68 15.13 573.11 636.16 504.16 132.00 13.08
Value Self Plus One S96 547.65 607.89 462.00 145.89 14.45 547.65 607.89 481.75 126.14 12.50
CDHP Self S91 319.91 355.11 244.94 110.17 29.31 319.91 355.11 255.00 100.11 29.07
CDHP Self & Family S92 719.82 798.99 570.06 228.93 56.17 719.82 798.99 593.48 205.51 56.15
CDHP Self Plus One S93 687.82 763.48 524.65 238.83 62.13 687.82 763.48 546.21 217.27 61.58
Biweekly Biweekly
Change in Change in
payment payment
Value Self AD4 340.40 381.25 244.94 136.31 34.96 340.40 381.25 255.00 126.25 34.72
Value Self & Family AD5 765.88 857.78 570.06 287.72 75.90 765.88 857.78 593.48 264.30 75.24
Value Self Plus One AD6 731.85 819.67 524.65 295.02 74.29 731.85 819.67 546.21 273.46 73.74
CDHP Self AD1 449.25 503.16 244.94 258.22 48.02 449.25 503.16 255.00 248.16 47.78
CDHP Self & Family AD2 1010.80 1132.09 570.06 562.03 105.29 1010.80 1132.09 593.48 538.61 104.63
CDHP Self Plus One AD3 965.88 1081.78 524.65 557.13 102.37 965.88 1081.78 546.21 535.57 101.82
CDHP Self LM1 313.49 344.83 244.94 99.89 24.65 313.49 344.83 255.00 89.83 24.78
CDHP Self & Family LM2 705.37 775.90 570.06 205.84 36.55 705.37 775.90 593.48 182.42 36.06
CDHP Self Plus One LM3 674.01 741.42 524.65 216.77 53.88 674.01 741.42 546.21 195.21 53.33
Value Self LM4 296.56 326.22 244.94 81.28 10.11 296.56 326.22 255.00 71.22 9.68
Value Self & Family LM5 667.25 733.98 557.82 176.16 16.02 667.25 733.98 581.68 152.30 13.85
Value Self Plus One LM6 637.60 701.37 524.65 176.72 23.70 637.60 701.37 546.21 155.16 22.86
Georgia Humana Employers Health Plan of Georgia, Inc.
Basic Self RM1 299.32 332.25 244.94 87.31 15.47 299.32 332.25 255.00 77.25 15.14
Basic Self & Family RM2 673.49 747.57 568.15 179.42 17.78 673.49 747.57 592.45 155.12 15.37
Basic Self Plus One RM3 643.55 714.34 524.65 189.69 35.24 643.55 714.34 546.21 168.13 34.59
Standard Self DN4 335.09 375.30 244.94 130.36 34.32 335.09 375.30 255.00 120.30 34.08
Standard Self & Family DN5 753.93 844.40 570.06 274.34 74.47 753.93 844.40 593.48 250.92 73.81
Standard Self Plus One DN6 720.43 806.88 524.65 282.23 72.92 720.43 806.88 546.21 260.67 72.37
High Self DN1 360.28 403.51 244.94 158.57 37.34 360.28 403.51 255.00 148.51 37.10
High Self & Family DN2 810.63 907.90 570.06 337.84 81.27 810.63 907.90 593.48 314.42 80.61
High Self Plus One DN3 774.60 867.56 524.65 342.91 79.43 774.60 867.56 546.21 321.35 78.88
Basic Self RJ1 276.04 309.16 234.96 74.20 7.95 276.04 309.16 245.01 64.15 6.87
Basic Self & Family RJ2 621.10 695.64 528.69 166.95 17.89 621.10 695.64 551.29 144.35 15.47
Basic Self Plus One RJ3 593.50 664.72 505.19 159.53 17.09 593.50 664.72 526.79 137.93 14.78
Basic Self Q71 352.06 390.79 244.94 145.85 32.84 352.06 390.79 255.00 135.79 32.60
Basic Self & Family Q72 792.15 879.28 570.06 309.22 71.13 792.15 879.28 593.48 285.80 70.47
Basic Self Plus One Q73 756.93 840.20 524.65 315.55 69.74 756.93 840.20 546.21 293.99 69.19
Biweekly Biweekly
Change in Change in
payment payment
Standard Self CB4 577.13 525.18 244.94 280.24 ‐57.84 577.13 525.18 255.00 270.18 ‐58.08
Standard Self & Family CB5 1298.54 1181.68 570.06 611.62 ‐132.86 1298.54 1181.68 593.48 588.20 ‐133.52
Standard Self Plus One CB6 1240.83 1129.16 524.65 604.51 ‐125.20 1240.83 1129.16 546.21 582.95 ‐125.75
High Self CB1 530.11 588.41 244.94 343.47 52.41 530.11 588.41 255.00 333.41 52.17
High Self & Family CB2 1192.80 1324.00 570.06 753.94 115.20 1192.80 1324.00 593.48 730.52 114.54
High Self Plus One CB3 1139.82 1265.20 524.65 740.55 111.85 1139.82 1265.20 546.21 718.99 111.30
High Self DG1 610.12 640.63 244.94 395.69 24.62 610.12 640.63 255.00 385.63 24.38
High Self & Family DG2 1372.77 1441.41 570.06 871.35 52.64 1372.77 1441.41 593.48 847.93 51.98
High Self Plus One DG3 1311.78 1377.37 524.65 852.72 52.06 1311.78 1377.37 546.21 831.16 51.51
Standard Self DG4 540.85 600.35 244.94 355.41 53.61 540.85 600.35 255.00 345.35 53.37
Standard Self & Family DG5 1216.94 1350.79 570.06 780.73 117.85 1216.94 1350.79 593.48 757.31 117.19
Standard Self Plus One DG6 1162.88 1290.79 524.65 766.14 114.38 1162.88 1290.79 546.21 744.58 113.83
Georgia Kaiser Permanente ‐ Georgia
High Self F81 336.94 346.66 244.94 101.72 3.83 336.94 346.66 255.00 91.66 3.59
High Self & Family F82 761.48 783.46 570.06 213.40 5.98 761.48 783.46 593.48 189.98 5.32
High Self Plus One F83 761.48 783.46 524.65 258.81 8.45 761.48 783.46 546.21 237.25 7.90
Standard Self F84 254.92 268.20 203.83 64.37 3.19 254.92 268.20 212.55 55.65 2.75
Standard Self & Family F85 576.12 606.12 460.65 145.47 7.20 576.12 606.12 480.35 125.77 6.23
Standard Self Plus One F86 576.12 606.12 460.65 145.47 7.20 576.12 606.12 480.35 125.77 6.23
Georgia Kaiser Permanente ‐ Georgia
Basic Self LA1 181.55 193.34 146.94 46.40 2.83 181.55 193.34 153.22 40.12 2.45
Basic Self & Family LA2 410.30 436.92 332.06 104.86 6.39 410.30 436.92 346.26 90.66 5.52
Basic Self Plus One LA3 410.30 436.92 332.06 104.86 6.39 410.30 436.92 346.26 90.66 5.52
Georgia UnitedHealthcare Insurance Company, Inc. ‐ Choice Plus Primary
High Self AS1 242.68 276.68 210.28 66.40 8.16 242.68 276.68 219.27 57.41 7.05
Georgia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced
Value Self LV1 323.74 346.44 244.94 101.50 16.81 323.74 346.44 255.00 91.44 16.57
Value Self & Family LV2 971.21 1039.34 570.06 469.28 52.13 971.21 1039.34 593.48 445.86 51.47
Value Self Plus One LV3 696.03 744.87 524.65 220.22 35.31 696.03 744.87 546.21 198.66 34.76
Biweekly Biweekly
Change in Change in
payment payment
Georgia UnitedHealthcare Insurance Company, Inc. Choice Primary
High Self Y81 233.88 266.18 202.30 63.88 7.75 233.88 266.18 210.95 55.23 6.70
Georgia UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Guam Calvo's SelectCare
Standard Self B44 183.11 198.36 150.75 47.61 3.66 183.11 198.36 157.20 41.16 3.16
Standard Self & Family B45 532.03 576.33 438.01 138.32 10.63 532.03 576.33 456.74 119.59 9.19
Standard Self Plus One B46 360.97 391.02 297.18 93.84 7.21 360.97 391.02 309.88 81.14 6.24
High Self B41 226.87 240.78 182.99 57.79 3.34 226.87 240.78 190.82 49.96 2.88
High Self & Family B42 600.87 637.74 484.68 153.06 8.85 600.87 637.74 505.41 132.33 7.65
High Self Plus One B43 442.72 469.88 357.11 112.77 6.52 442.72 469.88 372.38 97.50 5.64
Guam TakeCare
HDHP Self KX1 57.34 55.63 42.28 13.35 ‐0.41 57.34 55.63 44.09 11.54 ‐0.36
HDHP Self & Family KX2 156.61 149.15 113.35 35.80 ‐1.79 156.61 149.15 118.20 30.95 ‐1.55
HDHP Self Plus One KX3 141.28 134.28 102.05 32.23 ‐1.68 141.28 134.28 106.42 27.86 ‐1.46
Guam TakeCare
Standard Self JK4 179.65 186.67 141.87 44.80 1.68 179.65 186.67 147.94 38.73 1.45
Standard Self & Family JK5 508.76 528.64 401.77 126.87 4.77 508.76 528.64 418.95 109.69 4.12
Standard Self Plus One JK6 354.07 367.91 279.61 88.30 3.32 354.07 367.91 291.57 76.34 2.87
High Self JK1 227.24 229.76 174.62 55.14 0.60 227.24 229.76 182.08 47.68 0.53
High Self & Family JK2 542.03 548.02 416.50 131.52 1.43 542.03 548.02 434.31 113.71 1.24
High Self Plus One JK3 448.95 453.92 344.98 108.94 1.19 448.95 453.92 359.73 94.19 1.03
Hawaii Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Hawaii Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Biweekly Biweekly
Change in Change in
payment payment
Hawaii Aetna HealthFund CDHP and Aetna Value Plan
Value Self JS4 495.45 505.19 244.94 260.25 3.85 495.45 505.19 255.00 250.19 3.61
CDHP Self JS1 463.38 466.12 244.94 221.18 ‐3.15 463.38 466.12 255.00 211.12 ‐3.39
Hawaii Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Hawaii HMSA Plan
High Self 871 291.34 291.34 221.42 69.92 0.00 291.34 291.34 230.89 60.45 0.00
High Self & Family 872 654.93 654.93 497.75 157.18 0.00 654.93 654.93 519.03 135.90 0.00
Standard Self 874 198.91 209.46 159.19 50.27 2.53 198.91 209.46 166.00 43.46 2.19
Hawaii Kaiser Permanente ‐ Hawaii
High Self 631 311.79 311.79 236.96 74.83 0.00 311.79 311.79 247.09 64.70 0.00
High Self & Family 632 695.31 695.31 528.44 166.87 0.00 695.31 695.31 551.03 144.28 0.00
Standard Self 634 222.07 233.16 177.20 55.96 2.66 222.07 233.16 184.78 48.38 2.30
Idaho Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Idaho Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Biweekly Biweekly
Change in Change in
payment payment
Idaho Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self H41 382.37 381.62 244.94 136.68 ‐6.64 382.37 381.62 255.00 126.62 ‐6.88
CDHP Self & Family H42 871.59 869.88 570.06 299.82 ‐17.71 871.59 869.88 593.48 276.40 ‐18.37
CDHP Self Plus One H43 863.04 861.43 524.65 336.78 ‐15.14 863.04 861.43 546.21 315.22 ‐15.69
Value Self H44 372.48 377.30 244.94 132.36 ‐1.07 372.48 377.30 255.00 122.30 ‐1.31
Value Self & Family H45 854.85 865.92 570.06 295.86 ‐4.93 854.85 865.92 593.48 272.44 ‐5.59
Value Self Plus One H46 838.09 848.95 524.65 324.30 ‐2.67 838.09 848.95 546.21 302.74 ‐3.22
Idaho Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Idaho Altius Health Plan
High Self 9K1 465.72 483.86 244.94 238.92 12.25 465.72 483.86 255.00 228.86 12.01
High Self & Family 9K2 1029.93 1070.06 570.06 500.00 24.13 1029.93 1070.06 593.48 476.58 23.47
High Self Plus One 9K3 1019.73 1059.46 524.65 534.81 26.20 1019.73 1059.46 546.21 513.25 25.65
HDHP Self 9K4 244.26 310.38 235.89 74.49 15.87 244.26 310.38 245.98 64.40 13.72
HDHP Self & Family 9K5 510.48 648.66 492.98 155.68 33.16 510.48 648.66 514.06 134.60 28.68
HDHP Self Plus One 9K6 500.48 635.93 483.31 152.62 32.50 500.48 635.93 503.97 131.96 28.11
Idaho Altius Health Plan
Standard Self DK4 351.37 407.59 244.94 162.65 50.33 351.37 407.59 255.00 152.59 50.09
Standard Self & Family DK5 775.95 900.09 570.06 330.03 108.14 775.95 900.09 593.48 306.61 107.48
Standard Self Plus One DK6 768.26 891.17 524.65 366.52 109.38 768.26 891.17 546.21 344.96 108.83
Idaho Kaiser Permanente ‐ Washington Core
Standard Self 544 278.83 285.24 216.78 68.46 1.54 278.83 285.24 226.05 59.19 1.33
High Self 541 390.34 398.66 244.94 153.72 2.43 390.34 398.66 255.00 143.66 2.19
High Self & Family 542 858.76 877.04 570.06 306.98 2.28 858.76 877.04 593.48 283.56 1.62
Idaho Kaiser Permanente ‐ Washington Core
Prosper Self PT4 New Plan 180.00 136.80 43.20 New Plan New Plan 180.00 142.65 37.35 New Plan
Prosper Self & Family PT5 New Plan 503.99 383.03 120.96 New Plan New Plan 503.99 399.41 104.58 New Plan
Prosper Self Plus One PT6 New Plan 436.00 331.36 104.64 New Plan New Plan 436.00 345.53 90.47 New Plan
Biweekly Biweekly
Change in Change in
payment payment
Idaho UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Illinois Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Illinois Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Illinois Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self H41 382.37 381.62 244.94 136.68 ‐6.64 382.37 381.62 255.00 126.62 ‐6.88
Value Self H44 372.48 377.30 244.94 132.36 ‐1.07 372.48 377.30 255.00 122.30 ‐1.31
Illinois Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Illinois Blue Preferred
High Self 9G1 384.56 403.49 244.94 158.55 13.04 384.56 403.49 255.00 148.49 12.80
High Self & Family 9G2 857.94 915.93 570.06 345.87 41.99 857.94 915.93 593.48 322.45 41.33
High Self Plus One 9G3 812.58 859.44 524.65 334.79 33.33 812.58 859.44 546.21 313.23 32.78
Standard Self 9G4 277.21 292.46 222.27 70.19 3.66 277.21 292.46 231.77 60.69 3.17
Illinois Health Alliance HMO
Standard Self K84 308.37 315.49 239.77 75.72 1.71 308.37 315.49 250.03 65.46 1.47
Standard Self & Family K85 832.61 731.24 555.74 175.50 ‐103.05 832.61 731.24 579.51 151.73 ‐104.06
Standard Self Plus One K86 714.36 674.59 512.69 161.90 ‐41.34 714.36 674.59 534.61 139.98 ‐42.25
Biweekly Biweekly
Change in Change in
payment payment
Illinois Humana CoverageFirst and Humana Value Plan
Value Self GB4 349.91 363.91 244.94 118.97 8.11 349.91 363.91 255.00 108.91 7.87
Value Self & Family GB5 787.28 818.77 570.06 248.71 15.49 787.28 818.77 593.48 225.29 14.83
Value Self Plus One GB6 752.29 782.38 524.65 257.73 16.56 752.29 782.38 546.21 236.17 16.01
CDHP Self GB1 544.86 566.65 244.94 321.71 15.90 544.86 566.65 255.00 311.65 15.66
CDHP Self & Family GB2 1225.91 1274.95 570.06 704.89 33.04 1225.91 1274.95 593.48 681.47 32.38
CDHP Self Plus One GB3 1171.44 1218.30 524.65 693.65 33.33 1171.44 1218.30 546.21 672.09 32.78
Illinois Humana CoverageFirst and Humana Value Plan
Value Self MW4 348.42 372.81 244.94 127.87 18.50 348.42 372.81 255.00 117.81 18.26
Value Self & Family MW5 783.93 838.80 570.06 268.74 38.87 783.93 838.80 593.48 245.32 38.21
Value Self Plus One MW6 749.10 801.54 524.65 276.89 38.91 749.10 801.54 546.21 255.33 38.36
CDHP Self MW1 422.78 473.52 244.94 228.58 44.85 422.78 473.52 255.00 218.52 44.61
CDHP Self & Family MW2 951.30 1065.45 570.06 495.39 98.15 951.30 1065.45 593.48 471.97 97.49
CDHP Self Plus One MW3 909.00 1018.09 524.65 493.44 95.56 909.00 1018.09 546.21 471.88 95.01
Illinois Humana Health Plan, Inc.
Standard Self 754 439.34 482.47 244.94 237.53 37.24 439.34 482.47 255.00 227.47 37.00
High Self 751 571.82 631.85 244.94 386.91 54.14 571.82 631.85 255.00 376.85 53.90
High Self & Family 752 1286.59 1421.69 570.06 851.63 119.10 1286.59 1421.69 593.48 828.21 118.44
High Self 9F1 894.61 930.39 244.94 685.45 29.89 894.61 930.39 255.00 675.39 29.65
High Self & Family 9F2 2012.86 2093.37 570.06 1523.31 64.51 2012.86 2093.37 593.48 1499.89 63.85
High Self Plus One 9F3 1923.39 2000.32 524.65 1475.67 63.40 1923.39 2000.32 546.21 1454.11 62.85
Standard Self AB4 530.55 573.09 244.94 328.15 36.65 530.55 573.09 255.00 318.09 36.41
Standard Self & Family AB5 1193.74 1289.49 570.06 719.43 79.75 1193.74 1289.49 593.48 696.01 79.09
Standard Self Plus One AB6 1140.69 1232.18 524.65 707.53 77.96 1140.69 1232.18 546.21 685.97 77.41
Basic Self AB1 349.22 363.19 244.94 118.25 8.08 349.22 363.19 255.00 108.19 7.84
Basic Self & Family AB2 785.77 817.20 570.06 247.14 15.43 785.77 817.20 593.48 223.72 14.77
Basic Self Plus One AB3 750.85 780.88 524.65 256.23 16.50 750.85 780.88 546.21 234.67 15.95
Biweekly Biweekly
Change in Change in
payment payment
Basic Self RW1 345.34 378.02 244.94 133.08 26.79 345.34 378.02 255.00 123.02 26.55
Basic Self & Family RW2 777.02 850.55 570.06 280.49 57.53 777.02 850.55 593.48 257.07 56.87
Basic Self Plus One RW3 742.49 812.75 524.65 288.10 56.73 742.49 812.75 546.21 266.54 56.18
Illinois Union Health Service
High Self 761 343.42 360.95 244.94 116.01 11.64 343.42 360.95 255.00 105.95 11.40
High Self & Family 762 877.68 905.96 570.06 335.90 12.28 877.68 905.96 593.48 312.48 11.62
Illinois UnitedHealthcare Insurance Company, Inc. ‐ Choice Plus Primary
High Self AS1 242.68 276.68 210.28 66.40 8.16 242.68 276.68 219.27 57.41 7.05
Illinois UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced
Value Self L91 240.69 255.98 194.54 61.44 3.67 240.69 255.98 202.86 53.12 3.18
Illinois UnitedHealthcare Insurance Company, Inc. Choice Primary
High Self Y81 233.88 266.18 202.30 63.88 7.75 233.88 266.18 210.95 55.23 6.70
Illinois UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Indiana Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Indiana Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Biweekly Biweekly
Change in Change in
payment payment
Indiana Aetna HealthFund CDHP and Aetna Value Plan
Value Self JS4 495.45 505.19 244.94 260.25 3.85 495.45 505.19 255.00 250.19 3.61
CDHP Self JS1 463.38 466.12 244.94 221.18 ‐3.15 463.38 466.12 255.00 211.12 ‐3.39
Indiana Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Indiana Health Alliance HMO
Standard Self K84 308.37 315.49 239.77 75.72 1.71 308.37 315.49 250.03 65.46 1.47
Indiana Humana CoverageFirst
CDHP Self TC1 304.37 340.88 244.94 95.94 22.89 304.37 340.88 255.00 85.88 22.72
CDHP Self & Family TC2 684.80 766.98 570.06 196.92 32.57 684.80 766.98 593.48 173.50 31.40
CDHP Self Plus One TC3 654.38 732.90 524.65 208.25 51.20 654.38 732.90 546.21 186.69 50.91
Indiana Humana CoverageFirst and Humana Value Plan
Value Self MW4 348.42 372.81 244.94 127.87 18.50 348.42 372.81 255.00 117.81 18.26
Value Self & Family MW5 783.93 838.80 570.06 268.74 38.87 783.93 838.80 593.48 245.32 38.21
Value Self Plus One MW6 749.10 801.54 524.65 276.89 38.91 749.10 801.54 546.21 255.33 38.36
CDHP Self MW1 422.78 473.52 244.94 228.58 44.85 422.78 473.52 255.00 218.52 44.61
CDHP Self & Family MW2 951.30 1065.45 570.06 495.39 98.15 951.30 1065.45 593.48 471.97 97.49
CDHP Self Plus One MW3 909.00 1018.09 524.65 493.44 95.56 909.00 1018.09 546.21 471.88 95.01
Indiana Humana CoverageFirst and Humana Value Plan
Value Self X34 283.90 298.10 226.56 71.54 3.40 283.90 298.10 236.24 61.86 2.95
CDHP Self X31 368.97 387.42 244.94 142.48 12.56 368.97 387.42 255.00 132.42 12.32
Biweekly Biweekly
Change in Change in
payment payment
Indiana Humana Health Plan of Ohio, Inc.
High Self A61 692.76 727.40 244.94 482.46 28.75 692.76 727.40 255.00 472.40 28.51
High Self & Family A62 1558.72 1636.66 570.06 1066.60 61.94 1558.72 1636.66 593.48 1043.18 61.28
High Self Plus One A63 1489.45 1563.92 524.65 1039.27 60.94 1489.45 1563.92 546.21 1017.71 60.39
Standard Self A64 541.00 568.05 244.94 323.11 21.16 541.00 568.05 255.00 313.05 20.92
Standard Self & Family A65 1217.27 1278.14 570.06 708.08 44.87 1217.27 1278.14 593.48 684.66 44.21
Standard Self Plus One A66 1163.17 1221.32 524.65 696.67 44.62 1163.17 1221.32 546.21 675.11 44.07
Indiana Humana Health Plan, Inc.
Standard Self 754 439.34 482.47 244.94 237.53 37.24 439.34 482.47 255.00 227.47 37.00
High Self 751 571.82 631.85 244.94 386.91 54.14 571.82 631.85 255.00 376.85 53.90
High Self & Family 752 1286.59 1421.69 570.06 851.63 119.10 1286.59 1421.69 593.48 828.21 118.44
Indiana Humana Health Plan, Inc.
High Self MH1 509.98 560.99 244.94 316.05 45.12 509.98 560.99 255.00 305.99 44.88
High Self & Family MH2 1147.47 1262.23 570.06 692.17 98.76 1147.47 1262.23 593.48 668.75 98.10
High Self Plus One MH3 1096.47 1206.12 524.65 681.47 96.12 1096.47 1206.12 546.21 659.91 95.57
Standard Self MH4 396.76 436.44 244.94 191.50 33.79 396.76 436.44 255.00 181.44 33.55
Standard Self & Family MH5 892.70 981.98 570.06 411.92 73.28 892.70 981.98 593.48 388.50 72.62
Standard Self Plus One MH6 853.03 938.33 524.65 413.68 71.77 853.03 938.33 546.21 392.12 71.22
Indiana UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Iowa Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Iowa Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Biweekly Biweekly
Change in Change in
payment payment
Iowa Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self H41 382.37 381.62 244.94 136.68 ‐6.64 382.37 381.62 255.00 126.62 ‐6.88
Value Self H44 372.48 377.30 244.94 132.36 ‐1.07 372.48 377.30 255.00 122.30 ‐1.31
Iowa Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Iowa Health Alliance HMO
Standard Self K84 308.37 315.49 239.77 75.72 1.71 308.37 315.49 250.03 65.46 1.47
Iowa HealthPartners
Standard Self V34 212.27 235.11 178.68 56.43 5.49 212.27 235.11 186.32 48.79 4.74
Standard Self & Family V35 517.11 572.74 435.28 137.46 13.35 517.11 572.74 453.90 118.84 11.54
Standard Self Plus One V36 469.13 519.60 394.90 124.70 12.11 469.13 519.60 411.78 107.82 10.48
High Self V31 328.76 308.34 234.34 74.00 ‐15.71 328.76 308.34 244.36 63.98 ‐15.91
High Self & Family V32 800.86 751.10 570.06 181.04 ‐65.76 800.86 751.10 593.48 157.62 ‐66.42
High Self Plus One V33 726.56 681.42 517.88 163.54 ‐51.90 726.56 681.42 540.03 141.39 ‐53.04
Iowa UnitedHealthcare Insurance Company, Inc. ‐ Choice Plus Primary
High Self AS1 242.68 276.68 210.28 66.40 8.16 242.68 276.68 219.27 57.41 7.05
Iowa UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self N71 281.73 319.78 243.03 76.75 9.13 281.73 319.78 253.43 66.35 7.89
HDHP Self & Family N72 647.99 735.49 558.97 176.52 21.00 647.99 735.49 582.88 152.61 18.15
HDHP Self Plus One N73 605.73 687.52 522.52 165.00 19.62 605.73 687.52 544.86 142.66 16.97
Iowa UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self LJ1 332.39 358.54 244.94 113.60 20.26 332.39 358.54 255.00 103.54 20.02
High Self & Family LJ2 830.99 896.36 570.06 326.30 49.37 830.99 896.36 593.48 302.88 48.71
High Self Plus One LJ3 714.65 770.87 524.65 246.22 42.69 714.65 770.87 546.21 224.66 42.14
Biweekly Biweekly
Change in Change in
payment payment
Iowa UnitedHealthcare Insurance Company, Inc. Choice Primary
High Self Y81 233.88 266.18 202.30 63.88 7.75 233.88 266.18 210.95 55.23 6.70
Iowa UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Kansas Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Kansas Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Kansas Aetna HealthFund CDHP and Aetna Value Plan
Value Self G54 328.95 330.94 244.94 86.00 ‐3.90 328.95 330.94 255.00 75.94 ‐4.14
CDHP Self G51 417.46 488.66 244.94 243.72 65.31 417.46 488.66 255.00 233.66 65.07
Kansas Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Kansas Aetna Open Access
High Self HA1 507.66 533.78 244.94 288.84 20.23 507.66 533.78 255.00 278.78 19.99
High Self & Family HA2 1199.16 1260.88 570.06 690.82 45.72 1199.16 1260.88 593.48 667.40 45.06
High Self Plus One HA3 1187.32 1248.41 524.65 723.76 47.56 1187.32 1248.41 546.21 702.20 47.01
Standard Self HA4 330.63 416.01 244.94 171.07 79.49 330.63 416.01 255.00 161.01 79.25
Standard Self & Family HA5 780.41 981.94 570.06 411.88 185.53 780.41 981.94 593.48 388.46 184.87
Standard Self Plus One HA6 772.69 972.22 524.65 447.57 186.00 772.69 972.22 546.21 426.01 185.45
Biweekly Biweekly
Change in Change in
payment payment
Kansas Humana CoverageFirst and Humana Value Plan
Value Self PH4 223.40 243.51 185.07 58.44 4.82 223.40 243.51 192.98 50.53 4.17
Value Self & Family PH5 502.66 547.90 416.40 131.50 10.86 502.66 547.90 434.21 113.69 9.39
Value Self Plus One PH6 480.31 523.55 397.90 125.65 10.38 480.31 523.55 414.91 108.64 8.98
CDHP Self PH1 330.05 349.86 244.94 104.92 13.92 330.05 349.86 255.00 94.86 13.68
CDHP Self & Family PH2 742.63 787.19 570.06 217.13 28.56 742.63 787.19 593.48 193.71 27.90
CDHP Self Plus One PH3 709.62 752.20 524.65 227.55 29.05 709.62 752.20 546.21 205.99 28.50
Kansas Humana Health Plan, Inc.
High Self MS1 795.31 829.31 244.94 584.37 28.11 795.31 829.31 255.00 574.31 27.87
High Self & Family MS2 1789.44 1865.95 570.06 1295.89 60.51 1789.44 1865.95 593.48 1272.47 59.85
High Self Plus One MS3 1709.91 1783.00 524.65 1258.35 59.56 1709.91 1783.00 546.21 1236.79 59.01
Standard Self MS4 492.46 554.12 244.94 309.18 55.77 492.46 554.12 255.00 299.12 55.53
Standard Self & Family MS5 1108.05 1246.77 570.06 676.71 122.72 1108.05 1246.77 593.48 653.29 122.06
Standard Self Plus One MS6 1058.81 1191.38 524.65 666.73 119.04 1058.81 1191.38 546.21 645.17 118.49
Kansas UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Kentucky Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Kentucky Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Kentucky Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self H41 382.37 381.62 244.94 136.68 ‐6.64 382.37 381.62 255.00 126.62 ‐6.88
Value Self H44 372.48 377.30 244.94 132.36 ‐1.07 372.48 377.30 255.00 122.30 ‐1.31
Biweekly Biweekly
Change in Change in
payment payment
Kentucky Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Kentucky Humana CoverageFirst
CDHP Self TC1 304.37 340.88 244.94 95.94 22.89 304.37 340.88 255.00 85.88 22.72
CDHP Self & Family TC2 684.80 766.98 570.06 196.92 32.57 684.80 766.98 593.48 173.50 31.40
CDHP Self Plus One TC3 654.38 732.90 524.65 208.25 51.20 654.38 732.90 546.21 186.69 50.91
Kentucky Humana CoverageFirst
CDHP Self 6N1 353.86 382.17 244.94 137.23 22.42 353.86 382.17 255.00 127.17 22.18
CDHP Self & Family 6N2 796.19 859.88 570.06 289.82 47.69 796.19 859.88 593.48 266.40 47.03
CDHP Self Plus One 6N3 760.80 821.67 524.65 297.02 47.34 760.80 821.67 546.21 275.46 46.79
Kentucky Humana CoverageFirst and Humana Value Plan
Value Self X34 283.90 298.10 226.56 71.54 3.40 283.90 298.10 236.24 61.86 2.95
CDHP Self X31 368.97 387.42 244.94 142.48 12.56 368.97 387.42 255.00 132.42 12.32
Kentucky Humana Health Plan of Ohio, Inc.
High Self A61 692.76 727.40 244.94 482.46 28.75 692.76 727.40 255.00 472.40 28.51
Standard Self A64 541.00 568.05 244.94 323.11 21.16 541.00 568.05 255.00 313.05 20.92
Kentucky Humana Health Plan of Ohio, Inc.
Basic Self W61 280.90 294.95 224.16 70.79 3.37 280.90 294.95 233.75 61.20 2.91
Basic Self & Family W62 632.05 663.66 504.38 159.28 7.59 632.05 663.66 525.95 137.71 6.56
Basic Self Plus One W63 603.96 634.16 481.96 152.20 7.25 603.96 634.16 502.57 131.59 6.27
Biweekly Biweekly
Change in Change in
payment payment
Kentucky Humana Health Plan, Inc.
High Self MI1 637.59 663.10 244.94 418.16 19.62 637.59 663.10 255.00 408.10 19.38
High Self & Family MI2 1434.57 1491.94 570.06 921.88 41.37 1434.57 1491.94 593.48 898.46 40.71
High Self Plus One MI3 1370.81 1425.65 524.65 901.00 41.31 1370.81 1425.65 546.21 879.44 40.76
Standard Self MI4 408.46 424.80 244.94 179.86 10.45 408.46 424.80 255.00 169.80 10.21
Standard Self & Family MI5 919.02 955.78 570.06 385.72 20.76 919.02 955.78 593.48 362.30 20.10
Standard Self Plus One MI6 878.19 913.31 524.65 388.66 21.59 878.19 913.31 546.21 367.10 21.04
Kentucky Humana Health Plan, Inc.
High Self MH1 509.98 560.99 244.94 316.05 45.12 509.98 560.99 255.00 305.99 44.88
High Self & Family MH2 1147.47 1262.23 570.06 692.17 98.76 1147.47 1262.23 593.48 668.75 98.10
High Self Plus One MH3 1096.47 1206.12 524.65 681.47 96.12 1096.47 1206.12 546.21 659.91 95.57
Standard Self MH4 396.76 436.44 244.94 191.50 33.79 396.76 436.44 255.00 181.44 33.55
Standard Self & Family MH5 892.70 981.98 570.06 411.92 73.28 892.70 981.98 593.48 388.50 72.62
Standard Self Plus One MH6 853.03 938.33 524.65 413.68 71.77 853.03 938.33 546.21 392.12 71.22
Kentucky UnitedHealthcare Insurance Company, Inc. ‐ Choice Plus Primary
High Self AS1 242.68 276.68 210.28 66.40 8.16 242.68 276.68 219.27 57.41 7.05
Kentucky UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self N71 281.73 319.78 243.03 76.75 9.13 281.73 319.78 253.43 66.35 7.89
HDHP Self & Family N72 647.99 735.49 558.97 176.52 21.00 647.99 735.49 582.88 152.61 18.15
HDHP Self Plus One N73 605.73 687.52 522.52 165.00 19.62 605.73 687.52 544.86 142.66 16.97
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self LJ1 332.39 358.54 244.94 113.60 20.26 332.39 358.54 255.00 103.54 20.02
High Self & Family LJ2 830.99 896.36 570.06 326.30 49.37 830.99 896.36 593.48 302.88 48.71
High Self Plus One LJ3 714.65 770.87 524.65 246.22 42.69 714.65 770.87 546.21 224.66 42.14
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Primary
High Self Y81 233.88 266.18 202.30 63.88 7.75 233.88 266.18 210.95 55.23 6.70
Kentucky UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Biweekly Biweekly
Change in Change in
payment payment
Louisiana Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Louisiana Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Louisiana Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self F51 382.72 393.11 244.94 148.17 4.50 382.72 393.11 255.00 138.11 4.26
Value Self F54 378.45 379.30 244.94 134.36 ‐5.04 378.45 379.30 255.00 124.30 ‐5.28
Louisiana Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Louisiana Humana Health Benefit Plan of Louisiana, Inc.
Standard Self BC4 311.14 342.25 244.94 97.31 22.64 311.14 342.25 255.00 87.25 22.69
Standard Self & Family BC5 700.06 770.06 570.06 200.00 31.99 700.06 770.06 593.48 176.58 31.32
Standard Self Plus One BC6 668.94 735.83 524.65 211.18 50.63 668.94 735.83 546.21 189.62 50.81
High Self BC1 416.00 457.60 244.94 212.66 35.71 416.00 457.60 255.00 202.60 35.47
High Self & Family BC2 936.01 1029.61 570.06 459.55 77.60 936.01 1029.61 593.48 436.13 76.94
High Self Plus One BC3 894.41 983.85 524.65 459.20 75.91 894.41 983.85 546.21 437.64 75.36
Louisiana Humana Health Benefit Plan of Louisiana, Inc.
High Self AE1 494.50 558.78 244.94 313.84 58.39 494.50 558.78 255.00 303.78 58.15
High Self & Family AE2 1112.60 1257.25 570.06 687.19 128.65 1112.60 1257.25 593.48 663.77 127.99
High Self Plus One AE3 1063.16 1201.38 524.65 676.73 124.69 1063.16 1201.38 546.21 655.17 124.14
Standard Self AE4 372.67 421.12 244.94 176.18 42.56 372.67 421.12 255.00 166.12 42.32
Standard Self & Family AE5 838.52 947.53 570.06 377.47 93.01 838.52 947.53 593.48 354.05 92.35
Standard Self Plus One AE6 801.25 905.41 524.65 380.76 90.63 801.25 905.41 546.21 359.20 90.08
Biweekly Biweekly
Change in Change in
payment payment
Louisiana UnitedHealthcare Insurance Company, Inc. ‐ Choice Plus Primary
High Self AS1 242.68 276.68 210.28 66.40 8.16 242.68 276.68 219.27 57.41 7.05
Louisiana UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self LS1 209.88 224.24 170.42 53.82 3.45 209.88 224.24 177.71 46.53 2.98
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self KK1 329.48 354.94 244.94 110.00 19.57 329.48 354.94 255.00 99.94 19.33
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Primary
High Self Y81 233.88 266.18 202.30 63.88 7.75 233.88 266.18 210.95 55.23 6.70
Louisiana UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Maine Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Maine Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Biweekly Biweekly
Change in Change in
payment payment
Maine Aetna HealthFund CDHP and Aetna Value Plan
Value Self EP4 350.59 387.52 244.94 142.58 31.04 350.59 387.52 255.00 132.52 30.80
CDHP Self EP1 496.50 519.07 244.94 274.13 16.68 496.50 519.07 255.00 264.07 16.44
Maine Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Maine UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Maryland Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Maryland Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Maryland Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self F51 382.72 393.11 244.94 148.17 4.50 382.72 393.11 255.00 138.11 4.26
Value Self F54 378.45 379.30 244.94 134.36 ‐5.04 378.45 379.30 255.00 124.30 ‐5.28
Maryland Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Biweekly Biweekly
Change in Change in
payment payment
Maryland Aetna Open Access
High Self JN1 525.03 543.03 244.94 298.09 12.11 525.03 543.03 255.00 288.03 11.87
Basic Self JN4 321.74 329.73 244.94 84.79 2.10 321.74 329.73 255.00 74.73 1.86
Maryland Aetna Saver (Open Access)
Saver Self QQ4 274.71 274.71 208.78 65.93 0.00 274.71 274.71 217.71 57.00 0.00
Maryland CareFirst BlueChoice
Standard Self 2G4 390.25 409.76 244.94 164.82 13.62 390.25 409.76 255.00 154.76 13.38
Maryland CareFirst BlueChoice
HDHP Self B61 263.12 263.12 199.97 63.15 0.00 263.12 263.12 208.52 54.60 0.00
Maryland Kaiser Permanente ‐ Mid‐Atlantic States
Basic Self T71 193.90 197.41 150.03 47.38 0.84 193.90 197.41 156.45 40.96 0.73
Maryland Kaiser Permanente ‐ Mid‐Atlantic States
Standard Self E34 263.79 276.13 209.86 66.27 2.96 263.79 276.13 218.83 57.30 2.56
High Self E31 333.61 344.42 244.94 99.48 4.92 333.61 344.42 255.00 89.42 4.68
Biweekly Biweekly
Change in Change in
payment payment
Maryland M.D. IPA
High Self JP1 404.59 438.87 244.94 193.93 28.39 404.59 438.87 255.00 183.87 28.15
Maryland UnitedHealthcare Insurance Company, Inc. ‐ Choice Plus Primary
High Self AS1 242.68 276.68 210.28 66.40 8.16 242.68 276.68 219.27 57.41 7.05
Maryland UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self V41 224.57 239.96 182.37 57.59 3.69 224.57 239.96 190.17 49.79 3.19
Maryland UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self LR1 329.95 355.57 244.94 110.63 19.73 329.95 355.57 255.00 100.57 19.49
Maryland UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced
Value Self L91 240.69 255.98 194.54 61.44 3.67 240.69 255.98 202.86 53.12 3.18
Maryland UnitedHealthcare Insurance Company, Inc. Choice Primary
High Self Y81 233.88 266.18 202.30 63.88 7.75 233.88 266.18 210.95 55.23 6.70
Maryland UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Massachusetts Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Biweekly Biweekly
Change in Change in
payment payment
Massachusetts Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan
Value Self EP4 350.59 387.52 244.94 142.58 31.04 350.59 387.52 255.00 132.52 30.80
CDHP Self EP1 496.50 519.07 244.94 274.13 16.68 496.50 519.07 255.00 264.07 16.44
Massachusetts Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Massachusetts UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Michigan Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Michigan Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Michigan Aetna HealthFund CDHP and Aetna Value Plan
Value Self G54 328.95 330.94 244.94 86.00 ‐3.90 328.95 330.94 255.00 75.94 ‐4.14
CDHP Self G51 417.46 488.66 244.94 243.72 65.31 417.46 488.66 255.00 233.66 65.07
Biweekly Biweekly
Change in Change in
payment payment
Michigan Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Michigan Blue Care Network of Michigan
High Self LX1 342.86 353.45 244.94 108.51 4.70 342.86 353.45 255.00 98.45 4.46
High Self & Family LX2 836.58 862.42 570.06 292.36 9.84 836.58 862.42 593.48 268.94 9.18
High Self Plus One LX3 788.57 812.95 524.65 288.30 10.85 788.57 812.95 546.21 266.74 10.30
Michigan Blue Care Network of Michigan
High Self K51 442.03 459.92 244.94 214.98 12.00 442.03 459.92 255.00 204.92 11.76
High Self & Family K52 1078.53 1122.21 570.06 552.15 27.68 1078.53 1122.21 593.48 528.73 27.02
High Self Plus One K53 1016.64 1057.83 524.65 533.18 27.66 1016.64 1057.83 546.21 511.62 27.11
Michigan Health Alliance Plan
High Self 521 363.64 388.70 244.94 143.76 19.17 363.64 388.70 255.00 133.70 18.93
High Self & Family 522 887.28 948.43 570.06 378.37 45.15 887.28 948.43 593.48 354.95 44.49
Michigan Health Alliance Plan
Standard Self GY4 283.49 257.33 195.57 61.76 ‐6.28 283.49 257.33 203.93 53.40 ‐5.42
Standard Self & Family GY5 691.74 627.88 477.19 150.69 ‐15.33 691.74 627.88 497.59 130.29 ‐13.25
Standard Self Plus One GY6 652.05 591.85 449.81 142.04 ‐14.45 652.05 591.85 469.04 122.81 ‐12.49
Michigan Priority Health
High Self LE1 424.42 478.75 244.94 233.81 48.44 424.42 478.75 255.00 223.75 48.20
High Self & Family LE2 997.39 1125.06 570.06 555.00 111.67 997.39 1125.06 593.48 531.58 111.01
High Self Plus One LE3 933.72 1053.25 524.65 528.60 106.00 933.72 1053.25 546.21 507.04 105.45
Standard Self LE4 248.92 271.10 206.04 65.06 5.32 248.92 271.10 214.85 56.25 4.60
Standard Self & Family LE5 584.97 637.07 484.17 152.90 12.51 584.97 637.07 504.88 132.19 10.81
Standard Self Plus One LE6 547.63 596.41 453.27 143.14 11.71 547.63 596.41 472.65 123.76 10.13
Michigan Priority Health
Value Self Y41 218.42 218.42 166.00 52.42 0.00 218.42 218.42 173.10 45.32 0.00
Value Self & Family Y42 513.29 513.29 390.10 123.19 0.00 513.29 513.29 406.78 106.51 0.00
Value Self Plus One Y43 480.52 480.52 365.20 115.32 0.00 480.52 480.52 380.81 99.71 0.00
Biweekly Biweekly
Change in Change in
payment payment
Michigan UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Minnesota Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Minnesota Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Minnesota Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self H41 382.37 381.62 244.94 136.68 ‐6.64 382.37 381.62 255.00 126.62 ‐6.88
Value Self H44 372.48 377.30 244.94 132.36 ‐1.07 372.48 377.30 255.00 122.30 ‐1.31
Minnesota Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Minnesota HealthPartners
Standard Self V34 212.27 235.11 178.68 56.43 5.49 212.27 235.11 186.32 48.79 4.74
High Self V31 328.76 308.34 234.34 74.00 ‐15.71 328.76 308.34 244.36 63.98 ‐15.91
Minnesota UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Biweekly Biweekly
Change in Change in
payment payment
Mississippi Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Mississippi Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Mississippi Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self H41 382.37 381.62 244.94 136.68 ‐6.64 382.37 381.62 255.00 126.62 ‐6.88
Value Self H44 372.48 377.30 244.94 132.36 ‐1.07 372.48 377.30 255.00 122.30 ‐1.31
Mississippi Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Mississippi UnitedHealthcare Insurance Company, Inc. ‐ Choice Plus Primary
High Self AS1 242.68 276.68 210.28 66.40 8.16 242.68 276.68 219.27 57.41 7.05
Mississippi UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self LS1 209.88 224.24 170.42 53.82 3.45 209.88 224.24 177.71 46.53 2.98
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self KK1 329.48 354.94 244.94 110.00 19.57 329.48 354.94 255.00 99.94 19.33
Biweekly Biweekly
Change in Change in
payment payment
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Primary
High Self Y81 233.88 266.18 202.30 63.88 7.75 233.88 266.18 210.95 55.23 6.70
Mississippi UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Missouri Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Missouri Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Missouri Aetna HealthFund CDHP and Aetna Value Plan
Value Self G54 328.95 330.94 244.94 86.00 ‐3.90 328.95 330.94 255.00 75.94 ‐4.14
CDHP Self G51 417.46 488.66 244.94 243.72 65.31 417.46 488.66 255.00 233.66 65.07
Missouri Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Missouri Aetna Open Access
High Self HA1 507.66 533.78 244.94 288.84 20.23 507.66 533.78 255.00 278.78 19.99
High Self & Family HA2 1199.16 1260.88 570.06 690.82 45.72 1199.16 1260.88 593.48 667.40 45.06
High Self Plus One HA3 1187.32 1248.41 524.65 723.76 47.56 1187.32 1248.41 546.21 702.20 47.01
Standard Self HA4 330.63 416.01 244.94 171.07 79.49 330.63 416.01 255.00 161.01 79.25
Standard Self & Family HA5 780.41 981.94 570.06 411.88 185.53 780.41 981.94 593.48 388.46 184.87
Standard Self Plus One HA6 772.69 972.22 524.65 447.57 186.00 772.69 972.22 546.21 426.01 185.45
Biweekly Biweekly
Change in Change in
payment payment
Missouri Blue Preferred
High Self 9G1 384.56 403.49 244.94 158.55 13.04 384.56 403.49 255.00 148.49 12.80
High Self & Family 9G2 857.94 915.93 570.06 345.87 41.99 857.94 915.93 593.48 322.45 41.33
High Self Plus One 9G3 812.58 859.44 524.65 334.79 33.33 812.58 859.44 546.21 313.23 32.78
Standard Self 9G4 277.21 292.46 222.27 70.19 3.66 277.21 292.46 231.77 60.69 3.17
Missouri Humana CoverageFirst and Humana Value Plan
Value Self PH4 223.40 243.51 185.07 58.44 4.82 223.40 243.51 192.98 50.53 4.17
Value Self & Family PH5 502.66 547.90 416.40 131.50 10.86 502.66 547.90 434.21 113.69 9.39
Value Self Plus One PH6 480.31 523.55 397.90 125.65 10.38 480.31 523.55 414.91 108.64 8.98
CDHP Self PH1 330.05 349.86 244.94 104.92 13.92 330.05 349.86 255.00 94.86 13.68
CDHP Self & Family PH2 742.63 787.19 570.06 217.13 28.56 742.63 787.19 593.48 193.71 27.90
CDHP Self Plus One PH3 709.62 752.20 524.65 227.55 29.05 709.62 752.20 546.21 205.99 28.50
Missouri Humana Health Plan, Inc.
High Self MS1 795.31 829.31 244.94 584.37 28.11 795.31 829.31 255.00 574.31 27.87
High Self & Family MS2 1789.44 1865.95 570.06 1295.89 60.51 1789.44 1865.95 593.48 1272.47 59.85
High Self Plus One MS3 1709.91 1783.00 524.65 1258.35 59.56 1709.91 1783.00 546.21 1236.79 59.01
Standard Self MS4 492.46 554.12 244.94 309.18 55.77 492.46 554.12 255.00 299.12 55.53
Standard Self & Family MS5 1108.05 1246.77 570.06 676.71 122.72 1108.05 1246.77 593.48 653.29 122.06
Standard Self Plus One MS6 1058.81 1191.38 524.65 666.73 119.04 1058.81 1191.38 546.21 645.17 118.49
Missouri UnitedHealthcare Insurance Company, Inc. ‐ Choice Plus Primary
High Self AS1 242.68 276.68 210.28 66.40 8.16 242.68 276.68 219.27 57.41 7.05
Missouri UnitedHealthcare Insurance Company, Inc. Choice Primary
High Self Y81 233.88 266.18 202.30 63.88 7.75 233.88 266.18 210.95 55.23 6.70
Missouri UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Biweekly Biweekly
Change in Change in
payment payment
Montana Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Montana Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Montana Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self H41 382.37 381.62 244.94 136.68 ‐6.64 382.37 381.62 255.00 126.62 ‐6.88
Value Self H44 372.48 377.30 244.94 132.36 ‐1.07 372.48 377.30 255.00 122.30 ‐1.31
Montana Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Montana UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Nebraska Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Nebraska Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Biweekly Biweekly
Change in Change in
payment payment
Nebraska Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self H41 382.37 381.62 244.94 136.68 ‐6.64 382.37 381.62 255.00 126.62 ‐6.88
Value Self H44 372.48 377.30 244.94 132.36 ‐1.07 372.48 377.30 255.00 122.30 ‐1.31
Nebraska Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Nebraska UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Nevada Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Nevada Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Nevada Aetna HealthFund CDHP and Aetna Value Plan
Value Self G54 328.95 330.94 244.94 86.00 ‐3.90 328.95 330.94 255.00 75.94 ‐4.14
CDHP Self G51 417.46 488.66 244.94 243.72 65.31 417.46 488.66 255.00 233.66 65.07
Nevada Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Biweekly Biweekly
Change in Change in
payment payment
Nevada Health Plan of Nevada, Inc.
High Self NM1 326.30 342.08 244.94 97.14 9.89 326.30 342.08 255.00 87.08 9.65
High Self & Family NM2 773.30 810.69 570.06 240.63 21.39 773.30 810.69 593.48 217.21 20.73
High Self Plus One NM3 619.98 649.95 493.96 155.99 7.19 619.98 649.95 515.09 134.86 6.21
Nevada UnitedHealthcare Insurance Company, Inc. ‐ Choice Plus Primary
High Self WF1 241.32 287.18 218.26 68.92 11.00 241.32 287.18 227.59 59.59 9.52
Nevada UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self LU1 204.85 243.77 185.27 58.50 9.34 204.85 243.77 193.19 50.58 8.07
Nevada UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self KT1 334.51 360.98 244.94 116.04 20.58 334.51 360.98 255.00 105.98 20.34
Nevada UnitedHealthcare Insurance Company, Inc. Choice Primary
High Self VD1 240.93 286.71 217.90 68.81 10.99 240.93 286.71 227.22 59.49 9.50
Nevada UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
New Hampshire Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
New Hampshire Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Biweekly Biweekly
Change in Change in
payment payment
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan
Value Self EP4 350.59 387.52 244.94 142.58 31.04 350.59 387.52 255.00 132.52 30.80
CDHP Self EP1 496.50 519.07 244.94 274.13 16.68 496.50 519.07 255.00 264.07 16.44
New Hampshire Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
New Hampshire UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
New Jersey Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
New Jersey Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
New Jersey Aetna HealthFund CDHP and Aetna Value Plan
Value Self EP4 350.59 387.52 244.94 142.58 31.04 350.59 387.52 255.00 132.52 30.80
CDHP Self EP1 496.50 519.07 244.94 274.13 16.68 496.50 519.07 255.00 264.07 16.44
Biweekly Biweekly
Change in Change in
payment payment
New Jersey Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
New Jersey Aetna Open Access
High Self JR1 712.96 764.68 244.94 519.74 45.83 712.96 764.68 255.00 509.68 45.59
High Self & Family JR2 1646.86 1766.32 570.06 1196.26 103.46 1646.86 1766.32 593.48 1172.84 102.80
High Self Plus One JR3 1630.54 1748.82 524.65 1224.17 104.75 1630.54 1748.82 546.21 1202.61 104.20
Basic Self JR4 633.82 659.70 244.94 414.76 19.99 633.82 659.70 255.00 404.70 19.75
Basic Self & Family JR5 1468.93 1528.94 570.06 958.88 44.01 1468.93 1528.94 593.48 935.46 43.35
Basic Self Plus One JR6 1454.38 1513.79 524.65 989.14 45.88 1454.38 1513.79 546.21 967.58 45.33
New Jersey Aetna Open Access
Basic Self P34 604.65 694.86 244.94 449.92 84.32 604.65 694.86 255.00 439.86 84.08
High Self P31 672.28 733.03 244.94 488.09 54.86 672.28 733.03 255.00 478.03 54.62
New Jersey GHI Health Plan
Standard Self 804 463.69 479.93 244.94 234.99 10.35 463.69 479.93 255.00 224.93 10.11
New Jersey UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
New Mexico Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
New Mexico Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Biweekly Biweekly
Change in Change in
payment payment
New Mexico Aetna HealthFund CDHP and Aetna Value Plan
Value Self G54 328.95 330.94 244.94 86.00 ‐3.90 328.95 330.94 255.00 75.94 ‐4.14
CDHP Self G51 417.46 488.66 244.94 243.72 65.31 417.46 488.66 255.00 233.66 65.07
New Mexico Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
New Mexico Presbyterian Health Plan
High Self P21 388.15 390.89 244.94 145.95 ‐3.15 388.15 390.89 255.00 135.89 ‐3.39
High Self & Family P22 912.14 918.62 570.06 348.56 ‐9.52 912.14 918.62 593.48 325.14 ‐10.18
High Self Plus One P23 881.09 887.35 524.65 362.70 ‐7.27 881.09 887.35 546.21 341.14 ‐7.82
New Mexico Presbyterian Health Plan
Standard Self PS4 327.82 325.99 244.94 81.05 ‐7.72 327.82 325.99 255.00 70.99 ‐7.96
Standard Self & Family PS5 770.38 766.08 570.06 196.02 ‐20.30 770.38 766.08 593.48 172.60 ‐20.96
Standard Self Plus One PS6 744.16 740.02 524.65 215.37 ‐17.67 744.16 740.02 546.21 193.81 ‐18.22
Wellness Self PS1 286.10 291.72 221.71 70.01 1.35 286.10 291.72 231.19 60.53 1.16
Wellness Self & Family PS2 672.35 685.55 521.02 164.53 3.17 672.35 685.55 543.30 142.25 2.74
Wellness Self Plus One PS3 649.47 662.21 503.28 158.93 3.06 649.47 662.21 524.80 137.41 2.64
New Mexico True Health New Mexico
High Self EL1 286.23 294.96 224.17 70.79 2.09 286.23 294.96 233.76 61.20 1.81
High Self & Family EL2 675.91 696.52 529.36 167.16 4.94 675.91 696.52 551.99 144.53 4.28
High Self Plus One EL3 640.63 660.16 501.72 158.44 4.69 640.63 660.16 523.18 136.98 4.05
New Mexico UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
New York Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Biweekly Biweekly
Change in Change in
payment payment
New York Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
New York Aetna HealthFund CDHP and Aetna Value Plan
Value Self EP4 350.59 387.52 244.94 142.58 31.04 350.59 387.52 255.00 132.52 30.80
CDHP Self EP1 496.50 519.07 244.94 274.13 16.68 496.50 519.07 255.00 264.07 16.44
New York Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
New York Aetna Open Access
High Self JC1 609.40 673.65 244.94 428.71 58.36 609.40 673.65 255.00 418.65 58.12
High Self & Family JC2 1505.80 1664.57 570.06 1094.51 142.77 1505.80 1664.57 593.48 1071.09 142.11
High Self Plus One JC3 1490.89 1648.10 524.65 1123.45 143.68 1490.89 1648.10 546.21 1101.89 143.13
Basic Self JC4 508.81 563.01 244.94 318.07 48.31 508.81 563.01 255.00 308.01 48.07
Basic Self & Family JC5 1241.09 1373.31 570.06 803.25 116.22 1241.09 1373.31 593.48 779.83 115.56
Basic Self Plus One JC6 1228.82 1359.72 524.65 835.07 117.37 1228.82 1359.72 546.21 813.51 116.82
New York CDPHP
Standard Self SG4 290.59 325.18 244.94 80.24 10.50 290.59 325.18 255.00 70.18 9.88
Standard Self & Family SG5 827.37 780.40 570.06 210.34 ‐62.97 827.37 780.40 593.48 186.92 ‐63.63
Standard Self Plus One SG6 601.50 721.90 524.65 197.25 52.89 601.50 721.90 546.21 175.69 50.88
New York GHI Health Plan
Standard Self 804 463.69 479.93 244.94 234.99 10.35 463.69 479.93 255.00 224.93 10.11
New York HIP of Greater NY
Standard Self YL4 375.63 415.70 244.94 170.76 34.18 375.63 415.70 255.00 160.70 33.94
Standard Self & Family YL5 1079.99 1208.42 570.06 638.36 112.43 1079.99 1208.42 593.48 614.94 111.77
Standard Self Plus One YL6 683.19 759.04 524.65 234.39 62.32 683.19 759.04 546.21 212.83 61.77
Biweekly Biweekly
Change in Change in
payment payment
New York HIP of Greater NY
High Self 511 494.33 484.96 244.94 240.02 ‐15.26 494.33 484.96 255.00 229.96 ‐15.50
High Self & Family 512 1422.45 1409.72 570.06 839.66 ‐28.73 1422.45 1409.72 593.48 816.24 ‐29.39
New York Independent Health
Standard Self C54 328.44 333.30 244.94 88.36 ‐1.03 328.44 333.30 255.00 78.30 ‐1.27
Standard Self & Family C55 886.79 899.91 570.06 329.85 ‐2.88 886.79 899.91 593.48 306.43 ‐3.54
Standard Self Plus One C56 837.51 849.92 524.65 325.27 ‐1.12 837.51 849.92 546.21 303.71 ‐1.67
New York Independent Health
High Self QA1 352.00 365.05 244.94 120.11 7.16 352.00 365.05 255.00 110.05 6.92
High Self & Family QA2 950.39 985.64 570.06 415.58 19.25 950.39 985.64 593.48 392.16 18.59
High Self Plus One QA3 897.60 930.88 524.65 406.23 19.75 897.60 930.88 546.21 384.67 19.20
HDHP Self QA4 273.63 276.60 210.22 66.38 0.71 273.63 276.60 219.21 57.39 0.61
HDHP Self & Family QA5 707.60 716.01 544.17 171.84 2.02 707.60 716.01 567.44 148.57 1.74
HDHP Self Plus One QA6 659.82 681.12 517.65 163.47 5.11 659.82 681.12 539.79 141.33 4.42
New York UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
North Carolina Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
North Carolina Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
North Carolina Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self F51 382.72 393.11 244.94 148.17 4.50 382.72 393.11 255.00 138.11 4.26
Value Self F54 378.45 379.30 244.94 134.36 ‐5.04 378.45 379.30 255.00 124.30 ‐5.28
Biweekly Biweekly
Change in Change in
payment payment
North Carolina Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
North Carolina UnitedHealthcare Insurance Company, Inc. ‐ Choice Plus Primary
High Self AS1 242.68 276.68 210.28 66.40 8.16 242.68 276.68 219.27 57.41 7.05
North Carolina UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self LS1 209.88 224.24 170.42 53.82 3.45 209.88 224.24 177.71 46.53 2.98
North Carolina UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self KK1 329.48 354.94 244.94 110.00 19.57 329.48 354.94 255.00 99.94 19.33
North Carolina UnitedHealthcare Insurance Company, Inc. Choice Primary
High Self Y81 233.88 266.18 202.30 63.88 7.75 233.88 266.18 210.95 55.23 6.70
North Carolina UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
North Dakota Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
North Dakota Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Biweekly Biweekly
Change in Change in
payment payment
North Dakota Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self H41 382.37 381.62 244.94 136.68 ‐6.64 382.37 381.62 255.00 126.62 ‐6.88
Value Self H44 372.48 377.30 244.94 132.36 ‐1.07 372.48 377.30 255.00 122.30 ‐1.31
North Dakota Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
North Dakota HealthPartners
Standard Self V34 212.27 235.11 178.68 56.43 5.49 212.27 235.11 186.32 48.79 4.74
High Self V31 328.76 308.34 234.34 74.00 ‐15.71 328.76 308.34 244.36 63.98 ‐15.91
North Dakota UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Northern Mariana Islands TakeCare
HDHP Self KX1 57.34 55.63 42.28 13.35 ‐0.41 57.34 55.63 44.09 11.54 ‐0.36
Northern Mariana Islands TakeCare
Standard Self JK4 179.65 186.67 141.87 44.80 1.68 179.65 186.67 147.94 38.73 1.45
High Self JK1 227.24 229.76 174.62 55.14 0.60 227.24 229.76 182.08 47.68 0.53
Biweekly Biweekly
Change in Change in
payment payment
Ohio Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Ohio Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Ohio Aetna HealthFund CDHP and Aetna Value Plan
Value Self JS4 495.45 505.19 244.94 260.25 3.85 495.45 505.19 255.00 250.19 3.61
CDHP Self JS1 463.38 466.12 244.94 221.18 ‐3.15 463.38 466.12 255.00 211.12 ‐3.39
Ohio Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Ohio AultCare Insurance Company
High Self 3A1 388.63 404.25 244.94 159.31 9.73 388.63 404.25 255.00 149.25 9.49
High Self & Family 3A2 959.90 998.44 570.06 428.38 22.54 959.90 998.44 593.48 404.96 21.88
High Self Plus One 3A3 816.11 848.88 524.65 324.23 19.24 816.11 848.88 546.21 302.67 18.69
HDHP Self 3A4 201.98 215.02 163.42 51.60 3.12 201.98 215.02 170.40 44.62 2.71
HDHP Self & Family 3A5 646.73 688.51 523.27 165.24 10.02 646.73 688.51 545.64 142.87 8.67
HDHP Self Plus One 3A6 383.98 408.78 310.67 98.11 5.95 383.98 408.78 323.96 84.82 5.14
Ohio Humana CoverageFirst and Humana Value Plan
Value Self X34 283.90 298.10 226.56 71.54 3.40 283.90 298.10 236.24 61.86 2.95
CDHP Self X31 368.97 387.42 244.94 142.48 12.56 368.97 387.42 255.00 132.42 12.32
Biweekly Biweekly
Change in Change in
payment payment
Ohio Humana Health Plan of Ohio, Inc.
High Self A61 692.76 727.40 244.94 482.46 28.75 692.76 727.40 255.00 472.40 28.51
Standard Self A64 541.00 568.05 244.94 323.11 21.16 541.00 568.05 255.00 313.05 20.92
Ohio Humana Health Plan of Ohio, Inc.
Basic Self W61 280.90 294.95 224.16 70.79 3.37 280.90 294.95 233.75 61.20 2.91
Basic Self & Family W62 632.05 663.66 504.38 159.28 7.59 632.05 663.66 525.95 137.71 6.56
Basic Self Plus One W63 603.96 634.16 481.96 152.20 7.25 603.96 634.16 502.57 131.59 6.27
Ohio Medical Mutual of Ohio
Basic Self YF1 203.14 191.56 145.59 45.97 ‐2.78 203.14 191.56 151.81 39.75 ‐2.40
Basic Self & Family YF2 487.54 459.74 349.40 110.34 ‐6.67 487.54 459.74 364.34 95.40 ‐5.76
Basic Self Plus One YF3 446.92 421.43 320.29 101.14 ‐6.12 446.92 421.43 333.98 87.45 ‐5.29
Standard Self YF4 447.22 455.01 244.94 210.07 1.90 447.22 455.01 255.00 200.01 1.66
Standard Self & Family YF5 1073.33 1092.02 570.06 521.96 2.69 1073.33 1092.02 593.48 498.54 2.03
Standard Self Plus One YF6 983.88 1001.02 524.65 476.37 3.61 983.88 1001.02 546.21 454.81 3.06
Standard Self 644 474.36 434.29 244.94 189.35 ‐45.96 474.36 434.29 255.00 179.29 ‐46.20
Standard Self Plus One 646 1043.61 955.44 524.65 430.79 ‐101.70 1043.61 955.44 546.21 409.23 ‐102.25
Standard Self X64 392.04 397.54 244.94 152.60 ‐0.39 392.04 397.54 255.00 142.54 ‐0.63
Standard Self & Family X65 940.89 954.10 570.06 384.04 ‐2.79 940.89 954.10 593.48 360.62 ‐3.45
Standard Self Plus One X66 862.48 874.59 524.65 349.94 ‐1.42 862.48 874.59 546.21 328.38 ‐1.97
Basic Self X61 203.07 187.05 142.16 44.89 ‐3.85 203.07 187.05 148.24 38.81 ‐3.33
Basic Self & Family X62 487.36 448.93 341.19 107.74 ‐9.23 487.36 448.93 355.78 93.15 ‐7.98
Basic Self Plus One X63 446.75 411.52 312.76 98.76 ‐8.46 446.75 411.52 326.13 85.39 ‐7.31
Basic Self UX1 203.14 189.79 144.24 45.55 ‐3.20 203.14 189.79 150.41 39.38 ‐2.77
Basic Self & Family UX2 487.54 455.50 346.18 109.32 ‐7.69 487.54 455.50 360.98 94.52 ‐6.64
Basic Self Plus One UX3 446.92 417.54 317.33 100.21 ‐7.05 446.92 417.54 330.90 86.64 ‐6.10
Biweekly Biweekly
Change in Change in
payment payment
Ohio UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Oklahoma Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Oklahoma Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Oklahoma Aetna HealthFund CDHP and Aetna Value Plan
Value Self JS4 495.45 505.19 244.94 260.25 3.85 495.45 505.19 255.00 250.19 3.61
CDHP Self JS1 463.38 466.12 244.94 221.18 ‐3.15 463.38 466.12 255.00 211.12 ‐3.39
Oklahoma Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Oklahoma GlobalHealth
Standard Self IM4 287.51 304.58 231.48 73.10 4.10 287.51 304.58 241.38 63.20 3.54
Standard Self & Family IM5 718.79 761.47 570.06 191.41 18.90 718.79 761.47 593.48 167.99 18.84
Standard Self Plus One IM6 575.03 609.17 462.97 146.20 8.19 575.03 609.17 482.77 126.40 7.08
High Self IM1 304.28 322.28 244.93 77.35 4.32 304.28 322.28 255.00 67.28 4.14
High Self & Family IM2 760.69 805.69 570.06 235.63 29.00 760.69 805.69 593.48 212.21 28.34
High Self Plus One IM3 608.55 644.56 489.87 154.69 8.64 608.55 644.56 510.81 133.75 7.48
Oklahoma UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Biweekly Biweekly
Change in Change in
payment payment
Oregon Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Oregon Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Oregon Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self H41 382.37 381.62 244.94 136.68 ‐6.64 382.37 381.62 255.00 126.62 ‐6.88
Value Self H44 372.48 377.30 244.94 132.36 ‐1.07 372.48 377.30 255.00 122.30 ‐1.31
Oregon Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Oregon Kaiser Permanente ‐ Northwest
Standard Self 574 299.06 317.70 241.45 76.25 4.48 299.06 317.70 251.78 65.92 3.87
High Self 571 336.89 346.93 244.94 101.99 4.15 336.89 346.93 255.00 91.93 3.91
High Self & Family 572 760.94 783.61 570.06 213.55 6.67 760.94 783.61 593.48 190.13 6.01
Oregon Kaiser Permanente ‐ Northwest
Prosper Self AM1 New Plan 180.82 137.42 43.40 New Plan New Plan 180.82 143.30 37.52 New Plan
Prosper Self & Family AM2 New Plan 427.60 324.98 102.62 New Plan New Plan 427.60 338.87 88.73 New Plan
Prosper Self Plus One AM3 New Plan 388.75 295.45 93.30 New Plan New Plan 388.75 308.08 80.67 New Plan
Oregon UnitedHealthcare Insurance Company, Inc. ‐ Choice Plus Primary
High Self WF1 241.32 287.18 218.26 68.92 11.00 241.32 287.18 227.59 59.59 9.52
Biweekly Biweekly
Change in Change in
payment payment
Oregon UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self LU1 204.85 243.77 185.27 58.50 9.34 204.85 243.77 193.19 50.58 8.07
Oregon UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self KT1 334.51 360.98 244.94 116.04 20.58 334.51 360.98 255.00 105.98 20.34
Oregon UnitedHealthcare Insurance Company, Inc. Choice Primary
High Self VD1 240.93 286.71 217.90 68.81 10.99 240.93 286.71 227.22 59.49 9.50
Oregon UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Palau TakeCare
HDHP Self KX1 57.34 55.63 42.28 13.35 ‐0.41 57.34 55.63 44.09 11.54 ‐0.36
Palau TakeCare
Standard Self JK4 179.65 186.67 141.87 44.80 1.68 179.65 186.67 147.94 38.73 1.45
High Self JK1 227.24 229.76 174.62 55.14 0.60 227.24 229.76 182.08 47.68 0.53
Pennsylvania Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Biweekly Biweekly
Change in Change in
payment payment
Pennsylvania Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Pennsylvania Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self H41 382.37 381.62 244.94 136.68 ‐6.64 382.37 381.62 255.00 126.62 ‐6.88
Value Self H44 372.48 377.30 244.94 132.36 ‐1.07 372.48 377.30 255.00 122.30 ‐1.31
Pennsylvania Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Pennsylvania Aetna Open Access
Basic Self P34 604.65 694.86 244.94 449.92 84.32 604.65 694.86 255.00 439.86 84.08
High Self P31 672.28 733.03 244.94 488.09 54.86 672.28 733.03 255.00 478.03 54.62
Pennsylvania Aetna Open Access
High Self YE1 560.83 556.87 244.94 311.93 ‐9.85 560.83 556.87 255.00 301.87 ‐10.09
High Self & Family YE2 1408.24 1398.29 570.06 828.23 ‐25.95 1408.24 1398.29 593.48 804.81 ‐26.61
High Self Plus One YE3 1394.30 1384.45 524.65 859.80 ‐23.38 1394.30 1384.45 546.21 838.24 ‐23.93
Pennsylvania Geisinger Health Plan
Standard Self GG4 379.72 421.24 244.94 176.30 35.63 379.72 421.24 255.00 166.24 35.39
Standard Self & Family GG5 869.39 964.44 570.06 394.38 79.05 869.39 964.44 593.48 370.96 78.39
Standard Self Plus One GG6 820.48 910.19 524.65 385.54 76.18 820.48 910.19 546.21 363.98 75.63
Pennsylvania Geisinger Health Plan
Basic Self AJ1 New Plan 370.18 244.94 125.24 New Plan New Plan 370.18 255.00 115.18 New Plan
Basic Self & Family AJ2 New Plan 847.53 570.06 277.47 New Plan New Plan 847.53 593.48 254.05 New Plan
Basic Self Plus One AJ3 New Plan 799.84 524.65 275.19 New Plan New Plan 799.84 546.21 253.63 New Plan
Biweekly Biweekly
Change in Change in
payment payment
Pennsylvania UnitedHealthcare Insurance Company, Inc. ‐ Choice Plus Primary
High Self AS1 242.68 276.68 210.28 66.40 8.16 242.68 276.68 219.27 57.41 7.05
Pennsylvania UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self V41 224.57 239.96 182.37 57.59 3.69 224.57 239.96 190.17 49.79 3.19
Pennsylvania UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self LR1 329.95 355.57 244.94 110.63 19.73 329.95 355.57 255.00 100.57 19.49
Pennsylvania UnitedHealthcare Insurance Company, Inc. Choice Primary
High Self Y81 233.88 266.18 202.30 63.88 7.75 233.88 266.18 210.95 55.23 6.70
Pennsylvania UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Pennsylvania UPMC Health Plan
Standard Self YT4 417.27 445.99 244.94 201.05 22.83 417.27 445.99 255.00 190.99 22.59
Standard Self & Family YT5 979.37 1047.06 570.06 477.00 51.69 979.37 1047.06 593.48 453.58 51.03
Standard Self Plus One YT6 938.06 1002.82 524.65 478.17 51.23 938.06 1002.82 546.21 456.61 50.68
HDHP Self YS4 358.06 373.13 244.94 128.19 9.18 358.06 373.13 255.00 118.13 8.94
HDHP Self & Family YS5 826.64 862.11 570.06 292.05 19.47 826.64 862.11 593.48 268.63 18.81
HDHP Self Plus One YS6 794.64 828.60 524.65 303.95 20.43 794.64 828.60 546.21 282.39 19.88
HDHP Self 8W4 281.83 296.15 225.07 71.08 3.44 281.83 296.15 234.70 61.45 2.97
HDHP Self & Family 8W5 648.46 681.63 518.04 163.59 7.96 648.46 681.63 540.19 141.44 6.88
HDHP Self Plus One 8W6 623.83 655.71 498.34 157.37 7.65 623.83 655.71 519.65 136.06 6.62
Biweekly Biweekly
Change in Change in
payment payment
Standard Self UW4 310.93 314.87 239.30 75.57 0.95 310.93 314.87 249.53 65.34 0.82
Standard Self & Family UW5 729.57 739.04 561.67 177.37 1.86 729.57 739.04 585.69 153.35 0.60
Standard Self Plus One UW6 698.86 707.88 524.65 183.23 ‐4.51 698.86 707.88 546.21 161.67 ‐5.06
Puerto Rico Humana Health Plans of Puerto Rico, Inc.
High Self ZJ1 180.11 211.33 160.61 50.72 7.49 180.11 211.33 167.48 43.85 6.48
High Self & Family ZJ2 405.26 475.49 361.37 114.12 16.86 405.26 475.49 376.83 98.66 14.57
High Self Plus One ZJ3 387.24 454.36 345.31 109.05 16.11 387.24 454.36 360.08 94.28 13.93
Puerto Rico Triple‐S Salud Inc. Puerto Rico
High Self 891 180.02 180.02 136.82 43.20 0.00 180.02 180.02 142.67 37.35 0.00
High Self & Family 892 412.25 412.25 313.31 98.94 0.00 412.25 412.25 326.71 85.54 0.00
Rhode Island Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Rhode Island Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Rhode Island Aetna HealthFund CDHP and Aetna Value Plan
Value Self EP4 350.59 387.52 244.94 142.58 31.04 350.59 387.52 255.00 132.52 30.80
CDHP Self EP1 496.50 519.07 244.94 274.13 16.68 496.50 519.07 255.00 264.07 16.44
Rhode Island Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Biweekly Biweekly
Change in Change in
payment payment
Rhode Island UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
South Carolina Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
South Carolina Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
South Carolina Aetna HealthFund CDHP and Aetna Value Plan
Value Self JS4 495.45 505.19 244.94 260.25 3.85 495.45 505.19 255.00 250.19 3.61
CDHP Self JS1 463.38 466.12 244.94 221.18 ‐3.15 463.38 466.12 255.00 211.12 ‐3.39
South Carolina Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
South Carolina UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
South Dakota Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Biweekly Biweekly
Change in Change in
payment payment
South Dakota Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
South Dakota Aetna HealthFund CDHP and Aetna Value Plan
Value Self G54 328.95 330.94 244.94 86.00 ‐3.90 328.95 330.94 255.00 75.94 ‐4.14
CDHP Self G51 417.46 488.66 244.94 243.72 65.31 417.46 488.66 255.00 233.66 65.07
South Dakota Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
South Dakota HealthPartners
Standard Self V34 212.27 235.11 178.68 56.43 5.49 212.27 235.11 186.32 48.79 4.74
High Self V31 328.76 308.34 234.34 74.00 ‐15.71 328.76 308.34 244.36 63.98 ‐15.91
South Dakota UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Tennessee Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Tennessee Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Biweekly Biweekly
Change in Change in
payment payment
Tennessee Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self F51 382.72 393.11 244.94 148.17 4.50 382.72 393.11 255.00 138.11 4.26
Value Self F54 378.45 379.30 244.94 134.36 ‐5.04 378.45 379.30 255.00 124.30 ‐5.28
Tennessee Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Tennessee Humana CoverageFirst and Humana Value Plan
CDHP Self TT1 343.99 364.62 244.94 119.68 14.74 343.99 364.62 255.00 109.62 14.50
CDHP Self & Family TT2 773.99 820.42 570.06 250.36 30.43 773.99 820.42 593.48 226.94 29.77
CDHP Self Plus One TT3 739.59 783.96 524.65 259.31 30.84 739.59 783.96 546.21 237.75 30.29
Value Self TT4 315.21 334.12 244.94 89.18 13.02 315.21 334.12 255.00 79.12 12.78
Value Self & Family TT5 709.21 751.75 570.06 181.69 11.48 709.21 751.75 593.48 158.27 11.11
Value Self Plus One TT6 677.68 718.35 524.65 193.70 27.14 677.68 718.35 546.21 172.14 26.59
Tennessee Humana Health Plan, Inc.
High Self GJ1 542.67 564.38 244.94 319.44 15.82 542.67 564.38 255.00 309.38 15.58
High Self & Family GJ2 1220.97 1269.81 570.06 699.75 32.84 1220.97 1269.81 593.48 676.33 32.18
High Self Plus One GJ3 1166.70 1213.37 524.65 688.72 33.14 1166.70 1213.37 546.21 667.16 32.59
Standard Self GJ4 401.60 417.65 244.94 172.71 10.16 401.60 417.65 255.00 162.65 9.92
Standard Self & Family GJ5 903.59 939.73 570.06 369.67 20.14 903.59 939.73 593.48 346.25 19.48
Standard Self Plus One GJ6 863.43 897.97 524.65 373.32 21.01 863.43 897.97 546.21 351.76 20.46
Tennessee UnitedHealthcare Insurance Company, Inc. ‐ Choice Plus Primary
High Self AS1 242.68 276.68 210.28 66.40 8.16 242.68 276.68 219.27 57.41 7.05
Tennessee UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self LS1 209.88 224.24 170.42 53.82 3.45 209.88 224.24 177.71 46.53 2.98
Biweekly Biweekly
Change in Change in
payment payment
Tennessee UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self KK1 329.48 354.94 244.94 110.00 19.57 329.48 354.94 255.00 99.94 19.33
Tennessee UnitedHealthcare Insurance Company, Inc. Choice Primary
High Self Y81 233.88 266.18 202.30 63.88 7.75 233.88 266.18 210.95 55.23 6.70
Tennessee UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Texas Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Texas Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Texas Aetna HealthFund CDHP and Aetna Value Plan
Value Self JS4 495.45 505.19 244.94 260.25 3.85 495.45 505.19 255.00 250.19 3.61
CDHP Self JS1 463.38 466.12 244.94 221.18 ‐3.15 463.38 466.12 255.00 211.12 ‐3.39
Texas Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Biweekly Biweekly
Change in Change in
payment payment
Texas Humana CoverageFirst and Humana Value Plan
Value Self T34 243.77 260.82 198.22 62.60 4.10 243.77 260.82 206.70 54.12 3.54
Value Self & Family T35 548.46 586.86 446.01 140.85 9.22 548.46 586.86 465.09 121.77 7.96
Value Self Plus One T36 524.09 560.78 426.19 134.59 8.81 524.09 560.78 444.42 116.36 7.61
CDHP Self T31 350.19 374.71 244.94 129.77 18.63 350.19 374.71 255.00 119.71 18.39
CDHP Self & Family T32 787.92 843.08 570.06 273.02 39.16 787.92 843.08 593.48 249.60 38.50
CDHP Self Plus One T33 752.92 805.62 524.65 280.97 39.17 752.92 805.62 546.21 259.41 38.62
CDHP Self TV1 388.63 419.72 244.94 174.78 25.20 388.63 419.72 255.00 164.72 24.96
CDHP Self & Family TV2 874.43 944.38 570.06 374.32 53.95 874.43 944.38 593.48 350.90 53.29
CDHP Self Plus One TV3 835.57 902.42 524.65 377.77 53.32 835.57 902.42 546.21 356.21 52.77
Value Self TV4 307.38 331.97 244.94 87.03 13.26 307.38 331.97 255.00 76.97 13.19
Value Self & Family TV5 691.62 746.95 567.68 179.27 13.28 691.62 746.95 591.96 154.99 11.48
Value Self Plus One TV6 660.89 713.76 524.65 189.11 30.50 660.89 713.76 546.21 167.55 30.42
Value Self TU4 243.56 277.21 210.68 66.53 8.08 243.56 277.21 219.69 57.52 6.98
Value Self & Family TU5 548.02 623.73 474.03 149.70 18.18 548.02 623.73 494.31 129.42 15.71
Value Self Plus One TU6 523.67 596.02 452.98 143.04 17.36 523.67 596.02 472.35 123.67 15.01
CDHP Self TU1 298.05 336.80 244.94 91.86 20.33 298.05 336.80 255.00 81.80 19.95
CDHP Self & Family TU2 670.62 757.81 570.06 187.75 26.80 670.62 757.81 593.48 164.33 25.18
CDHP Self Plus One TU3 640.82 724.12 524.65 199.47 45.67 640.82 724.12 546.21 177.91 44.94
CDHP Self TP1 333.05 356.37 244.94 111.43 17.43 333.05 356.37 255.00 101.37 17.19
CDHP Self & Family TP2 749.36 801.82 570.06 231.76 36.46 749.36 801.82 593.48 208.34 35.80
CDHP Self Plus One TP3 716.07 766.19 524.65 241.54 36.59 716.07 766.19 546.21 219.98 36.04
Value Self TP4 195.17 208.83 158.71 50.12 3.28 195.17 208.83 165.50 43.33 2.83
Value Self & Family TP5 439.13 469.87 357.10 112.77 7.38 439.13 469.87 372.37 97.50 6.38
Value Self Plus One TP6 419.62 448.99 341.23 107.76 7.05 419.62 448.99 355.82 93.17 6.10
Biweekly Biweekly
Change in Change in
payment payment
Texas Humana Health Plan of Texas
Standard Self UC4 387.63 414.76 244.94 169.82 21.24 387.63 414.76 255.00 159.76 21.00
Standard Self & Family UC5 872.15 933.21 570.06 363.15 45.06 872.15 933.21 593.48 339.73 44.40
Standard Self Plus One UC6 833.39 891.73 524.65 367.08 44.81 833.39 891.73 546.21 345.52 44.26
High Self UC1 505.51 540.90 244.94 295.96 29.50 505.51 540.90 255.00 285.90 29.26
High Self & Family UC2 1137.42 1217.04 570.06 646.98 63.62 1137.42 1217.04 593.48 623.56 62.96
High Self Plus One UC3 1086.86 1162.95 524.65 638.30 62.56 1086.86 1162.95 546.21 616.74 62.01
Basic Self QX1 345.81 377.25 244.94 132.31 25.55 345.81 377.25 255.00 122.25 25.31
Basic Self & Family QX2 778.08 848.81 570.06 278.75 54.73 778.08 848.81 593.48 255.33 54.07
Basic Self Plus One QX3 743.50 811.09 524.65 286.44 54.06 743.50 811.09 546.21 264.88 53.51
Standard Self EW4 385.81 432.11 244.94 187.17 40.41 385.81 432.11 255.00 177.11 40.17
Standard Self & Family EW5 868.07 972.23 570.06 402.17 88.16 868.07 972.23 593.48 378.75 87.50
Standard Self Plus One EW6 829.48 929.02 524.65 404.37 86.01 829.48 929.02 546.21 382.81 85.46
High Self EW1 522.44 585.15 244.94 340.21 56.82 522.44 585.15 255.00 330.15 56.58
High Self & Family EW2 1175.51 1316.58 570.06 746.52 125.07 1175.51 1316.58 593.48 723.10 124.41
High Self Plus One EW3 1123.27 1258.07 524.65 733.42 121.27 1123.27 1258.07 546.21 711.86 120.72
Basic Self QY1 351.21 389.84 244.94 144.90 32.74 351.21 389.84 255.00 134.84 32.50
Basic Self & Family QY2 790.21 877.14 570.06 307.08 70.93 790.21 877.14 593.48 283.66 70.27
Basic Self Plus One QY3 755.10 838.17 524.65 313.52 69.54 755.10 838.17 546.21 291.96 68.99
Basic Self Q21 339.20 362.94 244.94 118.00 17.85 339.20 362.94 255.00 107.94 17.61
Basic Self Q61 288.12 322.69 244.94 77.75 8.60 288.12 322.69 255.00 67.69 7.91
Biweekly Biweekly
Change in Change in
payment payment
Standard Self UU4 766.51 742.24 244.94 497.30 ‐30.16 766.51 742.24 255.00 487.24 ‐30.40
Standard Self & Family UU5 1724.64 1670.03 570.06 1099.97 ‐70.61 1724.64 1670.03 593.48 1076.55 ‐71.27
Standard Self Plus One UU6 1647.98 1595.80 524.65 1071.15 ‐65.71 1647.98 1595.80 546.21 1049.59 ‐66.26
High Self UU1 712.96 748.61 244.94 503.67 29.76 712.96 748.61 255.00 493.61 29.52
High Self & Family UU2 1604.15 1684.35 570.06 1114.29 64.20 1604.15 1684.35 593.48 1090.87 63.54
High Self Plus One UU3 1532.86 1609.50 524.65 1084.85 63.11 1532.86 1609.50 546.21 1063.29 62.56
Standard Self UR4 452.31 493.64 244.94 248.70 35.44 452.31 493.64 255.00 238.64 35.20
Standard Self & Family UR5 1017.69 1110.67 570.06 540.61 76.98 1017.69 1110.67 593.48 517.19 76.32
Standard Self Plus One UR6 972.46 1061.30 524.65 536.65 75.31 972.46 1061.30 546.21 515.09 74.76
High Self UR1 637.98 721.73 244.94 476.79 77.86 637.98 721.73 255.00 466.73 77.62
High Self & Family UR2 1435.44 1623.90 570.06 1053.84 172.46 1435.44 1623.90 593.48 1030.42 171.80
High Self Plus One UR3 1371.65 1551.72 524.65 1027.07 166.54 1371.65 1551.72 546.21 1005.51 165.99
Texas Scott and White Health Plan
Basic Self A81 303.74 270.41 205.51 64.90 ‐8.00 303.74 270.41 214.30 56.11 ‐6.92
Basic Self & Family A82 712.71 634.40 482.14 152.26 ‐18.79 712.71 634.40 502.76 131.64 ‐16.25
Basic Self Plus One A83 673.33 599.35 455.51 143.84 ‐18.37 673.33 599.35 474.98 124.37 ‐16.83
Standard Self A84 362.50 397.49 244.94 152.55 29.10 362.50 397.49 255.00 142.49 28.86
Texas Scott and White Health Plan
Basic Self P81 313.09 278.74 211.84 66.90 ‐8.24 313.09 278.74 220.90 57.84 ‐7.13
Basic Self & Family P82 734.72 653.98 497.02 156.96 ‐23.70 734.72 653.98 518.28 135.70 ‐22.20
Basic Self Plus One P83 694.12 617.85 469.57 148.28 ‐34.72 694.12 617.85 489.65 128.20 ‐33.79
Standard Self P84 380.74 446.16 244.94 201.22 59.53 380.74 446.16 255.00 191.16 59.29
Standard Self & Family P85 893.68 1047.43 570.06 477.37 137.75 893.68 1047.43 593.48 453.95 137.09
Standard Self Plus One P86 844.29 989.52 524.65 464.87 131.70 844.29 989.52 546.21 443.31 131.15
Texas UnitedHealthcare Insurance Company, Inc. ‐ Choice Plus Primary
High Self AS1 242.68 276.68 210.28 66.40 8.16 242.68 276.68 219.27 57.41 7.05
Biweekly Biweekly
Change in Change in
payment payment
Texas UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced
Value Self L91 240.69 255.98 194.54 61.44 3.67 240.69 255.98 202.86 53.12 3.18
Texas UnitedHealthcare Insurance Company, Inc. Choice Primary
High Self Y81 233.88 266.18 202.30 63.88 7.75 233.88 266.18 210.95 55.23 6.70
Texas UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Utah Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Utah Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Utah Aetna HealthFund CDHP and Aetna Value Plan
Value Self G54 328.95 330.94 244.94 86.00 ‐3.90 328.95 330.94 255.00 75.94 ‐4.14
CDHP Self G51 417.46 488.66 244.94 243.72 65.31 417.46 488.66 255.00 233.66 65.07
Utah Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Biweekly Biweekly
Change in Change in
payment payment
Utah Altius Health Plan
High Self 9K1 465.72 483.86 244.94 238.92 12.25 465.72 483.86 255.00 228.86 12.01
HDHP Self 9K4 244.26 310.38 235.89 74.49 15.87 244.26 310.38 245.98 64.40 13.72
Utah Altius Health Plan
Standard Self DK4 351.37 407.59 244.94 162.65 50.33 351.37 407.59 255.00 152.59 50.09
Utah SelectHealth Plan
Standard Self SF4 279.23 290.13 220.50 69.63 2.61 279.23 290.13 229.93 60.20 2.26
Standard Self & Family SF5 636.40 725.33 551.25 174.08 21.34 636.40 725.33 574.82 150.51 18.46
Standard Self Plus One SF6 636.40 638.29 485.10 153.19 0.45 636.40 638.29 505.84 132.45 0.40
Utah SelectHealth Plan
HDHP Self WX1 243.32 248.99 189.23 59.76 1.36 243.32 248.99 197.32 51.67 1.18
HDHP Self & Family WX2 554.55 622.47 473.08 149.39 16.30 554.55 622.47 493.31 129.16 14.09
HDHP Self Plus One WX3 554.55 547.77 416.31 131.46 ‐1.63 554.55 547.77 434.11 113.66 ‐1.41
Utah UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Vermont Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Vermont Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Biweekly Biweekly
Change in Change in
payment payment
Vermont Aetna HealthFund CDHP and Aetna Value Plan
Value Self EP4 350.59 387.52 244.94 142.58 31.04 350.59 387.52 255.00 132.52 30.80
CDHP Self EP1 496.50 519.07 244.94 274.13 16.68 496.50 519.07 255.00 264.07 16.44
Vermont Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Vermont UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Virgin Islands Triple‐S Salud Inc. U.S. Virgin Islands
High Self 851 313.40 313.40 238.18 75.22 0.00 313.40 313.40 248.37 65.03 0.00
High Self & Family 852 717.70 717.70 545.45 172.25 0.00 717.70 717.70 568.78 148.92 0.00
Virginia Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Virginia Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Virginia Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self F51 382.72 393.11 244.94 148.17 4.50 382.72 393.11 255.00 138.11 4.26
Value Self F54 378.45 379.30 244.94 134.36 ‐5.04 378.45 379.30 255.00 124.30 ‐5.28
Biweekly Biweekly
Change in Change in
payment payment
Virginia Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Virginia Aetna Open Access
High Self JN1 525.03 543.03 244.94 298.09 12.11 525.03 543.03 255.00 288.03 11.87
Basic Self JN4 321.74 329.73 244.94 84.79 2.10 321.74 329.73 255.00 74.73 1.86
Virginia Aetna Saver (Open Access)
Saver Self QQ4 274.71 274.71 208.78 65.93 0.00 274.71 274.71 217.71 57.00 0.00
Virginia CareFirst BlueChoice
Standard Self 2G4 390.25 409.76 244.94 164.82 13.62 390.25 409.76 255.00 154.76 13.38
Virginia CareFirst BlueChoice
HDHP Self B61 263.12 263.12 199.97 63.15 0.00 263.12 263.12 208.52 54.60 0.00
Virginia Kaiser Permanente ‐ Mid‐Atlantic States
Basic Self T71 193.90 197.41 150.03 47.38 0.84 193.90 197.41 156.45 40.96 0.73
Biweekly Biweekly
Change in Change in
payment payment
Virginia Kaiser Permanente ‐ Mid‐Atlantic States
Standard Self E34 263.79 276.13 209.86 66.27 2.96 263.79 276.13 218.83 57.30 2.56
High Self E31 333.61 344.42 244.94 99.48 4.92 333.61 344.42 255.00 89.42 4.68
Virginia M.D. IPA
High Self JP1 404.59 438.87 244.94 193.93 28.39 404.59 438.87 255.00 183.87 28.15
Virginia Optima Health
HDHP Self PG4 297.42 279.27 212.25 67.02 ‐4.36 297.42 279.27 221.32 57.95 ‐3.76
HDHP Self & Family PG5 656.07 616.05 468.20 147.85 ‐9.61 656.07 616.05 488.22 127.83 ‐8.30
HDHP Self Plus One PG6 643.21 603.97 459.02 144.95 ‐9.42 643.21 603.97 478.65 125.32 ‐8.15
High Self PG1 319.43 332.10 244.94 87.16 6.78 319.43 332.10 255.00 77.10 6.54
High Self & Family PG2 771.86 802.47 570.06 232.41 14.61 771.86 802.47 593.48 208.99 13.95
High Self Plus One PG3 771.80 802.41 524.65 277.76 17.08 771.80 802.41 546.21 256.20 16.53
Virginia UnitedHealthcare Insurance Company, Inc. ‐ Choice Plus Primary
High Self AS1 242.68 276.68 210.28 66.40 8.16 242.68 276.68 219.27 57.41 7.05
Virginia UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self V41 224.57 239.96 182.37 57.59 3.69 224.57 239.96 190.17 49.79 3.19
Virginia UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self LR1 329.95 355.57 244.94 110.63 19.73 329.95 355.57 255.00 100.57 19.49
Biweekly Biweekly
Change in Change in
payment payment
Virginia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced
Value Self L91 240.69 255.98 194.54 61.44 3.67 240.69 255.98 202.86 53.12 3.18
Virginia UnitedHealthcare Insurance Company, Inc. Choice Primary
High Self Y81 233.88 266.18 202.30 63.88 7.75 233.88 266.18 210.95 55.23 6.70
Virginia UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Washington Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Washington Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Washington Aetna HealthFund CDHP and Aetna Value Plan
Value Self G54 328.95 330.94 244.94 86.00 ‐3.90 328.95 330.94 255.00 75.94 ‐4.14
CDHP Self G51 417.46 488.66 244.94 243.72 65.31 417.46 488.66 255.00 233.66 65.07
Washington Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Biweekly Biweekly
Change in Change in
payment payment
Washington Kaiser Permanente ‐ Northwest
Standard Self 574 299.06 317.70 241.45 76.25 4.48 299.06 317.70 251.78 65.92 3.87
High Self 571 336.89 346.93 244.94 101.99 4.15 336.89 346.93 255.00 91.93 3.91
High Self & Family 572 760.94 783.61 570.06 213.55 6.67 760.94 783.61 593.48 190.13 6.01
Washington Kaiser Permanente ‐ Northwest
Prosper Self AM1 New Plan 180.82 137.42 43.40 New Plan New Plan 180.82 143.30 37.52 New Plan
Prosper Self & Family AM2 New Plan 427.60 324.98 102.62 New Plan New Plan 427.60 338.87 88.73 New Plan
Prosper Self Plus One AM3 New Plan 388.75 295.45 93.30 New Plan New Plan 388.75 308.08 80.67 New Plan
Washington Kaiser Permanente ‐ Washington Core
Standard Self 544 278.83 285.24 216.78 68.46 1.54 278.83 285.24 226.05 59.19 1.33
High Self 541 390.34 398.66 244.94 153.72 2.43 390.34 398.66 255.00 143.66 2.19
High Self & Family 542 858.76 877.04 570.06 306.98 2.28 858.76 877.04 593.48 283.56 1.62
Washington Kaiser Permanente ‐ Washington Core
Prosper Self PT4 New Plan 180.00 136.80 43.20 New Plan New Plan 180.00 142.65 37.35 New Plan
Prosper Self & Family PT5 New Plan 503.99 383.03 120.96 New Plan New Plan 503.99 399.41 104.58 New Plan
Prosper Self Plus One PT6 New Plan 436.00 331.36 104.64 New Plan New Plan 436.00 345.53 90.47 New Plan
Washington Kaiser Permanente Washington Options Federal
Standard Self L11 335.95 343.00 244.94 98.06 1.16 335.95 343.00 255.00 88.00 0.92
Standard Self & Family L12 745.80 761.46 570.06 191.40 ‐0.34 745.80 761.46 593.48 167.98 ‐1.00
Standard Self Plus One L13 745.80 761.46 524.65 236.81 2.13 745.80 761.46 546.21 215.25 1.58
HDHP Self L14 297.96 305.41 232.11 73.30 1.79 297.96 305.41 242.04 63.37 1.54
HDHP Self & Family L15 661.45 677.99 515.27 162.72 3.97 661.45 677.99 537.31 140.68 3.43
HDHP Self Plus One L16 661.45 677.99 515.27 162.72 3.97 661.45 677.99 537.31 140.68 3.43
Biweekly Biweekly
Change in Change in
payment payment
Washington UnitedHealthcare Insurance Company, Inc. ‐ Choice Plus Primary
High Self WF1 241.32 287.18 218.26 68.92 11.00 241.32 287.18 227.59 59.59 9.52
Washington UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self LU1 204.85 243.77 185.27 58.50 9.34 204.85 243.77 193.19 50.58 8.07
Washington UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self KT1 334.51 360.98 244.94 116.04 20.58 334.51 360.98 255.00 105.98 20.34
Washington UnitedHealthcare Insurance Company, Inc. Choice Primary
High Self VD1 240.93 286.71 217.90 68.81 10.99 240.93 286.71 227.22 59.49 9.50
Washington UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
West Virginia Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
West Virginia Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Biweekly Biweekly
Change in Change in
payment payment
West Virginia Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self F51 382.72 393.11 244.94 148.17 4.50 382.72 393.11 255.00 138.11 4.26
Value Self F54 378.45 379.30 244.94 134.36 ‐5.04 378.45 379.30 255.00 124.30 ‐5.28
West Virginia Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
West Virginia UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Wisconsin Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Wisconsin Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Wisconsin Aetna HealthFund CDHP and Aetna Value Plan
Value Self JS4 495.45 505.19 244.94 260.25 3.85 495.45 505.19 255.00 250.19 3.61
CDHP Self JS1 463.38 466.12 244.94 221.18 ‐3.15 463.38 466.12 255.00 211.12 ‐3.39
Biweekly Biweekly
Change in Change in
payment payment
Wisconsin Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Wisconsin Dean Health Plan, Inc.
High Self WD1 529.42 581.94 244.94 337.00 46.63 529.42 581.94 255.00 326.94 46.39
High Self & Family WD2 1217.66 1338.48 570.06 768.42 104.82 1217.66 1338.48 593.48 745.00 104.16
High Self Plus One WD3 1111.78 1222.09 524.65 697.44 96.78 1111.78 1222.09 546.21 675.88 96.23
Standard Self WD4 314.57 316.21 240.32 75.89 0.37 314.57 316.21 250.60 65.61 ‐0.09
Standard Self & Family WD5 754.97 758.89 570.06 188.83 ‐12.08 754.97 758.89 593.48 165.41 ‐12.74
Standard Self Plus One WD6 692.06 695.66 524.65 171.01 ‐9.93 692.06 695.66 546.21 149.45 ‐10.48
Wisconsin Dean Health Plan, Inc.
Basic Self AG1 New Plan 210.03 159.62 50.41 New Plan New Plan 210.03 166.45 43.58 New Plan
Basic Self & Family AG2 New Plan 472.57 359.15 113.42 New Plan New Plan 472.57 374.51 98.06 New Plan
Basic Self Plus One AG3 New Plan 441.06 335.21 105.85 New Plan New Plan 441.06 349.54 91.52 New Plan
Wisconsin Group Health Cooperative of South Central Wisconsin
High Self WJ1 395.98 410.32 244.94 165.38 8.45 395.98 410.32 255.00 155.32 8.21
High Self & Family WJ2 1029.58 1066.85 570.06 496.79 21.27 1029.58 1066.85 593.48 473.37 20.61
High Self Plus One WJ3 871.18 902.72 524.65 378.07 18.01 871.18 902.72 546.21 356.51 17.46
Standard Self WJ4 New Plan 285.62 217.07 68.55 New Plan New Plan 285.62 226.35 59.27 New Plan
Standard Self & Family WJ5 New Plan 742.62 564.39 178.23 New Plan New Plan 742.62 588.53 154.09 New Plan
Standard Self Plus One WJ6 New Plan 628.37 477.56 150.81 New Plan New Plan 628.37 497.98 130.39 New Plan
Wisconsin HealthPartners
Standard Self V34 212.27 235.11 178.68 56.43 5.49 212.27 235.11 186.32 48.79 4.74
High Self V31 328.76 308.34 234.34 74.00 ‐15.71 328.76 308.34 244.36 63.98 ‐15.91
Biweekly Biweekly
Change in Change in
payment payment
Wisconsin Quartz Health Benefit Plans Corporation
High Self TF1 466.32 509.45 244.94 264.51 37.24 466.32 509.45 255.00 254.45 37.00
High Self & Family TF2 1119.18 1222.70 570.06 652.64 87.52 1119.18 1222.70 593.48 629.22 86.86
High Self Plus One TF3 1049.24 1146.29 524.65 621.64 83.52 1049.24 1146.29 546.21 600.08 82.97
Standard Self TF4 283.51 295.57 224.63 70.94 2.90 283.51 295.57 234.24 61.33 2.50
Standard Self & Family TF5 680.44 709.36 539.11 170.25 6.94 680.44 709.36 562.17 147.19 6.00
Standard Self Plus One TF6 623.74 650.24 494.18 156.06 6.36 623.74 650.24 515.32 134.92 5.49
Wisconsin UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan
Wyoming Aetna Advantage
Advantage Self Z24 214.08 230.78 175.39 55.39 4.01 214.08 230.78 182.89 47.89 3.47
Wyoming Aetna Direct
CDHP Self N61 282.76 284.23 216.01 68.22 0.36 282.76 284.23 225.25 58.98 0.31
Wyoming Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self H41 382.37 381.62 244.94 136.68 ‐6.64 382.37 381.62 255.00 126.62 ‐6.88
Value Self H44 372.48 377.30 244.94 132.36 ‐1.07 372.48 377.30 255.00 122.30 ‐1.31
Wyoming Aetna HealthFund HDHP
HDHP Self 224 336.37 362.78 244.94 117.84 20.52 336.37 362.78 255.00 107.78 20.28
HDHP Self & Family 225 741.97 800.23 570.06 230.17 42.26 741.97 800.23 593.48 206.75 41.60
Biweekly Biweekly
Change in Change in
payment payment
Wyoming Altius Health Plan
High Self 9K1 465.72 483.86 244.94 238.92 12.25 465.72 483.86 255.00 228.86 12.01
HDHP Self 9K4 244.26 310.38 235.89 74.49 15.87 244.26 310.38 245.98 64.40 13.72
Wyoming Altius Health Plan
Standard Self DK4 351.37 407.59 244.94 162.65 50.33 351.37 407.59 255.00 152.59 50.09
Wyoming UnitedHealthcare Insurance Company, Inc. UnitedHealthcare Advantage Plan

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