Postal Service HMO Rates For 2016

Postal Premium Rates for the Federal Employees Health Benefits Program
Health Management
Organizations (HMO)
Plan - Option - Enrollment Code
2016 Biweekly Postal Premium Rates

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
Govt
Pays
Alabama Aetna Direct

N61
210.05
218.45
173.12
CDHP Self
N62
474.42
550.93
436.61
CDHP Self & Family
N63
479.08
379.67
CDHP Self Plus One
Alabama Aetna HealthFund CDHP and Value Plan
F51
272.01
298.88
225.23
CDHP Self
F52
617.70
681.47
515.64
CDHP Self & Family
F53
674.72
486.63
CDHP Self Plus One
F54
243.50
250.64
198.63
Basic Self
F55
552.96
573.93
454.84
Basic Self & Family
F56
562.68
445.92
Basic Self Plus One
Alabama Aetna HealthFund HDHP
224
226.86
240.15
190.32
HDHP Self
225
496.83
529.73
419.81
HDHP Self & Family
226
519.34
411.58
HDHP Self Plus One
Alabama United Healthcare Insurance Company, Inc. (Choice HMO)
KK1
New Plan 245.00
194.16
High Self
KK2
New Plan 686.98
515.64
High Self & Family
KK3
New Plan 478.48
379.20
High Self Plus One
Alabama United Healthcare Insurance Company, Inc. (HDHP Choice Plus)
LS1
New Plan 234.69
185.99
HDHP Self
LS2
New
Plan
658.05
515.64
HDHP Self & Family
LS3
New Plan 458.33
363.23
HDHP Self Plus One
Alaska Aetna Direct
N61
210.05
218.45
173.12
CDHP Self
N62
474.42
550.93
436.61
CDHP Self & Family
N63
479.08
379.67
CDHP Self Plus One
Change in
Empl. Pays
empl.
payment
Biweekly
Premium
2016 Biweekly Postal Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
73.65
165.83
188.09
52.01
119.09
116.76
17.68
27.85
3.92
9.88
-
272.01
617.70
243.50
552.96
-
298.88
681.47
674.72
250.64
573.93
562.68
213.37
488.50
461.02
187.98
430.45
422.01
85.51
192.97
213.70
62.66
143.48
140.67
15.51
23.84
1.79
5.24
-
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
50.84
171.34
99.28
New Plan New Plan 245.00

183.75
488.50
358.86
61.25
198.48
119.62
New Plan
New Plan
New Plan
48.70
142.41
95.10

176.02
488.50
343.75
58.67
169.55
114.58
New Plan
New Plan
New Plan
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Alaska Aetna HealthFund CDHP and Value Plan

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
340.51
773.27
279.09
633.78
-
403.55
919.90
910.79
301.31
687.86
681.04
213.37
488.50
461.02
213.37
488.50
461.02
190.18
431.40
449.77
87.94
199.36
220.02
51.68
106.70
10.86
14.15
-
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
225.23
515.64
486.63
195.63
448.07
439.28
96.55
218.32
240.06
51.22
117.32
115.02
23.12
40.68
4.00
10.09
-
289.47
657.36
239.10
542.96
-
321.78
733.96
726.69
246.85
565.39
554.30
213.37
488.50
461.02
185.14
424.04
415.73
108.41
245.46
265.67
61.71
141.35
138.57
20.95
36.67
1.94
5.61
-
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
Total
Premium
Govt
Pays
403.55
919.90
910.79
301.31
687.86
681.04
225.23
515.64
486.63
225.23
515.64
486.63
178.32
404.26
424.16
76.08
172.22
194.41
53.85
110.71
13.03
18.16
-
240.15
529.73
519.34
190.32
419.81
411.58
49.83
109.92
107.76
218.45
550.93
479.08
173.12
436.61
379.67
321.78
733.96
726.69
246.85
565.39
554.30
240.15
529.73
519.34
Health Management
Organizations (HMO)
Arizona Aetna Open Access

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

Category 1
2015 Total
2015 Total
Biweekly
Premium
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
376.27
909.88
-
405.62
984.84
975.08
213.37
488.50
461.02
192.25
496.34
514.06
17.99
35.03
-
22.33
43.91
3.85
-2.96
-
331.53
839.45
302.58
766.16
-
363.05
919.28
919.28
315.62
799.12
799.12
213.37
488.50
461.02
213.37
488.50
461.02
149.68
430.78
458.26
102.25
310.62
338.10
20.16
39.90
1.68
-6.97
-
123.79
269.66
263.77
78.91
168.67
167.26
64.48
136.74
27.25
53.72
-
275.35
612.64
261.58
582.02
-
349.02
785.30
750.40
304.14
684.31
653.89
213.37
488.50
461.02
213.37
488.50
461.02
135.65
296.80
289.38
90.77
195.81
192.87
62.31
132.73
25.38
50.31
-
85.01
182.41
180.39
64.23
135.66
135.72
25.70
49.49
12.57
20.71
-
275.35
612.64
261.58
582.02
-
310.24
698.05
667.02
289.46
651.30
622.35
213.37
488.50
461.02
213.37
488.48
461.02
96.87
209.55
206.00
76.09
162.82
161.33
23.53
45.48
10.70
17.32
-
Total
Premium
Govt
Pays
376.27
909.88
-
405.62
984.84
975.08
225.23
515.64
486.63
180.39
469.20
488.45
20.16
39.04
-
331.53
839.45
302.58
766.16
-
363.05
919.28
919.28
315.62
799.12
799.12
225.23
515.64
486.63
225.23
515.64
486.63
137.82
403.64
432.65
90.39
283.48
312.49
275.35
612.64
261.58
582.02
-
349.02
785.30
750.40
304.14
684.31
653.89
225.23
515.64
486.63
225.23
515.64
486.63
275.35
612.64
261.58
582.02
-
310.24
698.05
667.02
289.46
651.30
622.35
225.23
515.64
486.63
225.23
515.64
486.63
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
Govt
Pays
Arizona United Healthcare Insurance Company, Inc. (Choice HMO)

KT1
New Plan 244.98
194.15
High Self
KT2
New Plan 686.93
515.64
High Self & Family
KT3
New Plan 478.45
379.17
High Self Plus One
Arizona United Healthcare Insurance Company, Inc. (HDHP Choice Plus)
LU1
New Plan 236.75
187.62
HDHP Self
LU2
New Plan 663.82
515.64
HDHP Self & Family
LU3
New Plan 462.35
366.41
HDHP Self Plus One
Arkansas Aetna Direct
N61
210.05
218.45
173.12
CDHP Self
N62
474.42
550.93
436.61
CDHP Self & Family
N63
479.08
379.67
CDHP Self Plus One
Arkansas Aetna HealthFund CDHP and Value Plan
F51
272.01
298.88
225.23
CDHP Self
F52
617.70
681.47
515.64
CDHP Self & Family
F53
674.72
486.63
CDHP Self Plus One
F54
243.50
250.64
198.63
Basic Self
F55
552.96
573.93
454.84
Basic Self & Family
F56
562.68
445.92
Basic Self Plus One
Arkansas Aetna HealthFund HDHP
224
226.86
240.15
190.32
HDHP Self
225
496.83
529.73
419.81
HDHP Self & Family
226
519.34
411.58
HDHP Self Plus One
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
50.83
171.29
99.28

183.74
488.50
358.84
61.24
198.43
119.61
New Plan
New Plan
New Plan
49.13
148.18
95.94

177.56
488.50
346.76
59.19
175.32
115.59
New Plan
New Plan
New Plan
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
73.65
165.83
188.09
52.01
119.09
116.76
17.68
27.85
3.92
9.88
-
272.01
617.70
243.50
552.96
-
298.88
681.47
674.72
250.64
573.93
562.68
213.37
488.50
461.02
187.98
430.45
422.01
85.51
192.97
213.70
62.66
143.48
140.67
15.51
23.84
1.79
5.24
-
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
Govt
Pays
Arkansas QualChoice
DH1
271.99
312.81
225.23
High Self
DH2
636.95
815.90
515.64
High Self & Family
DH3
607.64
481.55
High Self Plus One
DH4
231.48
243.98
193.35
Standard Self
DH5
542.08
636.37
504.32
DH6
473.93
375.59
Arkansas United Healthcare Insurance Company, Inc. (Choice HMO)
KK1
New Plan 245.00
194.16
High Self
KK2
New Plan 686.98
515.64
High Self & Family
KK3
New Plan 478.48
379.20
High Self Plus One
Arkansas United Healthcare Insurance Company, Inc. (HDHP Choice Plus)
LS1
New Plan 234.69
185.99
HDHP Self
LS2
New Plan 658.05
515.64
HDHP Self & Family
LS3
New Plan 458.33
363.23
HDHP Self Plus One
California Aetna Direct
N61
210.05
218.45
173.12
CDHP Self
N62
474.42
550.93
436.61
CDHP Self & Family
N63
479.08
379.67
CDHP Self Plus One
California Aetna HealthFund CDHP and Value Plan
JS1
340.51
403.55
225.23
CDHP Self
JS2
773.27
919.90
515.64
CDHP Self & Family
JS3
910.79
486.63
CDHP Self Plus One
JS4
279.09
301.31
225.23
Basic Self
JS5
633.78
687.86
515.64
Basic Self & Family
JS6
681.04
486.63
Basic Self Plus One
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
312.81
815.90
607.64
243.98
636.37
473.93
213.37
488.50
455.73
182.99
477.28
355.45
99.44
327.40
151.91
60.99
159.09
118.48
29.46
139.02
3.12
23.57
-
50.84
171.34
99.28

183.75
488.50
358.86
61.25
198.48
119.62
New Plan
New Plan
New Plan
48.70
142.41
95.10

176.02
488.50
343.75
58.67
169.55
114.58
New Plan
New Plan
New Plan
87.58
300.26
126.09
50.63
132.05
98.34
31.63
143.03
4.91
24.99
-
271.99
636.95
231.48
542.08
-
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
178.32
404.26
424.16
76.08
172.22
194.41
53.85
110.71
13.03
18.16
-
340.51
773.27
279.09
633.78
-
403.55
919.90
910.79
301.31
687.86
681.04
213.37
488.50
461.02
213.37
488.50
461.02
190.18
431.40
449.77
87.94
199.36
220.02
51.68
106.70
10.86
14.15
-
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
California Aetna HealthFund HDHP

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
0.27
-9.51
-
279.15
651.14
-
288.61
677.55
664.27
213.37
488.50
461.02
75.24
189.05
203.25
-1.90
-13.52
-
111.84
199.99
187.58
5.12
-14.22
-
322.76
693.93
-
337.07
715.63
674.21
213.37
488.50
461.02
123.70
227.13
213.19
2.95
-18.23
-
225.23
515.64
486.63
106.13
229.93
242.37
12.92
13.82
-
309.25
695.83
-
331.36
745.57
729.00
213.37
488.50
461.02
117.99
257.07
267.98
10.75
9.81
-
225.23
515.64
486.63
225.23
515.64
486.63
375.37
925.81
834.70
345.20
853.40
768.32
6.41
52.97
4.10
44.98
-
585.00
1352.56
557.14
1288.14
-
600.60
1441.45
1321.33
570.43
1369.04
1254.95
213.37
488.50
461.02
213.37
488.50
461.02
387.23
952.95
860.31
357.06
880.54
793.93
4.24
48.96
1.93
40.97
-
Total
Premium
Govt
Pays
240.15
529.73
519.34
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
288.61
677.55
664.27
225.23
515.64
486.63
63.38
161.91
177.64
337.07
715.63
674.21
225.23
515.64
486.63
331.36
745.57
729.00
600.60
1441.45
1321.33
570.43
1369.04
1254.95
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
350.22
840.52
770.47
332.20
797.30
730.85
213.37
488.50
461.02
213.37
488.50
461.02
136.85
352.02
309.45
118.83
308.80
269.83
-5.36
4.71
-6.54
0.43
-

99.61
239.05
219.13
33.20
79.68
73.04
New Plan
New Plan
New Plan
377.23
900.50
900.50
315.31
737.83
737.83
213.37
488.50
461.02
213.37
488.50
461.02
163.86
412.00
439.48
101.94
249.33
276.81
6.06
1.68
2.17
-8.26
-
275.88
637.61
637.61
178.91
413.50
413.50
206.91
478.21
461.02
134.18
310.13
310.13
68.97
159.40
176.59
44.73
103.37
103.37
2.38
-7.68
1.53
3.52
-
Total
Premium
Govt
Pays
350.22
840.52
770.47
332.20
797.30
730.85
225.23
515.64
486.63
225.23
515.64
486.63
124.99
324.88
283.84
106.97
281.66
244.22
132.81
318.73
292.17
105.25
252.59
231.54
27.56
66.14
60.63
377.23
900.50
900.50
315.31
737.83
737.83
225.23
515.64
486.63
225.23
515.64
486.63
152.00
384.86
413.87
90.08
222.19
251.20
8.23
5.69
4.34
-4.25
-
359.81
858.89
301.78
706.16
-
275.88
637.61
637.61
178.91
413.50
413.50
218.63
505.31
486.63
141.79
327.70
327.70
57.25
132.30
150.98
37.12
85.80
85.80
4.64
-3.63
2.99
6.92
-
266.38
615.65
172.81
399.39
-
-3.19
8.72
-4.37
4.44
-
344.22
795.88
327.38
756.94
-
Health Management
Organizations (HMO)

KC1
Basic Self
KC2
Basic Self & Family
KC3
Basic Self Plus One
NZ1
High Self
NZ2
High Self & Family
NZ3
High Self Plus One
NZ4
Standard Self
NZ5
NZ6
California UnitedHealthcare of California
CY1
High Self
CY2
High Self & Family
CY3
High Self Plus One
CY4
Standard Self
CY5
CY6
Colorado Aetna Direct
N61
CDHP Self
N62
CDHP Self & Family
N63
CDHP Self Plus One

Category 1
2015 Total
2015 Total
Biweekly
Premium
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
281.11
657.80
-
281.33
658.31
658.31
211.00
488.50
461.02
70.33
169.81
197.29
-8.77
-39.42
-
5.36
-1.94
3.48
8.05
-
266.38
615.65
172.81
399.39
-
279.39
645.73
645.73
181.26
418.94
418.94
209.54
484.30
461.02
135.95
314.21
314.21
69.85
161.43
184.71
45.31
104.73
104.73
3.26
-5.65
2.11
4.88
-
61.11
287.24
116.04
53.43
206.33
104.34
-20.10
87.73
3.77
92.54
-
297.25
679.23
251.45
576.15
-
286.34
802.88
559.21
257.47
721.97
502.85
213.37
488.50
419.41
193.10
488.50
377.14
72.97
314.38
139.80
64.37
233.47
125.71
-22.27
83.72
1.51
89.43
-
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
Total
Premium
Govt
Pays
281.11
657.80
-
281.33
658.31
658.31
222.95
515.64
486.63
58.38
142.67
171.68
-6.69
-35.41
-
266.38
615.65
172.81
399.39
-
279.39
645.73
645.73
181.26
418.94
418.94
221.42
511.74
486.63
143.65
332.01
332.01
57.97
133.99
159.10
37.61
86.93
86.93
297.25
679.23
251.45
576.15
-
286.34
802.88
559.21
257.47
721.97
502.85
225.23
515.64
443.17
204.04
515.64
398.51
210.05
474.42
-
218.45
550.93
479.08
173.12
436.61
379.67
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Colorado Aetna HealthFund CDHP and Value Plan

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
289.47
657.36
239.10
542.96
-
321.78
733.96
726.69
246.85
565.39
554.30
213.37
488.50
461.02
185.14
424.04
415.73
108.41
245.46
265.67
61.71
141.35
138.57
20.95
36.67
1.94
5.61
-
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
51.40
115.64
110.50
47.20
106.20
101.48
10.07
23.68
10.00
23.44
-
209.27
465.62
188.34
419.06
-
247.70
557.32
532.54
227.47
511.80
489.06
185.78
417.99
399.41
170.60
383.85
366.80
61.92
139.33
133.13
56.87
127.95
122.26
9.60
22.93
9.79
23.19
-
54.57
122.79
117.33
49.55
111.49
106.54
11.06
25.99
10.39
24.37
-
220.28
490.13
198.26
441.12
-
263.00
591.74
565.45
238.80
537.32
513.44
197.25
443.81
424.09
179.10
402.99
385.08
65.75
147.93
141.36
59.70
134.33
128.36
10.68
25.40
10.14
24.05
-
Total
Premium
Govt
Pays
321.78
733.96
726.69
246.85
565.39
554.30
225.23
515.64
486.63
195.63
448.07
439.28
96.55
218.32
240.06
51.22
117.32
115.02
23.12
40.68
4.00
10.09
-
240.15
529.73
519.34
190.32
419.81
411.58
49.83
109.92
107.76
247.70
557.32
532.54
227.47
511.80
489.06
196.30
441.68
422.04
180.27
405.60
387.58
263.00
591.74
565.45
238.80
537.32
513.44
208.43
468.95
448.12
189.25
425.83
406.90
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
Govt
Pays
Colorado Kaiser Foundation Health Plan of Colorado

651
315.92
318.22
225.23
High Self
652
713.98
719.18
515.64
High Self & Family
653
719.18
486.63
High Self Plus One
654
201.14
214.90
170.31
Standard Self
655
454.58
485.66
384.89
656
485.66
384.89
Colorado Kaiser Foundation Health Plan of Colorado
N41
143.68
162.00
128.39
Basic Self
N42
324.71
366.12
290.15
Basic Self & Family
N43
366.12
290.15
Basic Self Plus One
Colorado United Healthcare Insurance Company, Inc. (Choice HMO)
KT1
New Plan 244.98
194.15
High Self
KT2
New Plan 686.93
515.64
High Self & Family
KT3
New Plan 478.45
379.17
High Self Plus One
Colorado United Healthcare Insurance Company, Inc. (HDHP Choice Plus)
LU1
New Plan 236.75
187.62
HDHP Self
LU2
New Plan 663.82
515.64
HDHP Self & Family
LU3
New Plan 462.35
366.41
HDHP Self Plus One
Connecticut Aetna Direct
N61
210.05
218.45
173.12
CDHP Self
N62
474.42
550.93
436.61
CDHP Self & Family
N63
479.08
379.67
CDHP Self Plus One
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
92.99
203.54
232.55
44.59
100.77
100.77
-6.89
-30.72
4.86
10.99
-
315.92
713.98
201.14
454.58
-
318.22
719.18
719.18
214.90
485.66
485.66
213.37
488.50
461.02
161.18
364.25
364.25
104.85
230.68
258.16
53.72
121.41
121.41
-9.06
-34.73
3.44
7.77
-
33.61
75.97
75.97
5.23
11.84
-
143.68
324.71
-
162.00
366.12
366.12
121.50
274.59
274.59
40.50
91.53
91.53
4.58
10.35
-
50.83
171.29
99.28

183.74
488.50
358.84
61.24
198.43
119.61
New Plan
New Plan
New Plan
49.13
148.18
95.94

177.56
488.50
346.76
59.19
175.32
115.59
New Plan
New Plan
New Plan
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Connecticut Aetna HealthFund CDHP and Value Plan

EP1
296.95
CDHP Self
EP2
674.38
CDHP Self & Family
EP3
CDHP Self Plus One
EP4
236.69
Basic Self
EP5
537.52
Basic Self & Family
EP6
Basic Self Plus One
Connecticut Aetna HealthFund HDHP
224
226.86
HDHP Self
225
496.83
HDHP Self & Family
226
HDHP Self Plus One
Delaware Aetna Direct
N61
210.05
CDHP Self
N62
474.42
CDHP Self & Family
N63
CDHP Self Plus One
Delaware Aetna HealthFund CDHP and Value Plan
EP1
296.95
CDHP Self
EP2
674.38
CDHP Self & Family
EP3
CDHP Self Plus One
EP4
236.69
Basic Self
EP5
537.52
Basic Self & Family
EP6
Basic Self Plus One
Delaware Aetna HealthFund HDHP
224
226.86
HDHP Self
225
496.83
HDHP Self & Family
226
HDHP Self Plus One
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
296.95
674.38
236.69
537.52
-
353.14
805.37
797.39
243.00
556.47
545.55
213.37
488.50
461.02
182.25
417.35
409.16
139.77
316.87
336.37
60.75
139.12
136.39
44.83
91.06
1.58
4.74
-
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
225.23
515.64
486.63
192.58
441.00
432.35
127.91
289.73
310.76
50.42
115.47
113.20
47.00
95.07
3.67
9.31
-
296.95
674.38
236.69
537.52
-
353.14
805.37
797.39
243.00
556.47
545.55
213.37
488.50
461.02
182.25
417.35
409.16
139.77
316.87
336.37
60.75
139.12
136.39
44.83
91.06
1.58
4.74
-
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
Total
Premium
Govt
Pays
353.14
805.37
797.39
243.00
556.47
545.55
225.23
515.64
486.63
192.58
441.00
432.35
127.91
289.73
310.76
50.42
115.47
113.20
47.00
95.07
3.67
9.31
-
240.15
529.73
519.34
190.32
419.81
411.58
49.83
109.92
107.76
218.45
550.93
479.08
173.12
436.61
379.67
353.14
805.37
797.39
243.00
556.47
545.55
240.15
529.73
519.34
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
Delaware Aetna Open Access

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
225.23
515.64
486.63
225.23
515.64
486.63
406.02
1014.83
1028.69
283.19
664.43
681.76
64.37
148.93
16.13
28.61
-
557.69
1345.62
483.10
1115.54
-
631.25
1530.47
1515.32
508.42
1180.07
1168.39
213.37 417.88
488.50 1041.97
461.02 1054.30
213.37 295.05
488.50 691.57
461.02 707.37
62.20
144.92
13.96
24.60
-
173.12
436.61
379.67
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
225.23
515.64
486.63
198.63
454.84
445.92
73.65
165.83
188.09
52.01
119.09
116.76
17.68
27.85
3.92
9.88
-
272.01
617.70
243.50
552.96
-
298.88
681.47
674.72
250.64
573.93
562.68
213.37
488.50
461.02
187.98
430.45
422.01
85.51
192.97
213.70
62.66
143.48
140.67
15.51
23.84
1.79
5.24
-
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
Govt
Pays
District of Columbia Aetna Open Access

JN1
426.78
442.85
225.23
High Self
JN2
955.97
995.60
515.64
High Self & Family
JN3
985.75
486.63
High Self Plus One
JN4
265.88
275.96
218.70
Basic Self
JN5
594.52
621.16
492.27
Basic Self & Family
JN6
608.98
482.62
Basic Self Plus One
District of Columbia CareFirst BlueChoice
2G1
309.39
321.77
225.23
High Self
2G2
696.01
764.50
515.64
High Self & Family
2G3
643.53
486.63
High Self Plus One
2G4
276.57
287.63
225.23
Standard Self
2G5
622.18
683.40
515.64
2G6
575.27
455.90
District of Columbia CareFirst BlueChoice
B61
267.85
273.21
216.52
HDHP Self
B62
597.46
649.15
514.45
HDHP Self & Family
B63
546.43
433.05
HDHP Self Plus One
District of Columbia Kaiser Foundation Health Plan Mid-Atlantic States
E31
279.94
285.48
225.23
High Self
E32
643.87
668.01
515.64
High Self & Family
E33
645.17
486.63
High Self Plus One
E34
181.53
214.96
170.36
Standard Self
E35
417.50
503.01
398.64
E36
485.80
385.00
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
217.62
479.96
499.12
57.26
128.89
126.36
6.88
3.71
4.75
11.47
-
426.78
955.97
265.88
594.52
-
442.85
995.60
985.75
275.96
621.16
608.98
213.37
488.50
461.02
206.97
465.87
456.74
229.48
507.10
524.73
68.99
155.29
152.24
4.71
-0.30
2.52
6.66
-
96.54
248.86
156.90
62.40
167.76
119.37
3.19
32.57
1.87
25.30
-
309.39
696.01
276.57
622.18
-
321.77
764.50
643.53
287.63
683.40
575.27
213.37
488.50
461.02
213.37
488.50
431.45
108.40
276.00
182.51
74.26
194.90
143.82
1.02
28.56
-0.30
21.29
-
56.69
134.70
113.38
3.79
16.70
-
267.85
597.46
-
273.21
649.15
546.43
204.91
486.86
409.82
68.30
162.29
136.61
1.34
12.93
-
60.25
152.37
158.54
44.60
104.37
100.80
-3.65
-11.78
8.75
21.91
-
279.94
643.87
181.53
417.50
-
285.48
668.01
645.17
214.96
503.01
485.80
213.37
488.50
461.02
161.22
377.26
364.35
72.11
179.51
184.15
53.74
125.75
121.45
-5.82
-15.79
8.36
21.38
-
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
Govt
Pays
Change in
Empl. Pays
empl.
payment
District of Columbia M.D. IPA

JP1
314.55
295.87
225.23
70.64
High Self
JP2
725.30
829.62
515.64
313.98
High Self & Family
JP3
577.83
457.93
119.90
High Self Plus One
District of Columbia United Healthcare Insurance Company, Inc. (Choice HMO)
LR1
New Plan 245.13
194.27
50.86
High Self
LR2
New Plan 687.35
515.64
171.71
High Self & Family
LR3
New Plan 478.74
379.40
99.34
High Self Plus One
District of Columbia UnitedHealthcare Insurance Company
L91
244.32
212.71
168.57
44.14
Basic Self
L92
543.61
596.45
472.69
123.76
Basic Self & Family
L93
415.43
329.23
86.20
Basic Self Plus One
Florida Aetna Direct
N61
210.05
218.45
173.12
45.33
CDHP Self
N62
474.42
550.93
436.61
114.32
CDHP Self & Family
N63
479.08
379.67
99.41
CDHP Self Plus One
Florida Aetna HealthFund CDHP and Value Plan
F51
272.01
298.88
225.23
73.65
CDHP Self
F52
617.70
681.47
515.64
165.83
CDHP Self & Family
F53
674.72
486.63
188.09
CDHP Self Plus One
F54
243.50
250.64
198.63
52.01
Basic Self
F55
552.96
573.93
454.84
119.09
Basic Self & Family
F56
562.68
445.92
116.76
Basic Self Plus One
Florida Aetna HealthFund HDHP
224
226.86
240.15
190.32
49.83
HDHP Self
225
496.83
529.73
419.81
109.92
HDHP Self & Family
226
519.34
411.58
107.76
HDHP Self Plus One
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
295.87
829.62
577.83
213.37
488.50
433.37
82.50
341.12
144.46
-30.04
64.39
-

183.85
488.50
359.06
61.28
198.85
119.68
New Plan
New Plan
New Plan
-27.87
68.40
-
314.55
725.30
-
-4.11
16.40
-
244.32
543.61
-
212.71
596.45
415.43
159.53
447.34
311.57
53.18
149.11
103.86
-7.90
13.21
-
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
17.68
27.85
3.92
9.88
-
272.01
617.70
243.50
552.96
-
298.88
681.47
674.72
250.64
573.93
562.68
213.37
488.50
461.02
187.98
430.45
422.01
85.51
192.97
213.70
62.66
143.48
140.67
15.51
23.84
1.79
5.24
-
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Florida AvMed Health Plans

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
299.98
719.99
241.87
580.55
-
347.11
899.12
694.22
272.83
706.74
545.69
213.37
488.50
461.02
204.62
488.50
409.27
133.74
410.62
233.20
68.21
218.24
136.42
35.77
139.20
7.74
73.10
-
5.94
22.42
-
237.30
628.85
-
254.52
687.19
509.03
190.89
488.50
381.77
63.63
198.69
127.26
4.31
18.41
-
80.55
172.38
170.82
44.67
100.51
96.04
24.52
46.73
5.39
13.12
-
272.07
605.37
198.87
442.49
-
305.78
688.02
657.45
215.28
484.37
462.84
213.37
488.50
461.02
161.46
363.28
347.13
92.41
199.52
196.43
53.82
121.09
115.71
22.35
42.72
4.10
10.47
-
55.29
124.39
118.86
44.67
100.51
96.04
9.23
21.91
5.39
13.12
-
233.21
518.89
198.87
442.49
-
266.44
599.47
572.83
215.28
484.37
462.84
199.83
449.60
429.62
161.46
363.28
347.13
66.61
149.87
143.21
53.82
121.09
115.71
8.31
20.15
4.10
10.47
-
Total
Premium
Govt
Pays
347.11
899.12
694.22
272.83
706.74
545.69
225.23
515.64
486.63
216.22
515.64
432.46
121.88
383.48
207.59
56.61
191.10
113.23
37.94
143.21
8.84
76.44
-
254.52
687.19
509.03
201.71
515.64
403.41
52.81
171.55
105.62
305.78
688.02
657.45
215.28
484.37
462.84
225.23
515.64
486.63
170.61
383.86
366.80
266.44
599.47
572.83
215.28
484.37
462.84
211.15
475.08
453.97
170.61
383.86
366.80
Health Management
Organizations (HMO)
Florida Humana Medical Plan, Inc.

E21
High Self
E22
High Self & Family
E23
High Self Plus One
E24
Standard Self
E25
E26
EE1
High Self
EE2
High Self & Family
EE3
High Self Plus One
EE4
Standard Self
EE5
EE6
EX1
High Self
EX2
High Self & Family
EX3
High Self Plus One
EX4
Standard Self
EX5
EX6

Category 1
2015 Total
2015 Total
Biweekly
Premium
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
244.75
544.58
220.28
490.12
-
277.58
624.54
596.78
262.86
591.43
565.15
208.19
468.41
447.59
197.15
443.57
423.86
69.39
156.13
149.19
65.71
147.86
141.29
8.20
19.99
10.64
25.33
-
58.92
125.38
29.47
57.93
-
321.70
715.78
275.32
612.59
-
389.81
877.08
838.10
313.98
706.44
675.04
213.37
488.50
461.02
213.37
488.50
461.02
176.44
388.58
377.08
100.61
217.94
214.02
56.75
121.37
27.30
53.92
-
23.29
44.82
10.58
24.94
-
260.05
578.61
234.05
520.76
-
299.88
674.74
644.75
273.72
615.87
588.49
213.37
488.50
461.02
205.29
461.90
441.37
86.51
186.24
183.73
68.43
153.97
147.12
21.50
41.59
9.92
23.78
-
Total
Premium
Govt
Pays
244.75
544.58
220.28
490.12
-
277.58
624.54
596.78
262.86
591.43
565.15
219.98
494.95
472.95
208.32
468.71
447.88
57.60
129.59
123.83
54.54
122.72
117.27
9.26
22.04
11.03
25.92
-
321.70
715.78
275.32
612.59
-
389.81
877.08
838.10
313.98
706.44
675.04
225.23
515.64
486.63
225.23
515.64
486.63
164.58
361.44
351.47
88.75
190.80
188.41
260.05
578.61
234.05
520.76
-
299.88
674.74
644.75
273.72
615.87
588.49
225.23
515.64
486.63
216.92
488.08
466.38
74.65
159.10
158.12
56.80
127.79
122.11
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
472.12
1050.46
275.35
612.65
-
606.75
1365.20
1304.51
319.76
719.45
687.49
213.37
488.50
461.02
213.37
488.50
461.02
393.38
876.70
843.49
106.39
230.95
226.47
123.27
274.81
33.05
66.87
-
0.05
53.21
-
254.82
566.98
-
242.80
680.83
474.20
182.10
488.50
355.65
60.70
192.33
118.55
-3.00
50.59
-
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
225.23
515.64
486.63
198.63
454.84
445.92
73.65
165.83
188.09
52.01
119.09
116.76
17.68
27.85
3.92
9.88
-
272.01
617.70
243.50
552.96
-
298.88
681.47
674.72
250.64
573.93
562.68
213.37
488.50
461.02
187.98
430.45
422.01
85.51
192.97
213.70
62.66
143.48
140.67
15.51
23.84
1.79
5.24
-
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
Total
Premium
Govt
Pays
606.75
1365.20
1304.51
319.76
719.45
687.49
225.23
515.64
486.63
225.23
515.64
486.63
381.52
849.56
817.88
94.53
203.81
200.86
125.44
278.82
35.22
70.88
-
242.80
680.83
474.20
192.42
515.64
375.80
50.38
165.19
98.40
218.45
550.93
479.08
173.12
436.61
379.67
298.88
681.47
674.72
250.64
573.93
562.68
240.15
529.73
519.34
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Georgia Aetna Open Access

2U1
446.24
High Self
2U2
1023.98
High Self & Family
2U3
High Self Plus One
Georgia Humana CoverageFirst and Value Plan
AD1
259.13
CDHP Self
AD2
576.54
CDHP Self & Family
AD3
CDHP Self Plus One
AD4
198.87
Basic Self
AD5
442.49
Basic Self & Family
AD6
Basic Self Plus One
Georgia Humana CoverageFirst and Value Plan
LM1
259.13
CDHP Self
LM2
576.54
CDHP Self & Family
LM3
CDHP Self Plus One
LM4
198.87
Basic Self
LM5
442.49
Basic Self & Family
LM6
Basic Self Plus One
Georgia Humana Employers Health of Georgia, Inc.
CB1
275.35
High Self
CB2
612.64
High Self & Family
CB3
High Self Plus One
CB4
261.58
Standard Self
CB5
582.02
CB6
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Empl.
Pays
Change in
empl.
payment
505.45 213.37
1164.27 488.50
1152.74 461.02
292.08
675.77
691.72
47.85
100.36
-
259.13
576.54
198.87
442.49
-
283.43
637.72
609.37
215.28
484.37
462.84
212.57
478.29
457.03
161.46
363.28
347.13
70.86
159.43
152.34
53.82
121.09
115.71
6.08
15.30
4.10
10.47
-
5.29
13.19
5.39
13.12
-
259.13
576.54
198.87
442.49
-
272.15
612.33
585.11
215.28
484.37
462.84
204.11
459.25
438.83
161.46
363.28
347.13
68.04
153.08
146.28
53.82
121.09
115.71
3.26
8.95
4.10
10.47
-
29.76
58.61
21.47
40.72
-
275.35
612.64
261.58
582.02
-
314.30
707.17
675.74
298.36
671.31
641.47
213.37
488.50
461.02
213.37
488.50
461.02
100.93
218.67
214.72
84.99
182.81
180.45
27.59
54.60
19.60
37.31
-
Total
Premium
Govt
Pays
505.45
1164.27
1152.74
225.23
515.64
486.63
280.22
648.63
666.11
50.02
104.37
-
446.24
1023.98
-
283.43
637.72
609.37
215.28
484.37
462.84
224.62
505.39
482.93
170.61
383.86
366.80
58.81
132.33
126.44
44.67
100.51
96.04
7.63
18.46
5.39
13.12
-
272.15
612.33
585.11
215.28
484.37
462.84
215.68
485.27
463.70
170.61
383.86
366.80
56.47
127.06
121.41
44.67
100.51
96.04
314.30
707.17
675.74
298.36
671.31
641.47
225.23
515.64
486.63
225.23
515.64
486.63
89.07
191.53
189.11
73.13
155.67
154.84
Total
Premium
Govt
Pays
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
298.01
663.07
275.35
612.65
-
374.12
841.78
804.35
312.03
702.07
670.87
213.37
488.50
461.02
213.37
488.50
461.02
160.75
353.28
343.33
98.66
213.57
209.85
64.75
138.78
25.32
49.49
-
26.49
51.28
20.91
39.46
-
275.35
612.64
261.58
582.02
-
311.03
699.84
668.73
297.80
670.05
640.27
213.37
488.50
461.02
213.37
488.50
461.02
97.66
211.34
207.71
84.43
181.55
179.25
24.32
47.27
19.04
36.05
-
61.92
140.53
150.88
44.55
102.47
99.35
6.30
-0.51
4.91
11.90
-
271.66
620.76
200.69
458.58
-
287.15
656.17
637.51
214.72
493.83
478.81
213.37
488.50
461.02
161.04
370.37
359.11
73.78
167.67
176.49
53.68
123.46
119.70
4.13
-4.52
3.51
8.82
-
50.38
165.19
98.40
0.05
53.21
-
254.82
566.98
-
242.80
680.83
474.20
182.10
488.50
355.65
60.70
192.33
118.55
-3.00
50.59
-
Total
Premium
Govt
Pays
374.12
841.78
804.35
312.03
702.07
670.87
225.23
515.64
486.63
225.23
515.64
486.63
148.89
326.14
317.72
86.80
186.43
184.24
66.92
142.79
27.49
53.50
-
311.03
699.84
668.73
297.80
670.05
640.27
225.23
515.64
486.63
225.23
515.64
486.63
85.80
184.20
182.10
72.57
154.41
153.64
287.15
656.17
637.51
214.72
493.83
478.81
225.23
515.64
486.63
170.17
391.36
379.46
242.80
680.83
474.20
192.42
515.64
375.80
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Guam Calvos Selectcare

High Self
High Self & Family
High Self Plus One
Standard Self
Guam TakeCare
High Self
High Self & Family
High Self Plus One
Standard Self
Guam TakeCare
HDHP Self
HDHP Self & Family
HDHP Self Plus One
Hawaii Aetna Direct
CDHP Self
CDHP Self & Family
CDHP Self Plus One
Biweekly
Premium
Total
Premium
Govt
Pays
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
B41
B42
B43
B44
B45
B46
195.03
532.08
168.73
460.00
-
178.79
478.00
348.89
164.53
439.89
321.07
141.69
378.82
276.50
130.39
348.61
254.45
37.10
99.18
72.39
34.14
91.28
66.62
-1.42
-5.91
0.82
0.43
-
195.03
532.08
168.73
460.00
-
178.79
478.00
348.89
164.53
439.89
321.07
134.09
358.50
261.67
123.40
329.92
240.80
44.70
119.50
87.22
41.13
109.97
80.27
-4.06
-13.52
-1.05
-5.03
-
JK1
JK2
JK3
JK4
JK5
JK6
205.73
540.62
171.92
454.01
-
243.00
728.99
485.99
167.22
500.01
332.78
192.58
515.64
385.15
132.52
396.26
263.73
50.42
213.35
100.84
34.70
103.75
69.05
9.79
106.58
0.75
14.08
-
205.73
540.62
171.92
454.01
-
243.00
728.99
485.99
167.22
500.01
332.78
182.25
488.50
364.49
125.42
375.01
249.59
60.75
240.49
121.50
41.80
125.00
83.19
9.32
105.34
-1.18
11.50
-
KX1
KX2
KX3
89.04
233.54
-
76.38
223.94
159.48
60.53
177.47
126.39
15.85
46.47
33.09
-1.74
0.35
-
89.04
233.54
-
76.38
223.94
159.48
57.29
167.96
119.61
19.09
55.98
39.87
-3.17
-2.40
-
N61
N62
N63
210.05
474.42
-
218.45
550.93
479.08
173.12
436.61
379.67
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Hawaii Aetna HealthFund CDHP and Value Plan

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
340.51
773.27
279.09
633.78
-
403.55
919.90
910.79
301.31
687.86
681.04
213.37
488.50
461.02
213.37
488.50
461.02
190.18
431.40
449.77
87.94
199.36
220.02
51.68
106.70
10.86
14.15
-
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
53.82
120.99
117.93
8.40
19.88
-
230.00
511.96
-
259.39
583.10
568.32
194.54
437.33
426.24
64.85
145.77
142.08
7.35
17.78
-
209.18
466.48
466.48
143.60
320.23
320.23
54.77
122.14
122.14
37.60
83.85
83.85
6.61
14.75
4.36
9.74
-
243.84
543.75
168.28
375.26
-
263.95
588.62
588.62
181.20
404.08
404.08
197.96
441.47
441.47
135.90
303.06
303.06
65.99
147.15
147.15
45.30
101.02
101.02
5.03
11.21
3.23
7.21
-
173.12
436.61
379.67
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
Total
Premium
Govt
Pays
403.55
919.90
910.79
301.31
687.86
681.04
225.23
515.64
486.63
225.23
515.64
486.63
178.32
404.26
424.16
76.08
172.22
194.41
53.85
110.71
13.03
18.16
-
240.15
529.73
519.34
190.32
419.81
411.58
49.83
109.92
107.76
259.39
583.10
568.32
205.57
462.11
450.39
263.95
588.62
588.62
181.20
404.08
404.08
218.45
550.93
479.08
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
Idaho Aetna Health of Utah, Inc. dba Altius Health Plans

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
225.23
515.64
486.63
134.95
282.03
276.50
89.56
180.50
202.62
35.33
73.85
72.40
5.92
0.89
2.00
4.81
-
299.68
659.33
168.74
349.58
-
314.79
696.14
689.25
170.28
355.88
348.90
213.37
488.50
461.02
127.71
266.91
261.68
101.42
207.64
228.23
42.57
88.97
87.22
3.75
-3.12
0.39
1.58
-
182.26
402.47
398.49
47.72
105.38
104.34
3.20
7.43
-
225.43
495.93
-
229.98
507.85
502.83
172.49
380.89
377.12
57.49
126.96
125.71
1.13
2.98
-
225.23
515.64
486.63
196.32
450.57
441.73
87.45
197.12
219.07
51.40
117.97
115.66
26.54
47.90
3.19
8.48
-
276.95
628.94
244.12
554.39
-
312.68
712.76
705.70
247.72
568.54
557.39
213.37
488.50
461.02
185.79
426.41
418.04
99.31
224.26
244.68
61.93
142.13
139.35
24.37
43.89
0.90
3.53
-
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Idaho Group Health Cooperative

High Self
High Self & Family
High Self Plus One
Standard Self
Idaho Group Health Cooperative
HDHP Self
HDHP Self & Family
HDHP Self Plus One
Idaho SelectHealth
High Self
High Self & Family
High Self Plus One
Standard Self
Illinois Aetna Direct
CDHP Self
CDHP Self & Family
CDHP Self Plus One
Biweekly
Premium
Total
Premium
Govt
Pays
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
327.13
883.24
654.25
234.07
632.01
468.15
213.37
488.50
461.02
175.55
474.01
351.11
113.76
394.74
193.23
58.52
158.00
117.04
-8.65
145.81
2.85
32.31
-

164.03
442.88
328.05
54.67
147.62
109.35
New Plan
New Plan
New Plan
541
542
543
544
545
546
324.42
697.50
222.70
502.76
-
327.13
883.24
654.25
234.07
632.01
468.15
225.23
515.64
486.63
185.50
500.87
371.01
101.90
367.60
167.62
48.57
131.14
97.14
-6.48
149.82
4.59
31.84
-
324.42
697.50
222.70
502.76
-
PT1
PT2
PT3
New Plan
New Plan
New Plan
218.70
590.50
437.40
173.32
467.97
346.64
45.38
122.53
90.76
SF1
SF2
SF3
SF4
SF5
SF6
293.90
655.62
229.58
512.14
-
317.43
708.06
708.06
236.46
525.08
525.08
225.23
515.64
486.63
187.39
416.13
416.13
92.20
192.42
221.43
49.07
108.95
108.95
14.34
16.52
3.73
7.80
-
293.90
655.62
229.58
512.14
-
317.43
708.06
708.06
236.46
525.08
525.08
213.37
488.50
461.02
177.35
393.81
393.81
104.06
219.56
247.04
59.11
131.27
131.27
12.17
12.51
1.72
3.24
-
N61
N62
N63
210.05
474.42
-
218.45
550.93
479.08
173.12
436.61
379.67
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Illinois Aetna HealthFund CDHP and Value Plan

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
276.95
628.94
244.12
554.39
-
312.68
712.76
705.70
247.72
568.54
557.39
213.37
488.50
461.02
185.79
426.41
418.04
99.31
224.26
244.68
61.93
142.13
139.35
24.37
43.89
0.90
3.53
-
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
111.98
320.38
242.26
-27.05
-5.95
-
355.07
806.05
-
337.21
836.02
728.89
213.37
488.50
461.02
123.84
347.52
267.87
-29.22
-9.96
-
225.23
515.64
486.63
86.75
149.46
137.34
-98.40
-173.21
-
401.19
802.39
-
311.98
665.10
623.97
213.37
488.50
461.02
98.61
176.60
162.95
-100.57
-177.22
-
351.45
994.51
738.04
225.23
515.64
486.63
126.22
478.87
251.41
0.42
161.75
-
341.84
796.84
-
351.45
994.51
738.04
213.37
488.50
461.02
138.08
506.01
277.02
-1.75
157.74
-
288.42
800.36
605.69
225.23
515.64
480.01
63.19
284.72
125.68
-11.25
87.32
-
290.48
677.12
-
288.42
800.36
605.69
213.37
488.50
454.27
75.05
311.86
151.42
-13.42
83.31
-
Total
Premium
Govt
Pays
312.68
712.76
705.70
247.72
568.54
557.39
225.23
515.64
486.63
196.32
450.57
441.73
87.45
197.12
219.07
51.40
117.97
115.66
26.54
47.90
3.19
8.48
-
240.15
529.73
519.34
190.32
419.81
411.58
49.83
109.92
107.76
337.21
836.02
728.89
225.23
515.64
486.63
311.98
665.10
623.97
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Illinois Humana CoverageFirst and Value Plan

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
259.13
576.54
198.87
442.49
-
291.97
656.92
627.72
215.28
484.37
462.84
213.37
488.50
461.02
161.46
363.28
347.13
78.60
168.42
166.70
53.82
121.09
115.71
13.82
24.29
4.10
10.47
-
32.38
65.26
5.39
13.12
-
259.13
576.54
198.87
442.49
-
308.79
694.77
663.89
215.28
484.37
462.84
213.37
488.50
461.02
161.46
363.28
347.13
95.42
206.27
202.87
53.82
121.09
115.71
30.64
62.14
4.10
10.47
-
328.97
731.32
704.90
119.64
260.32
254.85
95.11
210.00
60.33
127.39
-
449.90
1001.04
275.35
612.65
-
554.20
1246.96
1191.53
344.87
775.96
741.48
213.37
488.50
461.02
213.37
488.50
461.02
340.83
758.46
730.51
131.50
287.46
280.46
92.94
205.99
58.16
123.38
-
462.79
1032.42
992.62
137.15
306.90
-
541.68
1205.24
-
688.02 213.37 474.65

1548.06 488.50 1059.56
1479.25 461.02 1018.23
134.98
302.89
-
Total
Premium
Govt
Pays
291.97
656.92
627.72
215.28
484.37
462.84
225.23
515.64
486.63
170.61
383.86
366.80
66.74
141.28
141.09
44.67
100.51
96.04
15.56
27.41
5.39
13.12
-
308.79
694.77
663.89
215.28
484.37
462.84
225.23
515.64
486.63
170.61
383.86
366.80
83.56
179.13
177.26
44.67
100.51
96.04
554.20
1246.96
1191.53
344.87
775.96
741.48
225.23
515.64
486.63
225.23
515.64
486.63
688.02
1548.06
1479.25
225.23
515.64
486.63
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium

AB4
281.14
Standard Self
AB5
625.55
AB6
Illinois Union Health Service
761
257.46
High Self
762
597.92
High Self & Family
763
High Self Plus One
Illinois UnitedHealthcare Insurance Company
L91
244.32
Basic Self
L92
543.61
Basic Self & Family
L93
Basic Self Plus One
Illinois UnitedHealthcare Plan of the River Valley Inc.
YH1
269.36
High Self
YH2
636.34
High Self & Family
YH3
High Self Plus One
Indiana Aetna Direct
N61
210.05
CDHP Self
N62
474.42
CDHP Self & Family
N63
CDHP Self Plus One
Indiana Aetna HealthFund CDHP and Value Plan
JS1
340.51
CDHP Self
JS2
773.27
CDHP Self & Family
JS3
CDHP Self Plus One
JS4
279.09
Basic Self
JS5
633.78
Basic Self & Family
JS6
Basic Self Plus One
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
281.14
625.55
-
361.84
814.15
777.95
213.37
488.50
461.02
148.47
325.65
316.93
69.34
148.67
-
6.40
51.92
-
257.46
597.92
-
275.92
685.76
603.48
206.94
488.50
452.61
68.98
197.26
150.87
4.62
47.78
-
44.14
123.76
86.20
-4.11
16.40
-
244.32
543.61
-
212.71
596.45
415.43
159.53
447.34
311.57
53.18
149.11
103.86
-7.90
13.21
-
225.23
515.64
446.03
62.94
292.40
116.78
9.62
135.78
-
269.36
636.34
-
288.17
808.04
562.81
213.37
488.50
422.11
74.80
319.54
140.70
7.45
131.77
-
218.45
550.93
479.08
173.12
436.61
379.67
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
403.55
919.90
910.79
301.31
687.86
681.04
225.23
515.64
486.63
225.23
515.64
486.63
178.32
404.26
424.16
76.08
172.22
194.41
53.85
110.71
13.03
18.16
-
340.51
773.27
279.09
633.78
-
403.55
919.90
910.79
301.31
687.86
681.04
213.37
488.50
461.02
213.37
488.50
461.02
190.18
431.40
449.77
87.94
199.36
220.02
51.68
106.70
10.86
14.15
-
Total
Premium
Govt
Pays
361.84
814.15
777.95
225.23
515.64
486.63
136.61
298.51
291.32
71.51
152.68
-
275.92
685.76
603.48
218.67
515.64
478.26
57.25
170.12
125.22
212.71
596.45
415.43
168.57
472.69
329.23
288.17
808.04
562.81
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Indiana Aetna HealthFund HDHP

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
0.42
161.75
-
341.84
796.84
-
351.45
994.51
738.04
213.37
488.50
461.02
138.08
506.01
277.02
-1.75
157.74
-
63.19
284.72
125.68
-11.25
87.32
-
290.48
677.12
-
288.42
800.36
605.69
213.37
488.50
454.27
75.05
311.86
151.42
-13.42
83.31
-
225.23
515.64
486.63
170.61
383.86
366.80
83.56
179.13
177.26
44.67
100.51
96.04
32.38
65.26
5.39
13.12
-
259.13
576.54
198.87
442.49
-
308.79
694.77
663.89
215.28
484.37
462.84
213.37
488.50
461.02
161.46
363.28
347.13
95.42
206.27
202.87
53.82
121.09
115.71
30.64
62.14
4.10
10.47
-
225.23
515.64
486.63
225.23
515.64
486.63
123.79
269.66
263.77
69.50
147.50
147.03
64.48
136.74
17.84
32.55
-
275.35
612.64
261.58
582.02
-
349.02
785.30
750.40
294.73
663.14
633.66
213.37
488.50
461.02
213.37
488.50
461.02
135.65
296.80
289.38
81.36
174.64
172.64
62.31
132.73
15.97
29.14
-
Total
Premium
Govt
Pays
240.15
529.73
519.34
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
351.45
994.51
738.04
225.23
515.64
486.63
126.22
478.87
251.41
288.42
800.36
605.69
225.23
515.64
480.01
308.79
694.77
663.89
215.28
484.37
462.84
349.02
785.30
750.40
294.73
663.14
633.66
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Indiana Humana Health Plan, Inc.

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
449.90
1001.04
275.35
612.65
-
554.20
1246.96
1191.53
344.87
775.96
741.48
213.37
488.50
461.02
213.37
488.50
461.02
340.83
758.46
730.51
131.50
287.46
280.46
92.94
205.99
58.16
123.38
-
33.98
68.11
12.57
20.71
-
275.35
612.64
261.58
582.02
-
318.52
716.67
684.83
289.46
651.30
622.35
213.37
488.50
461.02
213.37
488.48
461.02
105.15
228.17
223.81
76.09
162.82
161.33
31.81
64.10
10.70
17.32
-
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
87.45
197.12
219.07
51.40
117.97
115.66
26.54
47.90
3.19
8.48
-
276.95
628.94
244.12
554.39
-
312.68
712.76
705.70
247.72
568.54
557.39
213.37
488.50
461.02
185.79
426.41
418.04
99.31
224.26
244.68
61.93
142.13
139.35
24.37
43.89
0.90
3.53
-
Total
Premium
Govt
Pays
554.20
1246.96
1191.53
344.87
775.96
741.48
225.23
515.64
486.63
225.23
515.64
486.63
328.97
731.32
704.90
119.64
260.32
254.85
95.11
210.00
60.33
127.39
-
318.52
716.67
684.83
289.46
651.30
622.35
225.23
515.64
486.63
225.23
515.64
486.63
93.29
201.03
198.20
64.23
135.66
135.72
218.45
550.93
479.08
173.12
436.61
379.67
312.68
712.76
705.70
247.72
568.54
557.39
225.23
515.64
486.63
196.32
450.57
441.73
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Iowa Aetna HealthFund HDHP

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
0.42
161.75
-
341.84
796.84
-
351.45
994.51
738.04
213.37
488.50
461.02
138.08
506.01
277.02
-1.75
157.74
-
63.19
284.72
125.68
-11.25
87.32
-
290.48
677.12
-
288.42
800.36
605.69
213.37
488.50
454.27
75.05
311.86
151.42
-13.42
83.31
-
225.23
515.64
486.63
142.04
346.01
313.91
90.37
253.15
210.84
37.19
90.60
82.19
1.77
32.19
3.77
13.74
-
304.64
700.68
169.19
389.14
-
315.60
768.79
697.47
179.23
436.61
396.10
213.37
488.50
461.02
134.42
327.46
297.08
102.23
280.29
236.45
44.81
109.15
99.02
-0.40
28.18
2.51
11.87
-
225.23
515.64
480.83
225.23
515.64
466.14
111.84
428.16
125.90
101.55
399.33
122.05
-12.31
125.14
-8.86
128.19
-
340.19
782.74
326.45
750.86
-
337.07
943.80
606.73
326.78
914.97
588.19
213.37
488.50
455.05
213.37
488.50
441.14
123.70
455.30
151.68
113.41
426.47
147.05
-14.48
121.13
-11.03
124.18
-
Total
Premium
Govt
Pays
240.15
529.73
519.34
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
351.45
994.51
738.04
225.23
515.64
486.63
126.22
478.87
251.41
288.42
800.36
605.69
225.23
515.64
480.01
315.60
768.79
697.47
179.23
436.61
396.10
337.07
943.80
606.73
326.78
914.97
588.19
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
Govt
Pays
Iowa United Healthcare Insurance Company, Inc. (Choice HMO)

LJ1
New Plan 245.23
194.34
High Self
LJ2
New Plan 687.63
515.64
High Self & Family
LJ3
New Plan 478.94
379.56
High Self Plus One
Iowa United Healthcare Insurance Company, Inc. (HDHP Choice Plus)
N71
New Plan 236.63
187.53
HDHP Self
N72
New Plan 663.52
515.64
HDHP Self & Family
N73
New Plan 462.14
366.25
HDHP Self Plus One
Iowa UnitedHealthcare Plan of the River Valley Inc.
YH1
269.36
288.17
225.23
High Self
YH2
636.34
808.04
515.64
High Self & Family
YH3
562.81
446.03
High Self Plus One
Kansas Aetna Direct
N61
210.05
218.45
173.12
CDHP Self
N62
474.42
550.93
436.61
CDHP Self & Family
N63
479.08
379.67
CDHP Self Plus One
Kansas Aetna HealthFund CDHP and Value Plan
G51
289.47
321.78
225.23
CDHP Self
G52
657.36
733.96
515.64
CDHP Self & Family
G53
726.69
486.63
CDHP Self Plus One
G54
239.10
246.85
195.63
Basic Self
G55
542.96
565.39
448.07
Basic Self & Family
G56
554.30
439.28
Basic Self Plus One
Kansas Aetna HealthFund HDHP
224
226.86
240.15
190.32
HDHP Self
225
496.83
529.73
419.81
HDHP Self & Family
226
519.34
411.58
HDHP Self Plus One
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
50.89
171.99
99.38

183.92
488.50
359.21
61.31
199.13
119.73
New Plan
New Plan
New Plan
49.10
147.88
95.89

177.47
488.50
346.61
59.16
175.02
115.53
New Plan
New Plan
New Plan
62.94
292.40
116.78
9.62
135.78
-
269.36
636.34
-
288.17
808.04
562.81
213.37
488.50
422.11
74.80
319.54
140.70
7.45
131.77
-
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
96.55
218.32
240.06
51.22
117.32
115.02
23.12
40.68
4.00
10.09
-
289.47
657.36
239.10
542.96
-
321.78
733.96
726.69
246.85
565.39
554.30
213.37
488.50
461.02
185.14
424.04
415.73
108.41
245.46
265.67
61.71
141.35
138.57
20.95
36.67
1.94
5.61
-
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Kansas Aetna Open Access

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
244.44
574.46
261.53
614.60
-
289.24
683.26
676.50
281.30
664.00
657.43
213.37
488.50
461.02
210.98
488.50
461.02
75.87
194.76
215.48
70.32
175.50
196.41
14.76
51.15
4.94
9.47
-
12.21
28.62
5.39
13.12
-
233.21
518.89
198.87
442.49
-
280.80
631.82
603.74
215.28
484.37
462.84
210.60
473.87
452.81
161.46
363.28
347.13
70.20
157.95
150.93
53.82
121.09
115.71
11.90
28.23
4.10
10.47
-
449.96
1003.53
965.01
111.43
241.83
237.18
78.97
177.12
52.12
108.90
-
587.03
1306.13
275.35
612.65
-
675.19
1519.17
1451.64
336.66
757.47
723.81
213.37 461.82
488.50 1030.67
461.02 990.62
213.37 123.29
488.50 268.97
461.02 262.79
76.80
173.11
49.95
104.89
-
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
2.10
19.13
-
Total
Premium
Govt
Pays
289.24
683.26
676.50
281.30
664.00
657.43
225.23
515.64
486.63
222.93
515.64
486.63
64.01
167.62
189.87
58.37
148.36
170.80
15.73
54.16
6.72
13.48
-
280.80
631.82
603.74
215.28
484.37
462.84
222.53
500.72
478.46
170.61
383.86
366.80
58.27
131.10
125.28
44.67
100.51
96.04
675.19
1519.17
1451.64
336.66
757.47
723.81
225.23
515.64
486.63
225.23
515.64
486.63
218.45
550.93
479.08
173.12
436.61
379.67
54.61
137.73
119.77
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Kentucky Aetna HealthFund CDHP and Value Plan

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
276.95
628.94
244.12
554.39
-
312.68
712.76
705.70
247.72
568.54
557.39
213.37
488.50
461.02
185.79
426.41
418.04
99.31
224.26
244.68
61.93
142.13
139.35
24.37
43.89
0.90
3.53
-
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
53.05
119.36
114.05
6.99
16.88
-
233.21
518.89
-
255.65
575.21
549.65
191.74
431.41
412.24
63.91
143.80
137.41
5.61
14.08
-
123.79
269.66
263.77
69.50
147.50
147.03
64.48
136.74
17.84
32.55
-
275.35
612.64
261.58
582.02
-
349.02
785.30
750.40
294.73
663.14
633.66
213.37
488.50
461.02
213.37
488.50
461.02
135.65
296.80
289.38
81.36
174.64
172.64
62.31
132.73
15.97
29.14
-
Total
Premium
Govt
Pays
312.68
712.76
705.70
247.72
568.54
557.39
225.23
515.64
486.63
196.32
450.57
441.73
87.45
197.12
219.07
51.40
117.97
115.66
26.54
47.90
3.19
8.48
-
240.15
529.73
519.34
190.32
419.81
411.58
49.83
109.92
107.76
255.65
575.21
549.65
202.60
455.85
435.60
349.02
785.30
750.40
294.73
663.14
633.66
225.23
515.64
486.63
225.23
515.64
486.63
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
Govt
Pays
Kentucky Humana Health Plan, Inc.

MH1
275.35
318.52
225.23
High Self
MH2
612.64
716.67
515.64
High Self & Family
MH3
684.83
486.63
High Self Plus One
MH4
261.58
289.46
225.23
Standard Self
MH5
582.02
651.30
515.64
MH6
622.35
486.63
Kentucky Humana Health Plan, Inc.
MI1
275.35
315.02
225.23
High Self
MI2
612.65
708.79
515.64
High Self & Family
MI3
677.29
486.63
High Self Plus One
MI4
261.58
299.16
225.23
Standard Self
MI5
582.02
673.11
515.64
MI6
643.19
486.63
Kentucky United Healthcare Insurance Company, Inc. (Choice HMO)
LJ1
New Plan 245.23
194.34
High Self
LJ2
New Plan 687.63
515.64
High Self & Family
LJ3
New Plan 478.94
379.56
High Self Plus One
Kentucky United Healthcare Insurance Company, Inc. (HDHP Choice Plus)
N71
New Plan 236.63
187.53
HDHP Self
N72
New Plan 663.52
515.64
HDHP Self & Family
N73
New
Plan
462.14
366.25
HDHP Self Plus One
Louisiana Aetna Direct
N61
210.05
218.45
173.12
CDHP Self
N62
474.42
550.93
436.61
CDHP Self & Family
N63
479.08
379.67
CDHP Self Plus One
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
93.29
201.03
198.20
64.23
135.66
135.72
33.98
68.11
12.57
20.71
-
275.35
612.64
261.58
582.02
-
318.52
716.67
684.83
289.46
651.30
622.35
213.37
488.50
461.02
213.37
488.48
461.02
105.15
228.17
223.81
76.09
162.82
161.33
31.81
64.10
10.70
17.32
-
89.79
193.15
190.66
73.93
157.47
156.56
30.48
60.22
22.27
42.52
-
275.35
612.65
261.58
582.02
-
315.02
708.79
677.29
299.16
673.11
643.19
213.37
488.50
461.02
213.37
488.50
461.02
101.65
220.29
216.27
85.79
184.61
182.17
28.31
56.21
20.40
39.11
-
50.89
171.99
99.38

183.92
488.50
359.21
61.31
199.13
119.73
New Plan
New Plan
New Plan
49.10
147.88
95.89

177.47
488.50
346.61
59.16
175.02
115.53
New Plan
New Plan
New Plan
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
Louisiana Aetna HealthFund CDHP and Value Plan

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
225.23
515.64
486.63
198.63
454.84
445.92
73.65
165.83
188.09
52.01
119.09
116.76
17.68
27.85
3.92
9.88
-
272.01
617.70
243.50
552.96
-
298.88
681.47
674.72
250.64
573.93
562.68
213.37
488.50
461.02
187.98
430.45
422.01
85.51
192.97
213.70
62.66
143.48
140.67
15.51
23.84
1.79
5.24
-
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
225.23
515.64
486.63
225.23
515.64
486.63
88.84
191.02
188.62
72.83
155.48
154.67
29.53
58.09
23.89
46.58
-
275.35
612.65
247.81
551.39
-
314.07
706.66
675.25
298.06
671.12
641.30
213.37
488.50
461.02
213.37
488.50
461.02
100.70
218.16
214.23
84.69
182.62
180.28
27.36
54.08
22.74
44.77
-
225.23
515.64
486.63
209.67
471.76
450.79
71.50
152.00
151.34
54.90
123.52
118.03
20.14
37.72
8.68
20.67
-
260.05
578.61
234.05
520.76
-
296.73
667.64
637.97
264.57
595.28
568.82
213.37
488.50
461.02
198.43
446.46
426.62
83.36
179.14
176.95
66.14
148.82
142.20
18.35
34.49
7.63
18.63
-
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
Govt
Pays
Louisiana United Healthcare Insurance Company, Inc. (Choice HMO)

KK1
New Plan 245.00
194.16
High Self
KK2
New Plan 686.98
515.64
High Self & Family
KK3
New Plan 478.48
379.20
High Self Plus One
Louisiana United Healthcare Insurance Company, Inc. (HDHP Choice Plus)
LS1
New Plan 234.69
185.99
HDHP Self
LS2
New Plan 658.05
515.64
HDHP Self & Family
LS3
New Plan 458.33
363.23
HDHP Self Plus One
Maine Aetna Direct
N61
210.05
218.45
173.12
CDHP Self
N62
474.42
550.93
436.61
CDHP Self & Family
N63
479.08
379.67
CDHP Self Plus One
Maine Aetna HealthFund CDHP and Value Plan
EP1
296.95
353.14
225.23
CDHP Self
EP2
674.38
805.37
515.64
CDHP Self & Family
EP3
797.39
486.63
CDHP Self Plus One
EP4
236.69
243.00
192.58
Basic Self
EP5
537.52
556.47
441.00
Basic Self & Family
EP6
545.55
432.35
Basic Self Plus One
Maine Aetna HealthFund HDHP
224
226.86
240.15
190.32
HDHP Self
225
496.83
529.73
419.81
HDHP Self & Family
226
519.34
411.58
HDHP Self Plus One
Maryland Aetna Direct
N61
210.05
218.45
173.12
CDHP Self
N62
474.42
550.93
436.61
CDHP Self & Family
N63
479.08
379.67
CDHP Self Plus One
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
50.84
171.34
99.28

183.75
488.50
358.86
61.25
198.48
119.62
New Plan
New Plan
New Plan
48.70
142.41
95.10

176.02
488.50
343.75
58.67
169.55
114.58
New Plan
New Plan
New Plan
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
127.91
289.73
310.76
50.42
115.47
113.20
47.00
95.07
3.67
9.31
-
296.95
674.38
236.69
537.52
-
353.14
805.37
797.39
243.00
556.47
545.55
213.37
488.50
461.02
182.25
417.35
409.16
139.77
316.87
336.37
60.75
139.12
136.39
44.83
91.06
1.58
4.74
-
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Maryland Aetna HealthFund CDHP and Value Plan

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
272.01
617.70
243.50
552.96
-
298.88
681.47
674.72
250.64
573.93
562.68
213.37
488.50
461.02
187.98
430.45
422.01
85.51
192.97
213.70
62.66
143.48
140.67
15.51
23.84
1.79
5.24
-
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
217.62
479.96
499.12
57.26
128.89
126.36
6.88
3.71
4.75
11.47
-
426.78
955.97
265.88
594.52
-
442.85
995.60
985.75
275.96
621.16
608.98
213.37
488.50
461.02
206.97
465.87
456.74
229.48
507.10
524.73
68.99
155.29
152.24
4.71
-0.30
2.52
6.66
-
96.54
248.86
156.90
62.40
167.76
119.37
3.19
32.57
1.87
25.30
-
309.39
696.01
276.57
622.18
-
321.77
764.50
643.53
287.63
683.40
575.27
213.37
488.50
461.02
213.37
488.50
431.45
108.40
276.00
182.51
74.26
194.90
143.82
1.02
28.56
-0.30
21.29
-
Total
Premium
Govt
Pays
298.88
681.47
674.72
250.64
573.93
562.68
225.23
515.64
486.63
198.63
454.84
445.92
73.65
165.83
188.09
52.01
119.09
116.76
17.68
27.85
3.92
9.88
-
240.15
529.73
519.34
190.32
419.81
411.58
49.83
109.92
107.76
442.85
995.60
985.75
275.96
621.16
608.98
225.23
515.64
486.63
218.70
492.27
482.62
321.77
764.50
643.53
287.63
683.40
575.27
225.23
515.64
486.63
225.23
515.64
455.90
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
Govt
Pays
Maryland CareFirst BlueChoice

B61
267.85
273.21
216.52
HDHP Self
B62
597.46
649.15
514.45
HDHP Self & Family
B63
546.43
433.05
HDHP Self Plus One
Maryland Kaiser Foundation Health Plan Mid-Atlantic States
E31
279.94
285.48
225.23
High Self
E32
643.87
668.01
515.64
High Self & Family
E33
645.17
486.63
High Self Plus One
E34
181.53
214.96
170.36
Standard Self
E35
417.50
503.01
398.64
E36
485.80
385.00
Maryland M.D. IPA
JP1
314.55
295.87
225.23
High Self
JP2
725.30
829.62
515.64
High Self & Family
JP3
577.83
457.93
High Self Plus One
Maryland United Healthcare Insurance Company, Inc. (Choice HMO)
LR1
New Plan 245.13
194.27
High Self
LR2
New Plan 687.35
515.64
High Self & Family
LR3
New Plan 478.74
379.40
High Self Plus One
Maryland UnitedHealthcare Insurance Company
L91
244.32
212.71
168.57
Basic Self
L92
543.61
596.45
472.69
Basic Self & Family
L93
415.43
329.23
Basic Self Plus One
Massachusetts Aetna Direct
N61
210.05
218.45
173.12
CDHP Self
N62
474.42
550.93
436.61
CDHP Self & Family
N63
479.08
379.67
CDHP Self Plus One
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
56.69
134.70
113.38
3.79
16.70
-
267.85
597.46
-
273.21
649.15
546.43
204.91
486.86
409.82
68.30
162.29
136.61
1.34
12.93
-
60.25
152.37
158.54
44.60
104.37
100.80
-3.65
-11.78
8.75
21.91
-
279.94
643.87
181.53
417.50
-
285.48
668.01
645.17
214.96
503.01
485.80
213.37
488.50
461.02
161.22
377.26
364.35
72.11
179.51
184.15
53.74
125.75
121.45
-5.82
-15.79
8.36
21.38
-
70.64
313.98
119.90
-27.87
68.40
-
314.55
725.30
-
295.87
829.62
577.83
213.37
488.50
433.37
82.50
341.12
144.46
-30.04
64.39
-

183.85
488.50
359.06
61.28
198.85
119.68
New Plan
New Plan
New Plan
50.86
171.71
99.34
44.14
123.76
86.20
-4.11
16.40
-
244.32
543.61
-
212.71
596.45
415.43
159.53
447.34
311.57
53.18
149.11
103.86
-7.90
13.21
-
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
Massachusetts Aetna HealthFund CDHP and Value Plan

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
225.23
515.64
486.63
192.58
441.00
432.35
127.91
289.73
310.76
50.42
115.47
113.20
47.00
95.07
3.67
9.31
-
296.95
674.38
236.69
537.52
-
353.14
805.37
797.39
243.00
556.47
545.55
213.37
488.50
461.02
182.25
417.35
409.16
139.77
316.87
336.37
60.75
139.12
136.39
44.83
91.06
1.58
4.74
-
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
173.12
436.61
379.67
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
225.23
515.64
486.63
195.63
448.07
439.28
96.55
218.32
240.06
51.22
117.32
115.02
23.12
40.68
4.00
10.09
-
289.47
657.36
239.10
542.96
-
321.78
733.96
726.69
246.85
565.39
554.30
213.37
488.50
461.02
185.14
424.04
415.73
108.41
245.46
265.67
61.71
141.35
138.57
20.95
36.67
1.94
5.61
-
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
Health Management
Organizations (HMO)
Michigan Bluecare Network of MI

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

Category 1
2015 Total
2015 Total
Biweekly
Premium
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
316.70
722.04
-
327.06
798.66
752.38
213.37
488.50
461.02
113.69
310.16
291.36
-1.00
36.69
-
-4.23
-11.79
-
280.24
672.39
-
285.20
696.52
656.05
213.37
488.50
461.02
71.83
208.02
195.03
-6.40
-15.80
-
58.17
143.14
135.35
55.18
129.68
121.40
-36.02
-103.07
-18.84
-69.30
-
310.23
725.93
290.06
678.70
-
280.33
658.78
621.98
265.93
624.94
585.04
210.25
488.50
461.02
199.45
468.71
438.78
70.08
170.28
160.96
66.48
156.23
146.26
-38.14
-107.08
-21.57
-73.90
-
225.23
515.64
486.63
93.31
240.99
253.97
-4.07
-15.84
-
313.42
736.55
-
318.54
756.63
740.60
213.37
488.50
461.02
105.17
268.13
279.58
-6.24
-19.85
-
266.61
633.21
619.89
211.29
501.82
486.63
55.32
131.39
133.26
2.68
-15.24
-
266.53
626.35
-
266.61
633.21
619.89
199.96
474.91
461.02
66.65
158.30
158.87
0.02
-19.48
-
303.60
819.70
683.08
225.23
515.64
486.63
78.37
304.06
196.45
-1.55
73.64
-
295.96
710.14
-
303.60
819.70
683.08
213.37
488.50
461.02
90.23
331.20
222.06
-3.72
69.63
-
Total
Premium
Govt
Pays
316.70
722.04
-
327.06
798.66
752.38
225.23
515.64
486.63
101.83
283.02
265.75
1.17
40.70
-
280.24
672.39
-
285.20
696.52
656.05
225.23
515.64
486.63
59.97
180.88
169.42
310.23
725.93
290.06
678.70
-
280.33
658.78
621.98
265.93
624.94
585.04
222.16
515.64
486.63
210.75
495.26
463.64
313.42
736.55
-
318.54
756.63
740.60
266.53
626.35
295.96
710.14
-
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Michigan Priority Health

LE1
315.06
High Self
LE2
756.14
High Self & Family
LE3
High Self Plus One
LE4
267.98
Standard Self
LE5
643.14
LE6
Minnesota Aetna Direct
N61
210.05
CDHP Self
N62
474.42
CDHP Self & Family
N63
CDHP Self Plus One
Minnesota Aetna HealthFund CDHP and Value Plan
H41
276.95
CDHP Self
H42
628.94
CDHP Self & Family
H43
CDHP Self Plus One
H44
244.12
Basic Self
H45
554.39
Basic Self & Family
H46
Basic Self Plus One
Minnesota Aetna HealthFund HDHP
224
226.86
HDHP Self
225
496.83
HDHP Self & Family
226
HDHP Self Plus One
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
315.06
756.14
267.98
643.14
-
294.73
736.82
648.39
230.80
577.00
507.76
213.37
488.50
461.02
173.10
432.75
380.82
81.36
248.32
187.37
57.70
144.25
126.94
-31.69
-59.25
-9.29
-50.32
-
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
87.45
197.12
219.07
51.40
117.97
115.66
26.54
47.90
3.19
8.48
-
276.95
628.94
244.12
554.39
-
312.68
712.76
705.70
247.72
568.54
557.39
213.37
488.50
461.02
185.79
426.41
418.04
99.31
224.26
244.68
61.93
142.13
139.35
24.37
43.89
0.90
3.53
-
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
Total
Premium
Govt
Pays
294.73
736.82
648.39
230.80
577.00
507.76
225.23
515.64
486.63
182.91
457.27
402.40
69.50
221.18
161.76
47.89
119.73
105.36
-29.52
-55.24
-5.04
-43.69
-
218.45
550.93
479.08
173.12
436.61
379.67
45.33
114.32
99.41
312.68
712.76
705.70
247.72
568.54
557.39
225.23
515.64
486.63
196.32
450.57
441.73
240.15
529.73
519.34
190.32
419.81
411.58
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
Govt
Pays
Minnesota HealthPartners High and Standard Option

V31
304.64
315.60
225.23
High Self
V32
700.68
768.79
515.64
High Self & Family
V33
697.47
486.63
High Self Plus One
V34
169.19
179.23
142.04
Standard Self
V35
389.14
436.61
346.01
V36
396.10
313.91
Mississippi Aetna Direct
N61
210.05
218.45
173.12
CDHP Self
N62
474.42
550.93
436.61
CDHP Self & Family
N63
479.08
379.67
CDHP Self Plus One
Mississippi Aetna HealthFund CDHP and Value Plan
H41
276.95
312.68
225.23
CDHP Self
H42
628.94
712.76
515.64
CDHP Self & Family
H43
705.70
486.63
CDHP Self Plus One
H44
244.12
247.72
196.32
Basic Self
H45
554.39
568.54
450.57
Basic Self & Family
H46
557.39
441.73
Basic Self Plus One
Mississippi Aetna HealthFund HDHP
224
226.86
240.15
190.32
HDHP Self
225
496.83
529.73
419.81
HDHP Self & Family
226
519.34
411.58
HDHP Self Plus One
Mississippi United Healthcare Insurance Company, Inc. (Choice HMO)
KK1
New Plan 245.00
194.16
High Self
KK2
New Plan 686.98
515.64
High Self & Family
KK3
New Plan 478.48
379.20
High Self Plus One
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
90.37
253.15
210.84
37.19
90.60
82.19
1.77
32.19
3.77
13.74
-
304.64
700.68
169.19
389.14
-
315.60
768.79
697.47
179.23
436.61
396.10
213.37
488.50
461.02
134.42
327.46
297.08
102.23
280.29
236.45
44.81
109.15
99.02
-0.40
28.18
2.51
11.87
-
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
87.45
197.12
219.07
51.40
117.97
115.66
26.54
47.90
3.19
8.48
-
276.95
628.94
244.12
554.39
-
312.68
712.76
705.70
247.72
568.54
557.39
213.37
488.50
461.02
185.79
426.41
418.04
99.31
224.26
244.68
61.93
142.13
139.35
24.37
43.89
0.90
3.53
-
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-

183.75
488.50
358.86
61.25
198.48
119.62
New Plan
New Plan
New Plan
50.84
171.34
99.28
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
Govt
Pays
Mississippi United Healthcare Insurance Company, Inc. (HDHP Choice Plus)

LS1
New Plan 234.69
185.99
HDHP Self
LS2
New Plan 658.05
515.64
HDHP Self & Family
LS3
New Plan 458.33
363.23
HDHP Self Plus One
Missouri Aetna Direct
N61
210.05
218.45
173.12
CDHP Self
N62
474.42
550.93
436.61
CDHP Self & Family
N63
479.08
379.67
CDHP Self Plus One
Missouri Aetna HealthFund CDHP and Value Plan
G51
289.47
321.78
225.23
CDHP Self
G52
657.36
733.96
515.64
CDHP Self & Family
G53
726.69
486.63
CDHP Self Plus One
G54
239.10
246.85
195.63
Basic Self
G55
542.96
565.39
448.07
Basic Self & Family
G56
554.30
439.28
Basic Self Plus One
Missouri Aetna HealthFund HDHP
224
226.86
240.15
190.32
HDHP Self
225
496.83
529.73
419.81
HDHP Self & Family
226
519.34
411.58
HDHP Self Plus One
Missouri Aetna Open Access
HA1
244.44
289.24
225.23
High Self
HA2
574.46
683.26
515.64
High Self & Family
HA3
676.50
486.63
High Self Plus One
HA4
261.53
281.30
222.93
Standard Self
HA5
614.60
664.00
515.64
HA6
657.43
486.63
Change in
Empl. Pays
empl.
payment
48.70
142.41
95.10
Biweekly
Premium

Rates Category 2
Total
Premium

Govt
Pays
Empl.
Pays
Change in
empl.
payment
176.02
488.50
343.75
58.67
169.55
114.58
New Plan
New Plan
New Plan
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
96.55
218.32
240.06
51.22
117.32
115.02
23.12
40.68
4.00
10.09
-
289.47
657.36
239.10
542.96
-
321.78
733.96
726.69
246.85
565.39
554.30
213.37
488.50
461.02
185.14
424.04
415.73
108.41
245.46
265.67
61.71
141.35
138.57
20.95
36.67
1.94
5.61
-
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
64.01
167.62
189.87
58.37
148.36
170.80
15.73
54.16
6.72
13.48
-
244.44
574.46
261.53
614.60
-
289.24
683.26
676.50
281.30
664.00
657.43
213.37
488.50
461.02
210.98
488.50
461.02
75.87
194.76
215.48
70.32
175.50
196.41
14.76
51.15
4.94
9.47
-
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Missouri Blue Preferred Plus POS

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
401.19
802.39
-
311.98
665.10
623.97
213.37
488.50
461.02
98.61
176.60
162.95
-100.57
-177.22
-
12.21
28.62
5.39
13.12
-
233.21
518.89
198.87
442.49
-
280.80
631.82
603.74
215.28
484.37
462.84
210.60
473.87
452.81
161.46
363.28
347.13
70.20
157.95
150.93
53.82
121.09
115.71
11.90
28.23
4.10
10.47
-
449.96
1003.53
965.01
111.43
241.83
237.18
78.97
177.12
52.12
108.90
-
587.03
1306.13
275.35
612.65
-
675.19
1519.17
1451.64
336.66
757.47
723.81
213.37 461.82
488.50 1030.67
461.02 990.62
213.37 123.29
488.50 268.97
461.02 262.79
76.80
173.11
49.95
104.89
-
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
2.10
19.13
-
Total
Premium
Govt
Pays
311.98
665.10
623.97
225.23
515.64
486.63
86.75
149.46
137.34
-98.40
-173.21
-
280.80
631.82
603.74
215.28
484.37
462.84
222.53
500.72
478.46
170.61
383.86
366.80
58.27
131.10
125.28
44.67
100.51
96.04
675.19
1519.17
1451.64
336.66
757.47
723.81
225.23
515.64
486.63
225.23
515.64
486.63
218.45
550.93
479.08
173.12
436.61
379.67
54.61
137.73
119.77
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Montana Aetna HealthFund CDHP and Value Plan

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
276.95
628.94
244.12
554.39
-
312.68
712.76
705.70
247.72
568.54
557.39
213.37
488.50
461.02
185.79
426.41
418.04
99.31
224.26
244.68
61.93
142.13
139.35
24.37
43.89
0.90
3.53
-
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
225.23
515.64
486.63
196.32
450.57
441.73
87.45
197.12
219.07
51.40
117.97
115.66
26.54
47.90
3.19
8.48
-
276.95
628.94
244.12
554.39
-
312.68
712.76
705.70
247.72
568.54
557.39
213.37
488.50
461.02
185.79
426.41
418.04
99.31
224.26
244.68
61.93
142.13
139.35
24.37
43.89
0.90
3.53
-
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
Total
Premium
Govt
Pays
312.68
712.76
705.70
247.72
568.54
557.39
225.23
515.64
486.63
196.32
450.57
441.73
87.45
197.12
219.07
51.40
117.97
115.66
26.54
47.90
3.19
8.48
-
240.15
529.73
519.34
190.32
419.81
411.58
49.83
109.92
107.76
218.45
550.93
479.08
173.12
436.61
379.67
312.68
712.76
705.70
247.72
568.54
557.39
240.15
529.73
519.34
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Nevada Aetna Direct

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
23.12
40.68
4.00
10.09
-
289.47
657.36
239.10
542.96
-
321.78
733.96
726.69
246.85
565.39
554.30
213.37
488.50
461.02
185.14
424.04
415.73
108.41
245.46
265.67
61.71
141.35
138.57
20.95
36.67
1.94
5.61
-
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
185.07
438.63
351.65
48.46
114.85
92.07
7.57
18.44
-
207.02
488.17
-
233.53
553.48
443.72
175.15
415.11
332.79
58.38
138.37
110.93
6.63
16.33
-
173.12
436.61
379.67
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
Total
Premium
Govt
Pays
218.45
550.93
479.08
173.12
436.61
379.67
45.33
114.32
99.41
3.85
20.62
-
321.78
733.96
726.69
246.85
565.39
554.30
225.23
515.64
486.63
195.63
448.07
439.28
96.55
218.32
240.06
51.22
117.32
115.02
240.15
529.73
519.34
190.32
419.81
411.58
233.53
553.48
443.72
218.45
550.93
479.08
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
New Hampshire Aetna HealthFund CDHP and Value Plan

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
225.23
515.64
486.63
192.58
441.00
432.35
127.91
289.73
310.76
50.42
115.47
113.20
47.00
95.07
3.67
9.31
-
296.95
674.38
236.69
537.52
-
353.14
805.37
797.39
243.00
556.47
545.55
213.37
488.50
461.02
182.25
417.35
409.16
139.77
316.87
336.37
60.75
139.12
136.39
44.83
91.06
1.58
4.74
-
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
173.12
436.61
379.67
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
225.23
515.64
486.63
192.58
441.00
432.35
127.91
289.73
310.76
50.42
115.47
113.20
47.00
95.07
3.67
9.31
-
296.95
674.38
236.69
537.52
-
353.14
805.37
797.39
243.00
556.47
545.55
213.37
488.50
461.02
182.25
417.35
409.16
139.77
316.87
336.37
60.75
139.12
136.39
44.83
91.06
1.58
4.74
-
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
New Jersey Aetna Open Access

High Self
High Self & Family
High Self Plus One
Basic Self
Basic Self & Family
Basic Self Plus One
New Jersey Aetna Open Access
High Self
High Self & Family
High Self Plus One
Basic Self
Basic Self & Family
Basic Self Plus One
New Jersey GHI Health Plan
High Self
High Self & Family
High Self Plus One
Standard Self
New Mexico Aetna Direct
CDHP Self
CDHP Self & Family
CDHP Self Plus One
Biweekly
Premium
Total
Premium
Govt
Pays
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
JR1
JR2
JR3
JR4
JR5
JR6
534.78
1230.15
394.52
910.70
-
633.17
1462.59
1448.11
502.07
1163.56
1152.04
225.23
515.64
486.63
225.23
515.64
486.63
407.94
946.95
961.48
276.84
647.92
665.41
89.20
196.52
98.36
216.94
-
534.78
1230.15
394.52
910.70
-
633.17
1462.59
1448.11
502.07
1163.56
1152.04
213.37
488.50
461.02
213.37
488.50
461.02
419.80
974.09
987.09
288.70
675.06
691.02
87.03
192.51
96.19
212.93
-
P31
P32
P33
P34
P35
P36
557.69
1345.62
483.10
1115.54
-
631.25
1530.47
1515.32
508.42
1180.07
1168.39
225.23
515.64
486.63
225.23
515.64
486.63
406.02
1014.83
1028.69
283.19
664.43
681.76
64.37
148.93
16.13
28.61
-
557.69
1345.62
483.10
1115.54
-
631.25
1530.47
1515.32
508.42
1180.07
1168.39
213.37 417.88
488.50 1041.97
461.02 1054.30
213.37 295.05
488.50 691.57
461.02 707.37
62.20
144.92
13.96
24.60
-
801
802
803
804
805
806
359.25
898.21
270.09
613.31
-
393.81
1163.42
754.55
303.85
822.81
499.88
225.23
515.64
486.63
225.23
515.64
396.15
168.58
647.78
267.92
78.62
307.17
103.73
25.37
229.29
24.57
173.58
-
359.25
898.21
270.09
613.31
-
393.81
1163.42
754.55
303.85
822.81
499.88
213.37
488.50
461.02
213.37
488.50
374.91
180.44
674.92
293.53
90.48
334.31
124.97
23.20
225.28
22.40
169.57
-
N61
N62
N63
210.05
474.42
-
218.45
550.93
479.08
173.12
436.61
379.67
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
New Mexico Aetna HealthFund CDHP and Value Plan

G51
289.47
CDHP Self
G52
657.36
CDHP Self & Family
G53
CDHP Self Plus One
G54
239.10
Basic Self
G55
542.96
Basic Self & Family
G56
Basic Self Plus One
New Mexico Aetna HealthFund HDHP
224
226.86
HDHP Self
225
496.83
HDHP Self & Family
226
HDHP Self Plus One
New Mexico New Mexico BlueHMO Preferred
Q11
277.36
High Self
Q12
651.81
High Self & Family
Q13
High Self Plus One
New Mexico Presbyterian Health Plan
P21
317.02
High Self
P22
719.98
High Self & Family
P23
High Self Plus One
New Mexico Presbyterian Health Plan
PS4
New Plan
Standard Self
PS5
New Plan
PS6
New Plan
New York Aetna Direct
N61
210.05
CDHP Self
N62
474.42
CDHP Self & Family
N63
CDHP Self Plus One
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
289.47
657.36
239.10
542.96
-
321.78
733.96
726.69
246.85
565.39
554.30
213.37
488.50
461.02
185.14
424.04
415.73
108.41
245.46
265.67
61.71
141.35
138.57
20.95
36.67
1.94
5.61
-
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
98.43
282.49
209.22
37.11
110.40
-
277.36
651.81
-
323.66
798.13
695.85
213.37
488.50
461.02
110.29
309.63
234.83
34.94
106.39
-
225.23
515.64
486.63
88.53
221.70
225.61
-12.45
-18.56
-
317.02
719.98
-
313.76
737.34
712.24
213.37
488.50
461.02
100.39
248.84
251.22
-14.62
-22.57
-
266.31
625.82
604.52
211.05
495.96
479.08
55.26
129.86
125.44

199.73
469.37
453.39
66.58
156.45
151.13
New Plan
New Plan
New Plan
218.45
550.93
479.08
173.12
436.61
379.67
45.33
114.32
99.41
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
Total
Premium
Govt
Pays
321.78
733.96
726.69
246.85
565.39
554.30
225.23
515.64
486.63
195.63
448.07
439.28
96.55
218.32
240.06
51.22
117.32
115.02
23.12
40.68
4.00
10.09
-
240.15
529.73
519.34
190.32
419.81
411.58
49.83
109.92
107.76
323.66
798.13
695.85
225.23
515.64
486.63
313.76
737.34
712.24
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
New York Aetna HealthFund CDHP and Value Plan

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
296.95
674.38
236.69
537.52
-
353.14
805.37
797.39
243.00
556.47
545.55
213.37
488.50
461.02
182.25
417.35
409.16
139.77
316.87
336.37
60.75
139.12
136.39
44.83
91.06
1.58
4.74
-
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
254.99
671.01
688.27
121.07
329.05
349.70
53.78
123.63
13.69
22.91
-
417.25
1027.10
323.42
785.86
-
480.22
1186.65
1174.90
346.30
844.69
836.33
213.37
488.50
461.02
213.37
488.50
461.02
266.85
698.15
713.88
132.93
356.19
375.31
51.61
119.62
11.52
18.90
-
120.69
522.11
205.22
50.74
217.93
101.48
18.99
197.12
2.89
102.28
-
317.74
804.71
242.27
585.56
-
345.92
1037.75
691.85
244.54
733.57
489.06
213.37
488.50
461.02
183.41
488.50
366.80
132.55
549.25
230.83
61.13
245.07
122.26
16.82
193.11
0.56
98.68
-
Total
Premium
Govt
Pays
353.14
805.37
797.39
243.00
556.47
545.55
225.23
515.64
486.63
192.58
441.00
432.35
127.91
289.73
310.76
50.42
115.47
113.20
47.00
95.07
3.67
9.31
-
240.15
529.73
519.34
190.32
419.81
411.58
49.83
109.92
107.76
480.22
1186.65
1174.90
346.30
844.69
836.33
225.23
515.64
486.63
225.23
515.64
486.63
345.92
1037.75
691.85
244.54
733.57
489.06
225.23
515.64
486.63
193.80
515.64
387.58
Health Management
Organizations (HMO)
New York GHI Health Plan

801
High Self
802
High Self & Family
803
High Self Plus One
804
Standard Self
805
806
New York HIP Health of Greater New York
511
High Self
512
High Self & Family
513
High Self Plus One
New York Independent Health Assoc
QA1
High Self
QA2
High Self & Family
QA3
High Self Plus One
QA4
HDHP Self
QA5
HDHP Self & Family
QA6
HDHP Self Plus One
New York Independent Health Association
C54
Standard Self
C55
C56

Category 1
2015 Total
2015 Total
Biweekly
Premium
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
359.25
898.21
270.09
613.31
-
393.81
1163.42
754.55
303.85
822.81
499.88
213.37
488.50
461.02
213.37
488.50
374.91
180.44
674.92
293.53
90.48
334.31
124.97
23.20
225.28
22.40
169.57
-
-0.79
52.44
-
294.68
780.92
-
303.08
869.28
537.96
213.37
488.50
403.47
89.71
380.78
134.49
-2.96
48.43
-
60.96
257.06
243.14
43.00
113.96
105.32
-20.69
22.34
0.95
12.82
-
297.69
714.44
212.93
512.09
-
286.19
772.70
729.77
207.21
549.19
507.55
213.37
488.50
461.02
155.41
411.89
380.66
72.82
284.20
268.75
51.80
137.30
126.89
-22.86
18.33
-1.43
9.28
-
56.89
224.58
212.47
-20.18
0.83
-
293.11
703.47
-
274.15
740.22
699.10
205.61
488.50
461.02
68.54
251.72
238.08
-22.56
-3.18
-
Total
Premium
Govt
Pays
359.25
898.21
270.09
613.31
-
393.81
1163.42
754.55
303.85
822.81
499.88
225.23
515.64
486.63
225.23
515.64
396.15
168.58
647.78
267.92
78.62
307.17
103.73
25.37
229.29
24.57
173.58
-
294.68
780.92
-
303.08
869.28
537.96
225.23
515.64
426.33
77.85
353.64
111.63
297.69
714.44
212.93
512.09
-
286.19
772.70
729.77
207.21
549.19
507.55
225.23
515.64
486.63
164.21
435.23
402.23
293.11
703.47
-
274.15
740.22
699.10
217.26
515.64
486.63
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
New York MVP Health Care

High Self
High Self & Family
High Self Plus One
Standard Self
High Self
High Self & Family
High Self Plus One
Standard Self
High Self
High Self & Family
High Self Plus One
Standard Self
Biweekly
Premium
Total
Premium
Govt
Pays
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
GA1
GA2
GA3
GA4
GA5
GA6
299.86
751.24
278.81
700.50
-
313.35
768.85
721.34
285.99
699.39
661.51
225.23
515.64
486.63
225.23
515.64
486.63
88.12
253.21
234.71
60.76
183.75
174.88
4.30
-18.31
-2.01
-37.03
-
299.86
751.24
278.81
700.50
-
313.35
768.85
721.34
285.99
699.39
661.51
213.37
488.50
461.02
213.37
488.50
461.02
99.98
280.35
260.32
72.62
210.89
200.49
2.13
-22.32
-4.18
-41.04
-
GV1
GV2
GV3
GV4
GV5
GV6
276.62
692.22
247.83
620.16
-
293.39
719.54
674.84
259.58
636.58
597.03
225.23
515.64
486.63
205.72
504.49
473.15
68.16
203.90
188.21
53.86
132.09
123.88
7.58
-8.60
4.91
-8.35
-
276.62
692.22
247.83
620.16
-
293.39
719.54
674.84
259.58
636.58
597.03
213.37
488.50
461.02
194.69
477.44
447.77
80.02
231.04
213.82
64.89
159.14
149.26
5.41
-12.61
2.93
-12.45
-
M91
M92
M93
M94
M95
M96
297.43
745.43
279.45
698.02
-
311.50
764.42
718.85
296.13
727.26
682.74
225.23
515.64
486.63
225.23
515.64
486.63
86.27
248.78
232.22
70.90
211.62
196.11
4.88
-16.93
7.49
-6.68
-
297.43
745.43
279.45
698.02
-
311.50
764.42
718.85
296.13
727.26
682.74
213.37
488.50
461.02
213.37
488.50
461.02
98.13
275.92
257.83
82.76
238.76
221.72
2.71
-20.94
5.32
-10.69
-
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
225.23
515.64
486.63
225.23
515.64
486.63
131.29
358.70
333.38
118.79
328.03
304.60
8.50
-9.48
12.24
0.50
-
338.83
847.90
322.59
807.25
-
356.52
874.34
820.01
344.02
843.67
791.23
213.37
488.50
461.02
213.37
488.50
461.02
143.15
385.84
358.99
130.65
355.17
330.21
6.33
-13.49
10.07
-3.51
-
225.23
515.64
486.63
225.23
515.64
486.63
107.48
300.04
277.99
90.86
259.50
243.69
19.21
18.50
20.06
19.72
-
304.31
761.26
286.84
719.50
-
332.71
815.68
764.62
316.09
775.14
730.32
213.37
488.50
461.02
213.37
488.50
461.02
119.34
327.18
303.60
102.72
286.64
269.30
17.04
14.49
17.89
15.71
-
173.12
436.61
379.67
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
225.23
515.64
486.63
198.63
454.84
445.92
73.65
165.83
188.09
52.01
119.09
116.76
17.68
27.85
3.92
9.88
-
272.01
617.70
243.50
552.96
-
298.88
681.47
674.72
250.64
573.93
562.68
213.37
488.50
461.02
187.98
430.45
422.01
85.51
192.97
213.70
62.66
143.48
140.67
15.51
23.84
1.79
5.24
-
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
North Carolina Aetna HealthFund HDHP

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
173.12
436.61
379.67
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
225.23
515.64
486.63
196.32
450.57
441.73
87.45
197.12
219.07
51.40
117.97
115.66
26.54
47.90
3.19
8.48
-
276.95
628.94
244.12
554.39
-
312.68
712.76
705.70
247.72
568.54
557.39
213.37
488.50
461.02
185.79
426.41
418.04
99.31
224.26
244.68
61.93
142.13
139.35
24.37
43.89
0.90
3.53
-
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
225.23
515.64
486.63
142.04
346.01
313.91
90.37
253.15
210.84
37.19
90.60
82.19
1.77
32.19
3.77
13.74
-
304.64
700.68
169.19
389.14
-
315.60
768.79
697.47
179.23
436.61
396.10
213.37
488.50
461.02
134.42
327.46
297.08
102.23
280.29
236.45
44.81
109.15
99.02
-0.40
28.18
2.51
11.87
-
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
North Dakota Sanford Health Plan

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
329.47
757.79
293.11
728.73
-
399.12
1117.54
718.42
370.96
1038.68
667.72
213.37
488.50
461.02
213.37
488.50
461.02
185.75
629.04
257.40
157.59
550.18
206.70
58.29
319.82
66.49
270.02
-
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
178.32
404.26
424.16
76.08
172.22
194.41
53.85
110.71
13.03
18.16
-
340.51
773.27
279.09
633.78
-
403.55
919.90
910.79
301.31
687.86
681.04
213.37
488.50
461.02
213.37
488.50
461.02
190.18
431.40
449.77
87.94
199.36
220.02
51.68
106.70
10.86
14.15
-
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
Total
Premium
Govt
Pays
399.12
1117.54
718.42
370.96
1038.68
667.72
225.23
515.64
486.63
225.23
515.64
486.63
173.89
601.90
231.79
145.73
523.04
181.09
60.46
323.83
68.66
274.03
-
218.45
550.93
479.08
173.12
436.61
379.67
45.33
114.32
99.41
403.55
919.90
910.79
301.31
687.86
681.04
225.23
515.64
486.63
225.23
515.64
486.63
240.15
529.73
519.34
190.32
419.81
411.58
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Ohio AultCare HMO

High Self
High Self & Family
High Self Plus One
HDHP Self
HDHP Self & Family
HDHP Self Plus One
Ohio HealthSpan Integrated Care
High Self
High Self & Family
High Self Plus One
Standard Self
Ohio Humana Health Plan of Ohio
High Self
High Self & Family
High Self Plus One
Standard Self
Ohio Paramount Health Care
High Self
High Self & Family
High Self Plus One
Biweekly
Premium
Total
Premium
Govt
Pays
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
3A1
3A2
3A3
3A4
3A5
3A6
275.30
675.85
164.36
331.83
-
317.69
1016.58
603.60
145.49
465.52
276.41
225.23
515.64
478.35
115.30
368.92
219.05
92.46
500.94
125.25
30.19
96.60
57.36
33.20
304.81
-2.27
31.06
-
275.30
675.85
164.36
331.83
-
317.69
1016.58
603.60
145.49
465.52
276.41
213.37
488.50
452.70
109.12
349.14
207.31
104.32
528.08
150.90
36.37
116.38
69.10
31.03
300.80
-4.72
33.42
-
641
642
643
644
645
646
340.53
783.22
249.82
574.57
-
364.04
873.69
800.89
265.94
638.26
585.06
225.23
515.64
486.63
210.76
505.82
463.66
138.81
358.05
314.26
55.18
132.44
121.40
14.32
54.55
5.84
18.96
-
340.53
783.22
249.82
574.57
-
364.04
873.69
800.89
265.94
638.26
585.06
213.37
488.50
461.02
199.46
478.70
438.80
150.67
385.19
339.87
66.48
159.56
146.26
12.15
50.54
4.03
15.92
-
A61
A62
A63
A64
A65
A66
275.35
612.64
261.58
582.02
-
349.02
785.30
750.40
294.73
663.14
633.66
225.23
515.64
486.63
225.23
515.64
486.63
123.79
269.66
263.77
69.50
147.50
147.03
64.48
136.74
17.84
32.55
-
275.35
612.64
261.58
582.02
-
349.02
785.30
750.40
294.73
663.14
633.66
213.37
488.50
461.02
213.37
488.50
461.02
135.65
296.80
289.38
81.36
174.64
172.64
62.31
132.73
15.97
29.14
-
N81
N82
N83
New Plan
New Plan
New Plan
267.45
703.39
534.90
211.95
515.64
423.91
55.50
187.75
110.99

200.59
488.50
401.18
66.86
214.89
133.72
New Plan
New Plan
New Plan
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Oklahoma Aetna Direct

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
53.85
110.71
13.03
18.16
-
340.51
773.27
279.09
633.78
-
403.55
919.90
910.79
301.31
687.86
681.04
213.37
488.50
461.02
213.37
488.50
461.02
190.18
431.40
449.77
87.94
199.36
220.02
51.68
106.70
10.86
14.15
-
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
218.99
515.64
437.99
57.34
175.20
114.68
7.61
48.04
-
251.82
606.88
-
276.33
690.84
552.67
207.25
488.50
414.50
69.08
202.34
138.17
6.13
44.03
-
173.12
436.61
379.67
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
Total
Premium
Govt
Pays
218.45
550.93
479.08
173.12
436.61
379.67
45.33
114.32
99.41
3.85
20.62
-
403.55
919.90
910.79
301.31
687.86
681.04
225.23
515.64
486.63
225.23
515.64
486.63
178.32
404.26
424.16
76.08
172.22
194.41
240.15
529.73
519.34
190.32
419.81
411.58
276.33
690.84
552.67
218.45
550.93
479.08
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Oregon Aetna HealthFund CDHP and Value Plan

H41
276.95
CDHP Self
H42
628.94
CDHP Self & Family
H43
CDHP Self Plus One
H44
244.12
Basic Self
H45
554.39
Basic Self & Family
H46
Basic Self Plus One
Oregon Aetna HealthFund HDHP
224
226.86
HDHP Self
225
496.83
HDHP Self & Family
226
HDHP Self Plus One
Oregon Kaiser Foundation Health Plan of Northwest
571
288.33
High Self
572
651.28
High Self & Family
573
High Self Plus One
574
243.47
Standard Self
575
570.13
576
Pennsylvania Aetna Direct
N61
210.05
CDHP Self
N62
474.42
CDHP Self & Family
N63
CDHP Self Plus One
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
276.95
628.94
244.12
554.39
-
312.68
712.76
705.70
247.72
568.54
557.39
213.37
488.50
461.02
185.79
426.41
418.04
99.31
224.26
244.68
61.93
142.13
139.35
24.37
43.89
0.90
3.53
-
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
73.71
159.57
188.58
54.20
124.52
124.52
1.42
-11.99
6.11
11.92
-
288.33
651.28
243.47
570.13
-
298.94
675.21
675.21
261.22
600.10
600.10
213.37
488.50
461.02
195.92
450.08
450.08
85.57
186.71
214.19
65.30
150.02
150.02
-0.75
-16.00
4.43
7.49
-
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
Total
Premium
Govt
Pays
312.68
712.76
705.70
247.72
568.54
557.39
225.23
515.64
486.63
196.32
450.57
441.73
87.45
197.12
219.07
51.40
117.97
115.66
26.54
47.90
3.19
8.48
-
240.15
529.73
519.34
190.32
419.81
411.58
49.83
109.92
107.76
298.94
675.21
675.21
261.22
600.10
600.10
225.23
515.64
486.63
207.02
475.58
475.58
218.45
550.93
479.08
173.12
436.61
379.67
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Pennsylvania Aetna HealthFund CDHP and Value Plan

H41
276.95
CDHP Self
H42
628.94
CDHP Self & Family
H43
CDHP Self Plus One
H44
244.12
Basic Self
H45
554.39
Basic Self & Family
H46
Basic Self Plus One
Pennsylvania Aetna HealthFund HDHP
224
226.86
HDHP Self
225
496.83
HDHP Self & Family
226
HDHP Self Plus One
Pennsylvania Aetna Open Access
P31
557.69
High Self
P32
1345.62
High Self & Family
P33
High Self Plus One
P34
483.10
Basic Self
P35
1115.54
Basic Self & Family
P36
Basic Self Plus One
Pennsylvania Aetna Open Access
YE1
320.33
High Self
YE2
801.24
High Self & Family
YE3
High Self Plus One
Pennsylvania Geisinger Health Plan
GG4
292.09
Standard Self
GG5
671.81
GG6
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
276.95
628.94
244.12
554.39
-
312.68
712.76
705.70
247.72
568.54
557.39
213.37
488.50
461.02
185.79
426.41
418.04
99.31
224.26
244.68
61.93
142.13
139.35
24.37
43.89
0.90
3.53
-
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
406.02
1014.83
1028.69
283.19
664.43
681.76
64.37
148.93
16.13
28.61
-
557.69
1345.62
483.10
1115.54
-
631.25
1530.47
1515.32
508.42
1180.07
1168.39
213.37 417.88
488.50 1041.97
461.02 1054.30
213.37 295.05
488.50 691.57
461.02 707.37
62.20
144.92
13.96
24.60
-
225.23
515.64
486.63
102.39
307.01
327.89
-1.90
-14.51
-
320.33
801.24
-
327.62
822.65
814.52
213.37
488.50
461.02
114.25
334.15
353.50
-4.07
-18.52
-
225.23
515.64
486.63
74.02
172.65
201.66
-2.03
-19.44
-
292.09
671.81
-
299.25
688.29
688.29
213.37
488.50
461.02
85.88
199.79
227.27
-4.20
-23.45
-
Total
Premium
Govt
Pays
312.68
712.76
705.70
247.72
568.54
557.39
225.23
515.64
486.63
196.32
450.57
441.73
87.45
197.12
219.07
51.40
117.97
115.66
26.54
47.90
3.19
8.48
-
240.15
529.73
519.34
190.32
419.81
411.58
49.83
109.92
107.76
631.25
1530.47
1515.32
508.42
1180.07
1168.39
225.23
515.64
486.63
225.23
515.64
486.63
327.62
822.65
814.52
299.25
688.29
688.29
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Pennsylvania Keystone Health Plan West

NP1
204.93
High Self
NP2
479.54
High Self & Family
NP3
High Self Plus One
Pennsylvania UPMC Health Plan
8W1
305.67
High Self
8W2
703.01
High Self & Family
8W3
High Self Plus One
8W4
229.55
HDHP Self
8W5
518.14
HDHP Self & Family
8W6
HDHP Self Plus One
Pennsylvania UPMC Health Plan
UW4
250.98
Standard Self
UW5
577.28
UW6
Puerto Rico Humana Health Plans of Puerto Rico, Inc.
ZJ1
151.99
High Self
ZJ2
338.17
High Self & Family
ZJ3
High Self Plus One
Puerto Rico Triple-S Salud, Inc.
891
179.99
High Self
892
412.18
High Self & Family
893
High Self Plus One
Rhode Island Aetna Direct
N61
210.05
CDHP Self
N62
474.42
CDHP Self & Family
N63
CDHP Self Plus One
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
204.93
479.54
-
252.23
572.17
474.68
189.17
429.13
356.01
63.06
143.04
118.67
11.83
23.16
-
41.49
98.46
3.79
10.93
-
305.67
703.01
229.55
518.14
-
356.35
837.39
801.78
236.77
545.81
524.87
213.37
488.50
461.02
177.58
409.36
393.65
142.98
348.89
340.76
59.19
136.45
131.22
39.32
94.45
1.80
6.92
-
55.51
130.43
124.88
5.94
16.42
-
250.98
577.28
-
267.50
628.58
601.85
200.63
471.44
451.39
66.87
157.14
150.46
4.13
12.82
-
128.25
288.58
275.75
33.58
75.56
72.20
3.56
8.77
-
151.99
338.17
-
161.83
364.14
347.95
121.37
273.11
260.96
40.46
91.03
86.99
2.46
6.49
-
179.99
412.18
404.14
142.64
326.65
320.28
37.35
85.53
83.86
1.80
4.12
-
179.99
412.18
-
179.99
412.18
404.14
134.99
309.14
303.11
45.00
103.04
101.03
0.00
0.00
-
218.45
550.93
479.08
173.12
436.61
379.67
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
Total
Premium
Govt
Pays
252.23
572.17
474.68
199.89
453.44
376.18
52.34
118.73
98.50
11.87
24.02
-
356.35
837.39
801.78
236.77
545.81
524.87
225.23
515.64
486.63
187.64
432.55
415.96
131.12
321.75
315.15
49.13
113.26
108.91
267.50
628.58
601.85
211.99
498.15
476.97
161.83
364.14
347.95
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
Rhode Island Aetna HealthFund CDHP and Value Plan

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
225.23
515.64
486.63
192.58
441.00
432.35
127.91
289.73
310.76
50.42
115.47
113.20
47.00
95.07
3.67
9.31
-
296.95
674.38
236.69
537.52
-
353.14
805.37
797.39
243.00
556.47
545.55
213.37
488.50
461.02
182.25
417.35
409.16
139.77
316.87
336.37
60.75
139.12
136.39
44.83
91.06
1.58
4.74
-
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
173.12
436.61
379.67
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
225.23
515.64
486.63
225.23
515.64
486.63
178.32
404.26
424.16
76.08
172.22
194.41
53.85
110.71
13.03
18.16
-
340.51
773.27
279.09
633.78
-
403.55
919.90
910.79
301.31
687.86
681.04
213.37
488.50
461.02
213.37
488.50
461.02
190.18
431.40
449.77
87.94
199.36
220.02
51.68
106.70
10.86
14.15
-
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
South Dakota Aetna Direct

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
173.12
436.61
379.67
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
225.23
515.64
486.63
195.63
448.07
439.28
96.55
218.32
240.06
51.22
117.32
115.02
23.12
40.68
4.00
10.09
-
289.47
657.36
239.10
542.96
-
321.78
733.96
726.69
246.85
565.39
554.30
213.37
488.50
461.02
185.14
424.04
415.73
108.41
245.46
265.67
61.71
141.35
138.57
20.95
36.67
1.94
5.61
-
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
225.23
515.64
486.63
142.04
346.01
313.91
90.37
253.15
210.84
37.19
90.60
82.19
1.77
32.19
3.77
13.74
-
304.64
700.68
169.19
389.14
-
315.60
768.79
697.47
179.23
436.61
396.10
213.37
488.50
461.02
134.42
327.46
297.08
102.23
280.29
236.45
44.81
109.15
99.02
-0.40
28.18
2.51
11.87
-
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
South Dakota Sanford Health Plan

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
340.19
782.74
326.45
750.86
-
337.07
943.80
606.73
326.78
914.97
588.19
213.37
488.50
455.05
213.37
488.50
441.14
123.70
455.30
151.68
113.41
426.47
147.05
-14.48
121.13
-11.03
124.18
-
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
73.65
165.83
188.09
52.01
119.09
116.76
17.68
27.85
3.92
9.88
-
272.01
617.70
243.50
552.96
-
298.88
681.47
674.72
250.64
573.93
562.68
213.37
488.50
461.02
187.98
430.45
422.01
85.51
192.97
213.70
62.66
143.48
140.67
15.51
23.84
1.79
5.24
-
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
225.23
515.64
486.63
158.31
467.20
486.48
31.06
71.59
-
343.29
875.33
-
383.54
982.84
973.11
213.37
488.50
461.02
170.17
494.34
512.09
28.89
67.58
-
Total
Premium
Govt
Pays
337.07
943.80
606.73
326.78
914.97
588.19
225.23
515.64
480.83
225.23
515.64
466.14
111.84
428.16
125.90
101.55
399.33
122.05
-12.31
125.14
-8.86
128.19
-
218.45
550.93
479.08
173.12
436.61
379.67
45.33
114.32
99.41
298.88
681.47
674.72
250.64
573.93
562.68
225.23
515.64
486.63
198.63
454.84
445.92
240.15
529.73
519.34
383.54
982.84
973.11
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
Govt
Pays
Tennessee Humana Health Plan, Inc.

GJ1
260.05
296.48
225.23
High Self
GJ2
578.61
667.09
515.64
High Self & Family
GJ3
637.45
486.63
High Self Plus One
GJ4
234.05
270.49
214.36
Standard Self
GJ5
520.76
608.61
482.32
GJ6
581.56
460.89
Tennessee United Healthcare Insurance Company, Inc. (Choice HMO)
KK1
New Plan 245.00
194.16
High Self
KK2
New Plan 686.98
515.64
High Self & Family
KK3
New Plan 478.48
379.20
High Self Plus One
Tennessee United Healthcare Insurance Company, Inc. (HDHP Choice Plus)
LS1
New Plan 234.69
185.99
HDHP Self
LS2
New Plan 658.05
515.64
HDHP Self & Family
LS3
New Plan 458.33
363.23
HDHP Self Plus One
Texas Aetna Direct
N61
210.05
218.45
173.12
CDHP Self
N62
474.42
550.93
436.61
CDHP Self & Family
N63
479.08
379.67
CDHP Self Plus One
Texas Aetna HealthFund CDHP and Value Plan
JS1
340.51
403.55
225.23
CDHP Self
JS2
773.27
919.90
515.64
CDHP Self & Family
JS3
910.79
486.63
CDHP Self Plus One
JS4
279.09
301.31
225.23
Basic Self
JS5
633.78
687.86
515.64
Basic Self & Family
JS6
681.04
486.63
Basic Self Plus One
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
296.48
667.09
637.45
270.49
608.61
581.56
213.37
488.50
461.02
202.87
456.46
436.17
83.11
178.59
176.43
67.62
152.15
145.39
18.10
33.94
9.11
21.96
-
50.84
171.34
99.28

183.75
488.50
358.86
61.25
198.48
119.62
New Plan
New Plan
New Plan
48.70
142.41
95.10

176.02
488.50
343.75
58.67
169.55
114.58
New Plan
New Plan
New Plan
71.25
151.45
150.82
56.13
126.29
120.67
19.89
37.17
9.91
23.44
-
260.05
578.61
234.05
520.76
-
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
178.32
404.26
424.16
76.08
172.22
194.41
53.85
110.71
13.03
18.16
-
340.51
773.27
279.09
633.78
-
403.55
919.90
910.79
301.31
687.86
681.04
213.37
488.50
461.02
213.37
488.50
461.02
190.18
431.40
449.77
87.94
199.36
220.02
51.68
106.70
10.86
14.15
-
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Texas Aetna HealthFund HDHP

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
4.75
-3.59
-
243.73
642.48
-
254.88
674.81
668.14
191.16
488.50
461.02
63.72
186.31
207.12
2.79
-7.60
-
53.35
122.69
101.36
6.02
13.83
-
239.65
551.18
-
257.10
591.30
488.49
192.83
443.48
366.37
64.27
147.82
122.12
4.36
10.03
-
225.23
515.64
486.63
170.61
383.86
366.80
70.61
150.00
149.42
44.67
100.51
96.04
18.89
34.93
5.39
13.12
-
261.85
582.62
198.87
442.49
-
295.84
665.64
636.05
215.28
484.37
462.84
213.37
488.50
461.02
161.46
363.28
347.13
82.47
177.14
175.03
53.82
121.09
115.71
17.01
31.49
4.10
10.47
-
225.23
515.64
486.63
170.61
383.86
366.80
64.86
137.05
137.06
44.67
100.51
96.04
13.71
23.24
5.39
13.12
-
259.00
576.27
198.87
442.49
-
290.09
652.69
623.69
215.28
484.37
462.84
213.37
488.50
461.02
161.46
363.28
347.13
76.72
164.19
162.67
53.82
121.09
115.71
11.97
20.12
4.10
10.47
-
Total
Premium
Govt
Pays
240.15
529.73
519.34
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
254.88
674.81
668.14
201.99
515.64
486.63
52.89
159.17
181.51
257.10
591.30
488.49
203.75
468.61
387.13
295.84
665.64
636.05
215.28
484.37
462.84
290.09
652.69
623.69
215.28
484.37
462.84
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
272.17
605.59
198.87
442.49
-
300.33
675.74
645.70
215.28
484.37
462.84
213.37
488.50
461.02
161.46
363.28
347.13
86.96
187.24
184.68
53.82
121.09
115.71
16.80
30.22
4.10
10.47
-
23.11
44.38
10.50
24.78
-
260.05
578.61
234.05
520.76
-
299.70
674.30
644.34
273.37
615.09
587.75
213.37
488.50
461.02
205.03
461.32
440.81
86.33
185.80
183.32
68.34
153.77
146.94
21.32
41.15
9.83
23.58
-
29.97
59.07
20.35
38.20
-
275.35
612.65
261.58
582.02
-
314.51
707.64
676.18
297.24
668.79
639.07
213.37
488.50
461.02
213.37
488.50
461.02
101.14
219.14
215.16
83.87
180.29
178.05
27.80
55.06
18.48
34.79
-
Total
Premium
Govt
Pays
300.33
675.74
645.70
215.28
484.37
462.84
225.23
515.64
486.63
170.61
383.86
366.80
75.10
160.10
159.07
44.67
100.51
96.04
18.97
34.23
5.39
13.12
-
299.70
674.30
644.34
273.37
615.09
587.75
225.23
515.64
486.63
216.65
487.46
465.79
74.47
158.66
157.71
56.72
127.63
121.96
314.51
707.64
676.18
297.24
668.79
639.07
225.23
515.64
486.63
225.23
515.64
486.63
89.28
192.00
189.55
72.01
153.15
152.44
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
482.16
1072.80
275.35
612.65
-
603.57
1358.03
1297.67
313.84
706.14
674.75
213.37
488.50
461.02
213.37
488.50
461.02
390.20
869.53
836.65
100.47
217.64
213.73
110.05
245.30
27.13
53.56
-
137.86
303.82
66.02
140.22
-
355.47
790.92
275.35
612.65
-
502.52
1130.66
1080.40
350.56
788.79
753.73
213.37
488.50
461.02
213.37
488.50
461.02
289.15
642.16
619.38
137.19
300.29
292.71
135.69
299.81
63.85
136.21
-
56.44
132.42
118.35
4.98
13.87
-
260.56
598.27
-
272.01
638.18
570.37
204.01
478.64
427.78
68.00
159.54
142.59
2.86
9.84
-
225.23
515.64
486.63
171.04
595.50
287.28
21.55
233.33
-
365.53
841.89
-
396.27 213.37
1111.14 488.50
773.91 461.02
182.90
622.64
312.89
19.38
229.32
-
168.57
472.69
329.23
44.14
123.76
86.20
-4.11
16.40
-
244.32
543.61
-
212.71
596.45
415.43
53.18
149.11
103.86
-7.90
13.21
-
Total
Premium
Govt
Pays
603.57
1358.03
1297.67
313.84
706.14
674.75
225.23
515.64
486.63
225.23
515.64
486.63
378.34
842.39
811.04
88.61
190.50
188.12
112.22
249.31
29.30
57.57
-
502.52
1130.66
1080.40
350.56
788.79
753.73
225.23
515.64
486.63
225.23
515.64
486.63
277.29
615.02
593.77
125.33
273.15
267.10
272.01
638.18
570.37
215.57
505.76
452.02
396.27
1111.14
773.91
212.71
596.45
415.43
159.53
447.34
311.57
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
Utah Aetna Direct

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
173.12
436.61
379.67
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
225.23
515.64
486.63
134.95
282.03
276.50
89.56
180.50
202.62
35.33
73.85
72.40
5.92
0.89
2.00
4.81
-
299.68
659.33
168.74
349.58
-
314.79
696.14
689.25
170.28
355.88
348.90
213.37
488.50
461.02
127.71
266.91
261.68
101.42
207.64
228.23
42.57
88.97
87.22
3.75
-3.12
0.39
1.58
-
182.26
402.47
398.49
47.72
105.38
104.34
3.20
7.43
-
225.43
495.93
-
229.98
507.85
502.83
172.49
380.89
377.12
57.49
126.96
125.71
1.13
2.98
-
225.23
515.64
486.63
195.63
448.07
439.28
96.55
218.32
240.06
51.22
117.32
115.02
23.12
40.68
4.00
10.09
-
289.47
657.36
239.10
542.96
-
321.78
733.96
726.69
246.85
565.39
554.30
213.37
488.50
461.02
185.14
424.04
415.73
108.41
245.46
265.67
61.71
141.35
138.57
20.95
36.67
1.94
5.61
-
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Utah SelectHealth
SF1
293.90
High Self
SF2
655.62
High Self & Family
SF3
High Self Plus One
SF4
229.58
Standard Self
SF5
512.14
SF6
Vermont Aetna Direct
N61
210.05
CDHP Self
N62
474.42
CDHP Self & Family
N63
CDHP Self Plus One
Vermont Aetna HealthFund CDHP and Value Plan
EP1
296.95
CDHP Self
EP2
674.38
CDHP Self & Family
EP3
CDHP Self Plus One
EP4
236.69
Basic Self
EP5
537.52
Basic Self & Family
EP6
Basic Self Plus One
Vermont Aetna HealthFund HDHP
224
226.86
HDHP Self
225
496.83
HDHP Self & Family
226
HDHP Self Plus One
Virgin Islands Triple-S Salud, Inc.
851
227.85
High Self
852
521.80
High Self & Family
853
High Self Plus One
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
293.90
655.62
229.58
512.14
-
317.43
708.06
708.06
236.46
525.08
525.08
213.37
488.50
461.02
177.35
393.81
393.81
104.06
219.56
247.04
59.11
131.27
131.27
12.17
12.51
1.72
3.24
-
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
127.91
289.73
310.76
50.42
115.47
113.20
47.00
95.07
3.67
9.31
-
296.95
674.38
236.69
537.52
-
353.14
805.37
797.39
243.00
556.47
545.55
213.37
488.50
461.02
182.25
417.35
409.16
139.77
316.87
336.37
60.75
139.12
136.39
44.83
91.06
1.58
4.74
-
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
180.57
413.53
405.46
47.28
108.27
106.16
2.28
5.21
-
227.85
521.80
-
227.85
521.80
511.62
170.89
391.35
383.72
56.96
130.45
127.90
0.00
0.00
-
Total
Premium
Govt
Pays
317.43
708.06
708.06
236.46
525.08
525.08
225.23
515.64
486.63
187.39
416.13
416.13
92.20
192.42
221.43
49.07
108.95
108.95
14.34
16.52
3.73
7.80
-
218.45
550.93
479.08
173.12
436.61
379.67
45.33
114.32
99.41
353.14
805.37
797.39
243.00
556.47
545.55
225.23
515.64
486.63
192.58
441.00
432.35
240.15
529.73
519.34
227.85
521.80
511.62
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Virginia Aetna Direct

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
17.68
27.85
3.92
9.88
-
272.01
617.70
243.50
552.96
-
298.88
681.47
674.72
250.64
573.93
562.68
213.37
488.50
461.02
187.98
430.45
422.01
85.51
192.97
213.70
62.66
143.48
140.67
15.51
23.84
1.79
5.24
-
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
225.23
515.64
486.63
218.70
492.27
482.62
217.62
479.96
499.12
57.26
128.89
126.36
6.88
3.71
4.75
11.47
-
426.78
955.97
265.88
594.52
-
442.85
995.60
985.75
275.96
621.16
608.98
213.37
488.50
461.02
206.97
465.87
456.74
229.48
507.10
524.73
68.99
155.29
152.24
4.71
-0.30
2.52
6.66
-
191.94
515.64
486.63
50.26
164.12
186.41
4.68
1.36
-
230.81
642.48
-
242.20
679.76
673.04
181.65
488.50
461.02
60.55
191.26
212.02
2.85
-2.65
-
Total
Premium
Govt
Pays
218.45
550.93
479.08
173.12
436.61
379.67
45.33
114.32
99.41
3.85
20.62
-
298.88
681.47
674.72
250.64
573.93
562.68
225.23
515.64
486.63
198.63
454.84
445.92
73.65
165.83
188.09
52.01
119.09
116.76
240.15
529.73
519.34
190.32
419.81
411.58
442.85
995.60
985.75
275.96
621.16
608.98
242.20
679.76
673.04
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
Virginia Aetna Whole Health

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
203.99
515.64
486.63
53.41
157.42
179.76
11.05
47.14
-
214.50
558.39
-
257.40
673.06
666.39
193.05
488.50
461.02
64.35
184.56
205.37
10.73
44.96
-
225.23
515.64
486.63
225.23
515.64
455.90
96.54
248.86
156.90
62.40
167.76
119.37
3.19
32.57
1.87
25.30
-
309.39
696.01
276.57
622.18
-
321.77
764.50
643.53
287.63
683.40
575.27
213.37
488.50
461.02
213.37
488.50
431.45
108.40
276.00
182.51
74.26
194.90
143.82
1.02
28.56
-0.30
21.29
-
216.52
514.45
433.05
56.69
134.70
113.38
3.79
16.70
-
267.85
597.46
-
273.21
649.15
546.43
204.91
486.86
409.82
68.30
162.29
136.61
1.34
12.93
-
200.48
471.79
467.12
52.49
123.53
122.30
4.91
12.05
-
240.93
564.46
-
252.97
595.32
589.42
189.73
446.49
442.07
63.24
148.83
147.35
3.01
7.72
-
225.23
515.64
486.63
170.36
398.64
385.00
60.25
152.37
158.54
44.60
104.37
100.80
-3.65
-11.78
8.75
21.91
-
279.94
643.87
181.53
417.50
-
285.48
668.01
645.17
214.96
503.01
485.80
213.37
488.50
461.02
161.22
377.26
364.35
72.11
179.51
184.15
53.74
125.75
121.45
-5.82
-15.79
8.36
21.38
-
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
Govt
Pays
Virginia M.D. IPA

JP1
314.55
295.87
225.23
High Self
JP2
725.30
829.62
515.64
High Self & Family
JP3
577.83
457.93
High Self Plus One
Virginia Optima Health Plan
PG1
New Plan 240.85
190.87
High Self
PG2
New Plan 629.57
498.93
High Self & Family
PG3
New Plan 598.09
473.99
High Self Plus One
Virginia United Healthcare Insurance Company, Inc. (Choice HMO)
LR1
New Plan 245.13
194.27
High Self
LR2
New Plan 687.35
515.64
High Self & Family
LR3
New Plan 478.74
379.40
High Self Plus One
Virginia UnitedHealthcare Insurance Company
L91
244.32
212.71
168.57
Basic Self
L92
543.61
596.45
472.69
Basic Self & Family
L93
415.43
329.23
Basic Self Plus One
Washington Aetna Direct
N61
210.05
218.45
173.12
CDHP Self
N62
474.42
550.93
436.61
CDHP Self & Family
N63
479.08
379.67
CDHP Self Plus One
Washington Aetna HealthFund CDHP and Value Plan
G51
289.47
321.78
225.23
CDHP Self
G52
657.36
733.96
515.64
CDHP Self & Family
G53
726.69
486.63
CDHP Self Plus One
G54
239.10
246.85
195.63
Basic Self
G55
542.96
565.39
448.07
Basic Self & Family
G56
554.30
439.28
Basic Self Plus One
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
295.87
829.62
577.83
213.37
488.50
433.37
82.50
341.12
144.46
-30.04
64.39
-
49.98
130.64
124.10

180.64
472.18
448.57
60.21
157.39
149.52
New Plan
New Plan
New Plan
50.86
171.71
99.34

183.85
488.50
359.06
61.28
198.85
119.68
New Plan
New Plan
New Plan
70.64
313.98
119.90
-27.87
68.40
-
314.55
725.30
-
44.14
123.76
86.20
-4.11
16.40
-
244.32
543.61
-
212.71
596.45
415.43
159.53
447.34
311.57
53.18
149.11
103.86
-7.90
13.21
-
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
96.55
218.32
240.06
51.22
117.32
115.02
23.12
40.68
4.00
10.09
-
289.47
657.36
239.10
542.96
-
321.78
733.96
726.69
246.85
565.39
554.30
213.37
488.50
461.02
185.14
424.04
415.73
108.41
245.46
265.67
61.71
141.35
138.57
20.95
36.67
1.94
5.61
-
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
Washington Aetna HealthFund HDHP

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
225.23
515.64
486.63
79.79
320.75
341.48
16.95
39.18
-
278.88
761.29
-
305.02
836.39
828.11
213.37
488.50
461.02
91.65
347.89
367.09
14.78
35.17
-
225.23
515.64
486.63
185.50
500.87
371.01
101.90
367.60
167.62
48.57
131.14
97.14
-6.48
149.82
4.59
31.84
-
324.42
697.50
222.70
502.76
-
327.13
883.24
654.25
234.07
632.01
468.15
213.37
488.50
461.02
175.55
474.01
351.11
113.76
394.74
193.23
58.52
158.00
117.04
-8.65
145.81
2.85
32.31
-
173.32
467.97
346.64
45.38
122.53
90.76

164.03
442.88
328.05
54.67
147.62
109.35
New Plan
New Plan
New Plan
225.23
515.64
486.63
207.02
475.58
475.58
73.71
159.57
188.58
54.20
124.52
124.52
213.37
488.50
461.02
195.92
450.08
450.08
85.57
186.71
214.19
65.30
150.02
150.02
-0.75
-16.00
4.43
7.49
-
1.42
-11.99
6.11
11.92
-
288.33
651.28
243.47
570.13
-
298.94
675.21
675.21
261.22
600.10
600.10
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Washington KPS Health Plans

L11
268.40
Standard Self
L12
579.35
L13
L14
216.02
HDHP Self
L15
472.06
HDHP Self & Family
L16
HDHP Self Plus One
Washington KPS Health Plans
VT1
332.48
High Self
VT2
726.50
High Self & Family
VT3
High Self Plus One
West Virginia Aetna Direct
N61
210.05
CDHP Self
N62
474.42
CDHP Self & Family
N63
CDHP Self Plus One
West Virginia Aetna HealthFund CDHP and Value Plan
F51
272.01
CDHP Self
F52
617.70
CDHP Self & Family
F53
CDHP Self Plus One
F54
243.50
Basic Self
F55
552.96
Basic Self & Family
F56
Basic Self Plus One
West Virginia Aetna HealthFund HDHP
224
226.86
HDHP Self
225
496.83
HDHP Self & Family
226
HDHP Self Plus One
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
268.40
579.35
216.02
472.06
-
285.33
684.80
599.21
224.81
526.79
468.92
213.37
488.50
449.41
168.61
395.09
351.69
71.96
196.30
149.80
56.20
131.70
117.23
4.86
51.46
2.20
13.69
-
53.82
186.75
-
332.48
726.50
-
395.49
949.17
830.52
213.37
488.50
461.02
182.12
460.67
369.50
51.65
182.74
-
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
225.23
515.64
486.63
198.63
454.84
445.92
73.65
165.83
188.09
52.01
119.09
116.76
17.68
27.85
3.92
9.88
-
272.01
617.70
243.50
552.96
-
298.88
681.47
674.72
250.64
573.93
562.68
213.37
488.50
461.02
187.98
430.45
422.01
85.51
192.97
213.70
62.66
143.48
140.67
15.51
23.84
1.79
5.24
-
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
Total
Premium
Govt
Pays
285.33
684.80
599.21
224.81
526.79
468.92
225.23
515.64
474.87
178.16
417.48
371.62
60.10
169.16
124.34
46.65
109.31
97.30
7.09
54.74
3.99
16.08
-
395.49
949.17
830.52
225.23
515.64
486.63
170.26
433.53
343.89
218.45
550.93
479.08
173.12
436.61
379.67
298.88
681.47
674.72
250.64
573.93
562.68
240.15
529.73
519.34
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Wisconsin Aetna Direct

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
210.05
474.42
-
218.45
550.93
479.08
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
53.85
110.71
13.03
18.16
-
340.51
773.27
279.09
633.78
-
403.55
919.90
910.79
301.31
687.86
681.04
213.37
488.50
461.02
213.37
488.50
461.02
190.18
431.40
449.77
87.94
199.36
220.02
51.68
106.70
10.86
14.15
-
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-
167.72
464.10
459.51
43.92
121.51
120.31
4.11
11.82
-
201.56
555.41
-
211.64
585.61
579.82
158.73
439.21
434.87
52.91
146.40
144.95
2.52
7.55
-
225.23
515.64
486.63
214.21
514.10
471.26
163.59
378.67
329.92
56.09
134.61
123.39
21.42
-37.12
8.60
13.18
-
358.21
895.51
240.46
601.15
-
388.82
894.31
816.55
270.30
648.71
594.65
213.37
488.50
461.02
202.73
486.53
445.99
175.45
405.81
355.53
67.57
162.18
148.66
19.25
-41.13
7.46
9.60
-
Total
Premium
Govt
Pays
218.45
550.93
479.08
173.12
436.61
379.67
45.33
114.32
99.41
3.85
20.62
-
403.55
919.90
910.79
301.31
687.86
681.04
225.23
515.64
486.63
225.23
515.64
486.63
178.32
404.26
424.16
76.08
172.22
194.41
240.15
529.73
519.34
190.32
419.81
411.58
211.64
585.61
579.82
388.82
894.31
816.55
270.30
648.71
594.65
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Wisconsin Group Health Cooperative

WJ1
275.75
High Self
WJ2
689.54
High Self & Family
WJ3
High Self Plus One
Wisconsin HealthPartners High and Standard Option
V31
304.64
High Self
V32
700.68
High Self & Family
V33
High Self Plus One
V34
169.19
Standard Self
V35
389.14
V36
Wisconsin MercyCare HMO
EY1
299.71
High Self
EY2
749.61
High Self & Family
EY3
High Self Plus One
Wisconsin Physicians Plus
LW1
299.78
High Self
LW2
763.85
High Self & Family
LW3
High Self Plus One
LW4
New Plan
Standard Self
LW5
New Plan
LW6
New Plan
Wyoming Aetna Direct
N61
210.05
CDHP Self
N62
474.42
CDHP Self & Family
N63
CDHP Self Plus One
Change in
Empl. Pays
empl.
payment
Biweekly
Premium

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
275.75
689.54
-
295.88
881.73
585.85
213.37
488.50
439.39
82.51
393.23
146.46
8.77
152.26
-
1.77
32.19
3.77
13.74
-
304.64
700.68
169.19
389.14
-
315.60
768.79
697.47
179.23
436.61
396.10
213.37
488.50
461.02
134.42
327.46
297.08
102.23
280.29
236.45
44.81
109.15
99.02
-0.40
28.18
2.51
11.87
-
-3.29
131.31
-
299.71
749.61
-
305.61
916.84
611.23
213.37
488.50
458.42
92.24
428.34
152.81
-5.46
127.30
-
-5.77
299.78
303.20
-27.19
763.85
772.58
725.11
213.37
488.50
461.02
201.49
488.50
461.02
89.83
284.08
264.09
67.16
196.05
181.46
-7.94
-31.20
New Plan
New Plan
New Plan
163.84
413.20
359.31
54.61
137.73
119.77
2.10
19.13
-
Total
Premium
Govt
Pays
295.88
881.73
585.85
225.23
515.64
464.29
70.65
366.09
121.56
10.94
156.27
-
315.60
768.79
697.47
179.23
436.61
396.10
225.23
515.64
486.63
142.04
346.01
313.91
90.37
253.15
210.84
37.19
90.60
82.19
305.61
916.84
611.23
225.23
515.64
484.40
80.38
401.20
126.83
303.20
772.58
725.11
268.65
684.55
642.48
225.23
515.64
486.63
212.91
515.64
486.63
77.97
256.94
238.48
55.74
168.91
155.85
218.45
550.93
479.08
173.12
436.61
379.67
45.33
114.32
99.41
3.85
20.62
-
210.05
474.42
-
218.45
550.93
479.08
Health Management
Organizations (HMO)

Category 1
2015 Total
2015 Total
Biweekly
Premium
Total
Premium
Wyoming Aetna Health of Utah, Inc. dba Altius Health Plans

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

Rates Category 2
Total
Premium
Govt
Pays
Empl.
Pays
Change in
empl.
payment
225.23
515.64
486.63
134.95
282.03
276.50
89.56
180.50
202.62
35.33
73.85
72.40
5.92
0.89
2.00
4.81
-
299.68
659.33
168.74
349.58
-
314.79
696.14
689.25
170.28
355.88
348.90
213.37
488.50
461.02
127.71
266.91
261.68
101.42
207.64
228.23
42.57
88.97
87.22
3.75
-3.12
0.39
1.58
-
182.26
402.47
398.49
47.72
105.38
104.34
3.20
7.43
-
225.43
495.93
-
229.98
507.85
502.83
172.49
380.89
377.12
57.49
126.96
125.71
1.13
2.98
-
225.23
515.64
486.63
196.32
450.57
441.73
87.45
197.12
219.07
51.40
117.97
115.66
26.54
47.90
3.19
8.48
-
276.95
628.94
244.12
554.39
-
312.68
712.76
705.70
247.72
568.54
557.39
213.37
488.50
461.02
185.79
426.41
418.04
99.31
224.26
244.68
61.93
142.13
139.35
24.37
43.89
0.90
3.53
-
190.32
419.81
411.58
49.83
109.92
107.76
5.03
11.80
-
226.86
496.83
-
240.15
529.73
519.34
180.11
397.30
389.51
60.04
132.43
129.83
3.33
8.22
-

Postal Service HMO Rates For 2016

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Postal Service HMO Rates For 2016

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Postal Premium Rates for the Federal Employees Health Benefits Program

2016 Biweekly Postal Premium Rates

Alabama Aetna Direct

2016 Biweekly Postal Premium

New Plan New Plan 245.00

New Plan New Plan 234.69

2016 Biweekly Postal Premium Rates

Alaska Aetna HealthFund CDHP and Value Plan

2016 Biweekly Postal Premium

Arizona Aetna Open Access

2016 Biweekly Postal Premium Rates

2016 Biweekly Postal Premium

2016 Biweekly Postal Premium Rates

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

2016 Biweekly Postal Premium

New Plan New Plan 244.98

New Plan New Plan 236.75

2016 Biweekly Postal Premium Rates

2016 Biweekly Postal Premium

New Plan New Plan 245.00

New Plan New Plan 234.69

2016 Biweekly Postal Premium Rates

California Aetna HealthFund HDHP

2016 Biweekly Postal Premium

2016 Biweekly Postal Premium Rates

California Health Net of California

2016 Biweekly Postal Premium

New Plan New Plan 132.81

California Kaiser Foundation Health Plan

2016 Biweekly Postal Premium Rates

2016 Biweekly Postal Premium

2016 Biweekly Postal Premium Rates

Colorado Aetna HealthFund CDHP and Value Plan

2016 Biweekly Postal Premium

2016 Biweekly Postal Premium Rates

Colorado Kaiser Foundation Health Plan of Colorado

2016 Biweekly Postal Premium

New Plan New Plan 244.98

New Plan New Plan 236.75

2016 Biweekly Postal Premium Rates

Connecticut Aetna HealthFund CDHP and Value Plan

2016 Biweekly Postal Premium

2016 Biweekly Postal Premium Rates

Delaware Aetna Open Access

2016 Biweekly Postal Premium

2016 Biweekly Postal Premium Rates

District of Columbia Aetna Open Access

2016 Biweekly Postal Premium

2016 Biweekly Postal Premium Rates

District of Columbia M.D. IPA

2016 Biweekly Postal Premium

New Plan New Plan 245.13

2016 Biweekly Postal Premium Rates

Florida AvMed Health Plans

2016 Biweekly Postal Premium

Florida Humana Medical Plan, Inc.

2016 Biweekly Postal Premium Rates

2016 Biweekly Postal Premium

2016 Biweekly Postal Premium Rates

Florida Humana Medical Plan, Inc.

2016 Biweekly Postal Premium

2016 Biweekly Postal Premium Rates