2023 Plan Information for New York
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Location Specific Rates
| Contract | Enrollment Code | Enrollment Type | Option/Enrollment Type | Payment Period | Employee Payment |
|---|---|---|---|---|---|
| Aetna Direct | 224 | Non-Postal | HDHP Self | Monthly | 269.92 |
| Aetna Direct | 225 | Non-Postal | HDHP Self & Family | Monthly | 511.92 |
| Aetna Direct | 226 | Non-Postal | HDHP Self Plus One | Monthly | 586.26 |
| Aetna Direct | N61 | Non-Postal | CDHP Self | Monthly | 160.35 |
| Aetna Direct | N62 | Non-Postal | CDHP Self & Family | Monthly | 404.39 |
| Aetna Direct | N63 | Non-Postal | CDHP Self Plus One | Monthly | 351.67 |
| Aetna Direct | Z24 | Non-Postal | Advantage Self | Monthly | 125 |
| Aetna Direct | Z25 | Non-Postal | Advantage Self & Family | Monthly | 331.25 |
| Aetna Direct | Z26 | Non-Postal | Advantage Self Plus One | Monthly | 275 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP1 | Non-Postal | CDHP Self | Monthly | 694.5 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP2 | Non-Postal | CDHP Self & Family | Monthly | 1542.43 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP3 | Non-Postal | CDHP Self Plus One | Monthly | 1624.31 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP4 | Non-Postal | Value Self | Monthly | 531.05 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP5 | Non-Postal | Value Self & Family | Monthly | 1179.86 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP6 | Non-Postal | Value Self Plus One | Monthly | 1241.02 |
| Aetna Open Access | JC1 | Non-Postal | High Self | Monthly | 1141.4 |
| Aetna Open Access | JC2 | Non-Postal | High Self & Family | Monthly | 2886.13 |
| Aetna Open Access | JC3 | Non-Postal | High Self Plus One | Monthly | 2954.73 |
| Aetna Open Access | JC4 | Non-Postal | Basic Self | Monthly | 933.96 |
| Aetna Open Access | JC5 | Non-Postal | Basic Self & Family | Monthly | 2325.96 |
| Aetna Open Access | JC6 | Non-Postal | Basic Self Plus One | Monthly | 2400.13 |
| CDPHP Universal Benefits, Inc. | SG4 | Non-Postal | Standard Self | Monthly | 317.22 |
| CDPHP Universal Benefits, Inc. | SG5 | Non-Postal | Standard Self & Family | Monthly | 787.15 |
| CDPHP Universal Benefits, Inc. | SG6 | Non-Postal | Standard Self Plus One | Monthly | 739.03 |
| HIP of Greater New York | 511 | Non-Postal | High Self | Monthly | 488.02 |
| HIP of Greater New York | 512 | Non-Postal | High Self & Family | Monthly | 1729.76 |
| HIP of Greater New York | 513 | Non-Postal | High Self Plus One | Monthly | 704.25 |
| HIP of Greater New York | YL4 | Non-Postal | Standard Self | Monthly | 443.25 |
| HIP of Greater New York | YL5 | Non-Postal | Standard Self & Family | Monthly | 1599.52 |
| HIP of Greater New York | YL6 | Non-Postal | Standard Self Plus One | Monthly | 622.44 |
| Independent Health Assoc | C54 | Non-Postal | Standard Self | Monthly | 189.15 |
| Independent Health Assoc | C55 | Non-Postal | Standard Self & Family | Monthly | 705.34 |
| Independent Health Assoc | C56 | Non-Postal | Standard Self Plus One | Monthly | 702.82 |
| Independent Health Assoc | QA1 | Non-Postal | High Self | Monthly | 260.13 |
| Independent Health Assoc | QA2 | Non-Postal | High Self & Family | Monthly | 896.98 |
| Independent Health Assoc | QA3 | Non-Postal | High Self Plus One | Monthly | 883.85 |
| Independent Health Assoc | QA4 | Non-Postal | HDHP Self | Monthly | 157.77 |
| Independent Health Assoc | QA5 | Non-Postal | HDHP Self & Family | Monthly | 409.73 |
| Independent Health Assoc | QA6 | Non-Postal | HDHP Self Plus One | Monthly | 389.51 |