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2024 Plan Information for Pennsylvania
Choose a Location, Employee Type, & Payment Period
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Nationwide
Federal & U.S. Postal Service Employee
Certain Temporary Employees
Annuitant
Former Spouse Enrollee
Federal Deposit Insurance Corporation
Temporary Continuation of Coverage (TCC)
Tribal Employee
Biweekly
Every Four Weeks
Semi-Monthly
Monthly
Location Specific Rates
Contract
Enrollment Code
Enrollment Type
Option/Enrollment Type
Payment Period
Employee Payment
Aetna Direct
224
Non-Postal
HDHP Self
Monthly
272.61
Aetna Direct
225
Non-Postal
HDHP Self & Family
Monthly
498.46
Aetna Direct
226
Non-Postal
HDHP Self Plus One
Monthly
590.61
Aetna Direct
N61
Non-Postal
CDHP Self
Monthly
160.8
Aetna Direct
N62
Non-Postal
CDHP Self & Family
Monthly
405.51
Aetna Direct
N63
Non-Postal
CDHP Self Plus One
Monthly
352.64
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
H41
Non-Postal
CDHP Self
Monthly
310.22
Aetna HealthFund CDHP and Aetna Value Plan
H42
Non-Postal
CDHP Self & Family
Monthly
647.59
Aetna HealthFund CDHP and Aetna Value Plan
H43
Non-Postal
CDHP Self Plus One
Monthly
757.06
Aetna HealthFund CDHP and Aetna Value Plan
H44
Non-Postal
Value Self
Monthly
524.94
Aetna HealthFund CDHP and Aetna Value Plan
H45
Non-Postal
Value Self & Family
Monthly
1154.29
Aetna HealthFund CDHP and Aetna Value Plan
H46
Non-Postal
Value Self Plus One
Monthly
1233.53
Aetna Open Access
P31
Non-Postal
High Self
Monthly
1218.53
Aetna Open Access
P32
Non-Postal
High Self & Family
Monthly
2980.12
Aetna Open Access
P33
Non-Postal
High Self Plus One
Monthly
3066.09
Aetna Open Access
P34
Non-Postal
Basic Self
Monthly
1245.12
Aetna Open Access
P35
Non-Postal
Basic Self & Family
Monthly
2854.84
Aetna Open Access
P36
Non-Postal
Basic Self Plus One
Monthly
2941.97
Aetna Open Access
YE1
Non-Postal
High Self
Monthly
697.56
Aetna Open Access
YE2
Non-Postal
High Self & Family
Monthly
1828.27
Aetna Open Access
YE3
Non-Postal
High Self Plus One
Monthly
1925.63
Geisinger Health Plan
AJ1
Non-Postal
Basic Self
Monthly
255.21
Geisinger Health Plan
AJ2
Non-Postal
Basic Self & Family
Monthly
530.7
Geisinger Health Plan
AJ3
Non-Postal
Basic Self Plus One
Monthly
551.4
Geisinger Health Plan
GG4
Non-Postal
Standard Self
Monthly
344.24
Geisinger Health Plan
GG5
Non-Postal
Standard Self & Family
Monthly
734.54
Geisinger Health Plan
GG6
Non-Postal
Standard Self Plus One
Monthly
743.77
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
V41
Non-Postal
HDHP Self
Monthly
173.39
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
V42
Non-Postal
HDHP Self & Family
Monthly
396.95
UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA))
V43
Non-Postal
HDHP Self Plus One
Monthly
372.8
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
LR1
Non-Postal
High Self
Monthly
419.44
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
LR2
Non-Postal
High Self & Family
Monthly
987.82
UnitedHealthcare Insurance Company, Inc. (Choice Open Access)
LR3
Non-Postal
High Self Plus One
Monthly
895.46
UnitedHealthcare Insurance Company, Inc. Choice Plus Primary
AS1
Non-Postal
High Self
Monthly
203.41
UnitedHealthcare Insurance Company, Inc. Choice Plus Primary
AS2
Non-Postal
High Self & Family
Monthly
471.92
UnitedHealthcare Insurance Company, Inc. Choice Plus Primary
AS3
Non-Postal
High Self Plus One
Monthly
431.04
UnitedHealthcare Insurance Company, Inc. Choice Primary
Y81
Non-Postal
High Self
Monthly
181.3
UnitedHealthcare Insurance Company, Inc. Choice Primary
Y82
Non-Postal
High Self & Family
Monthly
428.78
UnitedHealthcare Insurance Company, Inc. Choice Primary
Y83
Non-Postal
High Self Plus One
Monthly
389.8
UPMC Health Plan
8W4
Non-Postal
HDHP Self
Monthly
174.89
UPMC Health Plan
8W5
Non-Postal
HDHP Self & Family
Monthly
403.32
UPMC Health Plan
8W6
Non-Postal
HDHP Self Plus One
Monthly
387.51
UPMC Health Plan
UW4
Non-Postal
Standard Self
Monthly
192.96
UPMC Health Plan
UW5
Non-Postal
Standard Self & Family
Monthly
453.89
UPMC Health Plan
UW6
Non-Postal
Standard Self Plus One
Monthly
462.41
U.S. Office of Personnel Management
1900 E Street, NW, Washington, DC 20415
202-606-1800
Federal Relay Service
