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Healthcare Plan Information

Tribal Premium Rates for the Federal Employees Health Benefits Program

FFS (Fee-for-Service/Nationwide Plans)

Plan - Option Enrollment Code 2019 Total Monthly Premium 2020 Monthly Premium Rates - Total Premium 2020 Monthly Premium Rates - Tribal Employer Pays 2020 Monthly Premium Rates - Employee Pays 2020 Monthly Premium Rates - Change in Employee Payment
Nationwide APWU Health Plan - CDHP Self 474 597.68 597.68 448.26 149.42 0.00
Nationwide APWU Health Plan - CDHP Self & Family 475 1417.09 1417.09 1062.82 354.27 0.00
Nationwide APWU Health Plan - CDHP Self Plus One 476 1299.00 1299.00 974.25 324.75 0.00
Nationwide APWU Health Plan - High Self 471 726.22 726.22 510.84 215.38 -12.12
Nationwide APWU Health Plan - High Self & Family 472 1742.91 1742.91 1184.02 558.89 -45.83
Nationwide APWU Health Plan - High Self Plus One 473 1525.03 1525.03 1092.26 432.77 -25.67
Nationwide Blue Cross and Blue Shield Service Benefit Plan Basic Option - Basic Self 111 638.95 658.19 493.64 164.55 4.81
Nationwide Blue Cross and Blue Shield Service Benefit Plan Basic Option - Basic Self & Family 112 1522.21 1598.33 1184.02 414.31 30.29
Nationwide Blue Cross and Blue Shield Service Benefit Plan Basic Option - Basic Self Plus One 113 1436.15 1479.25 1092.26 386.99 17.43
Nationwide Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - FEP Blue Focus Self 131 460.59 460.59 345.44 115.15 0.00
Nationwide Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - FEP Blue Focus Self & Family 132 1089.18 1089.18 816.89 272.29 0.00
Nationwide Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - FEP Blue Focus Self Plus One 133 990.21 990.21 742.66 247.55 0.00
Nationwide Blue Cross and Blue Shield Service Benefit Plan Standard Option - Standard Self 104 741.89 764.14 510.84 253.30 10.13
Nationwide Blue Cross and Blue Shield Service Benefit Plan Standard Option - Standard Self & Family 105 1719.32 1805.29 1184.02 621.27 40.14
Nationwide Blue Cross and Blue Shield Service Benefit Plan Standard Option - Standard Self Plus One 106 1622.42 1671.09 1092.26 578.83 23.00
Nationwide GEHA Benefit Plan - High Self 311 728.33 739.25 510.84 228.41 -1.20
Nationwide GEHA Benefit Plan - High Self & Family 312 1816.25 1843.53 1184.02 659.51 -18.55
Nationwide GEHA Benefit Plan - High Self Plus One 313 1602.32 1626.37 1092.26 534.11 -1.62
Nationwide GEHA Benefit Plan - Standard Self 314 509.45 524.72 393.54 131.18 3.82
Nationwide GEHA Benefit Plan - Standard Self & Family 315 1283.66 1347.84 1010.88 336.96 16.05
Nationwide GEHA Benefit Plan - Standard Self Plus One 316 1095.34 1128.21 846.16 282.05 8.22
Nationwide GEHA HDHP - HDHP Self 341 508.78 513.85 385.39 128.46 1.27
Nationwide GEHA HDHP - HDHP Self & Family 342 1262.50 1300.35 975.26 325.09 9.47
Nationwide GEHA HDHP - HDHP Self Plus One 343 1093.86 1104.81 828.61 276.20 2.74
Nationwide GEHA Indemnity Benefit Plan - Elevate Plus Self 251 New Plan 629.83 472.37 157.46 New Plan
Nationwide GEHA Indemnity Benefit Plan - Elevate Plus Self & Family 252 New Plan 1561.97 1171.48 390.49 New Plan
Nationwide GEHA Indemnity Benefit Plan - Elevate Plus Self Plus One 253 New Plan 1461.18 1092.26 368.92 New Plan
Nationwide GEHA Indemnity Benefit Plan - Elevate Self 254 New Plan 410.13 307.60 102.53 New Plan
Nationwide GEHA Indemnity Benefit Plan - Elevate Self & Family 255 New Plan 1148.40 861.30 287.10 New Plan
Nationwide GEHA Indemnity Benefit Plan - Elevate Self Plus One 256 New Plan 943.32 707.49 235.83 New Plan
Nationwide MHBP Consumer Option - HDHP Self 481 562.03 573.28 429.96 143.32 2.81
Nationwide MHBP Consumer Option - HDHP Self & Family 482 1305.94 1332.07 999.05 333.02 6.54
Nationwide MHBP Consumer Option - HDHP Self Plus One 483 1243.78 1268.65 951.49 317.16 6.22
Nationwide MHBP Standard Option - Standard Self 454 576.64 570.85 428.14 142.71 -1.45
Nationwide MHBP Standard Option - Standard Self & Family 455 1340.04 1326.65 994.99 331.66 -3.35
Nationwide MHBP Standard Option - Standard Self Plus One 456 1327.28 1314.02 985.52 328.50 -3.32
Nationwide MHBP Value Plan - Value Self 414 477.17 453.31 339.98 113.33 -5.96
Nationwide MHBP Value Plan - Value Self & Family 415 1153.19 1095.53 821.65 273.88 -14.42
Nationwide MHBP Value Plan - Value Self Plus One 416 1130.61 1074.08 805.56 268.52 -14.13
Nationwide NALC Health Benefit Plan - CDHP Self 324 473.53 473.53 355.15 118.38 0.00
Nationwide NALC Health Benefit Plan - CDHP Self & Family 325 1067.67 1089.03 816.77 272.26 5.34
Nationwide NALC Health Benefit Plan - CDHP Self Plus One 326 1034.35 1044.68 783.51 261.17 2.58
Nationwide NALC Health Benefit Plan - High Self 321 682.09 707.66 510.84 196.82 13.45
Nationwide NALC Health Benefit Plan - High Self & Family 322 1531.68 1592.96 1184.02 408.94 15.45
Nationwide NALC Health Benefit Plan - High Self Plus One 323 1501.44 1565.27 1092.26 473.01 38.16
Nationwide NALC Health Benefit Plan - Value Self KM1 388.64 388.64 291.48 97.16 0.00
Nationwide NALC Health Benefit Plan - Value Self & Family KM2 876.63 894.16 670.62 223.54 4.38
Nationwide NALC Health Benefit Plan - Value Self Plus One KM3 848.86 857.35 643.01 214.34 2.13
Nationwide SAMBA Health Benefit Plan - High Self 441 912.69 901.75 510.84 390.91 -23.06
Nationwide SAMBA Health Benefit Plan - High Self & Family 442 2190.44 2164.15 1184.02 980.13 -72.12
Nationwide SAMBA Health Benefit Plan - High Self Plus One 443 2007.89 1983.82 1092.26 891.56 -49.74
Nationwide SAMBA Health Benefit Plan - Standard Self 444 686.90 680.51 510.38 170.13 -18.05
Nationwide SAMBA Health Benefit Plan - Standard Self & Family 445 1579.93 1552.55 1164.41 388.14 -53.60
Nationwide SAMBA Health Benefit Plan - Standard Self Plus One 446 1511.23 1464.67 1092.26 372.41 -72.23
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