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2020 Plan Information for Ohio
Choose a Location, Employee Type, & Payment Period
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Nationwide
Non-Postal
Certain Temporary Employees
Annuitant
U.S. Postal Service (Category 1)
Former Spouse Enrollee
Federal Deposit Insurance Corporation
Temporary Continuation of Coverage (TCC)
U.S. Postal Service (Category 2)
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
217.96
Aetna Direct
225
Non-Postal
HDHP Self & Family
Monthly
423.58
Aetna Direct
226
Non-Postal
HDHP Self Plus One
Monthly
483.84
Aetna Direct
N61
Non-Postal
CDHP Self
Monthly
153.16
Aetna Direct
N62
Non-Postal
CDHP Self & Family
Monthly
386.25
Aetna Direct
N63
Non-Postal
CDHP Self Plus One
Monthly
335.89
Aetna Direct
Z24
Non-Postal
Advantage Self
Monthly
115.96
Aetna Direct
Z25
Non-Postal
Advantage Self & Family
Monthly
307.29
Aetna Direct
Z26
Non-Postal
Advantage Self Plus One
Monthly
255.11
Aetna HealthFund CDHP and Aetna Value Plan
JS1
Non-Postal
CDHP Self
Monthly
493.15
Aetna HealthFund CDHP and Aetna Value Plan
JS2
Non-Postal
CDHP Self & Family
Monthly
1104.63
Aetna HealthFund CDHP and Aetna Value Plan
JS3
Non-Postal
CDHP Self Plus One
Monthly
1173.73
Aetna HealthFund CDHP and Aetna Value Plan
JS4
Non-Postal
Value Self
Monthly
562.64
Aetna HealthFund CDHP and Aetna Value Plan
JS5
Non-Postal
Value Self & Family
Monthly
1266.57
Aetna HealthFund CDHP and Aetna Value Plan
JS6
Non-Postal
Value Self Plus One
Monthly
1334.06
AultCare Insurance Company
3A1
Non-Postal
High Self
Monthly
331.19
AultCare Insurance Company
3A2
Non-Postal
High Self & Family
Monthly
895.76
AultCare Insurance Company
3A3
Non-Postal
High Self Plus One
Monthly
675.98
AultCare Insurance Company
3A4
Non-Postal
HDHP Self
Monthly
109.4
AultCare Insurance Company
3A5
Non-Postal
HDHP Self & Family
Monthly
350.31
AultCare Insurance Company
3A6
Non-Postal
HDHP Self Plus One
Monthly
207.99
Humana CoverageFirst and Humana Value Plan
X31
Non-Postal
CDHP Self
Monthly
288.6
Humana CoverageFirst and Humana Value Plan
X32
Non-Postal
CDHP Self & Family
Monthly
614.75
Humana CoverageFirst and Humana Value Plan
X33
Non-Postal
CDHP Self Plus One
Monthly
626.56
Humana CoverageFirst and Humana Value Plan
X34
Non-Postal
Value Self
Monthly
153.78
Humana CoverageFirst and Humana Value Plan
X35
Non-Postal
Value Self & Family
Monthly
346.01
Humana CoverageFirst and Humana Value Plan
X36
Non-Postal
Value Self Plus One
Monthly
330.63
Humana Health Plan of Ohio, Inc.
A61
Non-Postal
High Self
Monthly
990.14
Humana Health Plan of Ohio, Inc.
A62
Non-Postal
High Self & Family
Monthly
2193.21
Humana Health Plan of Ohio, Inc.
A63
Non-Postal
High Self Plus One
Monthly
2134.88
Humana Health Plan of Ohio, Inc.
A64
Non-Postal
Standard Self
Monthly
661.33
Humana Health Plan of Ohio, Inc.
A65
Non-Postal
Standard Self & Family
Monthly
1453.4
Humana Health Plan of Ohio, Inc.
A66
Non-Postal
Standard Self Plus One
Monthly
1427.94
Humana Health Plan of Ohio, Inc.
W61
Non-Postal
Basic Self
Monthly
152.15
Humana Health Plan of Ohio, Inc.
W62
Non-Postal
Basic Self & Family
Monthly
342.36
Humana Health Plan of Ohio, Inc.
W63
Non-Postal
Basic Self Plus One
Monthly
327.14
Medical Mutual of Ohio
644
Non-Postal
Standard Self
Monthly
516.94
Medical Mutual of Ohio
645
Non-Postal
Standard Self & Family
Monthly
1282.69
Medical Mutual of Ohio
646
Non-Postal
Standard Self Plus One
Monthly
1168.9
Medical Mutual of Ohio
UX1
Non-Postal
Basic Self
Monthly
110.03
Medical Mutual of Ohio
UX2
Non-Postal
Basic Self & Family
Monthly
264.08
Medical Mutual of Ohio
UX3
Non-Postal
Basic Self Plus One
Monthly
242.08
Medical Mutual of Ohio
X61
Non-Postal
Basic Self
Monthly
110
Medical Mutual of Ohio
X62
Non-Postal
Basic Self & Family
Monthly
263.99
Medical Mutual of Ohio
X63
Non-Postal
Basic Self Plus One
Monthly
241.99
Medical Mutual of Ohio
X64
Non-Postal
Standard Self
Monthly
338.58
Medical Mutual of Ohio
X65
Non-Postal
Standard Self & Family
Monthly
854.58
Medical Mutual of Ohio
X66
Non-Postal
Standard Self Plus One
Monthly
776.45
Medical Mutual of Ohio
YF1
Non-Postal
Basic Self
Monthly
110.03
Medical Mutual of Ohio
YF2
Non-Postal
Basic Self & Family
Monthly
264.08
Medical Mutual of Ohio
YF3
Non-Postal
Basic Self Plus One
Monthly
242.08
Medical Mutual of Ohio
YF4
Non-Postal
Standard Self
Monthly
458.14
Medical Mutual of Ohio
YF5
Non-Postal
Standard Self & Family
Monthly
1141.53
Medical Mutual of Ohio
YF6
Non-Postal
Standard Self Plus One
Monthly
1039.48
U.S. Office of Personnel Management
1900 E Street, NW, Washington, DC 20415
202-606-1800
Federal Relay Service