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Federal Employees Health Benefits Program 2004 Premiums   
  FEHB Home  |    Non-Postal Premiums
You are here: OPM Home > Insurance > FEHB > 2004 Premiums > Non-postal > Fee-for-Service

2004 FEHB Non-Postal Fee-for-Service Premium Rates


Fee-for-Service (FFS) 2003 Total Biweekly Premium 2004 Biweekly premium rates 2003 Total Monthly Premium 2004 Monthly premium rates
Plan - Option - Enrollment Code Total Premium Gov't Pays Empl. Pays Change in employee payment Total Premium Gov't Pays Empl. Pays Change in employee payment
APWU Health Plan
High Self 471 161.38 178.32 121.40 56.92 4.84 349.66 386.36 263.03 123.33 10.49
High Family 472 354.15 391.34 277.09 114.25 9.72 767.33 847.90 600.36 247.54 21.05
Consumer-Driven Self 474 145.60 155.79 116.84 38.95 2.55 315.47 337.55 253.16 84.39 5.52
Consumer-Driven Family 475 335.92 362.79 272.09 90.70 4.40 727.83 786.05 589.54 196.51 9.52
Blue Cross and Blue Shield Service Benefit Plan
Standard Self 104 154.96 170.30 121.40 48.90 3.24 335.75 368.98 263.03 105.95 7.02
Standard Family 105 354.84 389.97 277.09 112.88 7.66 768.82 844.94 600.36 244.58 16.60
Basic Self 111 139.98 151.98 113.99 37.99 3.00 303.29 329.29 246.97 82.32 6.50
Basic Family 112 329.10 355.98 266.99 88.99 6.72 713.05 771.29 578.47 192.82 14.56
GEHA Benefit Plan
High Self 311 176.47 197.64 121.40 76.24 9.07 382.35 428.22 263.03 165.19 19.66
High Family 312 384.06 430.14 277.09 153.05 18.61 832.13 931.97 600.36 331.61 40.32
Standard Self 314 110.00 121.00 90.75 30.25 2.75 238.33 262.17 196.63 65.54 5.96
Standard Family 315 250.00 275.00 206.25 68.75 6.25 541.67 595.83 446.87 148.96 13.54
Mail Handlers
High Self 451 173.59 216.99 121.40 95.59 31.30 376.11 470.15 263.03 207.12 67.83
High Family 452 366.16 457.70 277.09 180.61 64.07 793.35 991.68 600.36 391.32 138.81
Standard Self 454 112.35 128.64 96.48 32.16 4.07 243.43 278.72 209.04 69.68 8.82
Standard Family 455 243.89 279.25 209.44 69.81 8.84 528.43 605.04 453.78 151.26 19.15
NALC
High Self 321 157.74 173.08 121.40 51.68 3.24 341.77 375.01 263.03 111.98 7.03
High Family 322 337.07 369.87 277.09 92.78 5.33 730.32 801.39 600.36 201.03 11.55
PBP Health Plan
High Self 361 269.12 304.46 121.40 183.06 23.24 583.09 659.66 263.03 396.63 50.36
High Family 362 580.64 656.87 277.09 379.78 48.76 1258.05 1423.22 600.36 822.86 105.65
Standard Self 364 157.75 189.30 121.40 67.90 19.45 341.79 410.15 263.03 147.12 42.15
Standard Family 365 357.32 428.79 277.09 151.70 44.00 774.19 929.05 600.36 328.69 95.34
Association Benefit Plan
High Self 421 163.85 180.16 121.40 58.76 4.21 355.01 390.35 263.03 127.32 9.13
High Family 422 377.46 415.01 277.09 137.92 10.08 817.83 899.19 600.36 298.83 21.84
Foreign Service Benefit Plan
High Self 401 148.56 162.68 121.40 41.28 2.02 321.88 352.47 263.03 89.44 4.38
High Family 402 360.81 394.00 277.09 116.91 5.72 781.76 853.67 600.36 253.31 12.39
Panama Canal Area Benefit Plan
High Self 431 144.96 152.21 114.16 38.05 1.81 314.08 329.79 247.34 82.45 3.93
High Family 432 302.59 317.72 238.29 79.43 3.78 655.61 688.39 516.29 172.10 8.20
Rural Carrier Benefit Plan
High Self 381 179.98 199.94 121.40 78.54 7.86 389.96 433.20 263.03 170.17 17.03
High Family 382 366.60 406.82 277.09 129.73 12.75 794.30 881.44 600.36 281.08 27.62
SAMBA
High Self 441 182.96 192.11 121.40 70.71 -2.95 396.41 416.24 263.03 153.21 -6.38
High Family 442 430.88 452.42 277.09 175.33 -5.93 933.57 980.24 600.36 379.88 -12.85
Secret Service Employees Health Association
High Self Y71 146.45 175.74 121.40 54.34 17.19 317.31 380.77 263.03 117.74 37.25
High Family Y72 347.08 416.50 277.09 139.41 41.95 752.01 902.42 600.36 302.06 90.89

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Page updated 09/24/2003