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Insurance Services Programs

Federal Employees Health Benefits Program

2004 Premiums

2004 FEHB Non-Postal Premium Rates for Iowa

HMO Plans		2003 Total Biweekly Premium	2004 Biweekly premium rates				2003 Total Monthly Premium	2004 Monthly premium rates
Plan - Option - Enrollment Code		2003 Total Biweekly Premium	Total Premium	Gov't Pays	Empl. Pays	Change in employee payment	2003 Total Monthly Premium	Total Premium	Gov't Pays	Empl. Pays	Change in employee payment
Avera Health Plans
High Self	AV1	118.18	144.77	108.58	36.19	6.65	256.06	313.67	235.25	78.42	14.41
High Family	AV2	275.98	338.08	253.56	84.52	15.53	597.96	732.51	549.38	183.13	33.64
Coventry Health Care of Iowa
High Self	SV1	116.65	134.14	100.61	33.53	4.37	252.74	290.64	217.98	72.66	9.48
High Family	SV2	315.02	362.26	271.70	90.56	11.81	682.54	784.90	588.68	196.22	25.59
Health Alliance HMO
High Self	FX1	151.25	169.40	121.40	48.00	6.05	327.71	367.03	263.03	104.00	13.11
High Family	FX2	353.01	395.37	277.09	118.28	14.89	764.86	856.64	600.36	256.28	32.26
John Deere Health Plan
High Self	YH1	124.17	142.23	106.67	35.56	4.52	269.04	308.17	231.13	77.04	9.78
High Family	YH2	304.21	348.46	261.35	87.11	11.06	659.12	755.00	566.25	188.75	23.97
Sioux Valley Health Plan
High Self	AU1	167.09	213.66	121.40	92.26	34.47	362.03	462.93	263.03	199.90	74.69
High Family	AU2	382.64	491.25	277.09	214.16	81.14	829.05	1064.38	600.36	464.02	175.81
Standard Self	AU4	New Code	181.32	121.40	59.92	N/A	New Code	392.86	263.03	129.83	N/A
Standard Family	AU5	New Code	416.83	277.09	139.74	N/A	New Code	903.13	600.36	302.77	N/A

This page can be found on the web at the following url: http://www.opm.gov/insure/archive/health/04rates/html/nonpostal/ia.asp

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