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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 > Indiana

2004 FEHB Non-Postal Premium Rates for Indiana


HMO Plans 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
Advantage Health Plan, Inc.
High Self 6Y1 146.02 169.02 121.40 47.62 10.90 316.38 366.21 263.03 103.18 23.62
High Family 6Y2 342.85 396.85 277.09 119.76 26.53 742.84 859.84 600.36 259.48 57.48
Aetna Health Inc.
High Self RD1 139.97 151.00 113.25 37.75 2.76 303.27 327.17 245.38 81.79 5.97
High Family RD2 343.99 371.08 277.09 93.99 -0.38 745.31 804.01 600.36 203.65 -0.82
Aetna HealthFund (Consumer Driven Plan)
High Self 221 New Plan 129.44 97.08 32.36 N/A New Plan 280.45 210.34 70.11 New Code
High Family 222 New Plan 297.73 223.30 74.43 N/A New Plan 645.08 483.81 161.27 New Code
Arnett HMO
High Self G21 139.82 127.96 95.97 31.99 -2.96 302.94 277.25 207.94 69.31 -6.42
High Family G22 363.57 332.72 249.54 83.18 -30.77 787.74 720.89 540.67 180.22 -66.68
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
Humana CoverageFirst (Consumer Driven Plan)
High Self BM1 New Plan 115.28 86.46 28.82 N/A New Plan 249.77 187.33 62.44 N/A
High Family BM2 New Plan 265.16 198.87 66.29 N/A New Plan 574.51 430.88 143.63 N/A
Humana CoverageFirst (Consumer Driven Plan)
High Self MW1 New Plan 76.86 57.65 19.21 N/A New Plan 166.53 124.90 41.63 New Plan
High Family MW2 New Plan 176.77 132.58 44.19 N/A New Plan 383.00 287.25 95.75 N/A
Humana Health Plan
High Self D21 146.69 178.07 121.40 56.67 19.28 317.83 385.82 263.03 122.79 41.78
High Family D22 366.78 409.53 277.09 132.44 15.28 794.69 887.32 600.36 286.96 33.11
Humana Health Plan Inc.
High Self 751 134.52 155.99 116.99 39.00 5.37 291.46 337.98 253.49 84.49 11.63
High Family 752 322.63 358.77 269.08 89.69 9.03 699.03 777.34 583.01 194.33 19.57
Standard Self 754 102.11 119.60 89.70 29.90 4.37 221.24 259.13 194.35 64.78 9.47
Standard Family 755 244.89 275.06 206.30 68.76 7.54 530.60 595.96 446.97 148.99 16.34
M*Plan
High Self IN1 169.54 188.25 121.40 66.85 6.61 367.34 407.88 263.03 144.85 14.33
High Family IN2 389.11 432.04 277.09 154.95 15.46 843.07 936.09 600.36 335.73 33.50
Physicians Health Plan of Northern Indiana
High Self DQ1 129.52 154.74 116.06 38.68 6.30 280.63 335.27 251.45 83.82 13.66
High Family DQ2 291.09 347.45 260.59 86.86 14.09 630.70 752.81 564.61 188.20 30.53
Unicare HMO
High Self 171 122.22 146.30 109.73 36.57 6.02 264.81 316.98 237.74 79.24 13.04
High Family 172 350.19 398.16 277.09 121.07 20.50 758.75 862.68 600.36 262.32 44.41

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

 
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Page updated 09/24/03