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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		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
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

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