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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 > New York

2004 FEHB Non-Postal Premium Rates for New York

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
Aetna Health Inc.
High Self	JC1	132.37	161.50	121.13	40.37	7.28	286.80	349.92	262.44	87.48	15.78
High Family	JC2	331.29	397.55	277.09	120.46	37.64	717.80	861.36	600.36	261.00	81.55
Aetna HealthFund (Consumer Driven Plan)
High Self	221	New Plan	129.44	97.08	32.36	N/A	New Code	280.45	210.34	70.11	N/A
High Family	222	New Plan	297.73	223.30	74.43	N/A	New Code	645.08	483.81	161.27	N/A
Blue Choice
High Self	MK1	135.23	120.09	90.07	30.02	-3.79	293.00	260.20	195.15	65.05	-8.20
High Family	MK2	338.72	301.02	225.77	75.25	-13.85	733.89	652.21	489.16	163.05	-30.00
Capital District Physicians' Health Plan
High Self	PW1	137.60	156.93	117.70	39.23	4.83	298.13	340.02	255.02	85.00	10.47
High Family	PW2	351.92	401.55	277.09	124.46	22.16	762.49	870.03	600.36	269.67	48.02
Capital District Physicians' Health Plan
High Self	QB1	132.29	152.26	114.20	38.06	4.99	286.63	329.90	247.43	82.47	10.81
High Family	QB2	339.93	390.16	277.09	113.07	22.76	736.52	845.35	600.36	244.99	49.31
Capital District Physicians' Health Plan
High Self	SG1	128.69	147.61	110.71	36.90	4.73	278.83	319.82	239.87	79.95	10.24
High Family	SG2	329.49	378.03	277.09	100.94	18.57	713.90	819.07	600.36	218.71	40.24
GHI Health Plan
High Self	801	168.65	185.17	121.40	63.77	4.42	365.41	401.20	263.03	138.17	9.58
High Family	802	421.60	462.92	277.09	185.83	13.85	913.47	1002.99	600.36	402.63	30.00
Standard Self	804	New Code	158.87	119.15	39.72	N/A	New Code	344.22	258.17	86.05	N/A
Standard Family	805	New Code	397.20	277.09	120.11	N/A	New Code	860.60	600.36	260.24	N/A
GHI HMO Select
High Self	6V1	154.16	176.30	121.40	54.90	10.04	334.01	381.98	263.03	118.95	21.76
High Family	6V2	394.39	438.01	277.09	160.92	16.15	854.51	949.02	600.36	348.66	34.99
GHI HMO Select
High Self	X41	140.06	164.94	121.40	43.54	8.53	303.46	357.37	263.03	94.34	18.48
High Family	X42	333.67	423.59	277.09	146.50	62.45	722.95	917.78	600.36	317.42	135.31
HIP of Greater New York
High Self	511	134.40	146.09	109.57	36.52	2.92	291.20	316.53	237.40	79.13	6.33
High Family	512	376.99	409.03	277.09	131.94	4.57	816.81	886.23	600.36	285.87	9.90
Standard Self	514	107.50	116.96	87.72	29.24	2.37	232.92	253.41	190.06	63.35	5.12
Standard Family	515	301.02	327.48	245.61	81.87	6.62	652.21	709.54	532.16	177.38	14.33
HMO Blue
High Self	AH1	157.63	211.03	121.40	89.63	41.30	341.53	457.23	263.03	194.20	89.49
High Family	AH2	401.64	538.88	277.09	261.79	109.77	870.22	1167.57	600.36	567.21	237.83
HMOBlue-CNY
High Self	EB1	158.67	183.47	121.40	62.07	12.70	343.79	397.52	263.03	134.49	27.52
High Family	EB2	420.45	424.46	277.09	147.37	-23.46	910.98	919.66	600.36	319.30	-50.84
Independent Health Assoc
High Self	QA1	101.31	105.08	78.81	26.27	0.94	219.51	227.67	170.75	56.92	2.04
High Family	QA2	281.01	294.17	220.63	73.54	3.29	608.86	637.37	478.03	159.34	7.13
MVP Health Care
High Self	GA1	118.79	123.70	92.78	30.92	1.22	257.38	268.02	201.02	67.00	2.66
High Family	GA2	306.83	319.47	239.60	79.87	3.16	664.80	692.19	519.14	173.05	6.85
MVP Health Care
High Self	M91	128.06	140.28	105.21	35.07	3.06	277.46	303.94	227.96	75.98	6.62
High Family	M92	330.74	362.22	271.67	90.55	7.87	716.60	784.81	588.61	196.20	17.05
MVP Health Care
High Self	MX1	136.67	144.06	108.05	36.01	1.84	296.12	312.13	234.10	78.03	4.00
High Family	MX2	352.99	372.09	277.09	95.00	-8.37	764.81	806.20	600.36	205.84	-18.13
Preferred Care
High Self	GV1	108.86	119.56	89.67	29.89	2.68	235.86	259.05	194.29	64.76	5.80
High Family	GV2	290.63	319.21	239.41	79.80	7.14	629.70	691.62	518.72	172.90	15.48
Univera Healthcare
High Self	KQ1	131.94	144.68	108.51	36.17	3.19	285.87	313.47	235.10	78.37	6.90
High Family	KQ2	349.80	383.27	277.09	106.18	6.00	757.90	830.42	600.36	230.06	13.00
Univera Healthcare
High Self	Q81	111.03	114.15	85.61	28.54	0.78	240.57	247.33	185.50	61.83	1.69
High Family	Q82	314.82	323.66	242.75	80.91	2.21	682.11	701.26	525.95	175.31	4.78
Vytra Health Plans
High Self	J61	139.59	175.53	121.40	54.13	19.23	302.45	380.32	263.03	117.29	41.68
High Family	J62	365.86	460.32	277.09	183.23	66.99	792.70	997.36	600.36	397.00	145.14

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