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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 Total Premium Gov't Pays Empl. Pays Change in employee payment 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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Page updated 09/24/03