Click here to skip navigation
OPM.gov Home  |  Subject Index  |  Important Links  |  Contact Us  |  Help

U.S. Office of Personnel Management - Ensuring the Federal Government has an effective civilian workforce

Advanced Search

Insurance Services Programs

Federal Employees Health Benefits Program 2004 Premiums   
  FEHB Home  |    Non-Postal Premiums
You are here: OPM Home > Insurance > FEHB > 2004 Premiums > Non-postal > Pennsylvania

2004 FEHB Non-Postal Premium Rates for Pennsylvania


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 P31 148.51 158.90 119.18 39.72 0.51 321.77 344.28 258.21 86.07 1.12
High Family P32 358.34 383.43 277.09 106.34 -2.38 776.40 830.77 600.36 230.41 -5.15
Aetna Health Inc.
High Self YE1 New Code 123.99 92.99 31.00 N/A New Code 268.65 201.49 67.16 N/A
High Family YE2 New Code 341.92 256.44 85.48 N/A New Code 740.83 555.62 185.21 N/A
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
HealthAmerica Pennsylvania
High Self 261 137.03 164.23 121.40 42.83 8.57 296.90 355.83 263.03 92.80 18.58
High Family 262 356.28 418.79 277.09 141.70 35.04 771.94 907.38 600.36 307.02 75.92
Standard Self 264 New Code 147.93 110.95 36.98 N/A New Code 320.52 240.39 80.13 N/A
Standard Family 265 New Code 377.22 277.09 100.13 N/A New Code 817.31 600.36 216.95 N/A
HealthAmerica Pennsylvania
High Self 4N1 New Code 179.14 121.40 57.74 N/A New Code 388.14 263.03 125.11 N/A
High Family 4N2 New Code 444.26 277.09 167.17 N/A New Code 962.56 600.36 362.20 N/A
Standard Self 4N4 New Code 161.50 121.13 40.37 N/A New Code 349.92 262.44 87.48 N/A
Standard Family 4N5 New Code 400.52 277.09 123.43 N/A New Code 867.79 600.36 267.43 N/A
HealthAmerica Pennsylvania
High Self SW1 141.82 177.20 121.40 55.80 20.35 307.28 383.93 263.03 120.90 44.08
High Family SW2 368.75 429.17 277.09 152.08 32.95 798.96 929.87 600.36 329.51 71.39
Standard Self SW4 New Code 159.17 119.38 39.79 N/A New Code 344.87 258.65 86.22 N/A
Standard Family SW5 New Code 385.51 277.09 108.42 N/A New Code 835.27 600.36 234.91 N/A
HealthAmerica Pennsylvania
High Self VJ1 New Code 149.54 112.16 37.38 N/A New Code 324.00 243.00 81.00 N/A
High Family VJ2 New Code 381.34 277.09 104.25 N/A New Code 826.24 600.36 225.88 N/A
Standard Self VJ4 New Code 136.88 102.66 34.22 N/A New Code 296.57 222.43 74.14 N/A
Standard Family VJ5 New Code 349.07 261.80 87.27 N/A New Code 756.32 567.24 189.08 N/A
Keystone Health Plan Central
High Self S41 156.21 174.21 121.40 52.81 5.90 338.46 377.46 263.03 114.43 12.79
High Family S42 378.36 418.17 277.09 141.08 12.34 819.78 906.04 600.36 305.68 26.74
Keystone Health Plan East
High Self ED1 146.63 160.74 120.56 40.18 2.85 317.70 348.27 261.20 87.07 6.19
High Family ED2 386.69 423.86 277.09 146.77 9.70 837.83 918.36 600.36 318.00 21.01
UPMC Health Plan
High Self 8W1 138.90 156.11 117.08 39.03 4.31 300.95 338.24 253.68 84.56 9.32
High Family 8W2 354.29 398.21 277.09 121.12 16.45 767.63 862.79 600.36 262.43 35.64
 
PDF Help U.S. Office of Personnel Management 1900 E Street NW, Washington, DC 20415 | (202) 606-1800 | TTY (202) 606-2532

Page updated 09/24/03