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Federal Employees Health Benefits Program

2004 Premiums

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2004 FEHB Postal Premium Rates for Ohio

HMO Plans		2003 Total Biweekly Premium	2004 Total Biweekly Premium	2004 Biweekly Postal Premium Rates
Plan - Option - Enrollment Code		2003 Total Biweekly Premium	2004 Total Biweekly Premium	USPS Pays	Postal Empl. Pays	Change in employee payment
Aetna Health Inc.
High Self	7D1	139.73	141.10	125.23	15.87	0.15
High Family	7D2	336.55	339.83	301.60	38.23	-3.62
Aetna Health Inc.
High Self	RD1	139.97	151.00	134.01	16.99	1.24
High Family	RD2	343.99	371.08	327.12	43.96	-5.33
AultCare HMO
High Self	3A1	150.42	145.88	129.47	16.41	-4.98
High Family	3A2	380.95	358.16	317.87	40.29	-45.96
Blue HMO
High Self	R51	149.10	173.71	143.32	30.39	10.32
High Family	R52	370.33	431.43	327.12	104.31	28.68
HMO Health Ohio
High Self	L41	133.69	151.14	134.14	17.00	1.96
High Family	L42	341.96	386.65	327.12	59.53	12.27
HOMETOWN HEALTH PLAN
High Self	MZ1	New Plan	129.67	115.08	14.59	N/A
High Family	MZ2	New Plan	324.19	287.72	36.47	N/A
Humana CoverageFirst (Consumer Driven Plan)
High Self	L81	New Plan	96.08	85.27	10.81	N/A
High Family	L82	New Plan	220.97	196.11	24.86	N/A
Kaiser Permanente
High Self	641	137.00	151.78	134.70	17.08	1.67
High Family	642	336.18	372.47	327.12	45.35	3.87
Paramount Health Care
High Self	U21	140.20	154.56	137.17	17.39	1.62
High Family	U22	371.19	409.23	327.12	82.11	5.62
SummaCare Health Plan
High Self	5W1	132.62	145.43	129.07	16.36	1.44
High Family	5W2	364.66	399.92	327.12	72.80	2.84
SuperMed HMO
High Self	5M1	154.60	168.06	143.32	24.74	-0.83
High Family	5M2	395.45	429.89	327.12	102.77	2.02
The Health Plan of the Upper Ohio Valley
High Self	U41	149.39	154.45	137.07	17.38	-2.98
High Family	U42	410.83	355.20	315.24	39.96	-76.17
United Healthcare of Ohio, Inc.
High Self	3U1	177.82	197.49	143.32	54.17	5.38
High Family	3U2	409.00	454.23	327.12	127.11	12.81

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