Healthcare

2016 Plan Information for Indiana

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Location Specific Rates

Contract	Enrollment Code	Enrollment Type	Option/Enrollment Type	Payment Period	Employee Payment
Aetna Direct	224	Non-Postal	HDHP Self	Monthly	130.08
Aetna Direct	225	Non-Postal	HDHP Self & Family	Monthly	286.94
Aetna Direct	226	Non-Postal	HDHP Self Plus One	Monthly	281.31
Aetna Direct	N61	Non-Postal	CDHP Self	Monthly	118.33
Aetna Direct	N62	Non-Postal	CDHP Self & Family	Monthly	298.42
Aetna Direct	N63	Non-Postal	CDHP Self Plus One	Monthly	259.5
Aetna HealthFund CDHP and Aetna Value Plan	JS1	Non-Postal	CDHP Self	Monthly	412.06
Aetna HealthFund CDHP and Aetna Value Plan	JS2	Non-Postal	CDHP Self & Family	Monthly	934.7
Aetna HealthFund CDHP and Aetna Value Plan	JS3	Non-Postal	CDHP Self Plus One	Monthly	974.5
Aetna HealthFund CDHP and Aetna Value Plan	JS4	Non-Postal	Basic Self	Monthly	190.54
Aetna HealthFund CDHP and Aetna Value Plan	JS5	Non-Postal	Basic Self & Family	Monthly	431.94
Aetna HealthFund CDHP and Aetna Value Plan	JS6	Non-Postal	Basic Self Plus One	Monthly	476.71
Health Alliance HMO/POS	FX1	Non-Postal	High Self	Monthly	299.18
Health Alliance HMO/POS	FX2	Non-Postal	High Self & Family	Monthly	1096.35
Health Alliance HMO/POS	FX3	Non-Postal	High Self Plus One	Monthly	600.21
Health Alliance HMO/POS	K84	Non-Postal	Standard Self	Monthly	162.61
Health Alliance HMO/POS	K85	Non-Postal	Standard Self & Family	Monthly	675.69
Health Alliance HMO/POS	K86	Non-Postal	Standard Self Plus One	Monthly	328.08
Humana CoverageFirst and Humana Value Plan	MW1	Non-Postal	CDHP Self	Monthly	206.75
Humana CoverageFirst and Humana Value Plan	MW2	Non-Postal	CDHP Self & Family	Monthly	446.92
Humana CoverageFirst and Humana Value Plan	MW3	Non-Postal	CDHP Self Plus One	Monthly	439.55
Humana CoverageFirst and Humana Value Plan	MW4	Non-Postal	Value Self	Monthly	116.61
Humana CoverageFirst and Humana Value Plan	MW5	Non-Postal	Value Self & Family	Monthly	262.37
Humana CoverageFirst and Humana Value Plan	MW6	Non-Postal	Value Self Plus One	Monthly	250.7
Humana Health Plan of Ohio, Inc.	A61	Non-Postal	High Self	Monthly	293.91
Humana Health Plan of Ohio, Inc.	A62	Non-Postal	High Self & Family	Monthly	643.06
Humana Health Plan of Ohio, Inc.	A63	Non-Postal	High Self Plus One	Monthly	626.99
Humana Health Plan of Ohio, Inc.	A64	Non-Postal	Standard Self	Monthly	176.28
Humana Health Plan of Ohio, Inc.	A65	Non-Postal	Standard Self & Family	Monthly	378.38
Humana Health Plan of Ohio, Inc.	A66	Non-Postal	Standard Self Plus One	Monthly	374.05
Humana Health Plan, Inc.	751	Non-Postal	High Self	Monthly	738.47
Humana Health Plan, Inc.	752	Non-Postal	High Self & Family	Monthly	1643.33
Humana Health Plan, Inc.	753	Non-Postal	High Self Plus One	Monthly	1582.77
Humana Health Plan, Inc.	754	Non-Postal	Standard Self	Monthly	284.92
Humana Health Plan, Inc.	755	Non-Postal	Standard Self & Family	Monthly	622.83
Humana Health Plan, Inc.	756	Non-Postal	Standard Self Plus One	Monthly	607.66
Humana Health Plan, Inc.	MH1	Non-Postal	High Self	Monthly	227.83
Humana Health Plan, Inc.	MH2	Non-Postal	High Self & Family	Monthly	494.37
Humana Health Plan, Inc.	MH3	Non-Postal	High Self Plus One	Monthly	484.92
Humana Health Plan, Inc.	MH4	Non-Postal	Standard Self	Monthly	164.86
Humana Health Plan, Inc.	MH5	Non-Postal	Standard Self & Family	Monthly	352.79
Humana Health Plan, Inc.	MH6	Non-Postal	Standard Self Plus One	Monthly	349.55