2017 Plan Information for New York
Choose a Location, Employee Type, & Payment Period
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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 | 138.7 |
| Aetna Direct | 225 | Non-Postal | HDHP Self & Family | Monthly | 305.95 |
| Aetna Direct | 226 | Non-Postal | HDHP Self Plus One | Monthly | 299.95 |
| Aetna Direct | N61 | Non-Postal | CDHP Self | Monthly | 120.05 |
| Aetna Direct | N62 | Non-Postal | CDHP Self & Family | Monthly | 302.77 |
| Aetna Direct | N63 | Non-Postal | CDHP Self Plus One | Monthly | 263.29 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP1 | Non-Postal | CDHP Self | Monthly | 330.93 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP2 | Non-Postal | CDHP Self & Family | Monthly | 755.39 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP3 | Non-Postal | CDHP Self Plus One | Monthly | 800.84 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP4 | Non-Postal | Value Self | Monthly | 135.57 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP5 | Non-Postal | Value Self & Family | Monthly | 310.46 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP6 | Non-Postal | Value Self Plus One | Monthly | 304.37 |
| Aetna Open Access | JC1 | Non-Postal | High Self | Monthly | 566.9 |
| Aetna Open Access | JC2 | Non-Postal | High Self & Family | Monthly | 1492.99 |
| Aetna Open Access | JC3 | Non-Postal | High Self Plus One | Monthly | 1531.16 |
| Aetna Open Access | JC4 | Non-Postal | Basic Self | Monthly | 324.19 |
| Aetna Open Access | JC5 | Non-Postal | Basic Self & Family | Monthly | 867.62 |
| Aetna Open Access | JC6 | Non-Postal | Basic Self Plus One | Monthly | 911.99 |
| CDPHP Universal Benefits, Inc. | SG1 | Non-Postal | High Self | Monthly | 269.2 |
| CDPHP Universal Benefits, Inc. | SG2 | Non-Postal | High Self & Family | Monthly | 1153.82 |
| CDPHP Universal Benefits, Inc. | SG3 | Non-Postal | High Self Plus One | Monthly | 468.13 |
| CDPHP Universal Benefits, Inc. | SG4 | Non-Postal | Standard Self | Monthly | 132.46 |
| CDPHP Universal Benefits, Inc. | SG5 | Non-Postal | Standard Self & Family | Monthly | 494.76 |
| CDPHP Universal Benefits, Inc. | SG6 | Non-Postal | Standard Self Plus One | Monthly | 264.91 |
| EmblemHealth Plan | 801 | Non-Postal | High Self | Monthly | 475.34 |
| EmblemHealth Plan | 802 | Non-Postal | High Self & Family | Monthly | 1497.82 |
| EmblemHealth Plan | 803 | Non-Postal | High Self Plus One | Monthly | 1296.25 |
| EmblemHealth Plan | 804 | Non-Postal | Standard Self | Monthly | 230.7 |
| EmblemHealth Plan | 805 | Non-Postal | Standard Self & Family | Monthly | 601.21 |
| EmblemHealth Plan | 806 | Non-Postal | Standard Self Plus One | Monthly | 594.32 |
| HIP of Greater New York | 511 | Non-Postal | High Self | Monthly | 241.51 |
| HIP of Greater New York | 512 | Non-Postal | High Self & Family | Monthly | 1012.34 |
| HIP of Greater New York | 513 | Non-Postal | High Self Plus One | Monthly | 392.43 |
| Independent Health Assoc | C54 | Non-Postal | Standard Self | Monthly | 174.65 |
| Independent Health Assoc | C55 | Non-Postal | Standard Self & Family | Monthly | 673.69 |
| Independent Health Assoc | C56 | Non-Postal | Standard Self Plus One | Monthly | 639.21 |
| Independent Health Assoc | QA1 | Non-Postal | High Self | Monthly | 208.93 |
| Independent Health Assoc | QA2 | Non-Postal | High Self & Family | Monthly | 766.27 |
| Independent Health Assoc | QA3 | Non-Postal | High Self Plus One | Monthly | 726.66 |
| Independent Health Assoc | QA4 | Non-Postal | HDHP Self | Monthly | 112.43 |
| Independent Health Assoc | QA5 | Non-Postal | HDHP Self & Family | Monthly | 297.99 |
| Independent Health Assoc | QA6 | Non-Postal | HDHP Self Plus One | Monthly | 275.41 |
| MVP Health Care | GA1 | Non-Postal | High Self | Monthly | 277.05 |
| MVP Health Care | GA2 | Non-Postal | High Self & Family | Monthly | 760.87 |
| MVP Health Care | GA3 | Non-Postal | High Self Plus One | Monthly | 711.01 |
| MVP Health Care | GA4 | Non-Postal | Standard Self | Monthly | 215.45 |
| MVP Health Care | GA5 | Non-Postal | Standard Self & Family | Monthly | 609.9 |
| MVP Health Care | GA6 | Non-Postal | Standard Self Plus One | Monthly | 569.31 |
| MVP Health Care | GV1 | Non-Postal | High Self | Monthly | 203.6 |
| MVP Health Care | GV2 | Non-Postal | High Self & Family | Monthly | 580.84 |
| MVP Health Care | GV3 | Non-Postal | High Self Plus One | Monthly | 542.03 |
| MVP Health Care | GV4 | Non-Postal | Standard Self | Monthly | 152.6 |
| MVP Health Care | GV5 | Non-Postal | Standard Self & Family | Monthly | 400.88 |
| MVP Health Care | GV6 | Non-Postal | Standard Self Plus One | Monthly | 373.08 |
| MVP Health Care | M91 | Non-Postal | High Self | Monthly | 221.47 |
| MVP Health Care | M92 | Non-Postal | High Self & Family | Monthly | 624.61 |
| MVP Health Care | M93 | Non-Postal | High Self Plus One | Monthly | 583.14 |
| MVP Health Care | M94 | Non-Postal | Standard Self | Monthly | 205.98 |
| MVP Health Care | M95 | Non-Postal | Standard Self & Family | Monthly | 586.76 |
| MVP Health Care | M96 | Non-Postal | Standard Self Plus One | Monthly | 547.56 |
| MVP Health Care | MF1 | Non-Postal | High Self | Monthly | 458.59 |
| MVP Health Care | MF2 | Non-Postal | High Self & Family | Monthly | 1205.56 |
| MVP Health Care | MF3 | Non-Postal | High Self Plus One | Monthly | 1128.49 |
| MVP Health Care | MF4 | Non-Postal | Standard Self | Monthly | 395.48 |
| MVP Health Care | MF5 | Non-Postal | Standard Self & Family | Monthly | 1050.97 |
| MVP Health Care | MF6 | Non-Postal | Standard Self Plus One | Monthly | 983.36 |
| MVP Health Care | MX1 | Non-Postal | High Self | Monthly | 346.32 |
| MVP Health Care | MX2 | Non-Postal | High Self & Family | Monthly | 930.61 |
| MVP Health Care | MX3 | Non-Postal | High Self Plus One | Monthly | 870.35 |
| MVP Health Care | MX4 | Non-Postal | Standard Self | Monthly | 323.11 |
| MVP Health Care | MX5 | Non-Postal | Standard Self & Family | Monthly | 873.69 |
| MVP Health Care | MX6 | Non-Postal | Standard Self Plus One | Monthly | 816.94 |
