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    2017 Plan Information for Texas 
    
        Choose a Location, Employee Type, & Payment Period  
        
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                    Nationwide 
         
        
                    Non-Postal 
                    Certain Temporary Employees 
                    Annuitant 
                    U.S. Postal Service (Category 1) 
                    Former Spouse Enrollee 
                    Federal Deposit Insurance Corporation 
                    Temporary Continuation of Coverage (TCC) 
                    U.S. Postal Service (Category 2) 
                    Tribal Employee 
         
        
                    Biweekly 
                    Every Four Weeks 
                    Semi-Monthly 
                    Monthly 
         
         
     
    
 
    
        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 
                            JS1 
                            Non-Postal 
                            CDHP Self 
                            Monthly 
                            485.2 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            JS2 
                            Non-Postal 
                            CDHP Self & Family 
                            Monthly 
                            1106.22 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            JS3 
                            Non-Postal 
                            CDHP Self Plus One 
                            Monthly 
                            1148.2 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            JS4 
                            Non-Postal 
                            Value Self 
                            Monthly 
                            218.24 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            JS5 
                            Non-Postal 
                            Value Self & Family 
                            Monthly 
                            500.05 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            JS6 
                            Non-Postal 
                            Value Self Plus One 
                            Monthly 
                            548.01 
                         
                        
                            Aetna Whole Health 
                            ES1 
                            Non-Postal 
                            Basic Self 
                            Monthly 
                            153.22 
                         
                        
                            Aetna Whole Health 
                            ES2 
                            Non-Postal 
                            Basic Self & Family 
                            Monthly 
                            527.96 
                         
                        
                            Aetna Whole Health 
                            ES3 
                            Non-Postal 
                            Basic Self Plus One 
                            Monthly 
                            575.68 
                         
                        
                            Baylor Scott and White Health Plan 
                            A84 
                            Non-Postal 
                            Standard Self 
                            Monthly 
                            198.18 
                         
                        
                            Baylor Scott and White Health Plan 
                            A85 
                            Non-Postal 
                            Standard Self & Family 
                            Monthly 
                            495.26 
                         
                        
                            Baylor Scott and White Health Plan 
                            A86 
                            Non-Postal 
                            Standard Self Plus One 
                            Monthly 
                            390.24 
                         
                        
                            Baylor Scott and White Health Plan 
                            P84 
                            Non-Postal 
                            Standard Self 
                            Monthly 
                            279.21 
                         
                        
                            Baylor Scott and White Health Plan 
                            P85 
                            Non-Postal 
                            Standard Self & Family 
                            Monthly 
                            685.65 
                         
                        
                            Baylor Scott and White Health Plan 
                            P86 
                            Non-Postal 
                            Standard Self Plus One 
                            Monthly 
                            560.39 
                         
                        
                            Firstcare 
                            CK0 
                            Non-Postal 
                            High Self 
                            Monthly 
                             
                         
                        
                            Firstcare 
                            CK1 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                             
                         
                        
                            Firstcare 
                            CK2 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                             
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TP1 
                            Non-Postal 
                            CDHP Self 
                            Monthly 
                            175.04 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TP2 
                            Non-Postal 
                            CDHP Self & Family 
                            Monthly 
                            379.86 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TP3 
                            Non-Postal 
                            CDHP Self Plus One 
                            Monthly 
                            378.08 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TP4 
                            Non-Postal 
                            Value Self 
                            Monthly 
                            116.33 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TP5 
                            Non-Postal 
                            Value Self & Family 
                            Monthly 
                            261.73 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TP6 
                            Non-Postal 
                            Value Self Plus One 
                            Monthly 
                            250.1 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TU1 
                            Non-Postal 
                            CDHP Self 
                            Monthly 
                            159.4 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TU2 
                            Non-Postal 
                            CDHP Self & Family 
                            Monthly 
                            358.66 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TU3 
                            Non-Postal 
                            CDHP Self Plus One 
                            Monthly 
                            342.71 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TU4 
                            Non-Postal 
                            Value Self 
                            Monthly 
                            116.33 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TU5 
                            Non-Postal 
                            Value Self & Family 
                            Monthly 
                            261.73 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TU6 
                            Non-Postal 
                            Value Self Plus One 
                            Monthly 
                            250.1 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TV1 
                            Non-Postal 
                            CDHP Self 
                            Monthly 
                            172.31 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TV2 
                            Non-Postal 
                            CDHP Self & Family 
                            Monthly 
                            373.73 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TV3 
                            Non-Postal 
                            CDHP Self Plus One 
                            Monthly 
                            372.23 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TV4 
                            Non-Postal 
                            Value Self 
                            Monthly 
                            116.33 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TV5 
                            Non-Postal 
                            Value Self & Family 
                            Monthly 
                            261.73 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TV6 
                            Non-Postal 
                            Value Self Plus One 
                            Monthly 
                            250.1 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            EW1 
                            Non-Postal 
                            High Self 
                            Monthly 
                            297.05 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            EW2 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            654.36 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            EW3 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            640.38 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            EW4 
                            Non-Postal 
                            Standard Self 
                            Monthly 
                            188.13 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            EW5 
                            Non-Postal 
                            Standard Self & Family 
                            Monthly 
                            409.29 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            EW6 
                            Non-Postal 
                            Standard Self Plus One 
                            Monthly 
                            406.18 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UC1 
                            Non-Postal 
                            High Self 
                            Monthly 
                            313.77 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UC2 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            691.99 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UC3 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            676.35 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UC4 
                            Non-Postal 
                            Standard Self 
                            Monthly 
                            162.13 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UC5 
                            Non-Postal 
                            Standard Self & Family 
                            Monthly 
                            361.38 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UC6 
                            Non-Postal 
                            Standard Self Plus One 
                            Monthly 
                            350.37 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UR1 
                            Non-Postal 
                            High Self 
                            Monthly 
                            850.61 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UR2 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            1899.89 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UR3 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            1830.53 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UR4 
                            Non-Postal 
                            Standard Self 
                            Monthly 
                            266.04 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UR5 
                            Non-Postal 
                            Standard Self & Family 
                            Monthly 
                            584.61 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UR6 
                            Non-Postal 
                            Standard Self Plus One 
                            Monthly 
                            573.71 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UU1 
                            Non-Postal 
                            High Self 
                            Monthly 
                            691.47 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UU2 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            1541.8 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UU3 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            1488.39 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UU4 
                            Non-Postal 
                            Standard Self 
                            Monthly 
                            492.39 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UU5 
                            Non-Postal 
                            Standard Self & Family 
                            Monthly 
                            1093.87 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UU6 
                            Non-Postal 
                            Standard Self Plus One 
                            Monthly 
                            1060.34 
                         
                        
                            UnitedHealthcare Benefits of Texas, Inc. 
                            GF1 
                            Non-Postal 
                            High Self 
                            Monthly 
                            465.44 
                         
                        
                            UnitedHealthcare Benefits of Texas, Inc. 
                            GF2 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            1557.17 
                         
                        
                            UnitedHealthcare Benefits of Texas, Inc. 
                            GF3 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            816.12 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced) 
                            L91 
                            Non-Postal 
                            Value Self 
                            Monthly 
                            108.27 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced) 
                            L92 
                            Non-Postal 
                            Value Self & Family 
                            Monthly 
                            303.59 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced) 
                            L93 
                            Non-Postal 
                            Value Self Plus One 
                            Monthly 
                            211.44 
                         
                 
            
         
 
				 
			 
		 
		
		
			
				
					U.S. Office of Personnel Management 
					1900 E Street, NW, Washington, DC 20415
					202-606-1800
					Federal Relay Service