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    2020 Plan Information for Georgia 
    
        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 
                            217.96 
                         
                        
                            Aetna Direct  
                            225 
                            Non-Postal 
                            HDHP Self & Family 
                            Monthly 
                            423.58 
                         
                        
                            Aetna Direct  
                            226 
                            Non-Postal 
                            HDHP Self Plus One 
                            Monthly 
                            483.84 
                         
                        
                            Aetna Direct  
                            N61 
                            Non-Postal 
                            CDHP Self 
                            Monthly 
                            153.16 
                         
                        
                            Aetna Direct  
                            N62 
                            Non-Postal 
                            CDHP Self & Family 
                            Monthly 
                            386.25 
                         
                        
                            Aetna Direct  
                            N63 
                            Non-Postal 
                            CDHP Self Plus One 
                            Monthly 
                            335.89 
                         
                        
                            Aetna Direct  
                            Z24 
                            Non-Postal 
                            Advantage Self 
                            Monthly 
                            115.96 
                         
                        
                            Aetna Direct  
                            Z25 
                            Non-Postal 
                            Advantage Self & Family 
                            Monthly 
                            307.29 
                         
                        
                            Aetna Direct  
                            Z26 
                            Non-Postal 
                            Advantage Self Plus One 
                            Monthly 
                            255.11 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            F51 
                            Non-Postal 
                            CDHP Self 
                            Monthly 
                            318.39 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            F52 
                            Non-Postal 
                            CDHP Self & Family 
                            Monthly 
                            706.7 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            F53 
                            Non-Postal 
                            CDHP Self Plus One 
                            Monthly 
                            779.74 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            F54 
                            Non-Postal 
                            Value Self 
                            Monthly 
                            309.14 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            F55 
                            Non-Postal 
                            Value Self & Family 
                            Monthly 
                            693.59 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            F56 
                            Non-Postal 
                            Value Self Plus One 
                            Monthly 
                            748.52 
                         
                        
                            Aetna Open Access 
                            2U1 
                            Non-Postal 
                            High Self 
                            Monthly 
                            1222.52 
                         
                        
                            Aetna Open Access 
                            2U2 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            2808.67 
                         
                        
                            Aetna Open Access 
                            2U3 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            2860.89 
                         
                        
                            Blue Open Access POS  
                            QM1 
                            Non-Postal 
                            High Self 
                            Monthly 
                            156.29 
                         
                        
                            Blue Open Access POS  
                            QM2 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            456.45 
                         
                        
                            Blue Open Access POS  
                            QM3 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            344.43 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            AD1 
                            Non-Postal 
                            CDHP Self 
                            Monthly 
                            462.54 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            AD2 
                            Non-Postal 
                            CDHP Self & Family 
                            Monthly 
                            1006.05 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            AD3 
                            Non-Postal 
                            CDHP Self Plus One 
                            Monthly 
                            1000.48 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            AD4 
                            Non-Postal 
                            Value Self 
                            Monthly 
                            226.69 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            AD5 
                            Non-Postal 
                            Value Self & Family 
                            Monthly 
                            475.39 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            AD6 
                            Non-Postal 
                            Value Self Plus One 
                            Monthly 
                            493.42 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            LM1 
                            Non-Postal 
                            CDHP Self 
                            Monthly 
                            169.81 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            LM2 
                            Non-Postal 
                            CDHP Self & Family 
                            Monthly 
                            382.07 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            LM3 
                            Non-Postal 
                            CDHP Self Plus One 
                            Monthly 
                            368.1 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            LM4 
                            Non-Postal 
                            Value Self 
                            Monthly 
                            160.64 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            LM5 
                            Non-Postal 
                            Value Self & Family 
                            Monthly 
                            361.43 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            LM6 
                            Non-Postal 
                            Value Self Plus One 
                            Monthly 
                            345.37 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            S91 
                            Non-Postal 
                            CDHP Self 
                            Monthly 
                            182.3 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            S92 
                            Non-Postal 
                            CDHP Self & Family 
                            Monthly 
                            389.9 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            S93 
                            Non-Postal 
                            CDHP Self Plus One 
                            Monthly 
                            398.02 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            S94 
                            Non-Postal 
                            Value Self 
                            Monthly 
                            137.97 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            S95 
                            Non-Postal 
                            Value Self & Family 
                            Monthly 
                            310.43 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            S96 
                            Non-Postal 
                            Value Self Plus One 
                            Monthly 
                            296.64 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            CB1 
                            Non-Postal 
                            High Self 
                            Monthly 
                            637.73 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            CB2 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            1400.38 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            CB3 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            1377.35 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            CB4 
                            Non-Postal 
                            Standard Self 
                            Monthly 
                            739.61 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            CB5 
                            Non-Postal 
                            Standard Self & Family 
                            Monthly 
                            1629.48 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            CB6 
                            Non-Postal 
                            Standard Self Plus One 
                            Monthly 
                            1596.21 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            DG1 
                            Non-Postal 
                            High Self 
                            Monthly 
                            811.09 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            DG2 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            1790.32 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            DG3 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            1749.93 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            DG4 
                            Non-Postal 
                            Standard Self 
                            Monthly 
                            661 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            DG5 
                            Non-Postal 
                            Standard Self & Family 
                            Monthly 
                            1452.68 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            DG6 
                            Non-Postal 
                            Standard Self Plus One 
                            Monthly 
                            1427.31 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            DN1 
                            Non-Postal 
                            High Self 
                            Monthly 
                            269.77 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            DN2 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            572.35 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            DN3 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            586.04 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            DN4 
                            Non-Postal 
                            Standard Self 
                            Monthly 
                            215.19 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            DN5 
                            Non-Postal 
                            Standard Self & Family 
                            Monthly 
                            449.5 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            DN6 
                            Non-Postal 
                            Standard Self Plus One 
                            Monthly 
                            468.67 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            Q71 
                            Non-Postal 
                            Basic Self 
                            Monthly 
                            251.96 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            Q72 
                            Non-Postal 
                            Basic Self & Family 
                            Monthly 
                            532.31 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            Q73 
                            Non-Postal 
                            Basic Self Plus One 
                            Monthly 
                            547.76 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            RJ1 
                            Non-Postal 
                            Basic Self 
                            Monthly 
                            149.52 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            RJ2 
                            Non-Postal 
                            Basic Self & Family 
                            Monthly 
                            336.43 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            RJ3 
                            Non-Postal 
                            Basic Self Plus One 
                            Monthly 
                            321.48 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            RM1 
                            Non-Postal 
                            Basic Self 
                            Monthly 
                            162.13 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            RM2 
                            Non-Postal 
                            Basic Self & Family 
                            Monthly 
                            364.81 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            RM3 
                            Non-Postal 
                            Basic Self Plus One 
                            Monthly 
                            348.59 
                         
                        
                            Kaiser Permanente - Georgia 
                            F81 
                            Non-Postal 
                            High Self 
                            Monthly 
                            219.2 
                         
                        
                            Kaiser Permanente - Georgia 
                            F82 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            465.85 
                         
                        
                            Kaiser Permanente - Georgia 
                            F83 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            557.61 
                         
                        
                            Kaiser Permanente - Georgia 
                            F84 
                            Non-Postal 
                            Standard Self 
                            Monthly 
                            138.08 
                         
                        
                            Kaiser Permanente - Georgia 
                            F85 
                            Non-Postal 
                            Standard Self & Family 
                            Monthly 
                            312.06 
                         
                        
                            Kaiser Permanente - Georgia 
                            F86 
                            Non-Postal 
                            Standard Self Plus One 
                            Monthly 
                            312.06 
                         
                        
                            Kaiser Permanente - Georgia 
                            LA1 
                            Non-Postal 
                            Basic Self 
                            Monthly 
                            98.34 
                         
                        
                            Kaiser Permanente - Georgia 
                            LA2 
                            Non-Postal 
                            Basic Self & Family 
                            Monthly 
                            222.24 
                         
                        
                            Kaiser Permanente - Georgia 
                            LA3 
                            Non-Postal 
                            Basic Self Plus One 
                            Monthly 
                            222.24 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced) 
                            LV1 
                            Non-Postal 
                            Value Self 
                            Monthly 
                            190.6 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced) 
                            LV2 
                            Non-Postal 
                            Value Self & Family 
                            Monthly 
                            920.27 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced) 
                            LV3 
                            Non-Postal 
                            Value Self Plus One 
                            Monthly 
                            415.81 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Plus Primary  
                            AS1 
                            Non-Postal 
                            High Self 
                            Monthly 
                            131.45 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Plus Primary  
                            AS2 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            310.84 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Plus Primary  
                            AS3 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            282.6 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Primary  
                            Y81 
                            Non-Postal 
                            High Self 
                            Monthly 
                            126.68 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Primary  
                            Y82 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            299.56 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Primary  
                            Y83 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            272.34 
                         
                 
            
         
 
				 
			 
		 
		
		
			
				
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					1900 E Street, NW, Washington, DC 20415
					202-606-1800
					Federal Relay Service