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    2021 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 
                            262.6 
                         
                        
                            Aetna Direct  
                            225 
                            Non-Postal 
                            HDHP Self & Family 
                            Monthly 
                            515.62 
                         
                        
                            Aetna Direct  
                            226 
                            Non-Postal 
                            HDHP Self Plus One 
                            Monthly 
                            578.72 
                         
                        
                            Aetna Direct  
                            N61 
                            Non-Postal 
                            CDHP Self 
                            Monthly 
                            153.96 
                         
                        
                            Aetna Direct  
                            N62 
                            Non-Postal 
                            CDHP Self & Family 
                            Monthly 
                            388.27 
                         
                        
                            Aetna Direct  
                            N63 
                            Non-Postal 
                            CDHP Self Plus One 
                            Monthly 
                            337.64 
                         
                        
                            Aetna Direct  
                            Z24 
                            Non-Postal 
                            Advantage Self 
                            Monthly 
                            125 
                         
                        
                            Aetna Direct  
                            Z25 
                            Non-Postal 
                            Advantage Self & Family 
                            Monthly 
                            331.25 
                         
                        
                            Aetna Direct  
                            Z26 
                            Non-Postal 
                            Advantage Self Plus One 
                            Monthly 
                            275 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            F51 
                            Non-Postal 
                            CDHP Self 
                            Monthly 
                            328.32 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            F52 
                            Non-Postal 
                            CDHP Self & Family 
                            Monthly 
                            723.82 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            F53 
                            Non-Postal 
                            CDHP Self Plus One 
                            Monthly 
                            801.65 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            F54 
                            Non-Postal 
                            Value Self 
                            Monthly 
                            298.4 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            F55 
                            Non-Postal 
                            Value Self & Family 
                            Monthly 
                            663.67 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            F56 
                            Non-Postal 
                            Value Self Plus One 
                            Monthly 
                            723.8 
                         
                        
                            Aetna Open Access 
                            2U1 
                            Non-Postal 
                            High Self 
                            Monthly 
                            1282.43 
                         
                        
                            Aetna Open Access 
                            2U2 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            2941.51 
                         
                        
                            Aetna Open Access 
                            2U3 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            2997.37 
                         
                        
                            Blue Open Access POS  
                            QM1 
                            Non-Postal 
                            High Self 
                            Monthly 
                            164.1 
                         
                        
                            Blue Open Access POS  
                            QM2 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            471.47 
                         
                        
                            Blue Open Access POS  
                            QM3 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            361.65 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            AD1 
                            Non-Postal 
                            CDHP Self 
                            Monthly 
                            566.76 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            AD2 
                            Non-Postal 
                            CDHP Self & Family 
                            Monthly 
                            1234.65 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            AD3 
                            Non-Postal 
                            CDHP Self Plus One 
                            Monthly 
                            1222.7 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            AD4 
                            Non-Postal 
                            Value Self 
                            Monthly 
                            302.62 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            AD5 
                            Non-Postal 
                            Value Self & Family 
                            Monthly 
                            640.31 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            AD6 
                            Non-Postal 
                            Value Self Plus One 
                            Monthly 
                            654.79 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            LM1 
                            Non-Postal 
                            CDHP Self 
                            Monthly 
                            223.71 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            LM2 
                            Non-Postal 
                            CDHP Self & Family 
                            Monthly 
                            462.91 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            LM3 
                            Non-Postal 
                            CDHP Self Plus One 
                            Monthly 
                            485.25 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            LM4 
                            Non-Postal 
                            Value Self 
                            Monthly 
                            183.39 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            LM5 
                            Non-Postal 
                            Value Self & Family 
                            Monthly 
                            397.57 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            LM6 
                            Non-Postal 
                            Value Self Plus One 
                            Monthly 
                            398.48 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            S91 
                            Non-Postal 
                            CDHP Self 
                            Monthly 
                            245.99 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            S92 
                            Non-Postal 
                            CDHP Self & Family 
                            Monthly 
                            512.94 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            S93 
                            Non-Postal 
                            CDHP Self Plus One 
                            Monthly 
                            533.05 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            S94 
                            Non-Postal 
                            Value Self 
                            Monthly 
                            153.15 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            S95 
                            Non-Postal 
                            Value Self & Family 
                            Monthly 
                            344.59 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            S96 
                            Non-Postal 
                            Value Self Plus One 
                            Monthly 
                            329.27 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            CB1 
                            Non-Postal 
                            High Self 
                            Monthly 
                            751.47 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            CB2 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            1650.46 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            CB3 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            1620.11 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            CB4 
                            Non-Postal 
                            Standard Self 
                            Monthly 
                            614.47 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            CB5 
                            Non-Postal 
                            Standard Self & Family 
                            Monthly 
                            1342.1 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            CB6 
                            Non-Postal 
                            Standard Self Plus One 
                            Monthly 
                            1325.35 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            DG1 
                            Non-Postal 
                            High Self 
                            Monthly 
                            864.61 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            DG2 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            1904.85 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            DG3 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            1863.14 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            DG4 
                            Non-Postal 
                            Standard Self 
                            Monthly 
                            777.34 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            DG5 
                            Non-Postal 
                            Standard Self & Family 
                            Monthly 
                            1708.5 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            DG6 
                            Non-Postal 
                            Standard Self Plus One 
                            Monthly 
                            1675.55 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            DN1 
                            Non-Postal 
                            High Self 
                            Monthly 
                            350.85 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            DN2 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            748.91 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            DN3 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            758.55 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            DN4 
                            Non-Postal 
                            Standard Self 
                            Monthly 
                            289.73 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            DN5 
                            Non-Postal 
                            Standard Self & Family 
                            Monthly 
                            611.32 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            DN6 
                            Non-Postal 
                            Standard Self Plus One 
                            Monthly 
                            627.08 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            Q71 
                            Non-Postal 
                            Basic Self 
                            Monthly 
                            323.29 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            Q72 
                            Non-Postal 
                            Basic Self & Family 
                            Monthly 
                            686.9 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            Q73 
                            Non-Postal 
                            Basic Self Plus One 
                            Monthly 
                            699.27 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            RJ1 
                            Non-Postal 
                            Basic Self 
                            Monthly 
                            167.46 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            RJ2 
                            Non-Postal 
                            Basic Self & Family 
                            Monthly 
                            376.8 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            RJ3 
                            Non-Postal 
                            Basic Self Plus One 
                            Monthly 
                            360.06 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            RM1 
                            Non-Postal 
                            Basic Self 
                            Monthly 
                            196.46 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            RM2 
                            Non-Postal 
                            Basic Self & Family 
                            Monthly 
                            404.93 
                         
                        
                            Humana Employers Health Plan of Georgia, Inc. 
                            RM3 
                            Non-Postal 
                            Basic Self Plus One 
                            Monthly 
                            426.58 
                         
                        
                            Kaiser Permanente - Georgia 
                            F81 
                            Non-Postal 
                            High Self 
                            Monthly 
                            227.68 
                         
                        
                            Kaiser Permanente - Georgia 
                            F82 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            479.29 
                         
                        
                            Kaiser Permanente - Georgia 
                            F83 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            576.34 
                         
                        
                            Kaiser Permanente - Georgia 
                            F84 
                            Non-Postal 
                            Standard Self 
                            Monthly 
                            145.27 
                         
                        
                            Kaiser Permanente - Georgia 
                            F85 
                            Non-Postal 
                            Standard Self & Family 
                            Monthly 
                            328.31 
                         
                        
                            Kaiser Permanente - Georgia 
                            F86 
                            Non-Postal 
                            Standard Self Plus One 
                            Monthly 
                            328.31 
                         
                        
                            Kaiser Permanente - Georgia 
                            LA1 
                            Non-Postal 
                            Basic Self 
                            Monthly 
                            104.72 
                         
                        
                            Kaiser Permanente - Georgia 
                            LA2 
                            Non-Postal 
                            Basic Self & Family 
                            Monthly 
                            236.66 
                         
                        
                            Kaiser Permanente - Georgia 
                            LA3 
                            Non-Postal 
                            Basic Self Plus One 
                            Monthly 
                            236.66 
                         
                        
                            UnitedHealthcare Advantage Plan 
                            Y51 
                            Non-Postal 
                            High Self 
                            Monthly 
                            102.93 
                         
                        
                            UnitedHealthcare Advantage Plan 
                            Y52 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            272.77 
                         
                        
                            UnitedHealthcare Advantage Plan 
                            Y53 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            226.45 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced) 
                            LV1 
                            Non-Postal 
                            Value Self 
                            Monthly 
                            227.2 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced) 
                            LV2 
                            Non-Postal 
                            Value Self & Family 
                            Monthly 
                            1033.69 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced) 
                            LV3 
                            Non-Postal 
                            Value Self Plus One 
                            Monthly 
                            492.73 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Plus Primary  
                            AS1 
                            Non-Postal 
                            High Self 
                            Monthly 
                            149.87 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Plus Primary  
                            AS2 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            354.44 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Plus Primary  
                            AS3 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            322.22 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Primary  
                            Y81 
                            Non-Postal 
                            High Self 
                            Monthly 
                            144.18 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Primary  
                            Y82 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            340.98 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Primary  
                            Y83 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            309.98 
                         
                 
            
         
 
				 
			 
		 
		
		
			
				
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					202-606-1800
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