2021 Plan Information for New York
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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 | 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 | EP1 | Non-Postal | CDHP Self | Monthly | 601.23 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP2 | Non-Postal | CDHP Self & Family | Monthly | 1346.67 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP3 | Non-Postal | CDHP Self Plus One | Monthly | 1418.3 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP4 | Non-Postal | Value Self | Monthly | 316.21 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP5 | Non-Postal | Value Self & Family | Monthly | 704.47 |
| Aetna HealthFund CDHP and Aetna Value Plan | EP6 | Non-Postal | Value Self Plus One | Monthly | 763.8 |
| Aetna Open Access | JC1 | Non-Postal | High Self | Monthly | 936.16 |
| Aetna Open Access | JC2 | Non-Postal | High Self & Family | Monthly | 2388.36 |
| Aetna Open Access | JC3 | Non-Postal | High Self Plus One | Monthly | 2449.72 |
| Aetna Open Access | JC4 | Non-Postal | Basic Self | Monthly | 696.44 |
| Aetna Open Access | JC5 | Non-Postal | Basic Self & Family | Monthly | 1757.3 |
| Aetna Open Access | JC6 | Non-Postal | Basic Self Plus One | Monthly | 1824.9 |
| CDPHP Universal Benefits, Inc. | SG4 | Non-Postal | Standard Self | Monthly | 181.14 |
| CDPHP Universal Benefits, Inc. | SG5 | Non-Postal | Standard Self & Family | Monthly | 472.66 |
| CDPHP Universal Benefits, Inc. | SG6 | Non-Postal | Standard Self Plus One | Monthly | 442.96 |
| EmblemHealth Plan | 804 | Non-Postal | Standard Self | Monthly | 516.43 |
| EmblemHealth Plan | 805 | Non-Postal | Standard Self & Family | Monthly | 1304.51 |
| EmblemHealth Plan | 806 | Non-Postal | Standard Self Plus One | Monthly | 1297.58 |
| HIP of Greater New York | 511 | Non-Postal | High Self | Monthly | 527.33 |
| HIP of Greater New York | 512 | Non-Postal | High Self & Family | Monthly | 1836.18 |
| HIP of Greater New York | 513 | Non-Postal | High Self Plus One | Monthly | 797.47 |
| HIP of Greater New York | YL4 | Non-Postal | Standard Self | Monthly | 377.26 |
| HIP of Greater New York | YL5 | Non-Postal | Standard Self & Family | Monthly | 1400.03 |
| HIP of Greater New York | YL6 | Non-Postal | Standard Self Plus One | Monthly | 523.43 |
| Independent Health Assoc | C54 | Non-Postal | Standard Self | Monthly | 198.73 |
| Independent Health Assoc | C55 | Non-Postal | Standard Self & Family | Monthly | 731.6 |
| Independent Health Assoc | C56 | Non-Postal | Standard Self Plus One | Monthly | 720.33 |
| Independent Health Assoc | QA1 | Non-Postal | High Self | Monthly | 267.52 |
| Independent Health Assoc | QA2 | Non-Postal | High Self & Family | Monthly | 917.34 |
| Independent Health Assoc | QA3 | Non-Postal | High Self Plus One | Monthly | 895.75 |
| Independent Health Assoc | QA4 | Non-Postal | HDHP Self | Monthly | 149.82 |
| Independent Health Assoc | QA5 | Non-Postal | HDHP Self & Family | Monthly | 387.84 |
| Independent Health Assoc | QA6 | Non-Postal | HDHP Self Plus One | Monthly | 368.94 |
| 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 |