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    2022 Plan Information for Arizona 
    
        Choose a Location, Employee Type, & Payment Period  
        
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                    Nationwide 
         
        
                    Federal & U.S. Postal Service Employee 
                    Certain Temporary Employees 
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                    Temporary Continuation of Coverage (TCC) 
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                    Biweekly 
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                    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 
                            293.78 
                         
                        
                            Aetna Direct  
                            225 
                            Non-Postal 
                            HDHP Self & Family 
                            Monthly 
                            574.3 
                         
                        
                            Aetna Direct  
                            226 
                            Non-Postal 
                            HDHP Self Plus One 
                            Monthly 
                            645.93 
                         
                        
                            Aetna Direct  
                            N61 
                            Non-Postal 
                            CDHP Self 
                            Monthly 
                            157.07 
                         
                        
                            Aetna Direct  
                            N62 
                            Non-Postal 
                            CDHP Self & Family 
                            Monthly 
                            396.12 
                         
                        
                            Aetna Direct  
                            N63 
                            Non-Postal 
                            CDHP Self Plus One 
                            Monthly 
                            344.47 
                         
                        
                            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 
                            G51 
                            Non-Postal 
                            CDHP Self 
                            Monthly 
                            604.57 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            G52 
                            Non-Postal 
                            CDHP Self & Family 
                            Monthly 
                            1345.26 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            G53 
                            Non-Postal 
                            CDHP Self Plus One 
                            Monthly 
                            1426.9 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            G54 
                            Non-Postal 
                            Value Self 
                            Monthly 
                            303.85 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            G55 
                            Non-Postal 
                            Value Self & Family 
                            Monthly 
                            667.12 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            G56 
                            Non-Postal 
                            Value Self Plus One 
                            Monthly 
                            736.93 
                         
                        
                            Aetna Open Access 
                            WQ1 
                            Non-Postal 
                            High Self 
                            Monthly 
                            908.14 
                         
                        
                            Aetna Open Access 
                            WQ2 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            2249.11 
                         
                        
                            Aetna Open Access 
                            WQ3 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            2321.73 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            BV1 
                            Non-Postal 
                            HDHP Self 
                            Monthly 
                            113.29 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            BV2 
                            Non-Postal 
                            HDHP Self & Family 
                            Monthly 
                            282.25 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            BV3 
                            Non-Postal 
                            HDHP Self Plus One 
                            Monthly 
                            248.46 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            BY1 
                            Non-Postal 
                            HDHP Self 
                            Monthly 
                            99.44 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            BY2 
                            Non-Postal 
                            HDHP Self & Family 
                            Monthly 
                            247.63 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            BY3 
                            Non-Postal 
                            HDHP Self Plus One 
                            Monthly 
                            217.99 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            R61 
                            Non-Postal 
                            CDHP Self 
                            Monthly 
                            342.62 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            R62 
                            Non-Postal 
                            CDHP Self & Family 
                            Monthly 
                            720.61 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            R63 
                            Non-Postal 
                            CDHP Self Plus One 
                            Monthly 
                            740.54 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            R64 
                            Non-Postal 
                            Value Self 
                            Monthly 
                            166.36 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            R65 
                            Non-Postal 
                            Value Self & Family 
                            Monthly 
                            374.31 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            R66 
                            Non-Postal 
                            Value Self Plus One 
                            Monthly 
                            357.68 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            R91 
                            Non-Postal 
                            CDHP Self 
                            Monthly 
                            233.18 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            R92 
                            Non-Postal 
                            CDHP Self & Family 
                            Monthly 
                            474.33 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            R93 
                            Non-Postal 
                            CDHP Self Plus One 
                            Monthly 
                            505.2 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            R94 
                            Non-Postal 
                            Value Self 
                            Monthly 
                            146.3 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            R95 
                            Non-Postal 
                            Value Self & Family 
                            Monthly 
                            329.18 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            R96 
                            Non-Postal 
                            Value Self Plus One 
                            Monthly 
                            314.56 
                         
                        
                            Humana Health Plan, Inc. 
                            BF4 
                            Non-Postal 
                            Standard Self 
                            Monthly 
                            716.06 
                         
                        
                            Humana Health Plan, Inc. 
                            BF5 
                            Non-Postal 
                            Standard Self & Family 
                            Monthly 
                            1560.91 
                         
                        
                            Humana Health Plan, Inc. 
                            BF6 
                            Non-Postal 
                            Standard Self Plus One 
                            Monthly 
                            1543.51 
                         
                        
                            Humana Health Plan, Inc. 
                            C74 
                            Non-Postal 
                            Standard Self 
                            Monthly 
                            385.67 
                         
                        
                            Humana Health Plan, Inc. 
                            C75 
                            Non-Postal 
                            Standard Self & Family 
                            Monthly 
                            817.5 
                         
                        
                            Humana Health Plan, Inc. 
                            C76 
                            Non-Postal 
                            Standard Self Plus One 
                            Monthly 
                            833.13 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA)) 
                            LU1 
                            Non-Postal 
                            HDHP Self 
                            Monthly 
                            168.02 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA)) 
                            LU2 
                            Non-Postal 
                            HDHP Self & Family 
                            Monthly 
                            386.46 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA)) 
                            LU3 
                            Non-Postal 
                            HDHP Self Plus One 
                            Monthly 
                            361.26 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. (Choice Open Access)  
                            KT1 
                            Non-Postal 
                            High Self 
                            Monthly 
                            334.34 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. (Choice Open Access)  
                            KT2 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            918.21 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. (Choice Open Access)  
                            KT3 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            722.76 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Plus Primary  
                            WF1 
                            Non-Postal 
                            High Self 
                            Monthly 
                            167.11 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Plus Primary  
                            WF2 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            395.23 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Plus Primary  
                            WF3 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            359.29 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Primary  
                            VD1 
                            Non-Postal 
                            High Self 
                            Monthly 
                            164.41 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Primary  
                            VD2 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            388.85 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Primary  
                            VD3 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            353.49 
                         
                 
            
         
 
				 
			 
		 
		
		
			
				
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