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    2022 Plan Information for Texas 
    
        Choose a Location, Employee Type, & Payment Period  
        
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                    Nationwide 
         
        
                    Federal & U.S. Postal Service Employee 
                    Certain Temporary Employees 
                    Annuitant 
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                    Federal Deposit Insurance Corporation 
                    Temporary Continuation of Coverage (TCC) 
                    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 
                            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 
                            JS1 
                            Non-Postal 
                            CDHP Self 
                            Monthly 
                            506.81 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            JS2 
                            Non-Postal 
                            CDHP Self & Family 
                            Monthly 
                            1120.71 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            JS3 
                            Non-Postal 
                            CDHP Self Plus One 
                            Monthly 
                            1204.54 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            JS4 
                            Non-Postal 
                            Value Self 
                            Monthly 
                            563.98 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            JS5 
                            Non-Postal 
                            Value Self & Family 
                            Monthly 
                            1254.69 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            JS6 
                            Non-Postal 
                            Value Self Plus One 
                            Monthly 
                            1337.24 
                         
                        
                            Baylor Scott and White Health Plan 
                            A81 
                            Non-Postal 
                            Basic Self 
                            Monthly 
                            138.43 
                         
                        
                            Baylor Scott and White Health Plan 
                            A82 
                            Non-Postal 
                            Basic Self & Family 
                            Monthly 
                            324.72 
                         
                        
                            Baylor Scott and White Health Plan 
                            A83 
                            Non-Postal 
                            Basic Self Plus One 
                            Monthly 
                            306.78 
                         
                        
                            Baylor Scott and White Health Plan 
                            A84 
                            Non-Postal 
                            Standard Self 
                            Monthly 
                            482.15 
                         
                        
                            Baylor Scott and White Health Plan 
                            A85 
                            Non-Postal 
                            Standard Self & Family 
                            Monthly 
                            1133.49 
                         
                        
                            Baylor Scott and White Health Plan 
                            A86 
                            Non-Postal 
                            Standard Self Plus One 
                            Monthly 
                            1109.33 
                         
                        
                            Baylor Scott and White Health Plan 
                            P81 
                            Non-Postal 
                            Basic Self 
                            Monthly 
                            142.68 
                         
                        
                            Baylor Scott and White Health Plan 
                            P82 
                            Non-Postal 
                            Basic Self & Family 
                            Monthly 
                            334.75 
                         
                        
                            Baylor Scott and White Health Plan 
                            P83 
                            Non-Postal 
                            Basic Self Plus One 
                            Monthly 
                            316.25 
                         
                        
                            Baylor Scott and White Health Plan 
                            P84 
                            Non-Postal 
                            Standard Self 
                            Monthly 
                            510.64 
                         
                        
                            Baylor Scott and White Health Plan 
                            P85 
                            Non-Postal 
                            Standard Self & Family 
                            Monthly 
                            1200.51 
                         
                        
                            Baylor Scott and White Health Plan 
                            P86 
                            Non-Postal 
                            Standard Self Plus One 
                            Monthly 
                            1172.6 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            AN1 
                            Non-Postal 
                            HDHP Self 
                            Monthly 
                            114.65 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            AN2 
                            Non-Postal 
                            HDHP Self & Family 
                            Monthly 
                            285.66 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            AN3 
                            Non-Postal 
                            HDHP Self Plus One 
                            Monthly 
                            251.46 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            CG1 
                            Non-Postal 
                            HDHP Self 
                            Monthly 
                            128.14 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            CG2 
                            Non-Postal 
                            HDHP Self & Family 
                            Monthly 
                            319.36 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            CG3 
                            Non-Postal 
                            HDHP Self Plus One 
                            Monthly 
                            281.11 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            DX1 
                            Non-Postal 
                            HDHP Self 
                            Monthly 
                            101.14 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            DX2 
                            Non-Postal 
                            HDHP Self & Family 
                            Monthly 
                            251.87 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            DX3 
                            Non-Postal 
                            HDHP Self Plus One 
                            Monthly 
                            221.73 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            FD1 
                            Non-Postal 
                            HDHP Self 
                            Monthly 
                            99.44 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            FD2 
                            Non-Postal 
                            HDHP Self & Family 
                            Monthly 
                            247.63 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            FD3 
                            Non-Postal 
                            HDHP Self Plus One 
                            Monthly 
                            217.99 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            T31 
                            Non-Postal 
                            CDHP Self 
                            Monthly 
                            342.23 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            T32 
                            Non-Postal 
                            CDHP Self & Family 
                            Monthly 
                            719.72 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            T33 
                            Non-Postal 
                            CDHP Self Plus One 
                            Monthly 
                            739.72 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            T34 
                            Non-Postal 
                            Value Self 
                            Monthly 
                            148.34 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            T35 
                            Non-Postal 
                            Value Self & Family 
                            Monthly 
                            356.02 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            T36 
                            Non-Postal 
                            Value Self Plus One 
                            Monthly 
                            318.94 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TP1 
                            Non-Postal 
                            CDHP Self 
                            Monthly 
                            241.61 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TP2 
                            Non-Postal 
                            CDHP Self & Family 
                            Monthly 
                            493.33 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TP3 
                            Non-Postal 
                            CDHP Self Plus One 
                            Monthly 
                            523.4 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TP4 
                            Non-Postal 
                            Value Self 
                            Monthly 
                            121.6 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TP5 
                            Non-Postal 
                            Value Self & Family 
                            Monthly 
                            291.84 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TP6 
                            Non-Postal 
                            Value Self Plus One 
                            Monthly 
                            261.44 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TU1 
                            Non-Postal 
                            CDHP Self 
                            Monthly 
                            242.99 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TU2 
                            Non-Postal 
                            CDHP Self & Family 
                            Monthly 
                            496.51 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TU3 
                            Non-Postal 
                            CDHP Self Plus One 
                            Monthly 
                            526.41 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TU4 
                            Non-Postal 
                            Value Self 
                            Monthly 
                            153.91 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TU5 
                            Non-Postal 
                            Value Self & Family 
                            Monthly 
                            346.3 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TU6 
                            Non-Postal 
                            Value Self Plus One 
                            Monthly 
                            330.92 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TV1 
                            Non-Postal 
                            CDHP Self 
                            Monthly 
                            378.86 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TV2 
                            Non-Postal 
                            CDHP Self & Family 
                            Monthly 
                            802.23 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TV3 
                            Non-Postal 
                            CDHP Self Plus One 
                            Monthly 
                            818.54 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TV4 
                            Non-Postal 
                            Value Self 
                            Monthly 
                            188.74 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TV5 
                            Non-Postal 
                            Value Self & Family 
                            Monthly 
                            404.6 
                         
                        
                            Humana CoverageFirst and Humana Value Plan 
                            TV6 
                            Non-Postal 
                            Value Self Plus One 
                            Monthly 
                            409.78 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            EW4 
                            Non-Postal 
                            Standard Self 
                            Monthly 
                            419.75 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            EW5 
                            Non-Postal 
                            Standard Self & Family 
                            Monthly 
                            894.12 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            EW6 
                            Non-Postal 
                            Standard Self Plus One 
                            Monthly 
                            906.36 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            Q21 
                            Non-Postal 
                            Basic Self 
                            Monthly 
                            295.17 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            Q22 
                            Non-Postal 
                            Basic Self & Family 
                            Monthly 
                            613.86 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            Q23 
                            Non-Postal 
                            Basic Self Plus One 
                            Monthly 
                            638.47 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            Q61 
                            Non-Postal 
                            Basic Self 
                            Monthly 
                            186.12 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            Q62 
                            Non-Postal 
                            Basic Self & Family 
                            Monthly 
                            403.12 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            Q63 
                            Non-Postal 
                            Basic Self Plus One 
                            Monthly 
                            404.13 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            QX1 
                            Non-Postal 
                            Basic Self 
                            Monthly 
                            339.17 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            QX2 
                            Non-Postal 
                            Basic Self & Family 
                            Monthly 
                            712.85 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            QX3 
                            Non-Postal 
                            Basic Self Plus One 
                            Monthly 
                            733.13 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            QY1 
                            Non-Postal 
                            Basic Self 
                            Monthly 
                            314.12 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            QY2 
                            Non-Postal 
                            Basic Self & Family 
                            Monthly 
                            656.54 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            QY3 
                            Non-Postal 
                            Basic Self Plus One 
                            Monthly 
                            679.36 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UC4 
                            Non-Postal 
                            Standard Self 
                            Monthly 
                            368.12 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UC5 
                            Non-Postal 
                            Standard Self & Family 
                            Monthly 
                            778.01 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UC6 
                            Non-Postal 
                            Standard Self Plus One 
                            Monthly 
                            795.38 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UR4 
                            Non-Postal 
                            Standard Self 
                            Monthly 
                            539.02 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UR5 
                            Non-Postal 
                            Standard Self & Family 
                            Monthly 
                            1162.52 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UR6 
                            Non-Postal 
                            Standard Self Plus One 
                            Monthly 
                            1162.81 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UU4 
                            Non-Postal 
                            Standard Self 
                            Monthly 
                            1077.66 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UU5 
                            Non-Postal 
                            Standard Self & Family 
                            Monthly 
                            2374.41 
                         
                        
                            Humana Health Plan of Texas, Inc. 
                            UU6 
                            Non-Postal 
                            Standard Self Plus One 
                            Monthly 
                            2320.85 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced) 
                            L91 
                            Non-Postal 
                            Value Self 
                            Monthly 
                            165.94 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced) 
                            L92 
                            Non-Postal 
                            Value Self & Family 
                            Monthly 
                            396.6 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. (Choice Plus Advanced) 
                            L93 
                            Non-Postal 
                            Value Self Plus One 
                            Monthly 
                            331.88 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Plus Primary  
                            AS1 
                            Non-Postal 
                            High Self 
                            Monthly 
                            162.73 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Plus Primary  
                            AS2 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            384.86 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Plus Primary  
                            AS3 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            349.87 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Primary  
                            Y81 
                            Non-Postal 
                            High Self 
                            Monthly 
                            145.31 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Primary  
                            Y82 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            343.67 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Primary  
                            Y83 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            312.43 
                         
                 
            
         
 
				 
			 
		 
		
		
			
				
					U.S. Office of Personnel Management 
					1900 E Street, NW, Washington, DC 20415
					202-606-1800
					Federal Relay Service