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Healthcare

Temporary Continuation of Coverage (TCC) Premium Rates and Former Spouse Premiums

FFS (Fee-for-Service/Nationwide Plans)

Plan - Option Enrollment Code 2019 TCC Premium 2020 TCC Monthly Premiums - Total Premium 2020 TCC Monthly Premiums - Government Pays 2020 TCC Monthly Premiums - Employee Pays 2020 TCC Monthly Premiums - Change in Employee Payment 2019 Former Spouse Premium 2020 Former Spouse Monthly Premiums - Total Premium 2020 Former Spouse Monthly Premiums - Government Pays 2020 Former Spouse Monthly Premiums - Employee Pays 2020 Former Spouse Monthly Premiums - Change in Employee Payment
Nationwide APWU Health Plan - CDHP Self 474 609.63 609.63 0.00 609.63 0.00 597.68 597.68 0.00 597.68 0.00
Nationwide APWU Health Plan - CDHP Self & Family 475 1445.43 1445.43 0.00 1445.43 0.00 1417.09 1417.09 0.00 1417.09 0.00
Nationwide APWU Health Plan - CDHP Self Plus One 476 1324.98 1324.98 0.00 1324.98 0.00 1299.00 1299.00 0.00 1299.00 0.00
Nationwide APWU Health Plan - High Self 471 740.74 740.74 0.00 740.74 0.00 726.22 726.22 0.00 726.22 0.00
Nationwide APWU Health Plan - High Self & Family 472 1777.77 1777.77 0.00 1777.77 0.00 1742.91 1742.91 0.00 1742.91 0.00
Nationwide APWU Health Plan - High Self Plus One 473 1555.53 1555.53 0.00 1555.53 0.00 1525.03 1525.03 0.00 1525.03 0.00
Nationwide Blue Cross and Blue Shield Service Benefit Plan Basic Option - Basic Self 111 651.73 671.35 0.00 671.35 19.62 638.95 658.19 0.00 658.19 19.24
Nationwide Blue Cross and Blue Shield Service Benefit Plan Basic Option - Basic Self & Family 112 1552.65 1630.30 0.00 1630.30 77.65 1522.21 1598.33 0.00 1598.33 76.12
Nationwide Blue Cross and Blue Shield Service Benefit Plan Basic Option - Basic Self Plus One 113 1464.87 1508.84 0.00 1508.84 43.97 1436.15 1479.25 0.00 1479.25 43.10
Nationwide Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - FEP Blue Focus Self 131 469.80 469.80 0.00 469.80 0.00 460.59 460.59 0.00 460.59 0.00
Nationwide Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - FEP Blue Focus Self & Family 132 1110.96 1110.96 0.00 1110.96 0.00 1089.18 1089.18 0.00 1089.18 0.00
Nationwide Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - FEP Blue Focus Self Plus One 133 1010.01 1010.01 0.00 1010.01 0.00 990.21 990.21 0.00 990.21 0.00
Nationwide Blue Cross and Blue Shield Service Benefit Plan Standard Option - Standard Self 104 756.73 779.42 0.00 779.42 22.69 741.89 764.14 0.00 764.14 22.25
Nationwide Blue Cross and Blue Shield Service Benefit Plan Standard Option - Standard Self & Family 105 1753.71 1841.40 0.00 1841.40 87.69 1719.32 1805.29 0.00 1805.29 85.97
Nationwide Blue Cross and Blue Shield Service Benefit Plan Standard Option - Standard Self Plus One 106 1654.87 1704.51 0.00 1704.51 49.64 1622.42 1671.09 0.00 1671.09 48.67
Nationwide Compass Rose Health Plan - High Self 421 710.21 745.72 0.00 745.72 35.51 696.28 731.10 0.00 731.10 34.82
Nationwide Compass Rose Health Plan - High Self & Family 422 1704.51 1789.74 0.00 1789.74 85.23 1671.09 1754.65 0.00 1754.65 83.56
Nationwide Compass Rose Health Plan - High Self Plus One 423 1562.47 1640.60 0.00 1640.60 78.13 1531.83 1608.43 0.00 1608.43 76.60
Nationwide Foreign Service Benefit Plan - High Self 401 592.68 609.85 0.00 609.85 17.17 581.06 597.89 0.00 597.89 16.83
Nationwide Foreign Service Benefit Plan - High Self & Family 402 1466.25 1508.76 0.00 1508.76 42.51 1437.50 1479.18 0.00 1479.18 41.68
Nationwide Foreign Service Benefit Plan - High Self Plus One 403 1451.66 1493.76 0.00 1493.76 42.10 1423.20 1464.47 0.00 1464.47 41.27
Nationwide GEHA Benefit Plan - High Self 311 742.90 754.04 0.00 754.04 11.14 728.33 739.25 0.00 739.25 10.92
Nationwide GEHA Benefit Plan - High Self & Family 312 1852.58 1880.40 0.00 1880.40 27.82 1816.25 1843.53 0.00 1843.53 27.28
Nationwide GEHA Benefit Plan - High Self Plus One 313 1634.37 1658.90 0.00 1658.90 24.53 1602.32 1626.37 0.00 1626.37 24.05
Nationwide GEHA Benefit Plan - Standard Self 314 519.64 535.21 0.00 535.21 15.57 509.45 524.72 0.00 524.72 15.27
Nationwide GEHA Benefit Plan - Standard Self & Family 315 1309.33 1374.80 0.00 1374.80 65.47 1283.66 1347.84 0.00 1347.84 64.18
Nationwide GEHA Benefit Plan - Standard Self Plus One 316 1117.25 1150.77 0.00 1150.77 33.52 1095.34 1128.21 0.00 1128.21 32.87
Nationwide GEHA HDHP - HDHP Self 341 518.96 524.13 0.00 524.13 5.17 508.78 513.85 0.00 513.85 5.07
Nationwide GEHA HDHP - HDHP Self & Family 342 1287.75 1326.36 0.00 1326.36 38.61 1262.50 1300.35 0.00 1300.35 37.85
Nationwide GEHA HDHP - HDHP Self Plus One 343 1115.74 1126.91 0.00 1126.91 11.17 1093.86 1104.81 0.00 1104.81 10.95
Nationwide GEHA Indemnity Benefit Plan - Elevate Plus Self 251 New Plan 642.43 0.00 642.43 New Plan New Plan 629.83 0.00 629.83 New Plan
Nationwide GEHA Indemnity Benefit Plan - Elevate Plus Self & Family 252 New Plan 1593.21 0.00 1593.21 New Plan New Plan 1561.97 0.00 1561.97 New Plan
Nationwide GEHA Indemnity Benefit Plan - Elevate Plus Self Plus One 253 New Plan 1490.40 0.00 1490.40 New Plan New Plan 1461.18 0.00 1461.18 New Plan
Nationwide GEHA Indemnity Benefit Plan - Elevate Self 254 New Plan 418.33 0.00 418.33 New Plan New Plan 410.13 0.00 410.13 New Plan
Nationwide GEHA Indemnity Benefit Plan - Elevate Self & Family 255 New Plan 1171.37 0.00 1171.37 New Plan New Plan 1148.40 0.00 1148.40 New Plan
Nationwide GEHA Indemnity Benefit Plan - Elevate Self Plus One 256 New Plan 962.19 0.00 962.19 New Plan New Plan 943.32 0.00 943.32 New Plan
Nationwide MHBP Consumer Option - HDHP Self 481 573.27 584.75 0.00 584.75 11.48 562.03 573.28 0.00 573.28 11.25
Nationwide MHBP Consumer Option - HDHP Self & Family 482 1332.06 1358.71 0.00 1358.71 26.65 1305.94 1332.07 0.00 1332.07 26.13
Nationwide MHBP Consumer Option - HDHP Self Plus One 483 1268.66 1294.02 0.00 1294.02 25.36 1243.78 1268.65 0.00 1268.65 24.87
Nationwide MHBP Standard Option - Standard Self 454 588.17 582.27 0.00 582.27 -5.90 576.64 570.85 0.00 570.85 -5.79
Nationwide MHBP Standard Option - Standard Self & Family 455 1366.84 1353.18 0.00 1353.18 -13.66 1340.04 1326.65 0.00 1326.65 -13.39
Nationwide MHBP Standard Option - Standard Self Plus One 456 1353.83 1340.30 0.00 1340.30 -13.53 1327.28 1314.02 0.00 1314.02 -13.26
Nationwide MHBP Value Plan - Value Self 414 486.71 462.38 0.00 462.38 -24.33 477.17 453.31 0.00 453.31 -23.86
Nationwide MHBP Value Plan - Value Self & Family 415 1176.25 1117.44 0.00 1117.44 -58.81 1153.19 1095.53 0.00 1095.53 -57.66
Nationwide MHBP Value Plan - Value Self Plus One 416 1153.22 1095.56 0.00 1095.56 -57.66 1130.61 1074.08 0.00 1074.08 -56.53
Nationwide NALC Health Benefit Plan - CDHP Self 324 483.00 483.00 0.00 483.00 0.00 473.53 473.53 0.00 473.53 0.00
Nationwide NALC Health Benefit Plan - CDHP Self & Family 325 1089.02 1110.81 0.00 1110.81 21.79 1067.67 1089.03 0.00 1089.03 21.36
Nationwide NALC Health Benefit Plan - CDHP Self Plus One 326 1055.04 1065.57 0.00 1065.57 10.53 1034.35 1044.68 0.00 1044.68 10.33
Nationwide NALC Health Benefit Plan - High Self 321 695.73 721.81 0.00 721.81 26.08 682.09 707.66 0.00 707.66 25.57
Nationwide NALC Health Benefit Plan - High Self & Family 322 1562.31 1624.82 0.00 1624.82 62.51 1531.68 1592.96 0.00 1592.96 61.28
Nationwide NALC Health Benefit Plan - High Self Plus One 323 1531.47 1596.58 0.00 1596.58 65.11 1501.44 1565.27 0.00 1565.27 63.83
Nationwide NALC Health Benefit Plan - Value Self KM1 396.41 396.41 0.00 396.41 0.00 388.64 388.64 0.00 388.64 0.00
Nationwide NALC Health Benefit Plan - Value Self & Family KM2 894.16 912.04 0.00 912.04 17.88 876.63 894.16 0.00 894.16 17.53
Nationwide NALC Health Benefit Plan - Value Self Plus One KM3 865.84 874.50 0.00 874.50 8.66 848.86 857.35 0.00 857.35 8.49
Nationwide Panama Canal Area Benefit Plan - High Self 431 613.50 641.10 0.00 641.10 27.60 601.47 628.53 0.00 628.53 27.06
Nationwide Panama Canal Area Benefit Plan - High Self & Family 432 1280.63 1338.24 0.00 1338.24 57.61 1255.52 1312.00 0.00 1312.00 56.48
Nationwide Panama Canal Area Benefit Plan - High Self Plus One 433 1224.47 1279.57 0.00 1279.57 55.10 1200.46 1254.48 0.00 1254.48 54.02
Nationwide Rural Carrier Benefit Plan - High Self 381 699.40 791.18 0.00 791.18 91.78 685.69 775.67 0.00 775.67 89.98
Nationwide Rural Carrier Benefit Plan - High Self & Family 382 1381.43 1622.14 0.00 1622.14 240.71 1354.34 1590.33 0.00 1590.33 235.99
Nationwide Rural Carrier Benefit Plan - High Self Plus One 383 1354.36 1566.89 0.00 1566.89 212.53 1327.80 1536.17 0.00 1536.17 208.37
Nationwide SAMBA Health Benefit Plan - High Self 441 930.94 919.79 0.00 919.79 -11.15 912.69 901.75 0.00 901.75 -10.94
Nationwide SAMBA Health Benefit Plan - High Self & Family 442 2234.25 2207.43 0.00 2207.43 -26.82 2190.44 2164.15 0.00 2164.15 -26.29
Nationwide SAMBA Health Benefit Plan - High Self Plus One 443 2048.05 2023.50 0.00 2023.50 -24.55 2007.89 1983.82 0.00 1983.82 -24.07
Nationwide SAMBA Health Benefit Plan - Standard Self 444 700.64 694.12 0.00 694.12 -6.52 686.90 680.51 0.00 680.51 -6.39
Nationwide SAMBA Health Benefit Plan - Standard Self & Family 445 1611.53 1583.60 0.00 1583.60 -27.93 1579.93 1552.55 0.00 1552.55 -27.38
Nationwide SAMBA Health Benefit Plan - Standard Self Plus One 446 1541.45 1493.96 0.00 1493.96 -47.49 1511.23 1464.67 0.00 1464.67 -46.56
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