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Healthcare Plan Information

Temporary Continuation of Coverage Premium Rates and Former Spouse Premiums

HMO (Regional Plans with Specific Service Areas)

Plan - Option Enrollment Code 2019 TCC Premium 2020 Temporary Continuation of Coverage Monthly Premiums 2019 Former Spouse Premium 2020 Former Spouse Monthly Premiums
Total Premium Gov't Pays Empl. Pays Change in empl. payment Total Premium Gov't Pays Empl. Pays Change in empl. payment
Alabama Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Alabama Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Alabama Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self F51 827.01 845.81 0 845.81 18.8 810.79 829.23 0 829.23 18.44
CDHP Self & Family F52 1885.68 1928.53 0 1928.53 42.85 1848.71 1890.72 0 1890.72 42.01
CDHP Self Plus One F53 1867.01 1909.44 0 1909.44 42.43 1830.4 1872 0 1872 41.6
Value Self F54 722.61 836.38 0 836.38 113.77 708.44 819.98 0 819.98 111.54
Value Self & Family F55 1654.7 1915.16 0 1915.16 260.46 1622.25 1877.61 0 1877.61 255.36
Value Self Plus One F56 1622.23 1877.6 0 1877.6 255.37 1590.42 1840.78 0 1840.78 250.36
Alabama Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Alabama UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self LS1 427.08 463.83 0 463.83 36.75 418.71 454.74 0 454.74 36.03
HDHP Self & Family LS2 982.34 1066.84 0 1066.84 84.5 963.08 1045.92 0 1045.92 82.84
HDHP Self Plus One LS3 918.26 997.26 0 997.26 79 900.25 977.71 0 977.71 77.46
Alabama UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self KK1 692.61 728.15 0 728.15 35.54 679.03 713.87 0 713.87 34.84
High Self & Family KK2 1731.58 1820.4 0 1820.4 88.82 1697.63 1784.71 0 1784.71 87.08
High Self Plus One KK3 1489.14 1565.57 0 1565.57 76.43 1459.94 1534.87 0 1534.87 74.93
Alabama UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage
High Self AS1 New Plan 536.33 0 536.33 New Plan New Plan 525.81 0 525.81 New Plan
High Self & Family AS2 New Plan 1268.23 0 1268.23 New Plan New Plan 1243.36 0 1243.36 New Plan
High Self Plus One AS3 New Plan 1153.03 0 1153.03 New Plan New Plan 1130.42 0 1130.42 New Plan
Alabama UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage
High Self Y81 New Plan 516.87 0 516.87 New Plan New Plan 506.74 0 506.74 New Plan
High Self & Family Y82 New Plan 1222.19 0 1222.19 New Plan New Plan 1198.23 0 1198.23 New Plan
High Self Plus One Y83 New Plan 1111.17 0 1111.17 New Plan New Plan 1089.38 0 1089.38 New Plan
Alaska Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Alaska Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Alaska Aetna HealthFund CDHP and Aetna Value Plan
Value Self JS4 820.07 1094.95 0 1094.95 274.88 803.99 1073.48 0 1073.48 269.49
Value Self & Family JS5 1872.12 2499.6 0 2499.6 627.48 1835.41 2450.59 0 2450.59 615.18
Value Self Plus One JS6 1853.6 2474.85 0 2474.85 621.25 1817.25 2426.32 0 2426.32 609.07
CDHP Self JS1 1070.02 1024.07 0 1024.07 -45.95 1049.04 1003.99 0 1003.99 -45.05
CDHP Self & Family JS2 2439.18 2334.42 0 2334.42 -104.76 2391.35 2288.65 0 2288.65 -102.7
CDHP Self Plus One JS3 2415.04 2311.31 0 2311.31 -103.73 2367.69 2265.99 0 2265.99 -101.7
Alaska Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Arizona Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Arizona Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Arizona Aetna HealthFund CDHP and Aetna Value Plan
Value Self G54 683.99 726.98 0 726.98 42.99 670.58 712.73 0 712.73 42.15
Value Self & Family G55 1566.58 1665.02 0 1665.02 98.44 1535.86 1632.37 0 1632.37 96.51
Value Self Plus One G56 1535.89 1632.38 0 1632.38 96.49 1505.77 1600.37 0 1600.37 94.6
CDHP Self G51 800.84 922.59 0 922.59 121.75 785.14 904.5 0 904.5 119.36
CDHP Self & Family G52 1826.7 2104.36 0 2104.36 277.66 1790.88 2063.1 0 2063.1 272.22
CDHP Self Plus One G53 1808.64 2083.56 0 2083.56 274.92 1773.18 2042.71 0 2042.71 269.53
Arizona Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Arizona Aetna Open Access
High Self WQ1 1147.52 1184.38 0 1184.38 36.86 1125.02 1161.16 0 1161.16 36.14
High Self & Family WQ2 2786.15 2875.66 0 2875.66 89.51 2731.52 2819.27 0 2819.27 87.75
High Self Plus One WQ3 2758.55 2847.17 0 2847.17 88.62 2704.46 2791.34 0 2791.34 86.88
Arizona Humana CoverageFirst and Humana Value Plan
CDHP Self R61 691.66 733.17 0 733.17 41.51 678.1 718.79 0 718.79 40.69
CDHP Self & Family R62 1556.21 1649.62 0 1649.62 93.41 1525.7 1617.27 0 1617.27 91.57
CDHP Self Plus One R63 1487.07 1576.29 0 1576.29 89.22 1457.91 1545.38 0 1545.38 87.47
Value Self R64 552.85 586.03 0 586.03 33.18 542.01 574.54 0 574.54 32.53
Value Self & Family R65 1243.9 1318.53 0 1318.53 74.63 1219.51 1292.68 0 1292.68 73.17
Value Self Plus One R66 1188.63 1259.94 0 1259.94 71.31 1165.32 1235.24 0 1235.24 69.92
Arizona Humana CoverageFirst and Humana Value Plan
Value Self R94 504.03 534.29 0 534.29 30.26 494.15 523.81 0 523.81 29.66
Value Self & Family R95 1134.09 1202.13 0 1202.13 68.04 1111.85 1178.56 0 1178.56 66.71
Value Self Plus One R96 1083.7 1148.71 0 1148.71 65.01 1062.45 1126.19 0 1126.19 63.74
CDHP Self R91 633.05 671.05 0 671.05 38 620.64 657.89 0 657.89 37.25
CDHP Self & Family R92 1424.35 1509.8 0 1509.8 85.45 1396.42 1480.2 0 1480.2 83.78
CDHP Self Plus One R93 1361.03 1442.69 0 1442.69 81.66 1334.34 1414.4 0 1414.4 80.06
Arizona Humana Health Plan, Inc.
Standard Self C74 741.1 799.78 0 799.78 58.68 726.57 784.1 0 784.1 57.53
Standard Self & Family C75 1667.42 1799.47 0 1799.47 132.05 1634.73 1764.19 0 1764.19 129.46
Standard Self Plus One C76 1593.3 1719.44 0 1719.44 126.14 1562.06 1685.73 0 1685.73 123.67
High Self C71 879.84 1038.24 0 1038.24 158.4 862.59 1017.88 0 1017.88 155.29
High Self & Family C72 1979.66 2335.99 0 2335.99 356.33 1940.84 2290.19 0 2290.19 349.35
High Self Plus One C73 1891.67 2232.17 0 2232.17 340.5 1854.58 2188.4 0 2188.4 333.82
Arizona Humana Health Plan, Inc.
High Self BF1 1388.66 1458.09 0 1458.09 69.43 1361.43 1429.5 0 1429.5 68.07
High Self & Family BF2 3124.41 3280.6 0 3280.6 156.19 3063.15 3216.27 0 3216.27 153.12
High Self Plus One BF3 2985.53 3134.82 0 3134.82 149.29 2926.99 3073.35 0 3073.35 146.36
Standard Self BF4 934.39 1177.34 0 1177.34 242.95 916.07 1154.25 0 1154.25 238.18
Standard Self & Family BF5 2102.39 2649.02 0 2649.02 546.63 2061.17 2597.08 0 2597.08 535.91
Standard Self Plus One BF6 2008.96 2531.29 0 2531.29 522.33 1969.57 2481.66 0 2481.66 512.09
Arizona UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self LU1 459.33 452.72 0 452.72 -6.61 450.32 443.84 0 443.84 -6.48
HDHP Self & Family LU2 1056.44 1041.27 0 1041.27 -15.17 1035.73 1020.85 0 1020.85 -14.88
HDHP Self Plus One LU3 987.56 973.36 0 973.36 -14.2 968.2 954.27 0 954.27 -13.93
Arizona UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self KT1 692.77 739.27 0 739.27 46.5 679.19 724.77 0 724.77 45.58
High Self & Family KT2 1731.91 1848.14 0 1848.14 116.23 1697.95 1811.9 0 1811.9 113.95
High Self Plus One KT3 1489.43 1589.42 0 1589.42 99.99 1460.23 1558.25 0 1558.25 98.02
Arizona UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage
High Self WF1 New Plan 533.32 0 533.32 New Plan New Plan 522.86 0 522.86 New Plan
High Self & Family WF2 New Plan 1261.12 0 1261.12 New Plan New Plan 1236.39 0 1236.39 New Plan
High Self Plus One WF3 New Plan 1146.53 0 1146.53 New Plan New Plan 1124.05 0 1124.05 New Plan
Arizona UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage
High Self VD1 New Plan 532.46 0 532.46 New Plan New Plan 522.02 0 522.02 New Plan
High Self & Family VD2 New Plan 1259.06 0 1259.06 New Plan New Plan 1234.37 0 1234.37 New Plan
High Self Plus One VD3 New Plan 1144.67 0 1144.67 New Plan New Plan 1122.23 0 1122.23 New Plan
Arkansas Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Arkansas Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Arkansas Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self F51 827.01 845.81 0 845.81 18.8 810.79 829.23 0 829.23 18.44
CDHP Self & Family F52 1885.68 1928.53 0 1928.53 42.85 1848.71 1890.72 0 1890.72 42.01
CDHP Self Plus One F53 1867.01 1909.44 0 1909.44 42.43 1830.4 1872 0 1872 41.6
Value Self F54 722.61 836.38 0 836.38 113.77 708.44 819.98 0 819.98 111.54
Value Self & Family F55 1654.7 1915.16 0 1915.16 260.46 1622.25 1877.61 0 1877.61 255.36
Value Self Plus One F56 1622.23 1877.6 0 1877.6 255.37 1590.42 1840.78 0 1840.78 250.36
Arkansas Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Arkansas QualChoice
High Self DH1 730.7 767.24 0 767.24 36.54 716.37 752.2 0 752.2 35.83
High Self & Family DH2 1905.86 2001.2 0 2001.2 95.34 1868.49 1961.96 0 1961.96 93.47
High Self Plus One DH3 1419.39 1490.4 0 1490.4 71.01 1391.56 1461.18 0 1461.18 69.62
Standard Self DH4 570.49 599 0 599 28.51 559.3 587.25 0 587.25 27.95
Standard Self & Family DH5 1488 1562.39 0 1562.39 74.39 1458.82 1531.75 0 1531.75 72.93
Standard Self Plus One DH6 1108.18 1163.59 0 1163.59 55.41 1086.45 1140.77 0 1140.77 54.32
Arkansas UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self LS1 427.08 463.83 0 463.83 36.75 418.71 454.74 0 454.74 36.03
HDHP Self & Family LS2 982.34 1066.84 0 1066.84 84.5 963.08 1045.92 0 1045.92 82.84
HDHP Self Plus One LS3 918.26 997.26 0 997.26 79 900.25 977.71 0 977.71 77.46
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self KK1 692.61 728.15 0 728.15 35.54 679.03 713.87 0 713.87 34.84
High Self & Family KK2 1731.58 1820.4 0 1820.4 88.82 1697.63 1784.71 0 1784.71 87.08
High Self Plus One KK3 1489.14 1565.57 0 1565.57 76.43 1459.94 1534.87 0 1534.87 74.93
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage
High Self AS1 New Plan 536.33 0 536.33 New Plan New Plan 525.81 0 525.81 New Plan
High Self & Family AS2 New Plan 1268.23 0 1268.23 New Plan New Plan 1243.36 0 1243.36 New Plan
High Self Plus One AS3 New Plan 1153.03 0 1153.03 New Plan New Plan 1130.42 0 1130.42 New Plan
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage
High Self Y81 New Plan 516.87 0 516.87 New Plan New Plan 506.74 0 506.74 New Plan
High Self & Family Y82 New Plan 1222.19 0 1222.19 New Plan New Plan 1198.23 0 1198.23 New Plan
High Self Plus One Y83 New Plan 1111.17 0 1111.17 New Plan New Plan 1089.38 0 1089.38 New Plan
California Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
California Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
California Aetna HealthFund CDHP and Aetna Value Plan
Value Self JS4 820.07 1094.95 0 1094.95 274.88 803.99 1073.48 0 1073.48 269.49
Value Self & Family JS5 1872.12 2499.6 0 2499.6 627.48 1835.41 2450.59 0 2450.59 615.18
Value Self Plus One JS6 1853.6 2474.85 0 2474.85 621.25 1817.25 2426.32 0 2426.32 609.07
CDHP Self JS1 1070.02 1024.07 0 1024.07 -45.95 1049.04 1003.99 0 1003.99 -45.05
CDHP Self & Family JS2 2439.18 2334.42 0 2334.42 -104.76 2391.35 2288.65 0 2288.65 -102.7
CDHP Self Plus One JS3 2415.04 2311.31 0 2311.31 -103.73 2367.69 2265.99 0 2265.99 -101.7
California Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
California Aetna Open Access
High Self 2X1 779.2 898.14 0 898.14 118.94 763.92 880.53 0 880.53 116.61
High Self & Family 2X2 1829.31 2108.58 0 2108.58 279.27 1793.44 2067.24 0 2067.24 273.8
High Self Plus One 2X3 1793.44 2067.23 0 2067.23 273.79 1758.27 2026.7 0 2026.7 268.43
California Anthem Blue Cross Select HMO
High Self B31 785.7 789.61 0 789.61 3.91 770.29 774.13 0 774.13 3.84
High Self & Family B32 1767.84 1804.29 0 1804.29 36.45 1733.18 1768.91 0 1768.91 35.73
High Self Plus One B33 1642.14 1673.98 0 1673.98 31.84 1609.94 1641.16 0 1641.16 31.22
California Blue Shield of California
Access + HMO Self SI1 794.88 850.52 0 850.52 55.64 779.29 833.84 0 833.84 54.55
Access + HMO Self & Family SI2 1828.25 1956.21 0 1956.21 127.96 1792.4 1917.85 0 1917.85 125.45
Access + HMO Self Plus One SI3 1748.73 1871.14 0 1871.14 122.41 1714.44 1834.45 0 1834.45 120.01
TRIO HMO Self SI4 719.18 755.14 0 755.14 35.96 705.08 740.33 0 740.33 35.25
TRIO HMO Self & Family SI5 1654.12 1736.82 0 1736.82 82.7 1621.69 1702.76 0 1702.76 81.07
TRIO HMO Self Plus One SI6 1582.2 1661.3 0 1661.3 79.1 1551.18 1628.73 0 1628.73 77.55
California Health Net of California
Basic Self P61 339.02 330.86 0 330.86 -8.16 332.37 324.37 0 324.37 -8
Basic Self & Family P62 813.65 794.03 0 794.03 -19.62 797.7 778.46 0 778.46 -19.24
Basic Self Plus One P63 745.85 727.86 0 727.86 -17.99 731.23 713.59 0 713.59 -17.64
California Health Net of California
Standard Self LP4 964.55 1033.58 0 1033.58 69.03 945.64 1013.31 0 1013.31 67.67
Standard Self & Family LP5 2314.93 2480.59 0 2480.59 165.66 2269.54 2431.95 0 2431.95 162.41
Standard Self Plus One LP6 2122.02 2273.87 0 2273.87 151.85 2080.41 2229.28 0 2229.28 148.87
High Self LP1 1012.91 1069.33 0 1069.33 56.42 993.05 1048.36 0 1048.36 55.31
High Self & Family LP2 2431 2566.38 0 2566.38 135.38 2383.33 2516.06 0 2516.06 132.73
High Self Plus One LP3 2228.41 2352.53 0 2352.53 124.12 2184.72 2306.4 0 2306.4 121.68
California Health Net of California
High Self LB1 1388.63 1540.77 0 1540.77 152.14 1361.4 1510.56 0 1510.56 149.16
High Self & Family LB2 3332.73 3697.89 0 3697.89 365.16 3267.38 3625.38 0 3625.38 358
High Self Plus One LB3 3054.99 3389.73 0 3389.73 334.74 2995.09 3323.26 0 3323.26 328.17
Standard Self LB4 1315.2 1367.35 0 1367.35 52.15 1289.41 1340.54 0 1340.54 51.13
Standard Self & Family LB5 3156.48 3281.63 0 3281.63 125.15 3094.59 3217.28 0 3217.28 122.69
Standard Self Plus One LB6 2893.44 3008.16 0 3008.16 114.72 2836.71 2949.18 0 2949.18 112.47
California Health Net of California
Basic Self T41 806.1 899.47 0 899.47 93.37 790.29 881.83 0 881.83 91.54
Basic Self & Family T42 1934.63 2158.73 0 2158.73 224.1 1896.7 2116.4 0 2116.4 219.7
Basic Self Plus One T43 1773.39 1978.86 0 1978.86 205.47 1738.62 1940.06 0 1940.06 201.44
California Kaiser Foundation Health Plan, Inc. Northern California Region
Basic Self KC1 653.63 665.12 0 665.12 11.49 640.81 652.08 0 652.08 11.27
Basic Self & Family KC2 1529.43 1556.37 0 1556.37 26.94 1499.44 1525.85 0 1525.85 26.41
Basic Self Plus One KC3 1529.43 1556.37 0 1556.37 26.94 1499.44 1525.85 0 1525.85 26.41
California Kaiser Foundation Health Plan, Inc. Northern California Region
High Self 591 1012.34 1020.47 0 1020.47 8.13 992.49 1000.46 0 1000.46 7.97
High Self & Family 592 2416.52 2435.97 0 2435.97 19.45 2369.14 2388.21 0 2388.21 19.07
High Self Plus One 593 2416.52 2435.97 0 2435.97 19.45 2369.14 2388.21 0 2388.21 19.07
Standard Self 594 813.52 826.08 0 826.08 12.56 797.57 809.88 0 809.88 12.31
Standard Self & Family 595 1903.61 1932.98 0 1932.98 29.37 1866.28 1895.08 0 1895.08 28.8
Standard Self Plus One 596 1903.61 1932.98 0 1932.98 29.37 1866.28 1895.08 0 1895.08 28.8
California Kaiser Foundation Health Plan, Inc. Northern California Region: Fresno
Standard Self NZ4 545.36 578.14 0 578.14 32.78 534.67 566.8 0 566.8 32.13
Standard Self & Family NZ5 1260.43 1336.15 0 1336.15 75.72 1235.72 1309.95 0 1309.95 74.23
Standard Self Plus One NZ6 1260.43 1336.15 0 1336.15 75.72 1235.72 1309.95 0 1309.95 74.23
High Self NZ1 745.65 792.46 0 792.46 46.81 731.03 776.92 0 776.92 45.89
High Self & Family NZ2 1723.34 1831.58 0 1831.58 108.24 1689.55 1795.67 0 1795.67 106.12
High Self Plus One NZ3 1723.34 1831.58 0 1831.58 108.24 1689.55 1795.67 0 1795.67 106.12
California Kaiser Foundation Health Plan, Inc. Southern California Region
Standard Self 624 439.99 475.64 0 475.64 35.65 431.36 466.31 0 466.31 34.95
Standard Self & Family 625 1016.87 1099.25 0 1099.25 82.38 996.93 1077.7 0 1077.7 80.77
Standard Self Plus One 626 1016.87 1099.25 0 1099.25 82.38 996.93 1077.7 0 1077.7 80.77
High Self 621 700.94 750.12 0 750.12 49.18 687.2 735.41 0 735.41 48.21
High Self & Family 622 1620.02 1733.65 0 1733.65 113.63 1588.25 1699.66 0 1699.66 111.41
High Self Plus One 623 1620.02 1733.65 0 1733.65 113.63 1588.25 1699.66 0 1699.66 111.41
Colorado Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Colorado Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Colorado Aetna HealthFund CDHP and Aetna Value Plan
Value Self G54 683.99 726.98 0 726.98 42.99 670.58 712.73 0 712.73 42.15
Value Self & Family G55 1566.58 1665.02 0 1665.02 98.44 1535.86 1632.37 0 1632.37 96.51
Value Self Plus One G56 1535.89 1632.38 0 1632.38 96.49 1505.77 1600.37 0 1600.37 94.6
CDHP Self G51 800.84 922.59 0 922.59 121.75 785.14 904.5 0 904.5 119.36
CDHP Self & Family G52 1826.7 2104.36 0 2104.36 277.66 1790.88 2063.1 0 2063.1 272.22
CDHP Self Plus One G53 1808.64 2083.56 0 2083.56 274.92 1773.18 2042.71 0 2042.71 269.53
Colorado Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Colorado BlueAdvantageHMO on the Pathway HMO Network
High Self WW1 606.6 649.08 0 649.08 42.48 594.71 636.35 0 636.35 41.64
High Self & Family WW2 1477.07 1580.48 0 1580.48 103.41 1448.11 1549.49 0 1549.49 101.38
High Self Plus One WW3 1380.01 1476.61 0 1476.61 96.6 1352.95 1447.66 0 1447.66 94.71
Colorado Humana Health Plan, Inc.
High Self NR1 710.14 837.94 0 837.94 127.8 696.22 821.51 0 821.51 125.29
High Self & Family NR2 1597.79 1885.38 0 1885.38 287.59 1566.46 1848.41 0 1848.41 281.95
High Self Plus One NR3 1526.78 1801.6 0 1801.6 274.82 1496.84 1766.27 0 1766.27 269.43
Standard Self NR4 532.75 580.7 0 580.7 47.95 522.3 569.31 0 569.31 47.01
Standard Self & Family NR5 1198.7 1306.6 0 1306.6 107.9 1175.2 1280.98 0 1280.98 105.78
Standard Self Plus One NR6 1145.4 1248.5 0 1248.5 103.1 1122.94 1224.02 0 1224.02 101.08
Colorado Humana Health Plan, Inc.
Basic Self RZ1 506.89 532.24 0 532.24 25.35 496.95 521.8 0 521.8 24.85
Basic Self & Family RZ2 1140.49 1197.51 0 1197.51 57.02 1118.13 1174.03 0 1174.03 55.9
Basic Self Plus One RZ3 1089.84 1144.34 0 1144.34 54.5 1068.47 1121.9 0 1121.9 53.43
Colorado Humana Health Plan, Inc.
High Self NT1 639.4 780.07 0 780.07 140.67 626.86 764.77 0 764.77 137.91
High Self & Family NT2 1438.69 1755.21 0 1755.21 316.52 1410.48 1720.79 0 1720.79 310.31
High Self Plus One NT3 1374.71 1677.17 0 1677.17 302.46 1347.75 1644.28 0 1644.28 296.53
Standard Self NT4 511.44 552.35 0 552.35 40.91 501.41 541.52 0 541.52 40.11
Standard Self & Family NT5 1150.77 1242.82 0 1242.82 92.05 1128.21 1218.45 0 1218.45 90.24
Standard Self Plus One NT6 1099.65 1187.64 0 1187.64 87.99 1078.09 1164.35 0 1164.35 86.26
Colorado Humana Health Plan, Inc.
Basic Self R21 501.61 541.74 0 541.74 40.13 491.77 531.12 0 531.12 39.35
Basic Self & Family R22 1128.63 1218.9 0 1218.9 90.27 1106.5 1195 0 1195 88.5
Basic Self Plus One R23 1078.46 1164.74 0 1164.74 86.28 1057.31 1141.9 0 1141.9 84.59
Colorado Kaiser Foundation Health Plan of Colorado
Standard Self 654 598.4 684.73 0 684.73 86.33 586.67 671.3 0 671.3 84.63
Standard Self & Family 655 1352.43 1547.46 0 1547.46 195.03 1325.91 1517.12 0 1517.12 191.21
Standard Self Plus One 656 1352.43 1547.46 0 1547.46 195.03 1325.91 1517.12 0 1517.12 191.21
High Self 651 753.72 804.95 0 804.95 51.23 738.94 789.17 0 789.17 50.23
High Self & Family 652 1703.45 1819.18 0 1819.18 115.73 1670.05 1783.51 0 1783.51 113.46
High Self Plus One 653 1703.45 1819.18 0 1819.18 115.73 1670.05 1783.51 0 1783.51 113.46
Colorado Kaiser Foundation Health Plan of Colorado
Basic Self N41 438.45 494.47 0 494.47 56.02 429.85 484.77 0 484.77 54.92
Basic Self & Family N42 990.86 1117.51 0 1117.51 126.65 971.43 1095.6 0 1095.6 124.17
Basic Self Plus One N43 990.86 1117.51 0 1117.51 126.65 971.43 1095.6 0 1095.6 124.17
Colorado UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self LU1 459.33 452.72 0 452.72 -6.61 450.32 443.84 0 443.84 -6.48
HDHP Self & Family LU2 1056.44 1041.27 0 1041.27 -15.17 1035.73 1020.85 0 1020.85 -14.88
HDHP Self Plus One LU3 987.56 973.36 0 973.36 -14.2 968.2 954.27 0 954.27 -13.93
Colorado UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self KT1 692.77 739.27 0 739.27 46.5 679.19 724.77 0 724.77 45.58
High Self & Family KT2 1731.91 1848.14 0 1848.14 116.23 1697.95 1811.9 0 1811.9 113.95
High Self Plus One KT3 1489.43 1589.42 0 1589.42 99.99 1460.23 1558.25 0 1558.25 98.02
Connecticut Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Connecticut Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Connecticut Aetna HealthFund CDHP and Aetna Value Plan
Value Self EP4 631.46 774.8 0 774.8 143.34 619.08 759.61 0 759.61 140.53
Value Self & Family EP5 1446 1774.3 0 1774.3 328.3 1417.65 1739.51 0 1739.51 321.86
Value Self Plus One EP6 1417.65 1739.49 0 1739.49 321.84 1389.85 1705.38 0 1705.38 315.53
CDHP Self EP1 935.14 1097.27 0 1097.27 162.13 916.8 1075.75 0 1075.75 158.95
CDHP Self & Family EP2 2132.65 2502.39 0 2502.39 369.74 2090.83 2453.32 0 2453.32 362.49
CDHP Self Plus One EP3 2111.52 2477.61 0 2477.61 366.09 2070.12 2429.03 0 2429.03 358.91
Connecticut Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Delaware Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Delaware Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Delaware Aetna HealthFund CDHP and Aetna Value Plan
Value Self EP4 631.46 774.8 0 774.8 143.34 619.08 759.61 0 759.61 140.53
Value Self & Family EP5 1446 1774.3 0 1774.3 328.3 1417.65 1739.51 0 1739.51 321.86
Value Self Plus One EP6 1417.65 1739.49 0 1739.49 321.84 1389.85 1705.38 0 1705.38 315.53
CDHP Self EP1 935.14 1097.27 0 1097.27 162.13 916.8 1075.75 0 1075.75 158.95
CDHP Self & Family EP2 2132.65 2502.39 0 2502.39 369.74 2090.83 2453.32 0 2453.32 362.49
CDHP Self Plus One EP3 2111.52 2477.61 0 2477.61 366.09 2070.12 2429.03 0 2429.03 358.91
Delaware Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Delaware Aetna Open Access
Basic Self P34 1324.43 1336.28 0 1336.28 11.85 1298.46 1310.08 0 1310.08 11.62
Basic Self & Family P35 3074.03 3101.49 0 3101.49 27.46 3013.75 3040.68 0 3040.68 26.93
Basic Self Plus One P36 3043.57 3070.75 0 3070.75 27.18 2983.89 3010.54 0 3010.54 26.65
High Self P31 1514.91 1485.74 0 1485.74 -29.17 1485.21 1456.61 0 1456.61 -28.6
High Self & Family P32 3672.93 3602.17 0 3602.17 -70.76 3600.91 3531.54 0 3531.54 -69.37
High Self Plus One P33 3636.56 3566.48 0 3566.48 -70.08 3565.25 3496.55 0 3496.55 -68.7
District Of Columbia Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
District Of Columbia Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self F51 827.01 845.81 0 845.81 18.8 810.79 829.23 0 829.23 18.44
CDHP Self & Family F52 1885.68 1928.53 0 1928.53 42.85 1848.71 1890.72 0 1890.72 42.01
CDHP Self Plus One F53 1867.01 1909.44 0 1909.44 42.43 1830.4 1872 0 1872 41.6
Value Self F54 722.61 836.38 0 836.38 113.77 708.44 819.98 0 819.98 111.54
Value Self & Family F55 1654.7 1915.16 0 1915.16 260.46 1622.25 1877.61 0 1877.61 255.36
Value Self Plus One F56 1622.23 1877.6 0 1877.6 255.37 1590.42 1840.78 0 1840.78 250.36
District Of Columbia Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
District Of Columbia Aetna Open Access
High Self JN1 1141.51 1160.32 0 1160.32 18.81 1119.13 1137.57 0 1137.57 18.44
High Self & Family JN2 2566.3 2608.58 0 2608.58 42.28 2515.98 2557.43 0 2557.43 41.45
High Self Plus One JN3 2540.86 2582.74 0 2582.74 41.88 2491.04 2532.1 0 2532.1 41.06
Basic Self JN4 694.07 711.04 0 711.04 16.97 680.46 697.1 0 697.1 16.64
Basic Self & Family JN5 1588.4 1627.25 0 1627.25 38.85 1557.25 1595.34 0 1595.34 38.09
Basic Self Plus One JN6 1458.6 1494.29 0 1494.29 35.69 1430 1464.99 0 1464.99 34.99
District Of Columbia Aetna Saver
Saver Self QQ4 New Plan 607.11 0 607.11 New Plan New Plan 595.21 0 595.21 New Plan
Saver Self & Family QQ5 New Plan 1389.38 0 1389.38 New Plan New Plan 1362.14 0 1362.14 New Plan
Saver Self Plus One QQ6 New Plan 1275.84 0 1275.84 New Plan New Plan 1250.82 0 1250.82 New Plan
District Of Columbia CareFirst BlueChoice
Standard Self 2G4 813.63 862.45 0 862.45 48.82 797.68 845.54 0 845.54 47.86
Standard Self & Family 2G5 1933.16 2049.14 0 2049.14 115.98 1895.25 2008.96 0 2008.96 113.71
Standard Self Plus One 2G6 1627.25 1724.88 0 1724.88 97.63 1595.34 1691.06 0 1691.06 95.72
District Of Columbia CareFirst BlueChoice
HDHP Self B61 528.64 581.49 0 581.49 52.85 518.27 570.09 0 570.09 51.82
HDHP Self & Family B62 1256.01 1381.6 0 1381.6 125.59 1231.38 1354.51 0 1354.51 123.13
HDHP Self Plus One B63 1057.24 1162.97 0 1162.97 105.73 1036.51 1140.17 0 1140.17 103.66
Blue Value Plus Self B64 New Plan 720.11 0 720.11 New Plan New Plan 705.99 0 705.99 New Plan
Blue Value Plus Self & Family B65 New Plan 1711.01 0 1711.01 New Plan New Plan 1677.46 0 1677.46 New Plan
Blue Value Plus Self Plus One B66 New Plan 1440.26 0 1440.26 New Plan New Plan 1412.02 0 1412.02 New Plan
District Of Columbia Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.
Basic Self T71 428.52 428.52 0 428.52 0 420.12 420.12 0 420.12 0
Basic Self & Family T72 1046.68 1046.68 0 1046.68 0 1026.16 1026.16 0 1026.16 0
Basic Self Plus One T73 953.6 953.6 0 953.6 0 934.9 934.9 0 934.9 0
District Of Columbia Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.
Standard Self E34 532.2 582.98 0 582.98 50.78 521.76 571.55 0 571.55 49.79
Standard Self & Family E35 1223.99 1340.79 0 1340.79 116.8 1199.99 1314.5 0 1314.5 114.51
Standard Self Plus One E36 1223.99 1340.79 0 1340.79 116.8 1199.99 1314.5 0 1314.5 114.51
High Self E31 706.53 737.28 0 737.28 30.75 692.68 722.82 0 722.82 30.14
High Self & Family E32 1625.01 1695.78 0 1695.78 70.77 1593.15 1662.53 0 1662.53 69.38
High Self Plus One E33 1625.01 1695.78 0 1695.78 70.77 1593.15 1662.53 0 1662.53 69.38
District Of Columbia M.D. IPA
High Self JP1 806.68 894.14 0 894.14 87.46 790.86 876.61 0 876.61 85.75
High Self & Family JP2 2261.89 2507.2 0 2507.2 245.31 2217.54 2458.04 0 2458.04 240.5
High Self Plus One JP3 1575.42 1746.28 0 1746.28 170.86 1544.53 1712.04 0 1712.04 167.51
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self V41 505.6 496.3 0 496.3 -9.3 495.69 486.57 0 486.57 -9.12
HDHP Self & Family V42 1162.86 1141.49 0 1141.49 -21.37 1140.06 1119.11 0 1119.11 -20.95
HDHP Self Plus One V43 1087.03 1067.05 0 1067.05 -19.98 1065.72 1046.13 0 1046.13 -19.59
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self LR1 681.3 729.19 0 729.19 47.89 667.94 714.89 0 714.89 46.95
High Self & Family LR2 1614.65 1728.18 0 1728.18 113.53 1582.99 1694.29 0 1694.29 111.3
High Self Plus One LR3 1464.77 1567.73 0 1567.73 102.96 1436.05 1536.99 0 1536.99 100.94
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced
Value Self L91 445.8 531.93 0 531.93 86.13 437.06 521.5 0 521.5 84.44
Value Self & Family L92 1250 1491.51 0 1491.51 241.51 1225.49 1462.26 0 1462.26 236.77
Value Self Plus One L93 870.63 1038.83 0 1038.83 168.2 853.56 1018.46 0 1018.46 164.9
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage
High Self AS1 New Plan 536.33 0 536.33 New Plan New Plan 525.81 0 525.81 New Plan
High Self & Family AS2 New Plan 1268.23 0 1268.23 New Plan New Plan 1243.36 0 1243.36 New Plan
High Self Plus One AS3 New Plan 1153.03 0 1153.03 New Plan New Plan 1130.42 0 1130.42 New Plan
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage
High Self Y81 New Plan 516.87 0 516.87 New Plan New Plan 506.74 0 506.74 New Plan
High Self & Family Y82 New Plan 1222.19 0 1222.19 New Plan New Plan 1198.23 0 1198.23 New Plan
High Self Plus One Y83 New Plan 1111.17 0 1111.17 New Plan New Plan 1089.38 0 1089.38 New Plan
Florida Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Florida Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Florida Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self F51 827.01 845.81 0 845.81 18.8 810.79 829.23 0 829.23 18.44
CDHP Self & Family F52 1885.68 1928.53 0 1928.53 42.85 1848.71 1890.72 0 1890.72 42.01
CDHP Self Plus One F53 1867.01 1909.44 0 1909.44 42.43 1830.4 1872 0 1872 41.6
Value Self F54 722.61 836.38 0 836.38 113.77 708.44 819.98 0 819.98 111.54
Value Self & Family F55 1654.7 1915.16 0 1915.16 260.46 1622.25 1877.61 0 1877.61 255.36
Value Self Plus One F56 1622.23 1877.6 0 1877.6 255.37 1590.42 1840.78 0 1840.78 250.36
Florida Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Florida AvMed
HDHP Self WZ1 829.57 821.26 0 821.26 -8.31 813.3 805.16 0 805.16 -8.14
HDHP Self & Family WZ2 2043.39 1908.78 0 1908.78 -134.61 2003.32 1871.35 0 1871.35 -131.97
HDHP Self Plus One WZ3 1592.83 1654.79 0 1654.79 61.96 1561.6 1622.34 0 1622.34 60.74
Florida AvMed
Standard Self ML4 723.4 723.42 0 723.42 0.02 709.22 709.24 0 709.24 0.02
Standard Self & Family ML5 1873.79 1761.35 0 1761.35 -112.44 1837.05 1726.81 0 1726.81 -110.24
Standard Self Plus One ML6 1446.8 1519.16 0 1519.16 72.36 1418.43 1489.37 0 1489.37 70.94
Florida Capital Health Plan
High Self EA1 704.22 694.23 0 694.23 -9.99 690.41 680.62 0 680.62 -9.79
High Self & Family EA2 1760.6 1608.88 0 1608.88 -151.72 1726.08 1577.33 0 1577.33 -148.75
High Self Plus One EA3 1514.1 1518.18 0 1518.18 4.08 1484.41 1488.41 0 1488.41 4
Florida Humana CoverageFirst and Humana Value Plan
Value Self W94 494.93 523.86 0 523.86 28.93 485.23 513.59 0 513.59 28.36
Value Self & Family W95 1113.62 1178.68 0 1178.68 65.06 1091.78 1155.57 0 1155.57 63.79
Value Self Plus One W96 1064.12 1126.28 0 1126.28 62.16 1043.25 1104.2 0 1104.2 60.95
CDHP Self W91 585.05 619.24 0 619.24 34.19 573.58 607.1 0 607.1 33.52
CDHP Self & Family W92 1316.39 1393.27 0 1393.27 76.88 1290.58 1365.95 0 1365.95 75.37
CDHP Self Plus One W93 1257.86 1331.38 0 1331.38 73.52 1233.2 1305.27 0 1305.27 72.07
Florida Humana CoverageFirst and Humana Value Plan
CDHP Self QP1 697.7 739.55 0 739.55 41.85 684.02 725.05 0 725.05 41.03
CDHP Self & Family QP2 1571.91 1666.21 0 1666.21 94.3 1541.09 1633.54 0 1633.54 92.45
CDHP Self Plus One QP3 1502.03 1592.15 0 1592.15 90.12 1472.58 1560.93 0 1560.93 88.35
Value Self QP4 499.75 529.74 0 529.74 29.99 489.95 519.35 0 519.35 29.4
Value Self & Family QP5 1124.41 1191.85 0 1191.85 67.44 1102.36 1168.48 0 1168.48 66.12
Value Self Plus One QP6 1074.44 1138.9 0 1138.9 64.46 1053.37 1116.57 0 1116.57 63.2
Florida Humana CoverageFirst and Humana Value Plan
Value Self MJ4 514.58 530 0 530 15.42 504.49 519.61 0 519.61 15.12
Value Self & Family MJ5 1157.8 1192.51 0 1192.51 34.71 1135.1 1169.13 0 1169.13 34.03
Value Self Plus One MJ6 1106.32 1139.52 0 1139.52 33.2 1084.63 1117.18 0 1117.18 32.55
CDHP Self MJ1 871.18 967.03 0 967.03 95.85 854.1 948.07 0 948.07 93.97
CDHP Self & Family MJ2 1960.19 2175.81 0 2175.81 215.62 1921.75 2133.15 0 2133.15 211.4
CDHP Self Plus One MJ3 1873.09 2079.13 0 2079.13 206.04 1836.36 2038.36 0 2038.36 202
Florida Humana CoverageFirst and Humana Value Plan
Value Self X24 479.71 503.04 0 503.04 23.33 470.3 493.18 0 493.18 22.88
Value Self & Family X25 1079.32 1131.85 0 1131.85 52.53 1058.16 1109.66 0 1109.66 51.5
Value Self Plus One X26 1031.36 1081.56 0 1081.56 50.2 1011.14 1060.35 0 1060.35 49.21
CDHP Self X21 567.04 594.65 0 594.65 27.61 555.92 582.99 0 582.99 27.07
CDHP Self & Family X22 1275.84 1337.97 0 1337.97 62.13 1250.82 1311.74 0 1311.74 60.92
CDHP Self Plus One X23 1219.14 1278.51 0 1278.51 59.37 1195.24 1253.44 0 1253.44 58.2
Florida Humana Medical Plan, Inc.
Standard Self LL4 884.25 1096.45 0 1096.45 212.2 866.91 1074.95 0 1074.95 208.04
Standard Self & Family LL5 1989.49 2466.98 0 2466.98 477.49 1950.48 2418.61 0 2418.61 468.13
Standard Self Plus One LL6 1901.09 2357.34 0 2357.34 456.25 1863.81 2311.12 0 2311.12 447.31
High Self LL1 1643.03 1692.33 0 1692.33 49.3 1610.81 1659.15 0 1659.15 48.34
High Self & Family LL2 3696.8 3807.72 0 3807.72 110.92 3624.31 3733.06 0 3733.06 108.75
High Self Plus One LL3 3532.5 3638.48 0 3638.48 105.98 3463.24 3567.14 0 3567.14 103.9
Florida Humana Medical Plan, Inc.
High Self EE1 932.33 1137.44 0 1137.44 205.11 914.05 1115.14 0 1115.14 201.09
High Self & Family EE2 2097.75 2559.25 0 2559.25 461.5 2056.62 2509.07 0 2509.07 452.45
High Self Plus One EE3 2004.56 2445.54 0 2445.54 440.98 1965.25 2397.59 0 2397.59 432.34
Standard Self EE4 833.66 1017.06 0 1017.06 183.4 817.31 997.12 0 997.12 179.81
Standard Self & Family EE5 1875.7 2288.37 0 2288.37 412.67 1838.92 2243.5 0 2243.5 404.58
Standard Self Plus One EE6 1792.33 2186.67 0 2186.67 394.34 1757.19 2143.79 0 2143.79 386.6
Florida Humana Medical Plan, Inc.
Standard Self E24 646.31 730.34 0 730.34 84.03 633.64 716.02 0 716.02 82.38
Standard Self & Family E25 1454.18 1643.22 0 1643.22 189.04 1425.67 1611 0 1611 185.33
Standard Self Plus One E26 1389.54 1570.19 0 1570.19 180.65 1362.29 1539.4 0 1539.4 177.11
High Self E21 1005.49 1226.7 0 1226.7 221.21 985.77 1202.65 0 1202.65 216.88
High Self & Family E22 2262.29 2759.98 0 2759.98 497.69 2217.93 2705.86 0 2705.86 487.93
High Self Plus One E23 2161.74 2637.32 0 2637.32 475.58 2119.35 2585.61 0 2585.61 466.26
Florida Humana Medical Plan, Inc.
High Self EX1 759.4 911.27 0 911.27 151.87 744.51 893.4 0 893.4 148.89
High Self & Family EX2 1708.59 2050.3 0 2050.3 341.71 1675.09 2010.1 0 2010.1 335.01
High Self Plus One EX3 1632.64 1959.19 0 1959.19 326.55 1600.63 1920.77 0 1920.77 320.14
Standard Self EX4 666.85 746.87 0 746.87 80.02 653.77 732.23 0 732.23 78.46
Standard Self & Family EX5 1500.39 1680.46 0 1680.46 180.07 1470.97 1647.51 0 1647.51 176.54
Standard Self Plus One EX6 1433.71 1605.77 0 1605.77 172.06 1405.6 1574.28 0 1574.28 168.68
Florida UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self LS1 427.08 463.83 0 463.83 36.75 418.71 454.74 0 454.74 36.03
HDHP Self & Family LS2 982.34 1066.84 0 1066.84 84.5 963.08 1045.92 0 1045.92 82.84
HDHP Self Plus One LS3 918.26 997.26 0 997.26 79 900.25 977.71 0 977.71 77.46
Florida UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self KK1 692.61 728.15 0 728.15 35.54 679.03 713.87 0 713.87 34.84
High Self & Family KK2 1731.58 1820.4 0 1820.4 88.82 1697.63 1784.71 0 1784.71 87.08
High Self Plus One KK3 1489.14 1565.57 0 1565.57 76.43 1459.94 1534.87 0 1534.87 74.93
Florida UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced
Value Self LV1 675.27 715.47 0 715.47 40.2 662.03 701.44 0 701.44 39.41
Value Self & Family LV2 2025.82 2146.38 0 2146.38 120.56 1986.1 2104.29 0 2104.29 118.19
Value Self Plus One LV3 1451.84 1538.23 0 1538.23 86.39 1423.37 1508.07 0 1508.07 84.7
Florida UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage
High Self AS1 New Plan 536.33 0 536.33 New Plan New Plan 525.81 0 525.81 New Plan
High Self & Family AS2 New Plan 1268.23 0 1268.23 New Plan New Plan 1243.36 0 1243.36 New Plan
High Self Plus One AS3 New Plan 1153.03 0 1153.03 New Plan New Plan 1130.42 0 1130.42 New Plan
Florida UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage
High Self Y81 New Plan 516.87 0 516.87 New Plan New Plan 506.74 0 506.74 New Plan
High Self & Family Y82 New Plan 1222.19 0 1222.19 New Plan New Plan 1198.23 0 1198.23 New Plan
High Self Plus One Y83 New Plan 1111.17 0 1111.17 New Plan New Plan 1089.38 0 1089.38 New Plan
Georgia Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Georgia Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Georgia Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self F51 827.01 845.81 0 845.81 18.8 810.79 829.23 0 829.23 18.44
CDHP Self & Family F52 1885.68 1928.53 0 1928.53 42.85 1848.71 1890.72 0 1890.72 42.01
CDHP Self Plus One F53 1867.01 1909.44 0 1909.44 42.43 1830.4 1872 0 1872 41.6
Value Self F54 722.61 836.38 0 836.38 113.77 708.44 819.98 0 819.98 111.54
Value Self & Family F55 1654.7 1915.16 0 1915.16 260.46 1622.25 1877.61 0 1877.61 255.36
Value Self Plus One F56 1622.23 1877.6 0 1877.6 255.37 1590.42 1840.78 0 1840.78 250.36
Georgia Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Georgia Aetna Open Access
High Self 2U1 1615.98 1768.03 0 1768.03 152.05 1584.29 1733.36 0 1733.36 149.07
High Self & Family 2U2 3722.35 4072.54 0 4072.54 350.19 3649.36 3992.69 0 3992.69 343.33
High Self Plus One 2U3 3685.48 4032.21 0 4032.21 346.73 3613.22 3953.15 0 3953.15 339.93
Georgia Blue Open Access POS
High Self QM1 607.31 637.67 0 637.67 30.36 595.4 625.17 0 625.17 29.77
High Self & Family QM2 1608.93 1673.28 0 1673.28 64.35 1577.38 1640.47 0 1640.47 63.09
High Self Plus One QM3 1344.77 1405.29 0 1405.29 60.52 1318.4 1377.74 0 1377.74 59.34
Georgia Humana CoverageFirst and Humana Value Plan
Value Self S94 531.06 562.93 0 562.93 31.87 520.65 551.89 0 551.89 31.24
Value Self & Family S95 1194.9 1266.57 0 1266.57 71.67 1171.47 1241.74 0 1241.74 70.27
Value Self Plus One S96 1141.8 1210.31 0 1210.31 68.51 1119.41 1186.58 0 1186.58 67.17
CDHP Self S91 667 707 0 707 40 653.92 693.14 0 693.14 39.22
CDHP Self & Family S92 1500.75 1590.8 0 1590.8 90.05 1471.32 1559.61 0 1559.61 88.29
CDHP Self Plus One S93 1434.05 1520.09 0 1520.09 86.04 1405.93 1490.28 0 1490.28 84.35
Georgia Humana CoverageFirst and Humana Value Plan
Value Self AD4 671.69 752.28 0 752.28 80.59 658.52 737.53 0 737.53 79.01
Value Self & Family AD5 1511.24 1692.6 0 1692.6 181.36 1481.61 1659.41 0 1659.41 177.8
Value Self Plus One AD6 1444.09 1617.39 0 1617.39 173.3 1415.77 1585.68 0 1585.68 169.91
CDHP Self AD1 813.79 992.85 0 992.85 179.06 797.83 973.38 0 973.38 175.55
CDHP Self & Family AD2 1831.03 2233.87 0 2233.87 402.84 1795.13 2190.07 0 2190.07 394.94
CDHP Self Plus One AD3 1749.66 2134.59 0 2134.59 384.93 1715.35 2092.74 0 2092.74 377.39
Georgia Humana CoverageFirst and Humana Value Plan
CDHP Self LM1 644.34 692.81 0 692.81 48.47 631.71 679.23 0 679.23 47.52
CDHP Self & Family LM2 1449.85 1558.87 0 1558.87 109.02 1421.42 1528.3 0 1528.3 106.88
CDHP Self Plus One LM3 1385.4 1489.57 0 1489.57 104.17 1358.24 1460.36 0 1460.36 102.12
Value Self LM4 524.3 655.4 0 655.4 131.1 514.02 642.55 0 642.55 128.53
Value Self & Family LM5 1179.7 1474.62 0 1474.62 294.92 1156.57 1445.71 0 1445.71 289.14
Value Self Plus One LM6 1127.27 1409.1 0 1409.1 281.83 1105.17 1381.47 0 1381.47 276.3
Georgia Humana Employers Health Plan of Georgia, Inc.
Basic Self RM1 606.89 661.5 0 661.5 54.61 594.99 648.53 0 648.53 53.54
Basic Self & Family RM2 1365.51 1488.41 0 1488.41 122.9 1338.74 1459.23 0 1459.23 120.49
Basic Self Plus One RM3 1304.82 1422.25 0 1422.25 117.43 1279.24 1394.36 0 1394.36 115.12
Georgia Humana Employers Health Plan of Georgia, Inc.
Standard Self DN4 698.63 740.55 0 740.55 41.92 684.93 726.03 0 726.03 41.1
Standard Self & Family DN5 1571.88 1666.19 0 1666.19 94.31 1541.06 1633.52 0 1633.52 92.46
Standard Self Plus One DN6 1502.03 1592.15 0 1592.15 90.12 1472.58 1560.93 0 1560.93 88.35
High Self DN1 751.14 796.22 0 796.22 45.08 736.41 780.61 0 780.61 44.2
High Self & Family DN2 1690.08 1791.5 0 1791.5 101.42 1656.94 1756.37 0 1756.37 99.43
High Self Plus One DN3 1614.98 1711.87 0 1711.87 96.89 1583.31 1678.3 0 1678.3 94.99
Georgia Humana Employers Health Plan of Georgia, Inc.
Basic Self RJ1 575.52 610.05 0 610.05 34.53 564.24 598.09 0 598.09 33.85
Basic Self & Family RJ2 1294.95 1372.63 0 1372.63 77.68 1269.56 1345.72 0 1345.72 76.16
Basic Self Plus One RJ3 1237.38 1311.64 0 1311.64 74.26 1213.12 1285.92 0 1285.92 72.8
Georgia Humana Employers Health Plan of Georgia, Inc.
Basic Self Q71 632.57 778.06 0 778.06 145.49 620.17 762.8 0 762.8 142.63
Basic Self & Family Q72 1423.29 1750.66 0 1750.66 327.37 1395.38 1716.33 0 1716.33 320.95
Basic Self Plus One Q73 1360.02 1672.82 0 1672.82 312.8 1333.35 1640.02 0 1640.02 306.67
Georgia Humana Employers Health Plan of Georgia, Inc.
Standard Self CB4 996.45 1275.46 0 1275.46 279.01 976.91 1250.45 0 1250.45 273.54
Standard Self & Family CB5 2242.02 2869.77 0 2869.77 627.75 2198.06 2813.5 0 2813.5 615.44
Standard Self Plus One CB6 2142.38 2742.24 0 2742.24 599.86 2100.37 2688.47 0 2688.47 588.1
High Self CB1 1010.17 1171.54 0 1171.54 161.37 990.36 1148.57 0 1148.57 158.21
High Self & Family CB2 2272.99 2636.09 0 2636.09 363.1 2228.42 2584.4 0 2584.4 355.98
High Self Plus One CB3 2171.93 2519 0 2519 347.07 2129.34 2469.61 0 2469.61 340.27
Georgia Humana Employers Health Plan of Georgia, Inc.
High Self DG1 1309.1 1348.37 0 1348.37 39.27 1283.43 1321.93 0 1321.93 38.5
High Self & Family DG2 2945.46 3033.83 0 3033.83 88.37 2887.71 2974.34 0 2974.34 86.63
High Self Plus One DG3 2814.59 2899.03 0 2899.03 84.44 2759.4 2842.19 0 2842.19 82.79
Standard Self DG4 956.67 1195.28 0 1195.28 238.61 937.91 1171.84 0 1171.84 233.93
Standard Self & Family DG5 2152.5 2689.43 0 2689.43 536.93 2110.29 2636.7 0 2636.7 526.41
Standard Self Plus One DG6 2056.83 2569.96 0 2569.96 513.13 2016.5 2519.57 0 2519.57 503.07
Georgia Kaiser Foundation Health Plan of Georgia, Inc.
High Self F81 710.01 744.64 0 744.64 34.63 696.09 730.04 0 730.04 33.95
High Self & Family F82 1604.61 1682.87 0 1682.87 78.26 1573.15 1649.87 0 1649.87 76.72
High Self Plus One F83 1604.61 1682.87 0 1682.87 78.26 1573.15 1649.87 0 1649.87 76.72
Standard Self F84 536.72 563.38 0 563.38 26.66 526.2 552.33 0 552.33 26.13
Standard Self & Family F85 1213 1273.23 0 1273.23 60.23 1189.22 1248.26 0 1248.26 59.04
Standard Self Plus One F86 1213 1273.23 0 1273.23 60.23 1189.22 1248.26 0 1248.26 59.04
Georgia Kaiser Foundation Health Plan of Georgia, Inc.
Basic Self LA1 New Plan 401.23 0 401.23 New Plan New Plan 393.36 0 393.36 New Plan
Basic Self & Family LA2 New Plan 906.76 0 906.76 New Plan New Plan 888.98 0 888.98 New Plan
Basic Self Plus One LA3 New Plan 906.76 0 906.76 New Plan New Plan 888.98 0 888.98 New Plan
Georgia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced
Value Self LV1 675.27 715.47 0 715.47 40.2 662.03 701.44 0 701.44 39.41
Value Self & Family LV2 2025.82 2146.38 0 2146.38 120.56 1986.1 2104.29 0 2104.29 118.19
Value Self Plus One LV3 1451.84 1538.23 0 1538.23 86.39 1423.37 1508.07 0 1508.07 84.7
Georgia UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage
High Self AS1 New Plan 536.33 0 536.33 New Plan New Plan 525.81 0 525.81 New Plan
High Self & Family AS2 New Plan 1268.23 0 1268.23 New Plan New Plan 1243.36 0 1243.36 New Plan
High Self Plus One AS3 New Plan 1153.03 0 1153.03 New Plan New Plan 1130.42 0 1130.42 New Plan
Georgia UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage
High Self Y81 New Plan 516.87 0 516.87 New Plan New Plan 506.74 0 506.74 New Plan
High Self & Family Y82 New Plan 1222.19 0 1222.19 New Plan New Plan 1198.23 0 1198.23 New Plan
High Self Plus One Y83 New Plan 1111.17 0 1111.17 New Plan New Plan 1089.38 0 1089.38 New Plan
Guam Calvo's SelectCare
Standard Self B44 411.57 404.67 0 404.67 -6.9 403.5 396.74 0 396.74 -6.76
Standard Self & Family B45 1195.81 1175.78 0 1175.78 -20.03 1172.36 1152.73 0 1152.73 -19.63
Standard Self Plus One B46 811.34 797.74 0 797.74 -13.6 795.43 782.1 0 782.1 -13.33
High Self B41 528.45 501.38 0 501.38 -27.07 518.09 491.55 0 491.55 -26.54
High Self & Family B42 1399.66 1327.93 0 1327.93 -71.73 1372.22 1301.89 0 1301.89 -70.33
High Self Plus One B43 1031.25 978.41 0 978.41 -52.84 1011.03 959.23 0 959.23 -51.8
Guam TakeCare
HDHP Self KX1 105.79 126.72 0 126.72 20.93 103.72 124.24 0 124.24 20.52
HDHP Self & Family KX2 283.61 346.11 0 346.11 62.5 278.05 339.32 0 339.32 61.27
HDHP Self Plus One KX3 255.46 312.23 0 312.23 56.77 250.45 306.11 0 306.11 55.66
Guam TakeCare
Standard Self JK4 397.61 397.02 0 397.02 -0.59 389.81 389.24 0 389.24 -0.57
Standard Self & Family JK5 1125.95 1124.36 0 1124.36 -1.59 1103.87 1102.31 0 1102.31 -1.56
Standard Self Plus One JK6 783.6 782.49 0 782.49 -1.11 768.24 767.15 0 767.15 -1.09
High Self JK1 481.3 502.2 0 502.2 20.9 471.86 492.35 0 492.35 20.49
High Self & Family JK2 1148.03 1197.89 0 1197.89 49.86 1125.52 1174.4 0 1174.4 48.88
High Self Plus One JK3 950.87 992.18 0 992.18 41.31 932.23 972.73 0 972.73 40.5
Hawaii Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Hawaii Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Hawaii Aetna HealthFund CDHP and Aetna Value Plan
Value Self JS4 820.07 1094.95 0 1094.95 274.88 803.99 1073.48 0 1073.48 269.49
Value Self & Family JS5 1872.12 2499.6 0 2499.6 627.48 1835.41 2450.59 0 2450.59 615.18
Value Self Plus One JS6 1853.6 2474.85 0 2474.85 621.25 1817.25 2426.32 0 2426.32 609.07
CDHP Self JS1 1070.02 1024.07 0 1024.07 -45.95 1049.04 1003.99 0 1003.99 -45.05
CDHP Self & Family JS2 2439.18 2334.42 0 2334.42 -104.76 2391.35 2288.65 0 2288.65 -102.7
CDHP Self Plus One JS3 2415.04 2311.31 0 2311.31 -103.73 2367.69 2265.99 0 2265.99 -101.7
Hawaii Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Hawaii HMSA Plan
High Self 871 619.09 643.86 0 643.86 24.77 606.95 631.24 0 631.24 24.29
High Self & Family 872 1391.73 1447.4 0 1447.4 55.67 1364.44 1419.02 0 1419.02 54.58
High Self Plus One 873 1356.48 1410.73 0 1410.73 54.25 1329.88 1383.07 0 1383.07 53.19
Standard Self 874 New Plan 439.59 0 439.59 New Plan New Plan 430.97 0 430.97 New Plan
Standard Self & Family 875 New Plan 988.21 0 988.21 New Plan New Plan 968.83 0 968.83 New Plan
Standard Self Plus One 876 New Plan 963.11 0 963.11 New Plan New Plan 944.23 0 944.23 New Plan
Hawaii Kaiser Foundation Health Plan, Inc. Hawaii Region
High Self 631 671.75 689.06 0 689.06 17.31 658.58 675.55 0 675.55 16.97
High Self & Family 632 1498 1536.64 0 1536.64 38.64 1468.63 1506.51 0 1506.51 37.88
High Self Plus One 633 1498 1536.64 0 1536.64 38.64 1468.63 1506.51 0 1506.51 37.88
Standard Self 634 453.58 490.77 0 490.77 37.19 444.69 481.15 0 481.15 36.46
Standard Self & Family 635 1011.47 1094.44 0 1094.44 82.97 991.64 1072.98 0 1072.98 81.34
Standard Self Plus One 636 1011.47 1094.44 0 1094.44 82.97 991.64 1072.98 0 1072.98 81.34
Idaho Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Idaho Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Idaho Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self H41 845.44 845.04 0 845.04 -0.4 828.86 828.47 0 828.47 -0.39
CDHP Self & Family H42 1927.17 1926.22 0 1926.22 -0.95 1889.38 1888.45 0 1888.45 -0.93
CDHP Self Plus One H43 1908.09 1907.32 0 1907.32 -0.77 1870.68 1869.92 0 1869.92 -0.76
Value Self H44 628.86 823.18 0 823.18 194.32 616.53 807.04 0 807.04 190.51
Value Self & Family H45 1443.29 1889.22 0 1889.22 445.93 1414.99 1852.18 0 1852.18 437.19
Value Self Plus One H46 1415 1852.18 0 1852.18 437.18 1387.25 1815.86 0 1815.86 428.61
Idaho Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Idaho Altius Health Plan
High Self 9K1 953.94 1029.24 0 1029.24 75.3 935.24 1009.06 0 1009.06 73.82
High Self & Family 9K2 2109.63 2276.15 0 2276.15 166.52 2068.26 2231.52 0 2231.52 163.26
High Self Plus One 9K3 2088.74 2253.61 0 2253.61 164.87 2047.78 2209.42 0 2209.42 161.64
HDHP Self 9K4 517.05 539.81 0 539.81 22.76 506.91 529.23 0 529.23 22.32
HDHP Self & Family 9K5 1080.6 1128.16 0 1128.16 47.56 1059.41 1106.04 0 1106.04 46.63
HDHP Self Plus One 9K6 1059.41 1106.06 0 1106.06 46.65 1038.64 1084.37 0 1084.37 45.73
Idaho Altius Health Plan
Standard Self DK4 726.69 776.53 0 776.53 49.84 712.44 761.3 0 761.3 48.86
Standard Self & Family DK5 1604.77 1714.85 0 1714.85 110.08 1573.3 1681.23 0 1681.23 107.93
Standard Self Plus One DK6 1588.85 1697.85 0 1697.85 109 1557.7 1664.56 0 1664.56 106.86
Idaho Kaiser Foundation Health Plan of Washington
Standard Self 544 596.87 616.21 0 616.21 19.34 585.17 604.13 0 604.13 18.96
Standard Self & Family 545 1372.83 1417.32 0 1417.32 44.49 1345.91 1389.53 0 1389.53 43.62
Standard Self Plus One 546 1372.83 1417.32 0 1417.32 44.49 1345.91 1389.53 0 1389.53 43.62
High Self 541 831.71 862.65 0 862.65 30.94 815.4 845.74 0 845.74 30.34
High Self & Family 542 1829.79 1897.86 0 1897.86 68.07 1793.91 1860.65 0 1860.65 66.74
High Self Plus One 543 1829.79 1897.86 0 1897.86 68.07 1793.91 1860.65 0 1860.65 66.74
Illinois Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Illinois Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Illinois Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self H41 845.44 845.04 0 845.04 -0.4 828.86 828.47 0 828.47 -0.39
CDHP Self & Family H42 1927.17 1926.22 0 1926.22 -0.95 1889.38 1888.45 0 1888.45 -0.93
CDHP Self Plus One H43 1908.09 1907.32 0 1907.32 -0.77 1870.68 1869.92 0 1869.92 -0.76
Value Self H44 628.86 823.18 0 823.18 194.32 616.53 807.04 0 807.04 190.51
Value Self & Family H45 1443.29 1889.22 0 1889.22 445.93 1414.99 1852.18 0 1852.18 437.19
Value Self Plus One H46 1415 1852.18 0 1852.18 437.18 1387.25 1815.86 0 1815.86 428.61
Illinois Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Illinois Blue Preferred
High Self 9G1 798.01 849.87 0 849.87 51.86 782.36 833.21 0 833.21 50.85
High Self & Family 9G2 1714.69 1896.05 0 1896.05 181.36 1681.07 1858.87 0 1858.87 177.8
High Self Plus One 9G3 1623.65 1795.8 0 1795.8 172.15 1591.81 1760.59 0 1760.59 168.78
Standard Self 9G4 569.89 612.63 0 612.63 42.74 558.72 600.62 0 600.62 41.9
Standard Self & Family 9G5 1619.67 1741.15 0 1741.15 121.48 1587.91 1707.01 0 1707.01 119.1
Standard Self Plus One 9G6 1464.74 1574.58 0 1574.58 109.84 1436.02 1543.71 0 1543.71 107.69
Illinois Health Alliance HMO
Standard Self K84 655.29 681.5 0 681.5 26.21 642.44 668.14 0 668.14 25.7
Standard Self & Family K85 1769.3 1840.07 0 1840.07 70.77 1734.61 1803.99 0 1803.99 69.38
Standard Self Plus One K86 1518 1578.74 0 1578.74 60.74 1488.24 1547.78 0 1547.78 59.54
Illinois Humana CoverageFirst and Humana Value Plan
Value Self GB4 628.7 773.3 0 773.3 144.6 616.37 758.14 0 758.14 141.77
Value Self & Family GB5 1414.56 1739.89 0 1739.89 325.33 1386.82 1705.77 0 1705.77 318.95
Value Self Plus One GB6 1351.68 1662.56 0 1662.56 310.88 1325.18 1629.96 0 1629.96 304.78
CDHP Self GB1 955.65 1204.14 0 1204.14 248.49 936.91 1180.53 0 1180.53 243.62
CDHP Self & Family GB2 2150.2 2709.26 0 2709.26 559.06 2108.04 2656.14 0 2656.14 548.1
CDHP Self Plus One GB3 2054.66 2588.88 0 2588.88 534.22 2014.37 2538.12 0 2538.12 523.75
Illinois Humana CoverageFirst and Humana Value Plan
Value Self MW4 620.99 770.01 0 770.01 149.02 608.81 754.91 0 754.91 146.1
Value Self & Family MW5 1397.19 1732.49 0 1732.49 335.3 1369.79 1698.52 0 1698.52 328.73
Value Self Plus One MW6 1335.11 1655.51 0 1655.51 320.4 1308.93 1623.05 0 1623.05 314.12
CDHP Self MW1 772.2 934.34 0 934.34 162.14 757.06 916.02 0 916.02 158.96
CDHP Self & Family MW2 1737.48 2102.37 0 2102.37 364.89 1703.41 2061.15 0 2061.15 357.74
CDHP Self Plus One MW3 1660.22 2008.89 0 2008.89 348.67 1627.67 1969.5 0 1969.5 341.83
Illinois Humana Health Plan, Inc.
Standard Self 754 872.77 970.94 0 970.94 98.17 855.66 951.9 0 951.9 96.24
Standard Self & Family 755 1963.74 2184.61 0 2184.61 220.87 1925.24 2141.77 0 2141.77 216.53
Standard Self Plus One 756 1876.46 2087.52 0 2087.52 211.06 1839.67 2046.59 0 2046.59 206.92
High Self 751 1236.3 1263.72 0 1263.72 27.42 1212.06 1238.94 0 1238.94 26.88
High Self & Family 752 2781.68 2843.36 0 2843.36 61.68 2727.14 2787.61 0 2787.61 60.47
High Self Plus One 753 2658.04 2717.01 0 2717.01 58.97 2605.92 2663.74 0 2663.74 57.82
Illinois Humana Health Plan, Inc.
High Self 9F1 1734.28 1977.09 0 1977.09 242.81 1700.27 1938.32 0 1938.32 238.05
High Self & Family 9F2 3902.11 4448.42 0 4448.42 546.31 3825.6 4361.2 0 4361.2 535.6
High Self Plus One 9F3 3728.67 4250.7 0 4250.7 522.03 3655.56 4167.35 0 4167.35 511.79
Illinois Humana Health Plan, Inc.
Standard Self AB4 1116.67 1172.52 0 1172.52 55.85 1094.77 1149.53 0 1149.53 54.76
Standard Self & Family AB5 2512.55 2638.17 0 2638.17 125.62 2463.28 2586.44 0 2586.44 123.16
Standard Self Plus One AB6 2400.86 2520.93 0 2520.93 120.07 2353.78 2471.5 0 2471.5 117.72
Basic Self AB1 627.46 771.77 0 771.77 144.31 615.16 756.64 0 756.64 141.48
Basic Self & Family AB2 1411.83 1736.55 0 1736.55 324.72 1384.15 1702.5 0 1702.5 318.35
Basic Self Plus One AB3 1349.09 1659.38 0 1659.38 310.29 1322.64 1626.84 0 1626.84 304.2
Illinois Humana Health Plan, Inc.
Basic Self RW1 636.02 763.2 0 763.2 127.18 623.55 748.24 0 748.24 124.69
Basic Self & Family RW2 1431.02 1717.21 0 1717.21 286.19 1402.96 1683.54 0 1683.54 280.58
Basic Self Plus One RW3 1367.44 1640.9 0 1640.9 273.46 1340.63 1608.73 0 1608.73 268.1
Illinois MercyCare Health Plans
High Self EY1 779.33 801.64 0 801.64 22.31 764.05 785.92 0 785.92 21.87
High Self & Family EY2 2033.89 2092.01 0 2092.01 58.12 1994.01 2050.99 0 2050.99 56.98
High Self Plus One EY3 1675.67 1723.58 0 1723.58 47.91 1642.81 1689.78 0 1689.78 46.97
Standard Self EY4 New Plan 621.78 0 621.78 New Plan New Plan 609.59 0 609.59 New Plan
Standard Self & Family EY5 New Plan 1622.67 0 1622.67 New Plan New Plan 1590.85 0 1590.85 New Plan
Standard Self Plus One EY6 New Plan 1336.89 0 1336.89 New Plan New Plan 1310.68 0 1310.68 New Plan
Illinois Union Health Service
High Self 761 695.37 758.96 0 758.96 63.59 681.74 744.08 0 744.08 62.34
High Self & Family 762 1745.94 1939.67 0 1939.67 193.73 1711.71 1901.64 0 1901.64 189.93
High Self Plus One 763 1541.45 1701.7 0 1701.7 160.25 1511.23 1668.33 0 1668.33 157.1
Illinois UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced
Value Self L91 445.8 531.93 0 531.93 86.13 437.06 521.5 0 521.5 84.44
Value Self & Family L92 1250 1491.51 0 1491.51 241.51 1225.49 1462.26 0 1462.26 236.77
Value Self Plus One L93 870.63 1038.83 0 1038.83 168.2 853.56 1018.46 0 1018.46 164.9
Illinois UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage
High Self AS1 New Plan 536.33 0 536.33 New Plan New Plan 525.81 0 525.81 New Plan
High Self & Family AS2 New Plan 1268.23 0 1268.23 New Plan New Plan 1243.36 0 1243.36 New Plan
High Self Plus One AS3 New Plan 1153.03 0 1153.03 New Plan New Plan 1130.42 0 1130.42 New Plan
Illinois UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage
High Self Y81 New Plan 516.87 0 516.87 New Plan New Plan 506.74 0 506.74 New Plan
High Self & Family Y82 New Plan 1222.19 0 1222.19 New Plan New Plan 1198.23 0 1198.23 New Plan
High Self Plus One Y83 New Plan 1111.17 0 1111.17 New Plan New Plan 1089.38 0 1089.38 New Plan
Indiana Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Indiana Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Indiana Aetna HealthFund CDHP and Aetna Value Plan
Value Self JS4 820.07 1094.95 0 1094.95 274.88 803.99 1073.48 0 1073.48 269.49
Value Self & Family JS5 1872.12 2499.6 0 2499.6 627.48 1835.41 2450.59 0 2450.59 615.18
Value Self Plus One JS6 1853.6 2474.85 0 2474.85 621.25 1817.25 2426.32 0 2426.32 609.07
CDHP Self JS1 1070.02 1024.07 0 1024.07 -45.95 1049.04 1003.99 0 1003.99 -45.05
CDHP Self & Family JS2 2439.18 2334.42 0 2334.42 -104.76 2391.35 2288.65 0 2288.65 -102.7
CDHP Self Plus One JS3 2415.04 2311.31 0 2311.31 -103.73 2367.69 2265.99 0 2265.99 -101.7
Indiana Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Indiana Health Alliance HMO
Standard Self K84 655.29 681.5 0 681.5 26.21 642.44 668.14 0 668.14 25.7
Standard Self & Family K85 1769.3 1840.07 0 1840.07 70.77 1734.61 1803.99 0 1803.99 69.38
Standard Self Plus One K86 1518 1578.74 0 1578.74 60.74 1488.24 1547.78 0 1547.78 59.54
Indiana Humana CoverageFirst
CDHP Self TC1 634.56 672.66 0 672.66 38.1 622.12 659.47 0 659.47 37.35
CDHP Self & Family TC2 1427.75 1513.4 0 1513.4 85.65 1399.75 1483.73 0 1483.73 83.98
CDHP Self Plus One TC3 1364.3 1446.18 0 1446.18 81.88 1337.55 1417.82 0 1417.82 80.27
Indiana Humana CoverageFirst and Humana Value Plan
Value Self MW4 620.99 770.01 0 770.01 149.02 608.81 754.91 0 754.91 146.1
Value Self & Family MW5 1397.19 1732.49 0 1732.49 335.3 1369.79 1698.52 0 1698.52 328.73
Value Self Plus One MW6 1335.11 1655.51 0 1655.51 320.4 1308.93 1623.05 0 1623.05 314.12
CDHP Self MW1 772.2 934.34 0 934.34 162.14 757.06 916.02 0 916.02 158.96
CDHP Self & Family MW2 1737.48 2102.37 0 2102.37 364.89 1703.41 2061.15 0 2061.15 357.74
CDHP Self Plus One MW3 1660.22 2008.89 0 2008.89 348.67 1627.67 1969.5 0 1969.5 341.83
Indiana Humana CoverageFirst and Humana Value Plan
Value Self X34 581.68 627.42 0 627.42 45.74 570.27 615.12 0 615.12 44.85
Value Self & Family X35 1308.78 1411.73 0 1411.73 102.95 1283.12 1384.05 0 1384.05 100.93
Value Self Plus One X36 1250.59 1348.98 0 1348.98 98.39 1226.07 1322.53 0 1322.53 96.46
CDHP Self X31 698.34 815.43 0 815.43 117.09 684.65 799.44 0 799.44 114.79
CDHP Self & Family X32 1571.29 1834.75 0 1834.75 263.46 1540.48 1798.77 0 1798.77 258.29
CDHP Self Plus One X33 1501.45 1753.2 0 1753.2 251.75 1472.01 1718.82 0 1718.82 246.81
Indiana Humana Health Plan of Ohio, Inc.
High Self A61 1196.09 1531 0 1531 334.91 1172.64 1500.98 0 1500.98 328.34
High Self & Family A62 2691.25 3444.77 0 3444.77 753.52 2638.48 3377.23 0 3377.23 738.75
High Self Plus One A63 2571.64 3291.68 0 3291.68 720.04 2521.22 3227.14 0 3227.14 705.92
Standard Self A64 948.89 1195.61 0 1195.61 246.72 930.28 1172.17 0 1172.17 241.89
Standard Self & Family A65 2135.03 2690.17 0 2690.17 555.14 2093.17 2637.42 0 2637.42 544.25
Standard Self Plus One A66 2040.16 2570.6 0 2570.6 530.44 2000.16 2520.2 0 2520.2 520.04
Indiana Humana Health Plan, Inc.
Standard Self 754 872.77 970.94 0 970.94 98.17 855.66 951.9 0 951.9 96.24
Standard Self & Family 755 1963.74 2184.61 0 2184.61 220.87 1925.24 2141.77 0 2141.77 216.53
Standard Self Plus One 756 1876.46 2087.52 0 2087.52 211.06 1839.67 2046.59 0 2046.59 206.92
High Self 751 1236.3 1263.72 0 1263.72 27.42 1212.06 1238.94 0 1238.94 26.88
High Self & Family 752 2781.68 2843.36 0 2843.36 61.68 2727.14 2787.61 0 2787.61 60.47
High Self Plus One 753 2658.04 2717.01 0 2717.01 58.97 2605.92 2663.74 0 2663.74 57.82
Indiana Humana Health Plan, Inc.
High Self MH1 901.66 1127.06 0 1127.06 225.4 883.98 1104.96 0 1104.96 220.98
High Self & Family MH2 2028.74 2535.91 0 2535.91 507.17 1988.96 2486.19 0 2486.19 497.23
High Self Plus One MH3 1938.57 2423.2 0 2423.2 484.63 1900.56 2375.69 0 2375.69 475.13
Standard Self MH4 736.84 876.84 0 876.84 140 722.39 859.65 0 859.65 137.26
Standard Self & Family MH5 1657.88 1972.86 0 1972.86 314.98 1625.37 1934.18 0 1934.18 308.81
Standard Self Plus One MH6 1584.19 1885.19 0 1885.19 301 1553.13 1848.23 0 1848.23 295.1
Iowa Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Iowa Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Iowa Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self H41 845.44 845.04 0 845.04 -0.4 828.86 828.47 0 828.47 -0.39
CDHP Self & Family H42 1927.17 1926.22 0 1926.22 -0.95 1889.38 1888.45 0 1888.45 -0.93
CDHP Self Plus One H43 1908.09 1907.32 0 1907.32 -0.77 1870.68 1869.92 0 1869.92 -0.76
Value Self H44 628.86 823.18 0 823.18 194.32 616.53 807.04 0 807.04 190.51
Value Self & Family H45 1443.29 1889.22 0 1889.22 445.93 1414.99 1852.18 0 1852.18 437.19
Value Self Plus One H46 1415 1852.18 0 1852.18 437.18 1387.25 1815.86 0 1815.86 428.61
Iowa Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Iowa Health Alliance HMO
Standard Self K84 655.29 681.5 0 681.5 26.21 642.44 668.14 0 668.14 25.7
Standard Self & Family K85 1769.3 1840.07 0 1840.07 70.77 1734.61 1803.99 0 1803.99 69.38
Standard Self Plus One K86 1518 1578.74 0 1578.74 60.74 1488.24 1547.78 0 1547.78 59.54
Iowa HealthPartners
Standard Self V34 436.65 469.12 0 469.12 32.47 428.09 459.92 0 459.92 31.83
Standard Self & Family V35 1063.68 1142.82 0 1142.82 79.14 1042.82 1120.41 0 1120.41 77.59
Standard Self Plus One V36 965 1036.78 0 1036.78 71.78 946.08 1016.45 0 1016.45 70.37
High Self V31 806.12 726.56 0 726.56 -79.56 790.31 712.31 0 712.31 -78
High Self & Family V32 1963.71 1769.9 0 1769.9 -193.81 1925.21 1735.2 0 1735.2 -190.01
High Self Plus One V33 1781.5 1605.69 0 1605.69 -175.81 1746.57 1574.21 0 1574.21 -172.36
Iowa UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self N71 542.8 622.63 0 622.63 79.83 532.16 610.42 0 610.42 78.26
HDHP Self & Family N72 1248.41 1432.06 0 1432.06 183.65 1223.93 1403.98 0 1403.98 180.05
HDHP Self Plus One N73 1166.99 1338.67 0 1338.67 171.68 1144.11 1312.42 0 1312.42 168.31
Iowa UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self LJ1 685.39 734.58 0 734.58 49.19 671.95 720.18 0 720.18 48.23
High Self & Family LJ2 1713.46 1836.49 0 1836.49 123.03 1679.86 1800.48 0 1800.48 120.62
High Self Plus One LJ3 1473.58 1579.38 0 1579.38 105.8 1444.69 1548.41 0 1548.41 103.72
Iowa UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage
High Self AS1 New Plan 536.33 0 536.33 New Plan New Plan 525.81 0 525.81 New Plan
High Self & Family AS2 New Plan 1268.23 0 1268.23 New Plan New Plan 1243.36 0 1243.36 New Plan
High Self Plus One AS3 New Plan 1153.03 0 1153.03 New Plan New Plan 1130.42 0 1130.42 New Plan
Iowa UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage
High Self Y81 New Plan 516.87 0 516.87 New Plan New Plan 506.74 0 506.74 New Plan
High Self & Family Y82 New Plan 1222.19 0 1222.19 New Plan New Plan 1198.23 0 1198.23 New Plan
High Self Plus One Y83 New Plan 1111.17 0 1111.17 New Plan New Plan 1089.38 0 1089.38 New Plan
Kansas Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Kansas Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Kansas Aetna HealthFund CDHP and Aetna Value Plan
Value Self G54 683.99 726.98 0 726.98 42.99 670.58 712.73 0 712.73 42.15
Value Self & Family G55 1566.58 1665.02 0 1665.02 98.44 1535.86 1632.37 0 1632.37 96.51
Value Self Plus One G56 1535.89 1632.38 0 1632.38 96.49 1505.77 1600.37 0 1600.37 94.6
CDHP Self G51 800.84 922.59 0 922.59 121.75 785.14 904.5 0 904.5 119.36
CDHP Self & Family G52 1826.7 2104.36 0 2104.36 277.66 1790.88 2063.1 0 2063.1 272.22
CDHP Self Plus One G53 1808.64 2083.56 0 2083.56 274.92 1773.18 2042.71 0 2042.71 269.53
Kansas Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Kansas Aetna Open Access
High Self HA1 898.63 1121.93 0 1121.93 223.3 881.01 1099.93 0 1099.93 218.92
High Self & Family HA2 2122.73 2650.14 0 2650.14 527.41 2081.11 2598.18 0 2598.18 517.07
High Self Plus One HA3 2101.75 2623.98 0 2623.98 522.23 2060.54 2572.53 0 2572.53 511.99
Standard Self HA4 722.01 730.7 0 730.7 8.69 707.85 716.37 0 716.37 8.52
Standard Self & Family HA5 1704.2 1724.71 0 1724.71 20.51 1670.78 1690.89 0 1690.89 20.11
Standard Self Plus One HA6 1687.34 1707.64 0 1707.64 20.3 1654.25 1674.16 0 1674.16 19.91
Kansas Humana CoverageFirst and Humana Value Plan
Value Self PH4 436.92 493.71 0 493.71 56.79 428.35 484.03 0 484.03 55.68
Value Self & Family PH5 983.1 1110.88 0 1110.88 127.78 963.82 1089.1 0 1089.1 125.28
Value Self Plus One PH6 939.38 1061.48 0 1061.48 122.1 920.96 1040.67 0 1040.67 119.71
CDHP Self PH1 612.97 729.41 0 729.41 116.44 600.95 715.11 0 715.11 114.16
CDHP Self & Family PH2 1379.17 1641.21 0 1641.21 262.04 1352.13 1609.03 0 1609.03 256.9
CDHP Self Plus One PH3 1317.89 1568.26 0 1568.26 250.37 1292.05 1537.51 0 1537.51 245.46
Kansas Humana Health Plan, Inc.
High Self MS1 1658.14 1757.63 0 1757.63 99.49 1625.63 1723.17 0 1723.17 97.54
High Self & Family MS2 3730.81 3954.66 0 3954.66 223.85 3657.66 3877.12 0 3877.12 219.46
High Self Plus One MS3 3564.99 3778.91 0 3778.91 213.92 3495.09 3704.81 0 3704.81 209.72
Standard Self MS4 971.83 1088.34 0 1088.34 116.51 952.77 1067 0 1067 114.23
Standard Self & Family MS5 2186.67 2448.8 0 2448.8 262.13 2143.79 2400.78 0 2400.78 256.99
Standard Self Plus One MS6 2089.47 2339.97 0 2339.97 250.5 2048.5 2294.09 0 2294.09 245.59
Kentucky Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Kentucky Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Kentucky Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self H41 845.44 845.04 0 845.04 -0.4 828.86 828.47 0 828.47 -0.39
CDHP Self & Family H42 1927.17 1926.22 0 1926.22 -0.95 1889.38 1888.45 0 1888.45 -0.93
CDHP Self Plus One H43 1908.09 1907.32 0 1907.32 -0.77 1870.68 1869.92 0 1869.92 -0.76
Value Self H44 628.86 823.18 0 823.18 194.32 616.53 807.04 0 807.04 190.51
Value Self & Family H45 1443.29 1889.22 0 1889.22 445.93 1414.99 1852.18 0 1852.18 437.19
Value Self Plus One H46 1415 1852.18 0 1852.18 437.18 1387.25 1815.86 0 1815.86 428.61
Kentucky Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Kentucky Humana CoverageFirst
CDHP Self TC1 634.56 672.66 0 672.66 38.1 622.12 659.47 0 659.47 37.35
CDHP Self & Family TC2 1427.75 1513.4 0 1513.4 85.65 1399.75 1483.73 0 1483.73 83.98
CDHP Self Plus One TC3 1364.3 1446.18 0 1446.18 81.88 1337.55 1417.82 0 1417.82 80.27
Kentucky Humana CoverageFirst
CDHP Self 6N1 646.31 782.03 0 782.03 135.72 633.64 766.7 0 766.7 133.06
CDHP Self & Family 6N2 1454.2 1759.58 0 1759.58 305.38 1425.69 1725.08 0 1725.08 299.39
CDHP Self Plus One 6N3 1389.56 1681.37 0 1681.37 291.81 1362.31 1648.4 0 1648.4 286.09
Kentucky Humana CoverageFirst and Humana Value Plan
Value Self X34 581.68 627.42 0 627.42 45.74 570.27 615.12 0 615.12 44.85
Value Self & Family X35 1308.78 1411.73 0 1411.73 102.95 1283.12 1384.05 0 1384.05 100.93
Value Self Plus One X36 1250.59 1348.98 0 1348.98 98.39 1226.07 1322.53 0 1322.53 96.46
CDHP Self X31 698.34 815.43 0 815.43 117.09 684.65 799.44 0 799.44 114.79
CDHP Self & Family X32 1571.29 1834.75 0 1834.75 263.46 1540.48 1798.77 0 1798.77 258.29
CDHP Self Plus One X33 1501.45 1753.2 0 1753.2 251.75 1472.01 1718.82 0 1718.82 246.81
Kentucky Humana Health Plan of Ohio, Inc.
High Self A61 1196.09 1531 0 1531 334.91 1172.64 1500.98 0 1500.98 328.34
High Self & Family A62 2691.25 3444.77 0 3444.77 753.52 2638.48 3377.23 0 3377.23 738.75
High Self Plus One A63 2571.64 3291.68 0 3291.68 720.04 2521.22 3227.14 0 3227.14 705.92
Standard Self A64 948.89 1195.61 0 1195.61 246.72 930.28 1172.17 0 1172.17 241.89
Standard Self & Family A65 2135.03 2690.17 0 2690.17 555.14 2093.17 2637.42 0 2637.42 544.25
Standard Self Plus One A66 2040.16 2570.6 0 2570.6 530.44 2000.16 2520.2 0 2520.2 520.04
Kentucky Humana Health Plan of Ohio, Inc.
Basic Self W61 597.5 620.79 0 620.79 23.29 585.78 608.62 0 608.62 22.84
Basic Self & Family W62 1344.37 1396.83 0 1396.83 52.46 1318.01 1369.44 0 1369.44 51.43
Basic Self Plus One W63 1284.61 1334.75 0 1334.75 50.14 1259.42 1308.58 0 1308.58 49.16
Kentucky Humana Health Plan, Inc.
High Self MI1 1145.6 1409.08 0 1409.08 263.48 1123.14 1381.45 0 1381.45 258.31
High Self & Family MI2 2577.57 3170.4 0 3170.4 592.83 2527.03 3108.24 0 3108.24 581.21
High Self Plus One MI3 2463 3029.49 0 3029.49 566.49 2414.71 2970.09 0 2970.09 555.38
Standard Self MI4 828.16 902.7 0 902.7 74.54 811.92 885 0 885 73.08
Standard Self & Family MI5 1863.34 2031.03 0 2031.03 167.69 1826.8 1991.21 0 1991.21 164.41
Standard Self Plus One MI6 1780.53 1940.81 0 1940.81 160.28 1745.62 1902.75 0 1902.75 157.13
Kentucky Humana Health Plan, Inc.
High Self MH1 901.66 1127.06 0 1127.06 225.4 883.98 1104.96 0 1104.96 220.98
High Self & Family MH2 2028.74 2535.91 0 2535.91 507.17 1988.96 2486.19 0 2486.19 497.23
High Self Plus One MH3 1938.57 2423.2 0 2423.2 484.63 1900.56 2375.69 0 2375.69 475.13
Standard Self MH4 736.84 876.84 0 876.84 140 722.39 859.65 0 859.65 137.26
Standard Self & Family MH5 1657.88 1972.86 0 1972.86 314.98 1625.37 1934.18 0 1934.18 308.81
Standard Self Plus One MH6 1584.19 1885.19 0 1885.19 301 1553.13 1848.23 0 1848.23 295.1
Kentucky UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self N71 542.8 622.63 0 622.63 79.83 532.16 610.42 0 610.42 78.26
HDHP Self & Family N72 1248.41 1432.06 0 1432.06 183.65 1223.93 1403.98 0 1403.98 180.05
HDHP Self Plus One N73 1166.99 1338.67 0 1338.67 171.68 1144.11 1312.42 0 1312.42 168.31
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self LJ1 685.39 734.58 0 734.58 49.19 671.95 720.18 0 720.18 48.23
High Self & Family LJ2 1713.46 1836.49 0 1836.49 123.03 1679.86 1800.48 0 1800.48 120.62
High Self Plus One LJ3 1473.58 1579.38 0 1579.38 105.8 1444.69 1548.41 0 1548.41 103.72
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage
High Self AS1 New Plan 536.33 0 536.33 New Plan New Plan 525.81 0 525.81 New Plan
High Self & Family AS2 New Plan 1268.23 0 1268.23 New Plan New Plan 1243.36 0 1243.36 New Plan
High Self Plus One AS3 New Plan 1153.03 0 1153.03 New Plan New Plan 1130.42 0 1130.42 New Plan
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage
High Self Y81 New Plan 516.87 0 516.87 New Plan New Plan 506.74 0 506.74 New Plan
High Self & Family Y82 New Plan 1222.19 0 1222.19 New Plan New Plan 1198.23 0 1198.23 New Plan
High Self Plus One Y83 New Plan 1111.17 0 1111.17 New Plan New Plan 1089.38 0 1089.38 New Plan
Louisiana Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Louisiana Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Louisiana Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self F51 827.01 845.81 0 845.81 18.8 810.79 829.23 0 829.23 18.44
CDHP Self & Family F52 1885.68 1928.53 0 1928.53 42.85 1848.71 1890.72 0 1890.72 42.01
CDHP Self Plus One F53 1867.01 1909.44 0 1909.44 42.43 1830.4 1872 0 1872 41.6
Value Self F54 722.61 836.38 0 836.38 113.77 708.44 819.98 0 819.98 111.54
Value Self & Family F55 1654.7 1915.16 0 1915.16 260.46 1622.25 1877.61 0 1877.61 255.36
Value Self Plus One F56 1622.23 1877.6 0 1877.6 255.37 1590.42 1840.78 0 1840.78 250.36
Louisiana Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Louisiana Humana Health Benefit Plan of Louisiana, Inc.
Standard Self BC4 608.5 687.62 0 687.62 79.12 596.57 674.14 0 674.14 77.57
Standard Self & Family BC5 1369.14 1547.14 0 1547.14 178 1342.29 1516.8 0 1516.8 174.51
Standard Self Plus One BC6 1308.27 1478.36 0 1478.36 170.09 1282.62 1449.37 0 1449.37 166.75
High Self BC1 766.12 919.36 0 919.36 153.24 751.1 901.33 0 901.33 150.23
High Self & Family BC2 1723.82 2068.58 0 2068.58 344.76 1690.02 2028.02 0 2028.02 338
High Self Plus One BC3 1647.2 1976.65 0 1976.65 329.45 1614.9 1937.89 0 1937.89 322.99
Louisiana Humana Health Benefit Plan of Louisiana, Inc.
High Self AE1 881.33 1092.85 0 1092.85 211.52 864.05 1071.42 0 1071.42 207.37
High Self & Family AE2 1982.94 2458.84 0 2458.84 475.9 1944.06 2410.63 0 2410.63 466.57
High Self Plus One AE3 1894.83 2349.58 0 2349.58 454.75 1857.68 2303.51 0 2303.51 445.83
Standard Self AE4 748.73 823.6 0 823.6 74.87 734.05 807.45 0 807.45 73.4
Standard Self & Family AE5 1684.66 1853.13 0 1853.13 168.47 1651.63 1816.79 0 1816.79 165.16
Standard Self Plus One AE6 1609.78 1770.76 0 1770.76 160.98 1578.22 1736.04 0 1736.04 157.82
Louisiana UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self LS1 427.08 463.83 0 463.83 36.75 418.71 454.74 0 454.74 36.03
HDHP Self & Family LS2 982.34 1066.84 0 1066.84 84.5 963.08 1045.92 0 1045.92 82.84
HDHP Self Plus One LS3 918.26 997.26 0 997.26 79 900.25 977.71 0 977.71 77.46
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self KK1 692.61 728.15 0 728.15 35.54 679.03 713.87 0 713.87 34.84
High Self & Family KK2 1731.58 1820.4 0 1820.4 88.82 1697.63 1784.71 0 1784.71 87.08
High Self Plus One KK3 1489.14 1565.57 0 1565.57 76.43 1459.94 1534.87 0 1534.87 74.93
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage
High Self AS1 New Plan 536.33 0 536.33 New Plan New Plan 525.81 0 525.81 New Plan
High Self & Family AS2 New Plan 1268.23 0 1268.23 New Plan New Plan 1243.36 0 1243.36 New Plan
High Self Plus One AS3 New Plan 1153.03 0 1153.03 New Plan New Plan 1130.42 0 1130.42 New Plan
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage
High Self Y81 New Plan 516.87 0 516.87 New Plan New Plan 506.74 0 506.74 New Plan
High Self & Family Y82 New Plan 1222.19 0 1222.19 New Plan New Plan 1198.23 0 1198.23 New Plan
High Self Plus One Y83 New Plan 1111.17 0 1111.17 New Plan New Plan 1089.38 0 1089.38 New Plan
Maine Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Maine Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Maine Aetna HealthFund CDHP and Aetna Value Plan
Value Self EP4 631.46 774.8 0 774.8 143.34 619.08 759.61 0 759.61 140.53
Value Self & Family EP5 1446 1774.3 0 1774.3 328.3 1417.65 1739.51 0 1739.51 321.86
Value Self Plus One EP6 1417.65 1739.49 0 1739.49 321.84 1389.85 1705.38 0 1705.38 315.53
CDHP Self EP1 935.14 1097.27 0 1097.27 162.13 916.8 1075.75 0 1075.75 158.95
CDHP Self & Family EP2 2132.65 2502.39 0 2502.39 369.74 2090.83 2453.32 0 2453.32 362.49
CDHP Self Plus One EP3 2111.52 2477.61 0 2477.61 366.09 2070.12 2429.03 0 2429.03 358.91
Maine Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Maryland Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Maryland Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Maryland Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self F51 827.01 845.81 0 845.81 18.8 810.79 829.23 0 829.23 18.44
CDHP Self & Family F52 1885.68 1928.53 0 1928.53 42.85 1848.71 1890.72 0 1890.72 42.01
CDHP Self Plus One F53 1867.01 1909.44 0 1909.44 42.43 1830.4 1872 0 1872 41.6
Value Self F54 722.61 836.38 0 836.38 113.77 708.44 819.98 0 819.98 111.54
Value Self & Family F55 1654.7 1915.16 0 1915.16 260.46 1622.25 1877.61 0 1877.61 255.36
Value Self Plus One F56 1622.23 1877.6 0 1877.6 255.37 1590.42 1840.78 0 1840.78 250.36
Maryland Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Maryland Aetna Open Access
High Self JN1 1141.51 1160.32 0 1160.32 18.81 1119.13 1137.57 0 1137.57 18.44
High Self & Family JN2 2566.3 2608.58 0 2608.58 42.28 2515.98 2557.43 0 2557.43 41.45
High Self Plus One JN3 2540.86 2582.74 0 2582.74 41.88 2491.04 2532.1 0 2532.1 41.06
Basic Self JN4 694.07 711.04 0 711.04 16.97 680.46 697.1 0 697.1 16.64
Basic Self & Family JN5 1588.4 1627.25 0 1627.25 38.85 1557.25 1595.34 0 1595.34 38.09
Basic Self Plus One JN6 1458.6 1494.29 0 1494.29 35.69 1430 1464.99 0 1464.99 34.99
Maryland Aetna Saver
Saver Self QQ4 New Plan 607.11 0 607.11 New Plan New Plan 595.21 0 595.21 New Plan
Saver Self & Family QQ5 New Plan 1389.38 0 1389.38 New Plan New Plan 1362.14 0 1362.14 New Plan
Saver Self Plus One QQ6 New Plan 1275.84 0 1275.84 New Plan New Plan 1250.82 0 1250.82 New Plan
Maryland CareFirst BlueChoice
Standard Self 2G4 813.63 862.45 0 862.45 48.82 797.68 845.54 0 845.54 47.86
Standard Self & Family 2G5 1933.16 2049.14 0 2049.14 115.98 1895.25 2008.96 0 2008.96 113.71
Standard Self Plus One 2G6 1627.25 1724.88 0 1724.88 97.63 1595.34 1691.06 0 1691.06 95.72
Maryland CareFirst BlueChoice
HDHP Self B61 528.64 581.49 0 581.49 52.85 518.27 570.09 0 570.09 51.82
HDHP Self & Family B62 1256.01 1381.6 0 1381.6 125.59 1231.38 1354.51 0 1354.51 123.13
HDHP Self Plus One B63 1057.24 1162.97 0 1162.97 105.73 1036.51 1140.17 0 1140.17 103.66
Blue Value Plus Self B64 New Plan 720.11 0 720.11 New Plan New Plan 705.99 0 705.99 New Plan
Blue Value Plus Self & Family B65 New Plan 1711.01 0 1711.01 New Plan New Plan 1677.46 0 1677.46 New Plan
Blue Value Plus Self Plus One B66 New Plan 1440.26 0 1440.26 New Plan New Plan 1412.02 0 1412.02 New Plan
Maryland Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.
Basic Self T71 428.52 428.52 0 428.52 0 420.12 420.12 0 420.12 0
Basic Self & Family T72 1046.68 1046.68 0 1046.68 0 1026.16 1026.16 0 1026.16 0
Basic Self Plus One T73 953.6 953.6 0 953.6 0 934.9 934.9 0 934.9 0
Maryland Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.
Standard Self E34 532.2 582.98 0 582.98 50.78 521.76 571.55 0 571.55 49.79
Standard Self & Family E35 1223.99 1340.79 0 1340.79 116.8 1199.99 1314.5 0 1314.5 114.51
Standard Self Plus One E36 1223.99 1340.79 0 1340.79 116.8 1199.99 1314.5 0 1314.5 114.51
High Self E31 706.53 737.28 0 737.28 30.75 692.68 722.82 0 722.82 30.14
High Self & Family E32 1625.01 1695.78 0 1695.78 70.77 1593.15 1662.53 0 1662.53 69.38
High Self Plus One E33 1625.01 1695.78 0 1695.78 70.77 1593.15 1662.53 0 1662.53 69.38
Maryland M.D. IPA
High Self JP1 806.68 894.14 0 894.14 87.46 790.86 876.61 0 876.61 85.75
High Self & Family JP2 2261.89 2507.2 0 2507.2 245.31 2217.54 2458.04 0 2458.04 240.5
High Self Plus One JP3 1575.42 1746.28 0 1746.28 170.86 1544.53 1712.04 0 1712.04 167.51
Maryland UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self V41 505.6 496.3 0 496.3 -9.3 495.69 486.57 0 486.57 -9.12
HDHP Self & Family V42 1162.86 1141.49 0 1141.49 -21.37 1140.06 1119.11 0 1119.11 -20.95
HDHP Self Plus One V43 1087.03 1067.05 0 1067.05 -19.98 1065.72 1046.13 0 1046.13 -19.59
Maryland UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self LR1 681.3 729.19 0 729.19 47.89 667.94 714.89 0 714.89 46.95
High Self & Family LR2 1614.65 1728.18 0 1728.18 113.53 1582.99 1694.29 0 1694.29 111.3
High Self Plus One LR3 1464.77 1567.73 0 1567.73 102.96 1436.05 1536.99 0 1536.99 100.94
Maryland UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced
Value Self L91 445.8 531.93 0 531.93 86.13 437.06 521.5 0 521.5 84.44
Value Self & Family L92 1250 1491.51 0 1491.51 241.51 1225.49 1462.26 0 1462.26 236.77
Value Self Plus One L93 870.63 1038.83 0 1038.83 168.2 853.56 1018.46 0 1018.46 164.9
Maryland UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage
High Self AS1 New Plan 536.33 0 536.33 New Plan New Plan 525.81 0 525.81 New Plan
High Self & Family AS2 New Plan 1268.23 0 1268.23 New Plan New Plan 1243.36 0 1243.36 New Plan
High Self Plus One AS3 New Plan 1153.03 0 1153.03 New Plan New Plan 1130.42 0 1130.42 New Plan
Maryland UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage
High Self Y81 New Plan 516.87 0 516.87 New Plan New Plan 506.74 0 506.74 New Plan
High Self & Family Y82 New Plan 1222.19 0 1222.19 New Plan New Plan 1198.23 0 1198.23 New Plan
High Self Plus One Y83 New Plan 1111.17 0 1111.17 New Plan New Plan 1089.38 0 1089.38 New Plan
Massachusetts Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Massachusetts Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan
Value Self EP4 631.46 774.8 0 774.8 143.34 619.08 759.61 0 759.61 140.53
Value Self & Family EP5 1446 1774.3 0 1774.3 328.3 1417.65 1739.51 0 1739.51 321.86
Value Self Plus One EP6 1417.65 1739.49 0 1739.49 321.84 1389.85 1705.38 0 1705.38 315.53
CDHP Self EP1 935.14 1097.27 0 1097.27 162.13 916.8 1075.75 0 1075.75 158.95
CDHP Self & Family EP2 2132.65 2502.39 0 2502.39 369.74 2090.83 2453.32 0 2453.32 362.49
CDHP Self Plus One EP3 2111.52 2477.61 0 2477.61 366.09 2070.12 2429.03 0 2429.03 358.91
Massachusetts Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Michigan Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Michigan Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Michigan Aetna HealthFund CDHP and Aetna Value Plan
Value Self G54 683.99 726.98 0 726.98 42.99 670.58 712.73 0 712.73 42.15
Value Self & Family G55 1566.58 1665.02 0 1665.02 98.44 1535.86 1632.37 0 1632.37 96.51
Value Self Plus One G56 1535.89 1632.38 0 1632.38 96.49 1505.77 1600.37 0 1600.37 94.6
CDHP Self G51 800.84 922.59 0 922.59 121.75 785.14 904.5 0 904.5 119.36
CDHP Self & Family G52 1826.7 2104.36 0 2104.36 277.66 1790.88 2063.1 0 2063.1 272.22
CDHP Self Plus One G53 1808.64 2083.56 0 2083.56 274.92 1773.18 2042.71 0 2042.71 269.53
Michigan Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Michigan Blue Care Network of Michigan
High Self LX1 749.41 757.72 0 757.72 8.31 734.72 742.86 0 742.86 8.14
High Self & Family LX2 1828.49 1848.84 0 1848.84 20.35 1792.64 1812.59 0 1812.59 19.95
High Self Plus One LX3 1723.61 1742.74 0 1742.74 19.13 1689.81 1708.57 0 1708.57 18.76
Michigan Blue Care Network of Michigan
High Self K51 962.32 976.88 0 976.88 14.56 943.45 957.73 0 957.73 14.28
High Self & Family K52 2347.99 2383.56 0 2383.56 35.57 2301.95 2336.82 0 2336.82 34.87
High Self Plus One K53 2213.3 2246.77 0 2246.77 33.47 2169.9 2202.72 0 2202.72 32.82
Michigan Health Alliance Plan
High Self 521 779.12 803.65 0 803.65 24.53 763.84 787.89 0 787.89 24.05
High Self & Family 522 1900.99 1960.89 0 1960.89 59.9 1863.72 1922.44 0 1922.44 58.72
High Self Plus One 523 1791.96 1848.38 0 1848.38 56.42 1756.82 1812.14 0 1812.14 55.32
Michigan Health Alliance Plan
Standard Self GY4 610.32 626.51 0 626.51 16.19 598.35 614.23 0 614.23 15.88
Standard Self & Family GY5 1489.21 1528.75 0 1528.75 39.54 1460.01 1498.77 0 1498.77 38.76
Standard Self Plus One GY6 1403.74 1441.04 0 1441.04 37.3 1376.22 1412.78 0 1412.78 36.56
Michigan Priority Health
High Self LE1 930.34 937.97 0 937.97 7.63 912.1 919.58 0 919.58 7.48
High Self & Family LE2 2186.31 2204.23 0 2204.23 17.92 2143.44 2161.01 0 2161.01 17.57
High Self Plus One LE3 2046.77 2063.52 0 2063.52 16.75 2006.64 2023.06 0 2023.06 16.42
Standard Self LE4 514.53 550.12 0 550.12 35.59 504.44 539.33 0 539.33 34.89
Standard Self & Family LE5 1209.16 1292.79 0 1292.79 83.63 1185.45 1267.44 0 1267.44 81.99
Standard Self Plus One LE6 1131.99 1210.26 0 1210.26 78.27 1109.79 1186.53 0 1186.53 76.74
Michigan Priority Health
Value Self Y41 New Plan 482.7 0 482.7 New Plan New Plan 473.24 0 473.24 New Plan
Value Self & Family Y42 New Plan 1134.37 0 1134.37 New Plan New Plan 1112.13 0 1112.13 New Plan
Value Self Plus One Y43 New Plan 1061.95 0 1061.95 New Plan New Plan 1041.13 0 1041.13 New Plan
Minnesota Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Minnesota Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Minnesota Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self H41 845.44 845.04 0 845.04 -0.4 828.86 828.47 0 828.47 -0.39
CDHP Self & Family H42 1927.17 1926.22 0 1926.22 -0.95 1889.38 1888.45 0 1888.45 -0.93
CDHP Self Plus One H43 1908.09 1907.32 0 1907.32 -0.77 1870.68 1869.92 0 1869.92 -0.76
Value Self H44 628.86 823.18 0 823.18 194.32 616.53 807.04 0 807.04 190.51
Value Self & Family H45 1443.29 1889.22 0 1889.22 445.93 1414.99 1852.18 0 1852.18 437.19
Value Self Plus One H46 1415 1852.18 0 1852.18 437.18 1387.25 1815.86 0 1815.86 428.61
Minnesota Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Minnesota HealthPartners
Standard Self V34 436.65 469.12 0 469.12 32.47 428.09 459.92 0 459.92 31.83
Standard Self & Family V35 1063.68 1142.82 0 1142.82 79.14 1042.82 1120.41 0 1120.41 77.59
Standard Self Plus One V36 965 1036.78 0 1036.78 71.78 946.08 1016.45 0 1016.45 70.37
High Self V31 806.12 726.56 0 726.56 -79.56 790.31 712.31 0 712.31 -78
High Self & Family V32 1963.71 1769.9 0 1769.9 -193.81 1925.21 1735.2 0 1735.2 -190.01
High Self Plus One V33 1781.5 1605.69 0 1605.69 -175.81 1746.57 1574.21 0 1574.21 -172.36
Mississippi Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Mississippi Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Mississippi Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self H41 845.44 845.04 0 845.04 -0.4 828.86 828.47 0 828.47 -0.39
CDHP Self & Family H42 1927.17 1926.22 0 1926.22 -0.95 1889.38 1888.45 0 1888.45 -0.93
CDHP Self Plus One H43 1908.09 1907.32 0 1907.32 -0.77 1870.68 1869.92 0 1869.92 -0.76
Value Self H44 628.86 823.18 0 823.18 194.32 616.53 807.04 0 807.04 190.51
Value Self & Family H45 1443.29 1889.22 0 1889.22 445.93 1414.99 1852.18 0 1852.18 437.19
Value Self Plus One H46 1415 1852.18 0 1852.18 437.18 1387.25 1815.86 0 1815.86 428.61
Mississippi Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Mississippi UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self LS1 427.08 463.83 0 463.83 36.75 418.71 454.74 0 454.74 36.03
HDHP Self & Family LS2 982.34 1066.84 0 1066.84 84.5 963.08 1045.92 0 1045.92 82.84
HDHP Self Plus One LS3 918.26 997.26 0 997.26 79 900.25 977.71 0 977.71 77.46
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self KK1 692.61 728.15 0 728.15 35.54 679.03 713.87 0 713.87 34.84
High Self & Family KK2 1731.58 1820.4 0 1820.4 88.82 1697.63 1784.71 0 1784.71 87.08
High Self Plus One KK3 1489.14 1565.57 0 1565.57 76.43 1459.94 1534.87 0 1534.87 74.93
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage
High Self AS1 New Plan 536.33 0 536.33 New Plan New Plan 525.81 0 525.81 New Plan
High Self & Family AS2 New Plan 1268.23 0 1268.23 New Plan New Plan 1243.36 0 1243.36 New Plan
High Self Plus One AS3 New Plan 1153.03 0 1153.03 New Plan New Plan 1130.42 0 1130.42 New Plan
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage
High Self Y81 New Plan 516.87 0 516.87 New Plan New Plan 506.74 0 506.74 New Plan
High Self & Family Y82 New Plan 1222.19 0 1222.19 New Plan New Plan 1198.23 0 1198.23 New Plan
High Self Plus One Y83 New Plan 1111.17 0 1111.17 New Plan New Plan 1089.38 0 1089.38 New Plan
Missouri Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Missouri Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Missouri Aetna HealthFund CDHP and Aetna Value Plan
Value Self G54 683.99 726.98 0 726.98 42.99 670.58 712.73 0 712.73 42.15
Value Self & Family G55 1566.58 1665.02 0 1665.02 98.44 1535.86 1632.37 0 1632.37 96.51
Value Self Plus One G56 1535.89 1632.38 0 1632.38 96.49 1505.77 1600.37 0 1600.37 94.6
CDHP Self G51 800.84 922.59 0 922.59 121.75 785.14 904.5 0 904.5 119.36
CDHP Self & Family G52 1826.7 2104.36 0 2104.36 277.66 1790.88 2063.1 0 2063.1 272.22
CDHP Self Plus One G53 1808.64 2083.56 0 2083.56 274.92 1773.18 2042.71 0 2042.71 269.53
Missouri Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Missouri Aetna Open Access
High Self HA1 898.63 1121.93 0 1121.93 223.3 881.01 1099.93 0 1099.93 218.92
High Self & Family HA2 2122.73 2650.14 0 2650.14 527.41 2081.11 2598.18 0 2598.18 517.07
High Self Plus One HA3 2101.75 2623.98 0 2623.98 522.23 2060.54 2572.53 0 2572.53 511.99
Standard Self HA4 722.01 730.7 0 730.7 8.69 707.85 716.37 0 716.37 8.52
Standard Self & Family HA5 1704.2 1724.71 0 1724.71 20.51 1670.78 1690.89 0 1690.89 20.11
Standard Self Plus One HA6 1687.34 1707.64 0 1707.64 20.3 1654.25 1674.16 0 1674.16 19.91
Missouri Blue Preferred
High Self 9G1 798.01 849.87 0 849.87 51.86 782.36 833.21 0 833.21 50.85
High Self & Family 9G2 1714.69 1896.05 0 1896.05 181.36 1681.07 1858.87 0 1858.87 177.8
High Self Plus One 9G3 1623.65 1795.8 0 1795.8 172.15 1591.81 1760.59 0 1760.59 168.78
Standard Self 9G4 569.89 612.63 0 612.63 42.74 558.72 600.62 0 600.62 41.9
Standard Self & Family 9G5 1619.67 1741.15 0 1741.15 121.48 1587.91 1707.01 0 1707.01 119.1
Standard Self Plus One 9G6 1464.74 1574.58 0 1574.58 109.84 1436.02 1543.71 0 1543.71 107.69
Missouri Humana CoverageFirst and Humana Value Plan
Value Self PH4 436.92 493.71 0 493.71 56.79 428.35 484.03 0 484.03 55.68
Value Self & Family PH5 983.1 1110.88 0 1110.88 127.78 963.82 1089.1 0 1089.1 125.28
Value Self Plus One PH6 939.38 1061.48 0 1061.48 122.1 920.96 1040.67 0 1040.67 119.71
CDHP Self PH1 612.97 729.41 0 729.41 116.44 600.95 715.11 0 715.11 114.16
CDHP Self & Family PH2 1379.17 1641.21 0 1641.21 262.04 1352.13 1609.03 0 1609.03 256.9
CDHP Self Plus One PH3 1317.89 1568.26 0 1568.26 250.37 1292.05 1537.51 0 1537.51 245.46
Missouri Humana Health Plan, Inc.
High Self MS1 1658.14 1757.63 0 1757.63 99.49 1625.63 1723.17 0 1723.17 97.54
High Self & Family MS2 3730.81 3954.66 0 3954.66 223.85 3657.66 3877.12 0 3877.12 219.46
High Self Plus One MS3 3564.99 3778.91 0 3778.91 213.92 3495.09 3704.81 0 3704.81 209.72
Standard Self MS4 971.83 1088.34 0 1088.34 116.51 952.77 1067 0 1067 114.23
Standard Self & Family MS5 2186.67 2448.8 0 2448.8 262.13 2143.79 2400.78 0 2400.78 256.99
Standard Self Plus One MS6 2089.47 2339.97 0 2339.97 250.5 2048.5 2294.09 0 2294.09 245.59
Missouri UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage
High Self AS1 New Plan 536.33 0 536.33 New Plan New Plan 525.81 0 525.81 New Plan
High Self & Family AS2 New Plan 1268.23 0 1268.23 New Plan New Plan 1243.36 0 1243.36 New Plan
High Self Plus One AS3 New Plan 1153.03 0 1153.03 New Plan New Plan 1130.42 0 1130.42 New Plan
Missouri UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage
High Self Y81 New Plan 516.87 0 516.87 New Plan New Plan 506.74 0 506.74 New Plan
High Self & Family Y82 New Plan 1222.19 0 1222.19 New Plan New Plan 1198.23 0 1198.23 New Plan
High Self Plus One Y83 New Plan 1111.17 0 1111.17 New Plan New Plan 1089.38 0 1089.38 New Plan
Montana Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Montana Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Montana Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self H41 845.44 845.04 0 845.04 -0.4 828.86 828.47 0 828.47 -0.39
CDHP Self & Family H42 1927.17 1926.22 0 1926.22 -0.95 1889.38 1888.45 0 1888.45 -0.93
CDHP Self Plus One H43 1908.09 1907.32 0 1907.32 -0.77 1870.68 1869.92 0 1869.92 -0.76
Value Self H44 628.86 823.18 0 823.18 194.32 616.53 807.04 0 807.04 190.51
Value Self & Family H45 1443.29 1889.22 0 1889.22 445.93 1414.99 1852.18 0 1852.18 437.19
Value Self Plus One H46 1415 1852.18 0 1852.18 437.18 1387.25 1815.86 0 1815.86 428.61
Montana Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Nebraska Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Nebraska Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Nebraska Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self H41 845.44 845.04 0 845.04 -0.4 828.86 828.47 0 828.47 -0.39
CDHP Self & Family H42 1927.17 1926.22 0 1926.22 -0.95 1889.38 1888.45 0 1888.45 -0.93
CDHP Self Plus One H43 1908.09 1907.32 0 1907.32 -0.77 1870.68 1869.92 0 1869.92 -0.76
Value Self H44 628.86 823.18 0 823.18 194.32 616.53 807.04 0 807.04 190.51
Value Self & Family H45 1443.29 1889.22 0 1889.22 445.93 1414.99 1852.18 0 1852.18 437.19
Value Self Plus One H46 1415 1852.18 0 1852.18 437.18 1387.25 1815.86 0 1815.86 428.61
Nebraska Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Nevada Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Nevada Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Nevada Aetna HealthFund CDHP and Aetna Value Plan
Value Self G54 683.99 726.98 0 726.98 42.99 670.58 712.73 0 712.73 42.15
Value Self & Family G55 1566.58 1665.02 0 1665.02 98.44 1535.86 1632.37 0 1632.37 96.51
Value Self Plus One G56 1535.89 1632.38 0 1632.38 96.49 1505.77 1600.37 0 1600.37 94.6
CDHP Self G51 800.84 922.59 0 922.59 121.75 785.14 904.5 0 904.5 119.36
CDHP Self & Family G52 1826.7 2104.36 0 2104.36 277.66 1790.88 2063.1 0 2063.1 272.22
CDHP Self Plus One G53 1808.64 2083.56 0 2083.56 274.92 1773.18 2042.71 0 2042.71 269.53
Nevada Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Nevada Health Plan of Nevada, Inc.
High Self NM1 671.71 721.12 0 721.12 49.41 658.54 706.98 0 706.98 48.44
High Self & Family NM2 1591.88 1708.99 0 1708.99 117.11 1560.67 1675.48 0 1675.48 114.81
High Self Plus One NM3 1276.28 1370.16 0 1370.16 93.88 1251.25 1343.29 0 1343.29 92.04
Nevada UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self LU1 459.33 452.72 0 452.72 -6.61 450.32 443.84 0 443.84 -6.48
HDHP Self & Family LU2 1056.44 1041.27 0 1041.27 -15.17 1035.73 1020.85 0 1020.85 -14.88
HDHP Self Plus One LU3 987.56 973.36 0 973.36 -14.2 968.2 954.27 0 954.27 -13.93
Nevada UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self KT1 692.77 739.27 0 739.27 46.5 679.19 724.77 0 724.77 45.58
High Self & Family KT2 1731.91 1848.14 0 1848.14 116.23 1697.95 1811.9 0 1811.9 113.95
High Self Plus One KT3 1489.43 1589.42 0 1589.42 99.99 1460.23 1558.25 0 1558.25 98.02
Nevada UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage
High Self WF1 New Plan 533.32 0 533.32 New Plan New Plan 522.86 0 522.86 New Plan
High Self & Family WF2 New Plan 1261.12 0 1261.12 New Plan New Plan 1236.39 0 1236.39 New Plan
High Self Plus One WF3 New Plan 1146.53 0 1146.53 New Plan New Plan 1124.05 0 1124.05 New Plan
Nevada UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage
High Self VD1 New Plan 532.46 0 532.46 New Plan New Plan 522.02 0 522.02 New Plan
High Self & Family VD2 New Plan 1259.06 0 1259.06 New Plan New Plan 1234.37 0 1234.37 New Plan
High Self Plus One VD3 New Plan 1144.67 0 1144.67 New Plan New Plan 1122.23 0 1122.23 New Plan
New Hampshire Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
New Hampshire Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan
Value Self EP4 631.46 774.8 0 774.8 143.34 619.08 759.61 0 759.61 140.53
Value Self & Family EP5 1446 1774.3 0 1774.3 328.3 1417.65 1739.51 0 1739.51 321.86
Value Self Plus One EP6 1417.65 1739.49 0 1739.49 321.84 1389.85 1705.38 0 1705.38 315.53
CDHP Self EP1 935.14 1097.27 0 1097.27 162.13 916.8 1075.75 0 1075.75 158.95
CDHP Self & Family EP2 2132.65 2502.39 0 2502.39 369.74 2090.83 2453.32 0 2453.32 362.49
CDHP Self Plus One EP3 2111.52 2477.61 0 2477.61 366.09 2070.12 2429.03 0 2429.03 358.91
New Hampshire Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
New Jersey Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
New Jersey Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
New Jersey Aetna HealthFund CDHP and Aetna Value Plan
Value Self EP4 631.46 774.8 0 774.8 143.34 619.08 759.61 0 759.61 140.53
Value Self & Family EP5 1446 1774.3 0 1774.3 328.3 1417.65 1739.51 0 1739.51 321.86
Value Self Plus One EP6 1417.65 1739.49 0 1739.49 321.84 1389.85 1705.38 0 1705.38 315.53
CDHP Self EP1 935.14 1097.27 0 1097.27 162.13 916.8 1075.75 0 1075.75 158.95
CDHP Self & Family EP2 2132.65 2502.39 0 2502.39 369.74 2090.83 2453.32 0 2453.32 362.49
CDHP Self Plus One EP3 2111.52 2477.61 0 2477.61 366.09 2070.12 2429.03 0 2429.03 358.91
New Jersey Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
New Jersey Aetna Open Access
High Self JR1 1437.99 1575.65 0 1575.65 137.66 1409.79 1544.75 0 1544.75 134.96
High Self & Family JR2 3321.59 3639.56 0 3639.56 317.97 3256.46 3568.2 0 3568.2 311.74
High Self Plus One JR3 3288.68 3603.5 0 3603.5 314.82 3224.2 3532.84 0 3532.84 308.64
Basic Self JR4 1186.68 1400.75 0 1400.75 214.07 1163.41 1373.28 0 1373.28 209.87
Basic Self & Family JR5 2750.26 3246.33 0 3246.33 496.07 2696.33 3182.68 0 3182.68 486.35
Basic Self Plus One JR6 2723.01 3214.18 0 3214.18 491.17 2669.62 3151.16 0 3151.16 481.54
New Jersey Aetna Open Access
Basic Self P34 1324.43 1336.28 0 1336.28 11.85 1298.46 1310.08 0 1310.08 11.62
Basic Self & Family P35 3074.03 3101.49 0 3101.49 27.46 3013.75 3040.68 0 3040.68 26.93
Basic Self Plus One P36 3043.57 3070.75 0 3070.75 27.18 2983.89 3010.54 0 3010.54 26.65
High Self P31 1514.91 1485.74 0 1485.74 -29.17 1485.21 1456.61 0 1456.61 -28.6
High Self & Family P32 3672.93 3602.17 0 3602.17 -70.76 3600.91 3531.54 0 3531.54 -69.37
High Self Plus One P33 3636.56 3566.48 0 3566.48 -70.08 3565.25 3496.55 0 3496.55 -68.7
New Jersey GHI Health Plan
Standard Self 804 944.49 1024.75 0 1024.75 80.26 925.97 1004.66 0 1004.66 78.69
Standard Self & Family 805 2291.4 2486.16 0 2486.16 194.76 2246.47 2437.41 0 2437.41 190.94
Standard Self Plus One 806 2196.92 2383.66 0 2383.66 186.74 2153.84 2336.92 0 2336.92 183.08
New Jersey GHI Health Plan
HDHP Self 811 New Plan 689.88 0 689.88 New Plan New Plan 676.35 0 676.35 New Plan
HDHP Self & Family 812 New Plan 1508.28 0 1508.28 New Plan New Plan 1478.71 0 1478.71 New Plan
HDHP Self Plus One 813 New Plan 1479.09 0 1479.09 New Plan New Plan 1450.09 0 1450.09 New Plan
New Mexico Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
New Mexico Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
New Mexico Aetna HealthFund CDHP and Aetna Value Plan
Value Self G54 683.99 726.98 0 726.98 42.99 670.58 712.73 0 712.73 42.15
Value Self & Family G55 1566.58 1665.02 0 1665.02 98.44 1535.86 1632.37 0 1632.37 96.51
Value Self Plus One G56 1535.89 1632.38 0 1632.38 96.49 1505.77 1600.37 0 1600.37 94.6
CDHP Self G51 800.84 922.59 0 922.59 121.75 785.14 904.5 0 904.5 119.36
CDHP Self & Family G52 1826.7 2104.36 0 2104.36 277.66 1790.88 2063.1 0 2063.1 272.22
CDHP Self Plus One G53 1808.64 2083.56 0 2083.56 274.92 1773.18 2042.71 0 2042.71 269.53
New Mexico Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
New Mexico Presbyterian Health Plan
High Self P21 755.12 857.81 0 857.81 102.69 740.31 840.99 0 840.99 100.68
High Self & Family P22 1774.55 2015.83 0 2015.83 241.28 1739.75 1976.3 0 1976.3 236.55
High Self Plus One P23 1714.14 1947.21 0 1947.21 233.07 1680.53 1909.03 0 1909.03 228.5
New Mexico Presbyterian Health Plan
Standard Self PS4 635.11 724.49 0 724.49 89.38 622.66 710.28 0 710.28 87.62
Standard Self & Family PS5 1492.55 1702.54 0 1702.54 209.99 1463.28 1669.16 0 1669.16 205.88
Standard Self Plus One PS6 1441.72 1644.6 0 1644.6 202.88 1413.45 1612.35 0 1612.35 198.9
Wellness Self PS1 New Plan 632.28 0 632.28 New Plan New Plan 619.88 0 619.88 New Plan
Wellness Self & Family PS2 New Plan 1485.9 0 1485.9 New Plan New Plan 1456.76 0 1456.76 New Plan
Wellness Self Plus One PS3 New Plan 1435.33 0 1435.33 New Plan New Plan 1407.19 0 1407.19 New Plan
New Mexico True Health New Mexico
High Self EL1 New Plan 632.57 0 632.57 New Plan New Plan 620.17 0 620.17 New Plan
High Self & Family EL2 New Plan 1493.76 0 1493.76 New Plan New Plan 1464.47 0 1464.47 New Plan
High Self Plus One EL3 New Plan 1415.79 0 1415.79 New Plan New Plan 1388.03 0 1388.03 New Plan
New York Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
New York Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
New York Aetna HealthFund CDHP and Aetna Value Plan
Value Self EP4 631.46 774.8 0 774.8 143.34 619.08 759.61 0 759.61 140.53
Value Self & Family EP5 1446 1774.3 0 1774.3 328.3 1417.65 1739.51 0 1739.51 321.86
Value Self Plus One EP6 1417.65 1739.49 0 1739.49 321.84 1389.85 1705.38 0 1705.38 315.53
CDHP Self EP1 935.14 1097.27 0 1097.27 162.13 916.8 1075.75 0 1075.75 158.95
CDHP Self & Family EP2 2132.65 2502.39 0 2502.39 369.74 2090.83 2453.32 0 2453.32 362.49
CDHP Self Plus One EP3 2111.52 2477.61 0 2477.61 366.09 2070.12 2429.03 0 2429.03 358.91
New York Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
New York Aetna Open Access
High Self JC1 1329.12 1346.78 0 1346.78 17.66 1303.06 1320.37 0 1320.37 17.31
High Self & Family JC2 3284.24 3327.82 0 3327.82 43.58 3219.84 3262.57 0 3262.57 42.73
High Self Plus One JC3 3251.75 3294.87 0 3294.87 43.12 3187.99 3230.26 0 3230.26 42.27
Basic Self JC4 1084.47 1124.47 0 1124.47 40 1063.21 1102.42 0 1102.42 39.21
Basic Self & Family JC5 2645.24 2742.81 0 2742.81 97.57 2593.37 2689.03 0 2689.03 95.66
Basic Self Plus One JC6 2619.07 2715.69 0 2715.69 96.62 2567.72 2662.44 0 2662.44 94.72
New York CDPHP
Standard Self SG4 589.12 642.2 0 642.2 53.08 577.57 629.61 0 629.61 52.04
Standard Self & Family SG5 1767.31 1828.49 0 1828.49 61.18 1732.66 1792.64 0 1792.64 59.98
Standard Self Plus One SG6 1178.24 1329.32 0 1329.32 151.08 1155.14 1303.25 0 1303.25 148.11
High Self SG1 887.7 1011.08 0 1011.08 123.38 870.29 991.25 0 991.25 120.96
High Self & Family SG2 2662.76 2881.55 0 2881.55 218.79 2610.55 2825.05 0 2825.05 214.5
High Self Plus One SG3 1775.36 2092.92 0 2092.92 317.56 1740.55 2051.88 0 2051.88 311.33
New York GHI Health Plan
Standard Self 804 944.49 1024.75 0 1024.75 80.26 925.97 1004.66 0 1004.66 78.69
Standard Self & Family 805 2291.4 2486.16 0 2486.16 194.76 2246.47 2437.41 0 2437.41 190.94
Standard Self Plus One 806 2196.92 2383.66 0 2383.66 186.74 2153.84 2336.92 0 2336.92 183.08
New York GHI Health Plan
HDHP Self 811 New Plan 689.88 0 689.88 New Plan New Plan 676.35 0 676.35 New Plan
HDHP Self & Family 812 New Plan 1508.28 0 1508.28 New Plan New Plan 1478.71 0 1478.71 New Plan
HDHP Self Plus One 813 New Plan 1479.09 0 1479.09 New Plan New Plan 1450.09 0 1450.09 New Plan
New York HIP of Greater NY
Standard Self YL4 671.77 830.15 0 830.15 158.38 658.6 813.87 0 813.87 155.27
Standard Self & Family YL5 1922.37 2386.78 0 2386.78 464.41 1884.68 2339.98 0 2339.98 455.3
Standard Self Plus One YL6 1192.6 1509.86 0 1509.86 317.26 1169.22 1480.25 0 1480.25 311.03
New York HIP of Greater NY
High Self 511 1005.07 1092.47 0 1092.47 87.4 985.36 1071.05 0 1071.05 85.69
High Self & Family 512 2877.82 3143.62 0 3143.62 265.8 2821.39 3081.98 0 3081.98 260.59
High Self Plus One 513 1790.57 1987.52 0 1987.52 196.95 1755.46 1948.55 0 1948.55 193.09
New York Independent Health
Standard Self C54 715.87 725.85 0 725.85 9.98 701.83 711.62 0 711.62 9.79
Standard Self & Family C55 1932.85 1959.81 0 1959.81 26.96 1894.95 1921.38 0 1921.38 26.43
Standard Self Plus One C56 1825.44 1850.9 0 1850.9 25.46 1789.65 1814.61 0 1814.61 24.96
New York Independent Health
High Self QA1 742.18 777.92 0 777.92 35.74 727.63 762.67 0 762.67 35.04
High Self & Family QA2 2003.85 2100.36 0 2100.36 96.51 1964.56 2059.18 0 2059.18 94.62
High Self Plus One QA3 1892.54 1983.7 0 1983.7 91.16 1855.43 1944.8 0 1944.8 89.37
HDHP Self QA4 602.38 604.73 0 604.73 2.35 590.57 592.87 0 592.87 2.3
HDHP Self & Family QA5 1555.34 1563.79 0 1563.79 8.45 1524.84 1533.13 0 1533.13 8.29
HDHP Self Plus One QA6 1449.62 1458.2 0 1458.2 8.58 1421.2 1429.61 0 1429.61 8.41
North Carolina Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
North Carolina Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
North Carolina Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self F51 827.01 845.81 0 845.81 18.8 810.79 829.23 0 829.23 18.44
CDHP Self & Family F52 1885.68 1928.53 0 1928.53 42.85 1848.71 1890.72 0 1890.72 42.01
CDHP Self Plus One F53 1867.01 1909.44 0 1909.44 42.43 1830.4 1872 0 1872 41.6
Value Self F54 722.61 836.38 0 836.38 113.77 708.44 819.98 0 819.98 111.54
Value Self & Family F55 1654.7 1915.16 0 1915.16 260.46 1622.25 1877.61 0 1877.61 255.36
Value Self Plus One F56 1622.23 1877.6 0 1877.6 255.37 1590.42 1840.78 0 1840.78 250.36
North Carolina Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
North Carolina UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self LS1 427.08 463.83 0 463.83 36.75 418.71 454.74 0 454.74 36.03
HDHP Self & Family LS2 982.34 1066.84 0 1066.84 84.5 963.08 1045.92 0 1045.92 82.84
HDHP Self Plus One LS3 918.26 997.26 0 997.26 79 900.25 977.71 0 977.71 77.46
North Carolina UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self KK1 692.61 728.15 0 728.15 35.54 679.03 713.87 0 713.87 34.84
High Self & Family KK2 1731.58 1820.4 0 1820.4 88.82 1697.63 1784.71 0 1784.71 87.08
High Self Plus One KK3 1489.14 1565.57 0 1565.57 76.43 1459.94 1534.87 0 1534.87 74.93
North Carolina UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage
High Self AS1 New Plan 536.33 0 536.33 New Plan New Plan 525.81 0 525.81 New Plan
High Self & Family AS2 New Plan 1268.23 0 1268.23 New Plan New Plan 1243.36 0 1243.36 New Plan
High Self Plus One AS3 New Plan 1153.03 0 1153.03 New Plan New Plan 1130.42 0 1130.42 New Plan
North Carolina UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage
High Self Y81 New Plan 516.87 0 516.87 New Plan New Plan 506.74 0 506.74 New Plan
High Self & Family Y82 New Plan 1222.19 0 1222.19 New Plan New Plan 1198.23 0 1198.23 New Plan
High Self Plus One Y83 New Plan 1111.17 0 1111.17 New Plan New Plan 1089.38 0 1089.38 New Plan
North Dakota Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
North Dakota Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
North Dakota Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self H41 845.44 845.04 0 845.04 -0.4 828.86 828.47 0 828.47 -0.39
CDHP Self & Family H42 1927.17 1926.22 0 1926.22 -0.95 1889.38 1888.45 0 1888.45 -0.93
CDHP Self Plus One H43 1908.09 1907.32 0 1907.32 -0.77 1870.68 1869.92 0 1869.92 -0.76
Value Self H44 628.86 823.18 0 823.18 194.32 616.53 807.04 0 807.04 190.51
Value Self & Family H45 1443.29 1889.22 0 1889.22 445.93 1414.99 1852.18 0 1852.18 437.19
Value Self Plus One H46 1415 1852.18 0 1852.18 437.18 1387.25 1815.86 0 1815.86 428.61
North Dakota Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
North Dakota HealthPartners
Standard Self V34 436.65 469.12 0 469.12 32.47 428.09 459.92 0 459.92 31.83
Standard Self & Family V35 1063.68 1142.82 0 1142.82 79.14 1042.82 1120.41 0 1120.41 77.59
Standard Self Plus One V36 965 1036.78 0 1036.78 71.78 946.08 1016.45 0 1016.45 70.37
High Self V31 806.12 726.56 0 726.56 -79.56 790.31 712.31 0 712.31 -78
High Self & Family V32 1963.71 1769.9 0 1769.9 -193.81 1925.21 1735.2 0 1735.2 -190.01
High Self Plus One V33 1781.5 1605.69 0 1605.69 -175.81 1746.57 1574.21 0 1574.21 -172.36
Ohio Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Ohio Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Ohio Aetna HealthFund CDHP and Aetna Value Plan
Value Self JS4 820.07 1094.95 0 1094.95 274.88 803.99 1073.48 0 1073.48 269.49
Value Self & Family JS5 1872.12 2499.6 0 2499.6 627.48 1835.41 2450.59 0 2450.59 615.18
Value Self Plus One JS6 1853.6 2474.85 0 2474.85 621.25 1817.25 2426.32 0 2426.32 609.07
CDHP Self JS1 1070.02 1024.07 0 1024.07 -45.95 1049.04 1003.99 0 1003.99 -45.05
CDHP Self & Family JS2 2439.18 2334.42 0 2334.42 -104.76 2391.35 2288.65 0 2288.65 -102.7
CDHP Self Plus One JS3 2415.04 2311.31 0 2311.31 -103.73 2367.69 2265.99 0 2265.99 -101.7
Ohio Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Ohio AultCare Insurance Company
High Self 3A1 784.88 858.87 0 858.87 73.99 769.49 842.03 0 842.03 72.54
High Self & Family 3A2 1938.68 2121.38 0 2121.38 182.7 1900.67 2079.78 0 2079.78 179.11
High Self Plus One 3A3 1648.26 1803.6 0 1803.6 155.34 1615.94 1768.24 0 1768.24 152.3
HDHP Self 3A4 380.72 446.37 0 446.37 65.65 373.25 437.62 0 437.62 64.37
HDHP Self & Family 3A5 1218.22 1429.28 0 1429.28 211.06 1194.33 1401.25 0 1401.25 206.92
HDHP Self Plus One 3A6 723.31 848.6 0 848.6 125.29 709.13 831.96 0 831.96 122.83
Ohio Humana CoverageFirst and Humana Value Plan
Value Self X34 581.68 627.42 0 627.42 45.74 570.27 615.12 0 615.12 44.85
Value Self & Family X35 1308.78 1411.73 0 1411.73 102.95 1283.12 1384.05 0 1384.05 100.93
Value Self Plus One X36 1250.59 1348.98 0 1348.98 98.39 1226.07 1322.53 0 1322.53 96.46
CDHP Self X31 698.34 815.43 0 815.43 117.09 684.65 799.44 0 799.44 114.79
CDHP Self & Family X32 1571.29 1834.75 0 1834.75 263.46 1540.48 1798.77 0 1798.77 258.29
CDHP Self Plus One X33 1501.45 1753.2 0 1753.2 251.75 1472.01 1718.82 0 1718.82 246.81
Ohio Humana Health Plan of Ohio, Inc.
High Self A61 1196.09 1531 0 1531 334.91 1172.64 1500.98 0 1500.98 328.34
High Self & Family A62 2691.25 3444.77 0 3444.77 753.52 2638.48 3377.23 0 3377.23 738.75
High Self Plus One A63 2571.64 3291.68 0 3291.68 720.04 2521.22 3227.14 0 3227.14 705.92
Standard Self A64 948.89 1195.61 0 1195.61 246.72 930.28 1172.17 0 1172.17 241.89
Standard Self & Family A65 2135.03 2690.17 0 2690.17 555.14 2093.17 2637.42 0 2637.42 544.25
Standard Self Plus One A66 2040.16 2570.6 0 2570.6 530.44 2000.16 2520.2 0 2520.2 520.04
Ohio Humana Health Plan of Ohio, Inc.
Basic Self W61 597.5 620.79 0 620.79 23.29 585.78 608.62 0 608.62 22.84
Basic Self & Family W62 1344.37 1396.83 0 1396.83 52.46 1318.01 1369.44 0 1369.44 51.43
Basic Self Plus One W63 1284.61 1334.75 0 1334.75 50.14 1259.42 1308.58 0 1308.58 49.16
Ohio Medical Mutual of Ohio
Standard Self 644 874.92 1048.34 0 1048.34 173.42 857.76 1027.78 0 1027.78 170.02
Standard Self & Family 645 2099.79 2516.04 0 2516.04 416.25 2058.62 2466.71 0 2466.71 408.09
Standard Self Plus One 646 1924.78 2306.38 0 2306.38 381.6 1887.04 2261.16 0 2261.16 374.12
Ohio Medical Mutual of Ohio
Standard Self X64 822.08 866.41 0 866.41 44.33 805.96 849.42 0 849.42 43.46
Standard Self & Family X65 1972.98 2079.37 0 2079.37 106.39 1934.29 2038.6 0 2038.6 104.31
Standard Self Plus One X66 1808.53 1906.08 0 1906.08 97.55 1773.07 1868.71 0 1868.71 95.64
Basic Self X61 470.95 448.79 0 448.79 -22.16 461.72 439.99 0 439.99 -21.73
Basic Self & Family X62 1130.28 1077.07 0 1077.07 -53.21 1108.12 1055.95 0 1055.95 -52.17
Basic Self Plus One X63 1036.1 987.32 0 987.32 -48.78 1015.78 967.96 0 967.96 -47.82
Ohio Medical Mutual of Ohio
Basic Self UX1 492.21 448.94 0 448.94 -43.27 482.56 440.14 0 440.14 -42.42
Basic Self & Family UX2 1181.31 1077.47 0 1077.47 -103.84 1158.15 1056.34 0 1056.34 -101.81
Basic Self Plus One UX3 1082.88 987.7 0 987.7 -95.18 1061.65 968.33 0 968.33 -93.32
Ohio Medical Mutual of Ohio
Basic Self YF1 500.37 448.94 0 448.94 -51.43 490.56 440.14 0 440.14 -50.42
Basic Self & Family YF2 1200.92 1077.47 0 1077.47 -123.45 1177.37 1056.34 0 1056.34 -121.03
Basic Self Plus One YF3 1100.85 987.7 0 987.7 -113.15 1079.26 968.33 0 968.33 -110.93
Standard Self YF4 938.24 988.36 0 988.36 50.12 919.84 968.98 0 968.98 49.14
Standard Self & Family YF5 2251.75 2372.06 0 2372.06 120.31 2207.6 2325.55 0 2325.55 117.95
Standard Self Plus One YF6 2064.07 2174.37 0 2174.37 110.3 2023.6 2131.74 0 2131.74 108.14
Oklahoma Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Oklahoma Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Oklahoma Aetna HealthFund CDHP and Aetna Value Plan
Value Self JS4 820.07 1094.95 0 1094.95 274.88 803.99 1073.48 0 1073.48 269.49
Value Self & Family JS5 1872.12 2499.6 0 2499.6 627.48 1835.41 2450.59 0 2450.59 615.18
Value Self Plus One JS6 1853.6 2474.85 0 2474.85 621.25 1817.25 2426.32 0 2426.32 609.07
CDHP Self JS1 1070.02 1024.07 0 1024.07 -45.95 1049.04 1003.99 0 1003.99 -45.05
CDHP Self & Family JS2 2439.18 2334.42 0 2334.42 -104.76 2391.35 2288.65 0 2288.65 -102.7
CDHP Self Plus One JS3 2415.04 2311.31 0 2311.31 -103.73 2367.69 2265.99 0 2265.99 -101.7
Oklahoma Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Oklahoma GlobalHealth
Standard Self IM4 614.2 635.4 0 635.4 21.2 602.16 622.94 0 622.94 20.78
Standard Self & Family IM5 1535.51 1588.53 0 1588.53 53.02 1505.4 1557.38 0 1557.38 51.98
Standard Self Plus One IM6 1228.41 1270.82 0 1270.82 42.41 1204.32 1245.9 0 1245.9 41.58
High Self IM1 631.38 672.46 0 672.46 41.08 619 659.27 0 659.27 40.27
High Self & Family IM2 1578.47 1681.12 0 1681.12 102.65 1547.52 1648.16 0 1648.16 100.64
High Self Plus One IM3 1262.77 1344.9 0 1344.9 82.13 1238.01 1318.53 0 1318.53 80.52
Oregon Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Oregon Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Oregon Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self H41 845.44 845.04 0 845.04 -0.4 828.86 828.47 0 828.47 -0.39
CDHP Self & Family H42 1927.17 1926.22 0 1926.22 -0.95 1889.38 1888.45 0 1888.45 -0.93
CDHP Self Plus One H43 1908.09 1907.32 0 1907.32 -0.77 1870.68 1869.92 0 1869.92 -0.76
Value Self H44 628.86 823.18 0 823.18 194.32 616.53 807.04 0 807.04 190.51
Value Self & Family H45 1443.29 1889.22 0 1889.22 445.93 1414.99 1852.18 0 1852.18 437.19
Value Self Plus One H46 1415 1852.18 0 1852.18 437.18 1387.25 1815.86 0 1815.86 428.61
Oregon Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Oregon Kaiser Foundation Health Plan of the Northwest
Standard Self 574 632.71 660.92 0 660.92 28.21 620.3 647.96 0 647.96 27.66
Standard Self & Family 575 1453.5 1518.31 0 1518.31 64.81 1425 1488.54 0 1488.54 63.54
Standard Self Plus One 576 1453.5 1518.31 0 1518.31 64.81 1425 1488.54 0 1488.54 63.54
High Self 571 720.81 744.53 0 744.53 23.72 706.68 729.93 0 729.93 23.25
High Self & Family 572 1628.08 1681.67 0 1681.67 53.59 1596.16 1648.7 0 1648.7 52.54
High Self Plus One 573 1628.08 1681.67 0 1681.67 53.59 1596.16 1648.7 0 1648.7 52.54
Oregon UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self LU1 459.33 452.72 0 452.72 -6.61 450.32 443.84 0 443.84 -6.48
HDHP Self & Family LU2 1056.44 1041.27 0 1041.27 -15.17 1035.73 1020.85 0 1020.85 -14.88
HDHP Self Plus One LU3 987.56 973.36 0 973.36 -14.2 968.2 954.27 0 954.27 -13.93
Oregon UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self KT1 692.77 739.27 0 739.27 46.5 679.19 724.77 0 724.77 45.58
High Self & Family KT2 1731.91 1848.14 0 1848.14 116.23 1697.95 1811.9 0 1811.9 113.95
High Self Plus One KT3 1489.43 1589.42 0 1589.42 99.99 1460.23 1558.25 0 1558.25 98.02
Oregon UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage
High Self WF1 New Plan 533.32 0 533.32 New Plan New Plan 522.86 0 522.86 New Plan
High Self & Family WF2 New Plan 1261.12 0 1261.12 New Plan New Plan 1236.39 0 1236.39 New Plan
High Self Plus One WF3 New Plan 1146.53 0 1146.53 New Plan New Plan 1124.05 0 1124.05 New Plan
Oregon UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage
High Self VD1 New Plan 532.46 0 532.46 New Plan New Plan 522.02 0 522.02 New Plan
High Self & Family VD2 New Plan 1259.06 0 1259.06 New Plan New Plan 1234.37 0 1234.37 New Plan
High Self Plus One VD3 New Plan 1144.67 0 1144.67 New Plan New Plan 1122.23 0 1122.23 New Plan
Pennsylvania Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Pennsylvania Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Pennsylvania Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self H41 845.44 845.04 0 845.04 -0.4 828.86 828.47 0 828.47 -0.39
CDHP Self & Family H42 1927.17 1926.22 0 1926.22 -0.95 1889.38 1888.45 0 1888.45 -0.93
CDHP Self Plus One H43 1908.09 1907.32 0 1907.32 -0.77 1870.68 1869.92 0 1869.92 -0.76
Value Self H44 628.86 823.18 0 823.18 194.32 616.53 807.04 0 807.04 190.51
Value Self & Family H45 1443.29 1889.22 0 1889.22 445.93 1414.99 1852.18 0 1852.18 437.19
Value Self Plus One H46 1415 1852.18 0 1852.18 437.18 1387.25 1815.86 0 1815.86 428.61
Pennsylvania Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Pennsylvania Aetna Open Access
High Self YE1 956.88 1239.43 0 1239.43 282.55 938.12 1215.13 0 1215.13 277.01
High Self & Family YE2 2402.73 3112.21 0 3112.21 709.48 2355.62 3051.19 0 3051.19 695.57
High Self Plus One YE3 2378.94 3081.4 0 3081.4 702.46 2332.29 3020.98 0 3020.98 688.69
Pennsylvania Aetna Open Access
Basic Self P34 1324.43 1336.28 0 1336.28 11.85 1298.46 1310.08 0 1310.08 11.62
Basic Self & Family P35 3074.03 3101.49 0 3101.49 27.46 3013.75 3040.68 0 3040.68 26.93
Basic Self Plus One P36 3043.57 3070.75 0 3070.75 27.18 2983.89 3010.54 0 3010.54 26.65
High Self P31 1514.91 1485.74 0 1485.74 -29.17 1485.21 1456.61 0 1456.61 -28.6
High Self & Family P32 3672.93 3602.17 0 3602.17 -70.76 3600.91 3531.54 0 3531.54 -69.37
High Self Plus One P33 3636.56 3566.48 0 3566.48 -70.08 3565.25 3496.55 0 3496.55 -68.7
Pennsylvania Geisinger Health Plan
Standard Self GG4 743.75 839.18 0 839.18 95.43 729.17 822.73 0 822.73 93.56
Standard Self & Family GG5 1702.85 1921.35 0 1921.35 218.5 1669.46 1883.68 0 1883.68 214.22
Standard Self Plus One GG6 1607.05 1813.26 0 1813.26 206.21 1575.54 1777.71 0 1777.71 202.17
Pennsylvania UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self V41 505.6 496.3 0 496.3 -9.3 495.69 486.57 0 486.57 -9.12
HDHP Self & Family V42 1162.86 1141.49 0 1141.49 -21.37 1140.06 1119.11 0 1119.11 -20.95
HDHP Self Plus One V43 1087.03 1067.05 0 1067.05 -19.98 1065.72 1046.13 0 1046.13 -19.59
Pennsylvania UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self LR1 681.3 729.19 0 729.19 47.89 667.94 714.89 0 714.89 46.95
High Self & Family LR2 1614.65 1728.18 0 1728.18 113.53 1582.99 1694.29 0 1694.29 111.3
High Self Plus One LR3 1464.77 1567.73 0 1567.73 102.96 1436.05 1536.99 0 1536.99 100.94
Pennsylvania UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage
High Self AS1 New Plan 536.33 0 536.33 New Plan New Plan 525.81 0 525.81 New Plan
High Self & Family AS2 New Plan 1268.23 0 1268.23 New Plan New Plan 1243.36 0 1243.36 New Plan
High Self Plus One AS3 New Plan 1153.03 0 1153.03 New Plan New Plan 1130.42 0 1130.42 New Plan
Pennsylvania UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage
High Self Y81 New Plan 516.87 0 516.87 New Plan New Plan 506.74 0 506.74 New Plan
High Self & Family Y82 New Plan 1222.19 0 1222.19 New Plan New Plan 1198.23 0 1198.23 New Plan
High Self Plus One Y83 New Plan 1111.17 0 1111.17 New Plan New Plan 1089.38 0 1089.38 New Plan
Pennsylvania UPMC Health Plan
Standard Self YT4 New Plan 922.17 0 922.17 New Plan New Plan 904.09 0 904.09 New Plan
Standard Self & Family YT5 New Plan 2164.41 0 2164.41 New Plan New Plan 2121.97 0 2121.97 New Plan
Standard Self Plus One YT6 New Plan 2073.11 0 2073.11 New Plan New Plan 2032.46 0 2032.46 New Plan
Pennsylvania UPMC Health Plan
HDHP Self YS4 New Plan 791.32 0 791.32 New Plan New Plan 775.8 0 775.8 New Plan
HDHP Self & Family YS5 New Plan 1826.87 0 1826.87 New Plan New Plan 1791.05 0 1791.05 New Plan
HDHP Self Plus One YS6 New Plan 1756.15 0 1756.15 New Plan New Plan 1721.72 0 1721.72 New Plan
High Self YS1 New Plan 1165.2 0 1165.2 New Plan New Plan 1142.35 0 1142.35 New Plan
High Self & Family YS2 New Plan 2738.57 0 2738.57 New Plan New Plan 2684.87 0 2684.87 New Plan
High Self Plus One YS3 New Plan 2622.1 0 2622.1 New Plan New Plan 2570.69 0 2570.69 New Plan
Pennsylvania UPMC Health Plan
HDHP Self 8W4 585.05 622.84 0 622.84 37.79 573.58 610.63 0 610.63 37.05
HDHP Self & Family 8W5 1343.94 1433.1 0 1433.1 89.16 1317.59 1405 0 1405 87.41
HDHP Self Plus One 8W6 1293.4 1378.66 0 1378.66 85.26 1268.04 1351.63 0 1351.63 83.59
High Self 8W1 890.24 955.12 0 955.12 64.88 872.78 936.39 0 936.39 63.61
High Self & Family 8W2 2092.34 2244.86 0 2244.86 152.52 2051.31 2200.84 0 2200.84 149.53
High Self Plus One 8W3 2003.41 2149.43 0 2149.43 146.02 1964.13 2107.28 0 2107.28 143.15
Pennsylvania UPMC Health Plan
Standard Self UW4 664.9 687.15 0 687.15 22.25 651.86 673.68 0 673.68 21.82
Standard Self & Family UW5 1554.28 1612.35 0 1612.35 58.07 1523.8 1580.74 0 1580.74 56.94
Standard Self Plus One UW6 1488.46 1544.48 0 1544.48 56.02 1459.27 1514.2 0 1514.2 54.93
Puerto Rico Humana Health Plans of Puerto Rico, Inc.
High Self ZJ1 372.41 398.04 0 398.04 25.63 365.11 390.24 0 390.24 25.13
High Self & Family ZJ2 837.92 895.62 0 895.62 57.7 821.49 878.06 0 878.06 56.57
High Self Plus One ZJ3 800.68 855.8 0 855.8 55.12 784.98 839.02 0 839.02 54.04
Puerto Rico Triple-S Salud Inc. Puerto Rico
High Self 891 415.53 397.84 0 397.84 -17.69 407.38 390.04 0 390.04 -17.34
High Self & Family 892 951.54 911.07 0 911.07 -40.47 932.88 893.21 0 893.21 -39.67
High Self Plus One 893 932.99 893.31 0 893.31 -39.68 914.7 875.79 0 875.79 -38.91
Rhode Island Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Rhode Island Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Rhode Island Aetna HealthFund CDHP and Aetna Value Plan
Value Self EP4 631.46 774.8 0 774.8 143.34 619.08 759.61 0 759.61 140.53
Value Self & Family EP5 1446 1774.3 0 1774.3 328.3 1417.65 1739.51 0 1739.51 321.86
Value Self Plus One EP6 1417.65 1739.49 0 1739.49 321.84 1389.85 1705.38 0 1705.38 315.53
CDHP Self EP1 935.14 1097.27 0 1097.27 162.13 916.8 1075.75 0 1075.75 158.95
CDHP Self & Family EP2 2132.65 2502.39 0 2502.39 369.74 2090.83 2453.32 0 2453.32 362.49
CDHP Self Plus One EP3 2111.52 2477.61 0 2477.61 366.09 2070.12 2429.03 0 2429.03 358.91
Rhode Island Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
South Carolina Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
South Carolina Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
South Carolina Aetna HealthFund CDHP and Aetna Value Plan
Value Self JS4 820.07 1094.95 0 1094.95 274.88 803.99 1073.48 0 1073.48 269.49
Value Self & Family JS5 1872.12 2499.6 0 2499.6 627.48 1835.41 2450.59 0 2450.59 615.18
Value Self Plus One JS6 1853.6 2474.85 0 2474.85 621.25 1817.25 2426.32 0 2426.32 609.07
CDHP Self JS1 1070.02 1024.07 0 1024.07 -45.95 1049.04 1003.99 0 1003.99 -45.05
CDHP Self & Family JS2 2439.18 2334.42 0 2334.42 -104.76 2391.35 2288.65 0 2288.65 -102.7
CDHP Self Plus One JS3 2415.04 2311.31 0 2311.31 -103.73 2367.69 2265.99 0 2265.99 -101.7
South Carolina Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
South Dakota Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
South Dakota Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
South Dakota Aetna HealthFund CDHP and Aetna Value Plan
Value Self G54 683.99 726.98 0 726.98 42.99 670.58 712.73 0 712.73 42.15
Value Self & Family G55 1566.58 1665.02 0 1665.02 98.44 1535.86 1632.37 0 1632.37 96.51
Value Self Plus One G56 1535.89 1632.38 0 1632.38 96.49 1505.77 1600.37 0 1600.37 94.6
CDHP Self G51 800.84 922.59 0 922.59 121.75 785.14 904.5 0 904.5 119.36
CDHP Self & Family G52 1826.7 2104.36 0 2104.36 277.66 1790.88 2063.1 0 2063.1 272.22
CDHP Self Plus One G53 1808.64 2083.56 0 2083.56 274.92 1773.18 2042.71 0 2042.71 269.53
South Dakota Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
South Dakota HealthPartners
Standard Self V34 436.65 469.12 0 469.12 32.47 428.09 459.92 0 459.92 31.83
Standard Self & Family V35 1063.68 1142.82 0 1142.82 79.14 1042.82 1120.41 0 1120.41 77.59
Standard Self Plus One V36 965 1036.78 0 1036.78 71.78 946.08 1016.45 0 1016.45 70.37
High Self V31 806.12 726.56 0 726.56 -79.56 790.31 712.31 0 712.31 -78
High Self & Family V32 1963.71 1769.9 0 1769.9 -193.81 1925.21 1735.2 0 1735.2 -190.01
High Self Plus One V33 1781.5 1605.69 0 1605.69 -175.81 1746.57 1574.21 0 1574.21 -172.36
Tennessee Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Tennessee Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Tennessee Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self F51 827.01 845.81 0 845.81 18.8 810.79 829.23 0 829.23 18.44
CDHP Self & Family F52 1885.68 1928.53 0 1928.53 42.85 1848.71 1890.72 0 1890.72 42.01
CDHP Self Plus One F53 1867.01 1909.44 0 1909.44 42.43 1830.4 1872 0 1872 41.6
Value Self F54 722.61 836.38 0 836.38 113.77 708.44 819.98 0 819.98 111.54
Value Self & Family F55 1654.7 1915.16 0 1915.16 260.46 1622.25 1877.61 0 1877.61 255.36
Value Self Plus One F56 1622.23 1877.6 0 1877.6 255.37 1590.42 1840.78 0 1840.78 250.36
Tennessee Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Tennessee Aetna Open Access
High Self UB1 1014.73 1082.41 0 1082.41 67.68 994.83 1061.19 0 1061.19 66.36
High Self & Family UB2 2600.25 2773.69 0 2773.69 173.44 2549.26 2719.3 0 2719.3 170.04
High Self Plus One UB3 2574.54 2746.26 0 2746.26 171.72 2524.06 2692.41 0 2692.41 168.35
Tennessee Humana CoverageFirst and Humana Value Plan
CDHP Self TT1 678.76 760.22 0 760.22 81.46 665.45 745.31 0 745.31 79.86
CDHP Self & Family TT2 1527.25 1710.52 0 1710.52 183.27 1497.3 1676.98 0 1676.98 179.68
CDHP Self Plus One TT3 1459.38 1634.5 0 1634.5 175.12 1430.76 1602.45 0 1602.45 171.69
Value Self TT4 548.53 696.62 0 696.62 148.09 537.77 682.96 0 682.96 145.19
Value Self & Family TT5 1234.13 1567.35 0 1567.35 333.22 1209.93 1536.62 0 1536.62 326.69
Value Self Plus One TT6 1179.28 1497.68 0 1497.68 318.4 1156.16 1468.31 0 1468.31 312.15
Tennessee Humana Health Plan, Inc.
High Self GJ1 983.04 1199.31 0 1199.31 216.27 963.76 1175.79 0 1175.79 212.03
High Self & Family GJ2 2211.75 2698.35 0 2698.35 486.6 2168.38 2645.44 0 2645.44 477.06
High Self Plus One GJ3 2113.45 2578.41 0 2578.41 464.96 2072.01 2527.85 0 2527.85 455.84
Standard Self GJ4 831.93 887.53 0 887.53 55.6 815.62 870.13 0 870.13 54.51
Standard Self & Family GJ5 1871.82 1996.94 0 1996.94 125.12 1835.12 1957.78 0 1957.78 122.66
Standard Self Plus One GJ6 1788.62 1908.19 0 1908.19 119.57 1753.55 1870.77 0 1870.77 117.22
Tennessee UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self LS1 427.08 463.83 0 463.83 36.75 418.71 454.74 0 454.74 36.03
HDHP Self & Family LS2 982.34 1066.84 0 1066.84 84.5 963.08 1045.92 0 1045.92 82.84
HDHP Self Plus One LS3 918.26 997.26 0 997.26 79 900.25 977.71 0 977.71 77.46
Tennessee UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self KK1 692.61 728.15 0 728.15 35.54 679.03 713.87 0 713.87 34.84
High Self & Family KK2 1731.58 1820.4 0 1820.4 88.82 1697.63 1784.71 0 1784.71 87.08
High Self Plus One KK3 1489.14 1565.57 0 1565.57 76.43 1459.94 1534.87 0 1534.87 74.93
Tennessee UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage
High Self AS1 New Plan 536.33 0 536.33 New Plan New Plan 525.81 0 525.81 New Plan
High Self & Family AS2 New Plan 1268.23 0 1268.23 New Plan New Plan 1243.36 0 1243.36 New Plan
High Self Plus One AS3 New Plan 1153.03 0 1153.03 New Plan New Plan 1130.42 0 1130.42 New Plan
Tennessee UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage
High Self Y81 New Plan 516.87 0 516.87 New Plan New Plan 506.74 0 506.74 New Plan
High Self & Family Y82 New Plan 1222.19 0 1222.19 New Plan New Plan 1198.23 0 1198.23 New Plan
High Self Plus One Y83 New Plan 1111.17 0 1111.17 New Plan New Plan 1089.38 0 1089.38 New Plan
Texas Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Texas Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Texas Aetna HealthFund CDHP and Aetna Value Plan
Value Self JS4 820.07 1094.95 0 1094.95 274.88 803.99 1073.48 0 1073.48 269.49
Value Self & Family JS5 1872.12 2499.6 0 2499.6 627.48 1835.41 2450.59 0 2450.59 615.18
Value Self Plus One JS6 1853.6 2474.85 0 2474.85 621.25 1817.25 2426.32 0 2426.32 609.07
CDHP Self JS1 1070.02 1024.07 0 1024.07 -45.95 1049.04 1003.99 0 1003.99 -45.05
CDHP Self & Family JS2 2439.18 2334.42 0 2334.42 -104.76 2391.35 2288.65 0 2288.65 -102.7
CDHP Self Plus One JS3 2415.04 2311.31 0 2311.31 -103.73 2367.69 2265.99 0 2265.99 -101.7
Texas Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Texas Humana CoverageFirst and Humana Value Plan
Value Self T34 508.22 538.73 0 538.73 30.51 498.25 528.17 0 528.17 29.92
Value Self & Family T35 1143.5 1212.1 0 1212.1 68.6 1121.08 1188.33 0 1188.33 67.25
Value Self Plus One T36 1092.7 1158.24 0 1158.24 65.54 1071.27 1135.53 0 1135.53 64.26
CDHP Self T31 667.18 773.93 0 773.93 106.75 654.1 758.75 0 758.75 104.65
CDHP Self & Family T32 1501.12 1741.3 0 1741.3 240.18 1471.69 1707.16 0 1707.16 235.47
CDHP Self Plus One T33 1434.43 1663.96 0 1663.96 229.53 1406.3 1631.33 0 1631.33 225.03
Texas Humana CoverageFirst and Humana Value Plan
CDHP Self TV1 721.74 858.87 0 858.87 137.13 707.59 842.03 0 842.03 134.44
CDHP Self & Family TV2 1623.93 1932.49 0 1932.49 308.56 1592.09 1894.6 0 1894.6 302.51
CDHP Self Plus One TV3 1551.78 1846.61 0 1846.61 294.83 1521.35 1810.4 0 1810.4 289.05
Value Self TV4 590.71 679.31 0 679.31 88.6 579.13 665.99 0 665.99 86.86
Value Self & Family TV5 1329.12 1528.48 0 1528.48 199.36 1303.06 1498.51 0 1498.51 195.45
Value Self Plus One TV6 1270.04 1460.57 0 1460.57 190.53 1245.14 1431.93 0 1431.93 186.79
Texas Humana CoverageFirst and Humana Value Plan
Value Self TU4 518.8 538.26 0 538.26 19.46 508.63 527.71 0 527.71 19.08
Value Self & Family TU5 1167.28 1211.13 0 1211.13 43.85 1144.39 1187.38 0 1187.38 42.99
Value Self Plus One TU6 1115.43 1157.31 0 1157.31 41.88 1093.56 1134.62 0 1134.62 41.06
CDHP Self TU1 652.17 658.7 0 658.7 6.53 639.38 645.78 0 645.78 6.4
CDHP Self & Family TU2 1467.42 1482.07 0 1482.07 14.65 1438.65 1453.01 0 1453.01 14.36
CDHP Self Plus One TU3 1402.18 1416.21 0 1416.21 14.03 1374.69 1388.44 0 1388.44 13.75
Texas Humana CoverageFirst and Humana Value Plan
CDHP Self TP1 603.31 736.04 0 736.04 132.73 591.48 721.61 0 721.61 130.13
CDHP Self & Family TP2 1357.45 1656.08 0 1656.08 298.63 1330.83 1623.61 0 1623.61 292.78
CDHP Self Plus One TP3 1297.13 1582.52 0 1582.52 285.39 1271.7 1551.49 0 1551.49 279.79
Value Self TP4 406.91 431.33 0 431.33 24.42 398.93 422.87 0 422.87 23.94
Value Self & Family TP5 915.54 970.48 0 970.48 54.94 897.59 951.45 0 951.45 53.86
Value Self Plus One TP6 874.87 927.36 0 927.36 52.49 857.72 909.18 0 909.18 51.46
Texas Humana Health Plan of Texas
Standard Self UC4 815.87 856.67 0 856.67 40.8 799.87 839.87 0 839.87 40
Standard Self & Family UC5 1835.69 1927.45 0 1927.45 91.76 1799.7 1889.66 0 1889.66 89.96
Standard Self Plus One UC6 1754.1 1841.79 0 1841.79 87.69 1719.71 1805.68 0 1805.68 85.97
High Self UC1 997.49 1117.18 0 1117.18 119.69 977.93 1095.27 0 1095.27 117.34
High Self & Family UC2 2244.37 2513.7 0 2513.7 269.33 2200.36 2464.41 0 2464.41 264.05
High Self Plus One UC3 2144.61 2401.96 0 2401.96 257.35 2102.56 2354.86 0 2354.86 252.3
Texas Humana Health Plan of Texas
Basic Self QX1 631.59 764.25 0 764.25 132.66 619.21 749.26 0 749.26 130.05
Basic Self & Family QX2 1421.07 1719.56 0 1719.56 298.49 1393.21 1685.84 0 1685.84 292.63
Basic Self Plus One QX3 1357.92 1643.14 0 1643.14 285.22 1331.29 1610.92 0 1610.92 279.63
Texas Humana Health Plan of Texas
Standard Self EW4 789.48 852.64 0 852.64 63.16 774 835.92 0 835.92 61.92
Standard Self & Family EW5 1776.31 1918.44 0 1918.44 142.13 1741.48 1880.82 0 1880.82 139.34
Standard Self Plus One EW6 1697.37 1833.15 0 1833.15 135.78 1664.09 1797.21 0 1797.21 133.12
High Self EW1 1049.64 1154.59 0 1154.59 104.95 1029.06 1131.95 0 1131.95 102.89
High Self & Family EW2 2361.72 2597.88 0 2597.88 236.16 2315.41 2546.94 0 2546.94 231.53
High Self Plus One EW3 2256.76 2482.43 0 2482.43 225.67 2212.51 2433.75 0 2433.75 221.24
Texas Humana Health Plan of Texas
Basic Self QY1 625.94 776.18 0 776.18 150.24 613.67 760.96 0 760.96 147.29
Basic Self & Family QY2 1408.37 1746.36 0 1746.36 337.99 1380.75 1712.12 0 1712.12 331.37
Basic Self Plus One QY3 1345.78 1668.77 0 1668.77 322.99 1319.39 1636.05 0 1636.05 316.66
Texas Humana Health Plan of Texas
Basic Self Q21 609.45 749.63 0 749.63 140.18 597.5 734.93 0 734.93 137.43
Basic Self & Family Q22 1371.24 1686.63 0 1686.63 315.39 1344.35 1653.56 0 1653.56 309.21
Basic Self Plus One Q23 1310.26 1611.64 0 1611.64 301.38 1284.57 1580.04 0 1580.04 295.47
Texas Humana Health Plan of Texas
Basic Self Q61 600.7 636.75 0 636.75 36.05 588.92 624.26 0 624.26 35.34
Basic Self & Family Q62 1351.61 1432.7 0 1432.7 81.09 1325.11 1404.61 0 1404.61 79.5
Basic Self Plus One Q63 1291.52 1369.03 0 1369.03 77.51 1266.2 1342.19 0 1342.19 75.99
Texas Humana Health Plan of Texas
Standard Self UU4 1323.42 1693.99 0 1693.99 370.57 1297.47 1660.77 0 1660.77 363.3
Standard Self & Family UU5 2977.71 3811.45 0 3811.45 833.74 2919.32 3736.72 0 3736.72 817.4
Standard Self Plus One UU6 2845.35 3642.03 0 3642.03 796.68 2789.56 3570.62 0 3570.62 781.06
High Self UU1 1500.63 1575.65 0 1575.65 75.02 1471.21 1544.75 0 1544.75 73.54
High Self & Family UU2 3376.35 3545.17 0 3545.17 168.82 3310.15 3475.66 0 3475.66 165.51
High Self Plus One UU3 3226.31 3387.62 0 3387.62 161.31 3163.05 3321.2 0 3321.2 158.15
Texas Humana Health Plan of Texas
Standard Self UR4 908.71 999.61 0 999.61 90.9 890.89 980.01 0 980.01 89.12
Standard Self & Family UR5 2044.63 2249.1 0 2249.1 204.47 2004.54 2205 0 2205 200.46
Standard Self Plus One UR6 1953.75 2149.14 0 2149.14 195.39 1915.44 2107 0 2107 191.56
High Self UR1 1317.67 1409.94 0 1409.94 92.27 1291.83 1382.29 0 1382.29 90.46
High Self & Family UR2 2964.78 3172.32 0 3172.32 207.54 2906.65 3110.12 0 3110.12 203.47
High Self Plus One UR3 2833 3031.35 0 3031.35 198.35 2777.45 2971.91 0 2971.91 194.46
Texas Scott and White Health Plan
Basic Self A81 618.01 671.26 0 671.26 53.25 605.89 658.1 0 658.1 52.21
Basic Self & Family A82 1449.96 1575.09 0 1575.09 125.13 1421.53 1544.21 0 1544.21 122.68
Basic Self Plus One A83 1369.87 1488.06 0 1488.06 118.19 1343.01 1458.88 0 1458.88 115.87
Standard Self A84 753.45 801.13 0 801.13 47.68 738.68 785.42 0 785.42 46.74
Standard Self & Family A85 1768.31 1880.36 0 1880.36 112.05 1733.64 1843.49 0 1843.49 109.85
Standard Self Plus One A86 1670.59 1776.42 0 1776.42 105.83 1637.83 1741.59 0 1741.59 103.76
Texas Scott and White Health Plan
Basic Self P81 693.54 691.93 0 691.93 -1.61 679.94 678.36 0 678.36 -1.58
Basic Self & Family P82 1627.51 1623.73 0 1623.73 -3.78 1595.6 1591.89 0 1591.89 -3.71
Basic Self Plus One P83 1537.57 1534.01 0 1534.01 -3.56 1507.42 1503.93 0 1503.93 -3.49
Standard Self P84 843.41 841.44 0 841.44 -1.97 826.87 824.94 0 824.94 -1.93
Standard Self & Family P85 1979.66 1975.04 0 1975.04 -4.62 1940.84 1936.31 0 1936.31 -4.53
Standard Self Plus One P86 1870.26 1865.89 0 1865.89 -4.37 1833.59 1829.3 0 1829.3 -4.29
Texas UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced
Value Self L91 445.8 531.93 0 531.93 86.13 437.06 521.5 0 521.5 84.44
Value Self & Family L92 1250 1491.51 0 1491.51 241.51 1225.49 1462.26 0 1462.26 236.77
Value Self Plus One L93 870.63 1038.83 0 1038.83 168.2 853.56 1018.46 0 1018.46 164.9
Texas UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage
High Self AS1 New Plan 536.33 0 536.33 New Plan New Plan 525.81 0 525.81 New Plan
High Self & Family AS2 New Plan 1268.23 0 1268.23 New Plan New Plan 1243.36 0 1243.36 New Plan
High Self Plus One AS3 New Plan 1153.03 0 1153.03 New Plan New Plan 1130.42 0 1130.42 New Plan
Texas UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage
High Self Y81 New Plan 516.87 0 516.87 New Plan New Plan 506.74 0 506.74 New Plan
High Self & Family Y82 New Plan 1222.19 0 1222.19 New Plan New Plan 1198.23 0 1198.23 New Plan
High Self Plus One Y83 New Plan 1111.17 0 1111.17 New Plan New Plan 1089.38 0 1089.38 New Plan
Utah Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Utah Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Utah Aetna HealthFund CDHP and Aetna Value Plan
Value Self G54 683.99 726.98 0 726.98 42.99 670.58 712.73 0 712.73 42.15
Value Self & Family G55 1566.58 1665.02 0 1665.02 98.44 1535.86 1632.37 0 1632.37 96.51
Value Self Plus One G56 1535.89 1632.38 0 1632.38 96.49 1505.77 1600.37 0 1600.37 94.6
CDHP Self G51 800.84 922.59 0 922.59 121.75 785.14 904.5 0 904.5 119.36
CDHP Self & Family G52 1826.7 2104.36 0 2104.36 277.66 1790.88 2063.1 0 2063.1 272.22
CDHP Self Plus One G53 1808.64 2083.56 0 2083.56 274.92 1773.18 2042.71 0 2042.71 269.53
Utah Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Utah Altius Health Plan
High Self 9K1 953.94 1029.24 0 1029.24 75.3 935.24 1009.06 0 1009.06 73.82
High Self & Family 9K2 2109.63 2276.15 0 2276.15 166.52 2068.26 2231.52 0 2231.52 163.26
High Self Plus One 9K3 2088.74 2253.61 0 2253.61 164.87 2047.78 2209.42 0 2209.42 161.64
HDHP Self 9K4 517.05 539.81 0 539.81 22.76 506.91 529.23 0 529.23 22.32
HDHP Self & Family 9K5 1080.6 1128.16 0 1128.16 47.56 1059.41 1106.04 0 1106.04 46.63
HDHP Self Plus One 9K6 1059.41 1106.06 0 1106.06 46.65 1038.64 1084.37 0 1084.37 45.73
Utah Altius Health Plan
Standard Self DK4 726.69 776.53 0 776.53 49.84 712.44 761.3 0 761.3 48.86
Standard Self & Family DK5 1604.77 1714.85 0 1714.85 110.08 1573.3 1681.23 0 1681.23 107.93
Standard Self Plus One DK6 1588.85 1697.85 0 1697.85 109 1557.7 1664.56 0 1664.56 106.86
Utah SelectHealth Plan
Standard Self SF4 631.59 617.1 0 617.1 -14.49 619.21 605 0 605 -14.21
Standard Self & Family SF5 1439.49 1406.45 0 1406.45 -33.04 1411.26 1378.87 0 1378.87 -32.39
Standard Self Plus One SF6 1439.49 1406.45 0 1406.45 -33.04 1411.26 1378.87 0 1378.87 -32.39
Utah SelectHealth Plan
HDHP Self WX1 517.05 537.73 0 537.73 20.68 506.91 527.19 0 527.19 20.28
HDHP Self & Family WX2 1178.42 1225.56 0 1225.56 47.14 1155.31 1201.53 0 1201.53 46.22
HDHP Self Plus One WX3 1178.42 1225.56 0 1225.56 47.14 1155.31 1201.53 0 1201.53 46.22
Vermont Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Vermont Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Vermont Aetna HealthFund CDHP and Aetna Value Plan
Value Self EP4 631.46 774.8 0 774.8 143.34 619.08 759.61 0 759.61 140.53
Value Self & Family EP5 1446 1774.3 0 1774.3 328.3 1417.65 1739.51 0 1739.51 321.86
Value Self Plus One EP6 1417.65 1739.49 0 1739.49 321.84 1389.85 1705.38 0 1705.38 315.53
CDHP Self EP1 935.14 1097.27 0 1097.27 162.13 916.8 1075.75 0 1075.75 158.95
CDHP Self & Family EP2 2132.65 2502.39 0 2502.39 369.74 2090.83 2453.32 0 2453.32 362.49
CDHP Self Plus One EP3 2111.52 2477.61 0 2477.61 366.09 2070.12 2429.03 0 2429.03 358.91
Vermont Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Virgin Islands Triple-S Salud Inc. U.S. Virgin Islands
High Self 851 672.44 692.61 0 692.61 20.17 659.25 679.03 0 679.03 19.78
High Self & Family 852 1539.9 1586.12 0 1586.12 46.22 1509.71 1555.02 0 1555.02 45.31
High Self Plus One 853 1509.88 1555.17 0 1555.17 45.29 1480.27 1524.68 0 1524.68 44.41
Virginia Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Virginia Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Virginia Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self F51 827.01 845.81 0 845.81 18.8 810.79 829.23 0 829.23 18.44
CDHP Self & Family F52 1885.68 1928.53 0 1928.53 42.85 1848.71 1890.72 0 1890.72 42.01
CDHP Self Plus One F53 1867.01 1909.44 0 1909.44 42.43 1830.4 1872 0 1872 41.6
Value Self F54 722.61 836.38 0 836.38 113.77 708.44 819.98 0 819.98 111.54
Value Self & Family F55 1654.7 1915.16 0 1915.16 260.46 1622.25 1877.61 0 1877.61 255.36
Value Self Plus One F56 1622.23 1877.6 0 1877.6 255.37 1590.42 1840.78 0 1840.78 250.36
Virginia Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Virginia Aetna Open Access
High Self JN1 1141.51 1160.32 0 1160.32 18.81 1119.13 1137.57 0 1137.57 18.44
High Self & Family JN2 2566.3 2608.58 0 2608.58 42.28 2515.98 2557.43 0 2557.43 41.45
High Self Plus One JN3 2540.86 2582.74 0 2582.74 41.88 2491.04 2532.1 0 2532.1 41.06
Basic Self JN4 694.07 711.04 0 711.04 16.97 680.46 697.1 0 697.1 16.64
Basic Self & Family JN5 1588.4 1627.25 0 1627.25 38.85 1557.25 1595.34 0 1595.34 38.09
Basic Self Plus One JN6 1458.6 1494.29 0 1494.29 35.69 1430 1464.99 0 1464.99 34.99
Virginia Aetna Saver
Saver Self QQ4 New Plan 607.11 0 607.11 New Plan New Plan 595.21 0 595.21 New Plan
Saver Self & Family QQ5 New Plan 1389.38 0 1389.38 New Plan New Plan 1362.14 0 1362.14 New Plan
Saver Self Plus One QQ6 New Plan 1275.84 0 1275.84 New Plan New Plan 1250.82 0 1250.82 New Plan
Virginia CareFirst BlueChoice
Standard Self 2G4 813.63 862.45 0 862.45 48.82 797.68 845.54 0 845.54 47.86
Standard Self & Family 2G5 1933.16 2049.14 0 2049.14 115.98 1895.25 2008.96 0 2008.96 113.71
Standard Self Plus One 2G6 1627.25 1724.88 0 1724.88 97.63 1595.34 1691.06 0 1691.06 95.72
Virginia CareFirst BlueChoice
HDHP Self B61 528.64 581.49 0 581.49 52.85 518.27 570.09 0 570.09 51.82
HDHP Self & Family B62 1256.01 1381.6 0 1381.6 125.59 1231.38 1354.51 0 1354.51 123.13
HDHP Self Plus One B63 1057.24 1162.97 0 1162.97 105.73 1036.51 1140.17 0 1140.17 103.66
Blue Value Plus Self B64 New Plan 720.11 0 720.11 New Plan New Plan 705.99 0 705.99 New Plan
Blue Value Plus Self & Family B65 New Plan 1711.01 0 1711.01 New Plan New Plan 1677.46 0 1677.46 New Plan
Blue Value Plus Self Plus One B66 New Plan 1440.26 0 1440.26 New Plan New Plan 1412.02 0 1412.02 New Plan
Virginia Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.
Basic Self T71 428.52 428.52 0 428.52 0 420.12 420.12 0 420.12 0
Basic Self & Family T72 1046.68 1046.68 0 1046.68 0 1026.16 1026.16 0 1026.16 0
Basic Self Plus One T73 953.6 953.6 0 953.6 0 934.9 934.9 0 934.9 0
Virginia Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.
Standard Self E34 532.2 582.98 0 582.98 50.78 521.76 571.55 0 571.55 49.79
Standard Self & Family E35 1223.99 1340.79 0 1340.79 116.8 1199.99 1314.5 0 1314.5 114.51
Standard Self Plus One E36 1223.99 1340.79 0 1340.79 116.8 1199.99 1314.5 0 1314.5 114.51
High Self E31 706.53 737.28 0 737.28 30.75 692.68 722.82 0 722.82 30.14
High Self & Family E32 1625.01 1695.78 0 1695.78 70.77 1593.15 1662.53 0 1662.53 69.38
High Self Plus One E33 1625.01 1695.78 0 1695.78 70.77 1593.15 1662.53 0 1662.53 69.38
Virginia M.D. IPA
High Self JP1 806.68 894.14 0 894.14 87.46 790.86 876.61 0 876.61 85.75
High Self & Family JP2 2261.89 2507.2 0 2507.2 245.31 2217.54 2458.04 0 2458.04 240.5
High Self Plus One JP3 1575.42 1746.28 0 1746.28 170.86 1544.53 1712.04 0 1712.04 167.51
Virginia Optima Health
HDHP Self PG4 617.29 657.3 0 657.3 40.01 605.19 644.41 0 644.41 39.22
HDHP Self & Family PG5 1361.69 1449.92 0 1449.92 88.23 1334.99 1421.49 0 1421.49 86.5
HDHP Self Plus One PG6 1334.98 1421.49 0 1421.49 86.51 1308.8 1393.62 0 1393.62 84.82
High Self PG1 692.04 705.94 0 705.94 13.9 678.47 692.1 0 692.1 13.63
High Self & Family PG2 1672.26 1705.81 0 1705.81 33.55 1639.47 1672.36 0 1672.36 32.89
High Self Plus One PG3 1672.16 1705.67 0 1705.67 33.51 1639.37 1672.23 0 1672.23 32.86
Virginia UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self V41 505.6 496.3 0 496.3 -9.3 495.69 486.57 0 486.57 -9.12
HDHP Self & Family V42 1162.86 1141.49 0 1141.49 -21.37 1140.06 1119.11 0 1119.11 -20.95
HDHP Self Plus One V43 1087.03 1067.05 0 1067.05 -19.98 1065.72 1046.13 0 1046.13 -19.59
Virginia UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self LR1 681.3 729.19 0 729.19 47.89 667.94 714.89 0 714.89 46.95
High Self & Family LR2 1614.65 1728.18 0 1728.18 113.53 1582.99 1694.29 0 1694.29 111.3
High Self Plus One LR3 1464.77 1567.73 0 1567.73 102.96 1436.05 1536.99 0 1536.99 100.94
Virginia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced
Value Self L91 445.8 531.93 0 531.93 86.13 437.06 521.5 0 521.5 84.44
Value Self & Family L92 1250 1491.51 0 1491.51 241.51 1225.49 1462.26 0 1462.26 236.77
Value Self Plus One L93 870.63 1038.83 0 1038.83 168.2 853.56 1018.46 0 1018.46 164.9
Virginia UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage
High Self AS1 New Plan 536.33 0 536.33 New Plan New Plan 525.81 0 525.81 New Plan
High Self & Family AS2 New Plan 1268.23 0 1268.23 New Plan New Plan 1243.36 0 1243.36 New Plan
High Self Plus One AS3 New Plan 1153.03 0 1153.03 New Plan New Plan 1130.42 0 1130.42 New Plan
Virginia UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage
High Self Y81 New Plan 516.87 0 516.87 New Plan New Plan 506.74 0 506.74 New Plan
High Self & Family Y82 New Plan 1222.19 0 1222.19 New Plan New Plan 1198.23 0 1198.23 New Plan
High Self Plus One Y83 New Plan 1111.17 0 1111.17 New Plan New Plan 1089.38 0 1089.38 New Plan
Washington Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Washington Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Washington Aetna HealthFund CDHP and Aetna Value Plan
Value Self G54 683.99 726.98 0 726.98 42.99 670.58 712.73 0 712.73 42.15
Value Self & Family G55 1566.58 1665.02 0 1665.02 98.44 1535.86 1632.37 0 1632.37 96.51
Value Self Plus One G56 1535.89 1632.38 0 1632.38 96.49 1505.77 1600.37 0 1600.37 94.6
CDHP Self G51 800.84 922.59 0 922.59 121.75 785.14 904.5 0 904.5 119.36
CDHP Self & Family G52 1826.7 2104.36 0 2104.36 277.66 1790.88 2063.1 0 2063.1 272.22
CDHP Self Plus One G53 1808.64 2083.56 0 2083.56 274.92 1773.18 2042.71 0 2042.71 269.53
Washington Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Washington Kaiser Foundation Health Plan of the Northwest
Standard Self 574 632.71 660.92 0 660.92 28.21 620.3 647.96 0 647.96 27.66
Standard Self & Family 575 1453.5 1518.31 0 1518.31 64.81 1425 1488.54 0 1488.54 63.54
Standard Self Plus One 576 1453.5 1518.31 0 1518.31 64.81 1425 1488.54 0 1488.54 63.54
High Self 571 720.81 744.53 0 744.53 23.72 706.68 729.93 0 729.93 23.25
High Self & Family 572 1628.08 1681.67 0 1681.67 53.59 1596.16 1648.7 0 1648.7 52.54
High Self Plus One 573 1628.08 1681.67 0 1681.67 53.59 1596.16 1648.7 0 1648.7 52.54
Washington Kaiser Foundation Health Plan of Washington
Standard Self 544 596.87 616.21 0 616.21 19.34 585.17 604.13 0 604.13 18.96
Standard Self & Family 545 1372.83 1417.32 0 1417.32 44.49 1345.91 1389.53 0 1389.53 43.62
Standard Self Plus One 546 1372.83 1417.32 0 1417.32 44.49 1345.91 1389.53 0 1389.53 43.62
High Self 541 831.71 862.65 0 862.65 30.94 815.4 845.74 0 845.74 30.34
High Self & Family 542 1829.79 1897.86 0 1897.86 68.07 1793.91 1860.65 0 1860.65 66.74
High Self Plus One 543 1829.79 1897.86 0 1897.86 68.07 1793.91 1860.65 0 1860.65 66.74
Washington Kaiser Permanente Washington Options Federal
Standard Self L11 711.78 742.45 0 742.45 30.67 697.82 727.89 0 727.89 30.07
Standard Self & Family L12 1580.1 1648.22 0 1648.22 68.12 1549.12 1615.9 0 1615.9 66.78
Standard Self Plus One L13 1580.1 1648.22 0 1648.22 68.12 1549.12 1615.9 0 1615.9 66.78
HDHP Self L14 598.91 658.49 0 658.49 59.58 587.17 645.58 0 645.58 58.41
HDHP Self & Family L15 1329.56 1461.8 0 1461.8 132.24 1303.49 1433.14 0 1433.14 129.65
HDHP Self Plus One L16 1329.56 1461.8 0 1461.8 132.24 1303.49 1433.14 0 1433.14 129.65
Washington UnitedHealthcare Insurance Company, Inc. Choice HDHP
HDHP Self LU1 459.33 452.72 0 452.72 -6.61 450.32 443.84 0 443.84 -6.48
HDHP Self & Family LU2 1056.44 1041.27 0 1041.27 -15.17 1035.73 1020.85 0 1020.85 -14.88
HDHP Self Plus One LU3 987.56 973.36 0 973.36 -14.2 968.2 954.27 0 954.27 -13.93
Washington UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO
High Self KT1 692.77 739.27 0 739.27 46.5 679.19 724.77 0 724.77 45.58
High Self & Family KT2 1731.91 1848.14 0 1848.14 116.23 1697.95 1811.9 0 1811.9 113.95
High Self Plus One KT3 1489.43 1589.42 0 1589.42 99.99 1460.23 1558.25 0 1558.25 98.02
Washington UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage
High Self WF1 New Plan 533.32 0 533.32 New Plan New Plan 522.86 0 522.86 New Plan
High Self & Family WF2 New Plan 1261.12 0 1261.12 New Plan New Plan 1236.39 0 1236.39 New Plan
High Self Plus One WF3 New Plan 1146.53 0 1146.53 New Plan New Plan 1124.05 0 1124.05 New Plan
Washington UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage
High Self VD1 New Plan 532.46 0 532.46 New Plan New Plan 522.02 0 522.02 New Plan
High Self & Family VD2 New Plan 1259.06 0 1259.06 New Plan New Plan 1234.37 0 1234.37 New Plan
High Self Plus One VD3 New Plan 1144.67 0 1144.67 New Plan New Plan 1122.23 0 1122.23 New Plan
West Virginia Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
West Virginia Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
West Virginia Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self F51 827.01 845.81 0 845.81 18.8 810.79 829.23 0 829.23 18.44
CDHP Self & Family F52 1885.68 1928.53 0 1928.53 42.85 1848.71 1890.72 0 1890.72 42.01
CDHP Self Plus One F53 1867.01 1909.44 0 1909.44 42.43 1830.4 1872 0 1872 41.6
Value Self F54 722.61 836.38 0 836.38 113.77 708.44 819.98 0 819.98 111.54
Value Self & Family F55 1654.7 1915.16 0 1915.16 260.46 1622.25 1877.61 0 1877.61 255.36
Value Self Plus One F56 1622.23 1877.6 0 1877.6 255.37 1590.42 1840.78 0 1840.78 250.36
West Virginia Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Wisconsin Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Wisconsin Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Wisconsin Aetna HealthFund CDHP and Aetna Value Plan
Value Self JS4 820.07 1094.95 0 1094.95 274.88 803.99 1073.48 0 1073.48 269.49
Value Self & Family JS5 1872.12 2499.6 0 2499.6 627.48 1835.41 2450.59 0 2450.59 615.18
Value Self Plus One JS6 1853.6 2474.85 0 2474.85 621.25 1817.25 2426.32 0 2426.32 609.07
CDHP Self JS1 1070.02 1024.07 0 1024.07 -45.95 1049.04 1003.99 0 1003.99 -45.05
CDHP Self & Family JS2 2439.18 2334.42 0 2334.42 -104.76 2391.35 2288.65 0 2288.65 -102.7
CDHP Self Plus One JS3 2415.04 2311.31 0 2311.31 -103.73 2367.69 2265.99 0 2265.99 -101.7
Wisconsin Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Wisconsin Dean Health Plan, Inc.
High Self WD1 1119.08 1170.02 0 1170.02 50.94 1097.14 1147.08 0 1147.08 49.94
High Self & Family WD2 2573.86 2691.03 0 2691.03 117.17 2523.39 2638.26 0 2638.26 114.87
High Self Plus One WD3 2350.05 2457.04 0 2457.04 106.99 2303.97 2408.86 0 2408.86 104.89
Standard Self WD4 658.58 695.2 0 695.2 36.62 645.67 681.57 0 681.57 35.9
Standard Self & Family WD5 1580.61 1668.49 0 1668.49 87.88 1549.62 1635.77 0 1635.77 86.15
Standard Self Plus One WD6 1448.92 1529.45 0 1529.45 80.53 1420.51 1499.46 0 1499.46 78.95
Wisconsin Group Health Cooperative of South Central Wisconsin
High Self WJ1 745.65 875.12 0 875.12 129.47 731.03 857.96 0 857.96 126.93
High Self & Family WJ2 1938.7 2275.38 0 2275.38 336.68 1900.69 2230.76 0 2230.76 330.07
High Self Plus One WJ3 1640.44 1925.31 0 1925.31 284.87 1608.27 1887.56 0 1887.56 279.29
Wisconsin HealthPartners
Standard Self V34 436.65 469.12 0 469.12 32.47 428.09 459.92 0 459.92 31.83
Standard Self & Family V35 1063.68 1142.82 0 1142.82 79.14 1042.82 1120.41 0 1120.41 77.59
Standard Self Plus One V36 965 1036.78 0 1036.78 71.78 946.08 1016.45 0 1016.45 70.37
High Self V31 806.12 726.56 0 726.56 -79.56 790.31 712.31 0 712.31 -78
High Self & Family V32 1963.71 1769.9 0 1769.9 -193.81 1925.21 1735.2 0 1735.2 -190.01
High Self Plus One V33 1781.5 1605.69 0 1605.69 -175.81 1746.57 1574.21 0 1574.21 -172.36
Wisconsin MercyCare Health Plans
High Self EY1 779.33 801.64 0 801.64 22.31 764.05 785.92 0 785.92 21.87
High Self & Family EY2 2033.89 2092.01 0 2092.01 58.12 1994.01 2050.99 0 2050.99 56.98
High Self Plus One EY3 1675.67 1723.58 0 1723.58 47.91 1642.81 1689.78 0 1689.78 46.97
Standard Self EY4 New Plan 621.78 0 621.78 New Plan New Plan 609.59 0 609.59 New Plan
Standard Self & Family EY5 New Plan 1622.67 0 1622.67 New Plan New Plan 1590.85 0 1590.85 New Plan
Standard Self Plus One EY6 New Plan 1336.89 0 1336.89 New Plan New Plan 1310.68 0 1310.68 New Plan
Wisconsin Quartz Health Benefit Plans Corporation
High Self TF1 New Plan 1030.57 0 1030.57 New Plan New Plan 1010.36 0 1010.36 New Plan
High Self & Family TF2 New Plan 2473.39 0 2473.39 New Plan New Plan 2424.89 0 2424.89 New Plan
High Self Plus One TF3 New Plan 2318.82 0 2318.82 New Plan New Plan 2273.35 0 2273.35 New Plan
Standard Self TF4 New Plan 626.56 0 626.56 New Plan New Plan 614.27 0 614.27 New Plan
Standard Self & Family TF5 New Plan 1503.78 0 1503.78 New Plan New Plan 1474.29 0 1474.29 New Plan
Standard Self Plus One TF6 New Plan 1378.47 0 1378.47 New Plan New Plan 1351.44 0 1351.44 New Plan
Wyoming Aetna Advantage
Advantage Self Z24 New Plan 473.12 0 473.12 New Plan New Plan 463.84 0 463.84 New Plan
Advantage Self & Family Z25 New Plan 1253.75 0 1253.75 New Plan New Plan 1229.17 0 1229.17 New Plan
Advantage Self Plus One Z26 New Plan 1040.85 0 1040.85 New Plan New Plan 1020.44 0 1020.44 New Plan
Wyoming Aetna Direct
CDHP Self N61 568.48 624.9 0 624.9 56.42 557.33 612.65 0 612.65 55.32
CDHP Self & Family N62 1433.65 1575.91 0 1575.91 142.26 1405.54 1545.01 0 1545.01 139.47
CDHP Self Plus One N63 1246.71 1370.42 0 1370.42 123.71 1222.26 1343.55 0 1343.55 121.29
Wyoming Aetna HealthFund CDHP and Aetna Value Plan
CDHP Self H41 845.44 845.04 0 845.04 -0.4 828.86 828.47 0 828.47 -0.39
CDHP Self & Family H42 1927.17 1926.22 0 1926.22 -0.95 1889.38 1888.45 0 1888.45 -0.93
CDHP Self Plus One H43 1908.09 1907.32 0 1907.32 -0.77 1870.68 1869.92 0 1869.92 -0.76
Value Self H44 628.86 823.18 0 823.18 194.32 616.53 807.04 0 807.04 190.51
Value Self & Family H45 1443.29 1889.22 0 1889.22 445.93 1414.99 1852.18 0 1852.18 437.19
Value Self Plus One H46 1415 1852.18 0 1852.18 437.18 1387.25 1815.86 0 1815.86 428.61
Wyoming Aetna HealthFund HDHP
HDHP Self 224 672.9 743.38 0 743.38 70.48 659.71 728.8 0 728.8 69.09
HDHP Self & Family 225 1484.3 1639.75 0 1639.75 155.45 1455.2 1607.6 0 1607.6 152.4
HDHP Self Plus One 226 1455.22 1607.62 0 1607.62 152.4 1426.69 1576.1 0 1576.1 149.41
Wyoming Altius Health Plan
High Self 9K1 953.94 1029.24 0 1029.24 75.3 935.24 1009.06 0 1009.06 73.82
High Self & Family 9K2 2109.63 2276.15 0 2276.15 166.52 2068.26 2231.52 0 2231.52 163.26
High Self Plus One 9K3 2088.74 2253.61 0 2253.61 164.87 2047.78 2209.42 0 2209.42 161.64
HDHP Self 9K4 517.05 539.81 0 539.81 22.76 506.91 529.23 0 529.23 22.32
HDHP Self & Family 9K5 1080.6 1128.16 0 1128.16 47.56 1059.41 1106.04 0 1106.04 46.63
HDHP Self Plus One 9K6 1059.41 1106.06 0 1106.06 46.65 1038.64 1084.37 0 1084.37 45.73
Wyoming Altius Health Plan
Standard Self DK4 726.69 776.53 0 776.53 49.84 712.44 761.3 0 761.3 48.86
Standard Self & Family DK5 1604.77 1714.85 0 1714.85 110.08 1573.3 1681.23 0 1681.23 107.93
Standard Self Plus One DK6 1588.85 1697.85 0 1697.85 109 1557.7 1664.56 0 1664.56 106.86
Control Panel