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Tribal Premium Rates for the Federal Employees Health Benefits Program
HMO (Regional Plans with Specific Service Areas)
Alabama Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Alabama Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Alabama Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Alabama Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Alabama Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Alabama Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
810.79 |
829.23 |
510.84 |
318.39 |
6.32 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
1848.71 |
1890.72 |
1184.02 |
706.70 |
-3.82 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
1830.40 |
1872.00 |
1092.26 |
779.74 |
15.93 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
708.44 |
819.98 |
510.84 |
309.14 |
99.42 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
1622.25 |
1877.61 |
1184.02 |
693.59 |
209.53 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
1590.42 |
1840.78 |
1092.26 |
748.52 |
224.69 |
Alabama Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Alabama Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Alabama Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LS1 |
418.71 |
454.74 |
341.06 |
113.68 |
9.00 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LS2 |
963.08 |
1045.92 |
784.44 |
261.48 |
20.71 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LS3 |
900.25 |
977.71 |
733.28 |
244.43 |
19.37 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KK1 |
679.03 |
713.87 |
510.84 |
203.03 |
22.72 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KK2 |
1697.63 |
1784.71 |
1184.02 |
600.69 |
41.25 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KK3 |
1459.94 |
1534.87 |
1092.26 |
442.61 |
49.26 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self |
AS1 |
New Plan |
525.81 |
394.36 |
131.45 |
New Plan |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self & Family |
AS2 |
New Plan |
1243.36 |
932.52 |
310.84 |
New Plan |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self Plus One |
AS3 |
New Plan |
1130.42 |
847.82 |
282.60 |
New Plan |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self |
Y81 |
New Plan |
506.74 |
380.06 |
126.68 |
New Plan |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self & Family |
Y82 |
New Plan |
1198.23 |
898.67 |
299.56 |
New Plan |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self Plus One |
Y83 |
New Plan |
1089.38 |
817.04 |
272.34 |
New Plan |
Alaska Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Alaska Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Alaska Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Alaska Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Alaska Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Alaska Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
JS4 |
803.99 |
1073.48 |
510.84 |
562.64 |
257.37 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
JS5 |
1835.41 |
2450.59 |
1184.02 |
1266.57 |
569.35 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
JS6 |
1817.25 |
2426.32 |
1092.26 |
1334.06 |
583.40 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
JS1 |
1049.04 |
1003.99 |
510.84 |
493.15 |
-57.17 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
JS2 |
2391.35 |
2288.65 |
1184.02 |
1104.63 |
-148.53 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
JS3 |
2367.69 |
2265.99 |
1092.26 |
1173.73 |
-127.37 |
Alaska Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Alaska Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Alaska Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Arizona Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Arizona Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Arizona Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Arizona Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Arizona Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Arizona Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
670.58 |
712.73 |
510.84 |
201.89 |
30.03 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
1535.86 |
1632.37 |
1184.02 |
448.35 |
50.68 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
1505.77 |
1600.37 |
1092.26 |
508.11 |
68.93 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
785.14 |
904.50 |
510.84 |
393.66 |
107.24 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
1790.88 |
2063.10 |
1184.02 |
879.08 |
226.39 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
1773.18 |
2042.71 |
1092.26 |
950.45 |
243.86 |
Arizona Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Arizona Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Arizona Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Arizona Aetna Open Access - High Self |
WQ1 |
1125.02 |
1161.16 |
510.84 |
650.32 |
24.02 |
Arizona Aetna Open Access - High Self & Family |
WQ2 |
2731.52 |
2819.27 |
1184.02 |
1635.25 |
41.92 |
Arizona Aetna Open Access - High Self Plus One |
WQ3 |
2704.46 |
2791.34 |
1092.26 |
1699.08 |
61.21 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self |
R61 |
678.10 |
718.79 |
510.84 |
207.95 |
28.57 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
R62 |
1525.70 |
1617.27 |
1184.02 |
433.25 |
45.74 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
R63 |
1457.91 |
1545.38 |
1092.26 |
453.12 |
61.80 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self |
R64 |
542.01 |
574.54 |
430.91 |
143.63 |
8.13 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self & Family |
R65 |
1219.51 |
1292.68 |
969.51 |
323.17 |
18.29 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
R66 |
1165.32 |
1235.24 |
926.43 |
308.81 |
17.48 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self |
R94 |
494.15 |
523.81 |
392.86 |
130.95 |
7.41 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self & Family |
R95 |
1111.85 |
1178.56 |
883.92 |
294.64 |
16.68 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
R96 |
1062.45 |
1126.19 |
844.64 |
281.55 |
15.94 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self |
R91 |
620.64 |
657.89 |
493.42 |
164.47 |
9.31 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
R92 |
1396.42 |
1480.20 |
1110.15 |
370.05 |
20.95 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
R93 |
1334.34 |
1414.40 |
1060.80 |
353.60 |
20.02 |
Arizona Humana Health Plan, Inc. - Standard Self |
C74 |
726.57 |
784.10 |
510.84 |
273.26 |
45.41 |
Arizona Humana Health Plan, Inc. - Standard Self & Family |
C75 |
1634.73 |
1764.19 |
1184.02 |
580.17 |
83.63 |
Arizona Humana Health Plan, Inc. - Standard Self Plus One |
C76 |
1562.06 |
1685.73 |
1092.26 |
593.47 |
98.00 |
Arizona Humana Health Plan, Inc. - High Self |
C71 |
862.59 |
1017.88 |
510.84 |
507.04 |
143.17 |
Arizona Humana Health Plan, Inc. - High Self & Family |
C72 |
1940.84 |
2290.19 |
1184.02 |
1106.17 |
303.52 |
Arizona Humana Health Plan, Inc. - High Self Plus One |
C73 |
1854.58 |
2188.40 |
1092.26 |
1096.14 |
308.15 |
Arizona Humana Health Plan, Inc. - High Self |
BF1 |
1361.43 |
1429.50 |
510.84 |
918.66 |
55.95 |
Arizona Humana Health Plan, Inc. - High Self & Family |
BF2 |
3063.15 |
3216.27 |
1184.02 |
2032.25 |
107.29 |
Arizona Humana Health Plan, Inc. - High Self Plus One |
BF3 |
2926.99 |
3073.35 |
1092.26 |
1981.09 |
120.69 |
Arizona Humana Health Plan, Inc. - Standard Self |
BF4 |
916.07 |
1154.25 |
510.84 |
643.41 |
226.06 |
Arizona Humana Health Plan, Inc. - Standard Self & Family |
BF5 |
2061.17 |
2597.08 |
1184.02 |
1413.06 |
490.08 |
Arizona Humana Health Plan, Inc. - Standard Self Plus One |
BF6 |
1969.57 |
2481.66 |
1092.26 |
1389.40 |
486.42 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LU1 |
450.32 |
443.84 |
332.88 |
110.96 |
-1.62 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LU2 |
1035.73 |
1020.85 |
765.64 |
255.21 |
-3.72 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LU3 |
968.20 |
954.27 |
715.70 |
238.57 |
-3.48 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KT1 |
679.19 |
724.77 |
510.84 |
213.93 |
33.46 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KT2 |
1697.95 |
1811.90 |
1184.02 |
627.88 |
68.12 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KT3 |
1460.23 |
1558.25 |
1092.26 |
465.99 |
72.35 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self |
WF1 |
New Plan |
522.86 |
392.15 |
130.71 |
New Plan |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self & Family |
WF2 |
New Plan |
1236.39 |
927.29 |
309.10 |
New Plan |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self Plus One |
WF3 |
New Plan |
1124.05 |
843.04 |
281.01 |
New Plan |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self |
VD1 |
New Plan |
522.02 |
391.52 |
130.50 |
New Plan |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self & Family |
VD2 |
New Plan |
1234.37 |
925.78 |
308.59 |
New Plan |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self Plus One |
VD3 |
New Plan |
1122.23 |
841.67 |
280.56 |
New Plan |
Arkansas Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Arkansas Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Arkansas Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Arkansas Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Arkansas Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Arkansas Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
810.79 |
829.23 |
510.84 |
318.39 |
6.32 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
1848.71 |
1890.72 |
1184.02 |
706.70 |
-3.82 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
1830.40 |
1872.00 |
1092.26 |
779.74 |
15.93 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
708.44 |
819.98 |
510.84 |
309.14 |
99.42 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
1622.25 |
1877.61 |
1184.02 |
693.59 |
209.53 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
1590.42 |
1840.78 |
1092.26 |
748.52 |
224.69 |
Arkansas Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Arkansas Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Arkansas Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Arkansas QualChoice - High Self |
DH1 |
716.37 |
752.20 |
510.84 |
241.36 |
23.71 |
Arkansas QualChoice - High Self & Family |
DH2 |
1868.49 |
1961.96 |
1184.02 |
777.94 |
47.64 |
Arkansas QualChoice - High Self Plus One |
DH3 |
1391.56 |
1461.18 |
1092.26 |
368.92 |
21.03 |
Arkansas QualChoice - Standard Self |
DH4 |
559.30 |
587.25 |
440.44 |
146.81 |
6.99 |
Arkansas QualChoice - Standard Self & Family |
DH5 |
1458.82 |
1531.75 |
1148.81 |
382.94 |
18.24 |
Arkansas QualChoice - Standard Self Plus One |
DH6 |
1086.45 |
1140.77 |
855.58 |
285.19 |
13.58 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LS1 |
418.71 |
454.74 |
341.06 |
113.68 |
9.00 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LS2 |
963.08 |
1045.92 |
784.44 |
261.48 |
20.71 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LS3 |
900.25 |
977.71 |
733.28 |
244.43 |
19.37 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KK1 |
679.03 |
713.87 |
510.84 |
203.03 |
22.72 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KK2 |
1697.63 |
1784.71 |
1184.02 |
600.69 |
41.25 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KK3 |
1459.94 |
1534.87 |
1092.26 |
442.61 |
49.26 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self |
AS1 |
New Plan |
525.81 |
394.36 |
131.45 |
New Plan |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self & Family |
AS2 |
New Plan |
1243.36 |
932.52 |
310.84 |
New Plan |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self Plus One |
AS3 |
New Plan |
1130.42 |
847.82 |
282.60 |
New Plan |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self |
Y81 |
New Plan |
506.74 |
380.06 |
126.68 |
New Plan |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self & Family |
Y82 |
New Plan |
1198.23 |
898.67 |
299.56 |
New Plan |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self Plus One |
Y83 |
New Plan |
1089.38 |
817.04 |
272.34 |
New Plan |
California Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
California Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
California Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
California Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
California Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
California Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
California Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
JS4 |
803.99 |
1073.48 |
510.84 |
562.64 |
257.37 |
California Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
JS5 |
1835.41 |
2450.59 |
1184.02 |
1266.57 |
569.35 |
California Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
JS6 |
1817.25 |
2426.32 |
1092.26 |
1334.06 |
583.40 |
California Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
JS1 |
1049.04 |
1003.99 |
510.84 |
493.15 |
-57.17 |
California Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
JS2 |
2391.35 |
2288.65 |
1184.02 |
1104.63 |
-148.53 |
California Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
JS3 |
2367.69 |
2265.99 |
1092.26 |
1173.73 |
-127.37 |
California Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
California Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
California Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
California Aetna Open Access - High Self |
2X1 |
763.92 |
880.53 |
510.84 |
369.69 |
104.49 |
California Aetna Open Access - High Self & Family |
2X2 |
1793.44 |
2067.24 |
1184.02 |
883.22 |
227.97 |
California Aetna Open Access - High Self Plus One |
2X3 |
1758.27 |
2026.70 |
1092.26 |
934.44 |
242.76 |
California Anthem Blue Cross Select HMO - High Self |
B31 |
770.29 |
774.13 |
510.84 |
263.29 |
-8.28 |
California Anthem Blue Cross Select HMO - High Self & Family |
B32 |
1733.18 |
1768.91 |
1184.02 |
584.89 |
-10.10 |
California Anthem Blue Cross Select HMO - High Self Plus One |
B33 |
1609.94 |
1641.16 |
1092.26 |
548.90 |
5.55 |
California Blue Shield of California - Access + HMO Self |
SI1 |
779.29 |
833.84 |
510.84 |
323.00 |
42.43 |
California Blue Shield of California - Access + HMO Self & Family |
SI2 |
1792.40 |
1917.85 |
1184.02 |
733.83 |
79.62 |
California Blue Shield of California - Access + HMO Self Plus One |
SI3 |
1714.44 |
1834.45 |
1092.26 |
742.19 |
94.34 |
California Blue Shield of California - TRIO HMO Self |
SI4 |
705.08 |
740.33 |
510.84 |
229.49 |
23.13 |
California Blue Shield of California - TRIO HMO Self & Family |
SI5 |
1621.69 |
1702.76 |
1184.02 |
518.74 |
35.24 |
California Blue Shield of California - TRIO HMO Self Plus One |
SI6 |
1551.18 |
1628.73 |
1092.26 |
536.47 |
51.88 |
California Health Net of California - Basic Self |
P61 |
332.37 |
324.37 |
243.28 |
81.09 |
-2.00 |
California Health Net of California - Basic Self & Family |
P62 |
797.70 |
778.46 |
583.85 |
194.61 |
-4.81 |
California Health Net of California - Basic Self Plus One |
P63 |
731.23 |
713.59 |
535.19 |
178.40 |
-4.41 |
California Health Net of California - Standard Self |
LP4 |
945.64 |
1013.31 |
510.84 |
502.47 |
55.55 |
California Health Net of California - Standard Self & Family |
LP5 |
2269.54 |
2431.95 |
1184.02 |
1247.93 |
116.58 |
California Health Net of California - Standard Self Plus One |
LP6 |
2080.41 |
2229.28 |
1092.26 |
1137.02 |
123.20 |
California Health Net of California - High Self |
LP1 |
993.05 |
1048.36 |
510.84 |
537.52 |
43.19 |
California Health Net of California - High Self & Family |
LP2 |
2383.33 |
2516.06 |
1184.02 |
1332.04 |
86.90 |
California Health Net of California - High Self Plus One |
LP3 |
2184.72 |
2306.40 |
1092.26 |
1214.14 |
96.01 |
California Health Net of California - High Self |
LB1 |
1361.40 |
1510.56 |
510.84 |
999.72 |
137.04 |
California Health Net of California - High Self & Family |
LB2 |
3267.38 |
3625.38 |
1184.02 |
2441.36 |
312.17 |
California Health Net of California - High Self Plus One |
LB3 |
2995.09 |
3323.26 |
1092.26 |
2231.00 |
302.50 |
California Health Net of California - Standard Self |
LB4 |
1289.41 |
1340.54 |
510.84 |
829.70 |
39.01 |
California Health Net of California - Standard Self & Family |
LB5 |
3094.59 |
3217.28 |
1184.02 |
2033.26 |
76.86 |
California Health Net of California - Standard Self Plus One |
LB6 |
2836.71 |
2949.18 |
1092.26 |
1856.92 |
86.80 |
California Health Net of California - Basic Self |
T41 |
790.29 |
881.83 |
510.84 |
370.99 |
79.42 |
California Health Net of California - Basic Self & Family |
T42 |
1896.70 |
2116.40 |
1184.02 |
932.38 |
173.87 |
California Health Net of California - Basic Self Plus One |
T43 |
1738.62 |
1940.06 |
1092.26 |
847.80 |
175.77 |
California Kaiser Foundation Health Plan, Inc. Northern California Region - Basic Self |
KC1 |
640.81 |
652.08 |
489.06 |
163.02 |
2.82 |
California Kaiser Foundation Health Plan, Inc. Northern California Region - Basic Self & Family |
KC2 |
1499.44 |
1525.85 |
1144.39 |
381.46 |
6.60 |
California Kaiser Foundation Health Plan, Inc. Northern California Region - Basic Self Plus One |
KC3 |
1499.44 |
1525.85 |
1092.26 |
433.59 |
0.74 |
California Kaiser Foundation Health Plan, Inc. Northern California Region - High Self |
591 |
992.49 |
1000.46 |
510.84 |
489.62 |
-4.15 |
California Kaiser Foundation Health Plan, Inc. Northern California Region - High Self & Family |
592 |
2369.14 |
2388.21 |
1184.02 |
1204.19 |
-26.76 |
California Kaiser Foundation Health Plan, Inc. Northern California Region - High Self Plus One |
593 |
2369.14 |
2388.21 |
1092.26 |
1295.95 |
-6.60 |
California Kaiser Foundation Health Plan, Inc. Northern California Region - Standard Self |
594 |
797.57 |
809.88 |
510.84 |
299.04 |
0.19 |
California Kaiser Foundation Health Plan, Inc. Northern California Region - Standard Self & Family |
595 |
1866.28 |
1895.08 |
1184.02 |
711.06 |
-17.03 |
California Kaiser Foundation Health Plan, Inc. Northern California Region - Standard Self Plus One |
596 |
1866.28 |
1895.08 |
1092.26 |
802.82 |
3.13 |
California Kaiser Foundation Health Plan, Inc. Northern California Region: Fresno - Standard Self |
NZ4 |
534.67 |
566.80 |
425.10 |
141.70 |
8.03 |
California Kaiser Foundation Health Plan, Inc. Northern California Region: Fresno - Standard Self & Family |
NZ5 |
1235.72 |
1309.95 |
982.46 |
327.49 |
18.56 |
California Kaiser Foundation Health Plan, Inc. Northern California Region: Fresno - Standard Self Plus One |
NZ6 |
1235.72 |
1309.95 |
982.46 |
327.49 |
18.56 |
California Kaiser Foundation Health Plan, Inc. Northern California Region: Fresno - High Self |
NZ1 |
731.03 |
776.92 |
510.84 |
266.08 |
33.77 |
California Kaiser Foundation Health Plan, Inc. Northern California Region: Fresno - High Self & Family |
NZ2 |
1689.55 |
1795.67 |
1184.02 |
611.65 |
60.29 |
California Kaiser Foundation Health Plan, Inc. Northern California Region: Fresno - High Self Plus One |
NZ3 |
1689.55 |
1795.67 |
1092.26 |
703.41 |
80.45 |
California Kaiser Foundation Health Plan, Inc. Southern California Region - Standard Self |
624 |
431.36 |
466.31 |
349.73 |
116.58 |
8.74 |
California Kaiser Foundation Health Plan, Inc. Southern California Region - Standard Self & Family |
625 |
996.93 |
1077.70 |
808.28 |
269.42 |
20.19 |
California Kaiser Foundation Health Plan, Inc. Southern California Region - Standard Self Plus One |
626 |
996.93 |
1077.70 |
808.28 |
269.42 |
20.19 |
California Kaiser Foundation Health Plan, Inc. Southern California Region - High Self |
621 |
687.20 |
735.41 |
510.84 |
224.57 |
36.09 |
California Kaiser Foundation Health Plan, Inc. Southern California Region - High Self & Family |
622 |
1588.25 |
1699.66 |
1184.02 |
515.64 |
65.58 |
California Kaiser Foundation Health Plan, Inc. Southern California Region - High Self Plus One |
623 |
1588.25 |
1699.66 |
1092.26 |
607.40 |
85.74 |
Colorado Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Colorado Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Colorado Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Colorado Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Colorado Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Colorado Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
670.58 |
712.73 |
510.84 |
201.89 |
30.03 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
1535.86 |
1632.37 |
1184.02 |
448.35 |
50.68 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
1505.77 |
1600.37 |
1092.26 |
508.11 |
68.93 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
785.14 |
904.50 |
510.84 |
393.66 |
107.24 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
1790.88 |
2063.10 |
1184.02 |
879.08 |
226.39 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
1773.18 |
2042.71 |
1092.26 |
950.45 |
243.86 |
Colorado Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Colorado Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Colorado Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Colorado BlueAdvantageHMO on the Pathway HMO Network - High Self |
WW1 |
594.71 |
636.35 |
477.26 |
159.09 |
10.41 |
Colorado BlueAdvantageHMO on the Pathway HMO Network - High Self & Family |
WW2 |
1448.11 |
1549.49 |
1162.12 |
387.37 |
25.34 |
Colorado BlueAdvantageHMO on the Pathway HMO Network - High Self Plus One |
WW3 |
1352.95 |
1447.66 |
1085.75 |
361.91 |
23.67 |
Colorado Humana Health Plan, Inc. - High Self |
NR1 |
696.22 |
821.51 |
510.84 |
310.67 |
113.17 |
Colorado Humana Health Plan, Inc. - High Self & Family |
NR2 |
1566.46 |
1848.41 |
1184.02 |
664.39 |
236.12 |
Colorado Humana Health Plan, Inc. - High Self Plus One |
NR3 |
1496.84 |
1766.27 |
1092.26 |
674.01 |
243.76 |
Colorado Humana Health Plan, Inc. - Standard Self |
NR4 |
522.30 |
569.31 |
426.98 |
142.33 |
11.76 |
Colorado Humana Health Plan, Inc. - Standard Self & Family |
NR5 |
1175.20 |
1280.98 |
960.74 |
320.24 |
26.44 |
Colorado Humana Health Plan, Inc. - Standard Self Plus One |
NR6 |
1122.94 |
1224.02 |
918.02 |
306.00 |
25.27 |
Colorado Humana Health Plan, Inc. - Basic Self |
RZ1 |
496.95 |
521.80 |
391.35 |
130.45 |
6.21 |
Colorado Humana Health Plan, Inc. - Basic Self & Family |
RZ2 |
1118.13 |
1174.03 |
880.52 |
293.51 |
13.98 |
Colorado Humana Health Plan, Inc. - Basic Self Plus One |
RZ3 |
1068.47 |
1121.90 |
841.43 |
280.47 |
13.35 |
Colorado Humana Health Plan, Inc. - High Self |
NT1 |
626.86 |
764.77 |
510.84 |
253.93 |
97.22 |
Colorado Humana Health Plan, Inc. - High Self & Family |
NT2 |
1410.48 |
1720.79 |
1184.02 |
536.77 |
184.15 |
Colorado Humana Health Plan, Inc. - High Self Plus One |
NT3 |
1347.75 |
1644.28 |
1092.26 |
552.02 |
215.08 |
Colorado Humana Health Plan, Inc. - Standard Self |
NT4 |
501.41 |
541.52 |
406.14 |
135.38 |
10.03 |
Colorado Humana Health Plan, Inc. - Standard Self & Family |
NT5 |
1128.21 |
1218.45 |
913.84 |
304.61 |
22.56 |
Colorado Humana Health Plan, Inc. - Standard Self Plus One |
NT6 |
1078.09 |
1164.35 |
873.26 |
291.09 |
21.57 |
Colorado Humana Health Plan, Inc. - Basic Self |
R21 |
491.77 |
531.12 |
398.34 |
132.78 |
9.84 |
Colorado Humana Health Plan, Inc. - Basic Self & Family |
R22 |
1106.50 |
1195.00 |
896.25 |
298.75 |
22.13 |
Colorado Humana Health Plan, Inc. - Basic Self Plus One |
R23 |
1057.31 |
1141.90 |
856.43 |
285.47 |
21.14 |
Colorado Kaiser Foundation Health Plan of Colorado - Standard Self |
654 |
586.67 |
671.30 |
503.48 |
167.82 |
21.15 |
Colorado Kaiser Foundation Health Plan of Colorado - Standard Self & Family |
655 |
1325.91 |
1517.12 |
1137.84 |
379.28 |
47.80 |
Colorado Kaiser Foundation Health Plan of Colorado - Standard Self Plus One |
656 |
1325.91 |
1517.12 |
1092.26 |
424.86 |
93.38 |
Colorado Kaiser Foundation Health Plan of Colorado - High Self |
651 |
738.94 |
789.17 |
510.84 |
278.33 |
38.11 |
Colorado Kaiser Foundation Health Plan of Colorado - High Self & Family |
652 |
1670.05 |
1783.51 |
1184.02 |
599.49 |
67.63 |
Colorado Kaiser Foundation Health Plan of Colorado - High Self Plus One |
653 |
1670.05 |
1783.51 |
1092.26 |
691.25 |
87.79 |
Colorado Kaiser Foundation Health Plan of Colorado - Basic Self |
N41 |
429.85 |
484.77 |
363.58 |
121.19 |
13.73 |
Colorado Kaiser Foundation Health Plan of Colorado - Basic Self & Family |
N42 |
971.43 |
1095.60 |
821.70 |
273.90 |
31.04 |
Colorado Kaiser Foundation Health Plan of Colorado - Basic Self Plus One |
N43 |
971.43 |
1095.60 |
821.70 |
273.90 |
31.04 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LU1 |
450.32 |
443.84 |
332.88 |
110.96 |
-1.62 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LU2 |
1035.73 |
1020.85 |
765.64 |
255.21 |
-3.72 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LU3 |
968.20 |
954.27 |
715.70 |
238.57 |
-3.48 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KT1 |
679.19 |
724.77 |
510.84 |
213.93 |
33.46 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KT2 |
1697.95 |
1811.90 |
1184.02 |
627.88 |
68.12 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KT3 |
1460.23 |
1558.25 |
1092.26 |
465.99 |
72.35 |
Connecticut Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Connecticut Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Connecticut Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Connecticut Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Connecticut Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Connecticut Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
619.08 |
759.61 |
510.84 |
248.77 |
94.00 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
1417.65 |
1739.51 |
1184.02 |
555.49 |
201.08 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
1389.85 |
1705.38 |
1092.26 |
613.12 |
265.66 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
916.80 |
1075.75 |
510.84 |
564.91 |
146.83 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
2090.83 |
2453.32 |
1184.02 |
1269.30 |
316.66 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
2070.12 |
2429.03 |
1092.26 |
1336.77 |
333.24 |
Connecticut Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Connecticut Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Connecticut Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Delaware Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Delaware Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Delaware Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Delaware Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Delaware Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Delaware Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
619.08 |
759.61 |
510.84 |
248.77 |
94.00 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
1417.65 |
1739.51 |
1184.02 |
555.49 |
201.08 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
1389.85 |
1705.38 |
1092.26 |
613.12 |
265.66 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
916.80 |
1075.75 |
510.84 |
564.91 |
146.83 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
2090.83 |
2453.32 |
1184.02 |
1269.30 |
316.66 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
2070.12 |
2429.03 |
1092.26 |
1336.77 |
333.24 |
Delaware Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Delaware Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Delaware Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Delaware Aetna Open Access - Basic Self |
P34 |
1298.46 |
1310.08 |
510.84 |
799.24 |
-0.50 |
Delaware Aetna Open Access - Basic Self & Family |
P35 |
3013.75 |
3040.68 |
1184.02 |
1856.66 |
-18.90 |
Delaware Aetna Open Access - Basic Self Plus One |
P36 |
2983.89 |
3010.54 |
1092.26 |
1918.28 |
0.98 |
Delaware Aetna Open Access - High Self |
P31 |
1485.21 |
1456.61 |
510.84 |
945.77 |
-40.72 |
Delaware Aetna Open Access - High Self & Family |
P32 |
3600.91 |
3531.54 |
1184.02 |
2347.52 |
-115.20 |
Delaware Aetna Open Access - High Self Plus One |
P33 |
3565.25 |
3496.55 |
1092.26 |
2404.29 |
-94.37 |
District Of Columbia Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
District Of Columbia Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
District Of Columbia Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
District Of Columbia Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
District Of Columbia Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
District Of Columbia Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
810.79 |
829.23 |
510.84 |
318.39 |
6.32 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
1848.71 |
1890.72 |
1184.02 |
706.70 |
-3.82 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
1830.40 |
1872.00 |
1092.26 |
779.74 |
15.93 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
708.44 |
819.98 |
510.84 |
309.14 |
99.42 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
1622.25 |
1877.61 |
1184.02 |
693.59 |
209.53 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
1590.42 |
1840.78 |
1092.26 |
748.52 |
224.69 |
District Of Columbia Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
District Of Columbia Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
District Of Columbia Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
District Of Columbia Aetna Open Access - High Self |
JN1 |
1119.13 |
1137.57 |
510.84 |
626.73 |
6.32 |
District Of Columbia Aetna Open Access - High Self & Family |
JN2 |
2515.98 |
2557.43 |
1184.02 |
1373.41 |
-4.38 |
District Of Columbia Aetna Open Access - High Self Plus One |
JN3 |
2491.04 |
2532.10 |
1092.26 |
1439.84 |
15.39 |
District Of Columbia Aetna Open Access - Basic Self |
JN4 |
680.46 |
697.10 |
510.84 |
186.26 |
4.52 |
District Of Columbia Aetna Open Access - Basic Self & Family |
JN5 |
1557.25 |
1595.34 |
1184.02 |
411.32 |
-7.74 |
District Of Columbia Aetna Open Access - Basic Self Plus One |
JN6 |
1430.00 |
1464.99 |
1092.26 |
372.73 |
9.32 |
District Of Columbia Aetna Saver - Saver Self |
QQ4 |
New Plan |
595.21 |
446.41 |
148.80 |
New Plan |
District Of Columbia Aetna Saver - Saver Self & Family |
QQ5 |
New Plan |
1362.14 |
1021.61 |
340.53 |
New Plan |
District Of Columbia Aetna Saver - Saver Self Plus One |
QQ6 |
New Plan |
1250.82 |
938.12 |
312.70 |
New Plan |
District Of Columbia CareFirst BlueChoice - Standard Self |
2G4 |
797.68 |
845.54 |
510.84 |
334.70 |
35.74 |
District Of Columbia CareFirst BlueChoice - Standard Self & Family |
2G5 |
1895.25 |
2008.96 |
1184.02 |
824.94 |
67.88 |
District Of Columbia CareFirst BlueChoice - Standard Self Plus One |
2G6 |
1595.34 |
1691.06 |
1092.26 |
598.80 |
70.05 |
District Of Columbia CareFirst BlueChoice - HDHP Self |
B61 |
518.27 |
570.09 |
427.57 |
142.52 |
12.95 |
District Of Columbia CareFirst BlueChoice - HDHP Self & Family |
B62 |
1231.38 |
1354.51 |
1015.88 |
338.63 |
30.79 |
District Of Columbia CareFirst BlueChoice - HDHP Self Plus One |
B63 |
1036.51 |
1140.17 |
855.13 |
285.04 |
25.91 |
District Of Columbia CareFirst BlueChoice - Blue Value Plus Self |
B64 |
New Plan |
705.99 |
510.84 |
195.15 |
New Plan |
District Of Columbia CareFirst BlueChoice - Blue Value Plus Self & Family |
B65 |
New Plan |
1677.46 |
1184.02 |
493.44 |
New Plan |
District Of Columbia CareFirst BlueChoice - Blue Value Plus Self Plus One |
B66 |
New Plan |
1412.02 |
1059.02 |
353.00 |
New Plan |
District Of Columbia Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. - Basic Self |
T71 |
420.12 |
420.12 |
315.09 |
105.03 |
0.00 |
District Of Columbia Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. - Basic Self & Family |
T72 |
1026.16 |
1026.16 |
769.62 |
256.54 |
0.00 |
District Of Columbia Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. - Basic Self Plus One |
T73 |
934.90 |
934.90 |
701.18 |
233.72 |
0.00 |
District Of Columbia Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. - Standard Self |
E34 |
521.76 |
571.55 |
428.66 |
142.89 |
12.45 |
District Of Columbia Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. - Standard Self & Family |
E35 |
1199.99 |
1314.50 |
985.88 |
328.62 |
28.62 |
District Of Columbia Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. - Standard Self Plus One |
E36 |
1199.99 |
1314.50 |
985.88 |
328.62 |
28.62 |
District Of Columbia Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. - High Self |
E31 |
692.68 |
722.82 |
510.84 |
211.98 |
18.02 |
District Of Columbia Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. - High Self & Family |
E32 |
1593.15 |
1662.53 |
1184.02 |
478.51 |
23.55 |
District Of Columbia Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. - High Self Plus One |
E33 |
1593.15 |
1662.53 |
1092.26 |
570.27 |
43.71 |
District Of Columbia M.D. IPA - High Self |
JP1 |
790.86 |
876.61 |
510.84 |
365.77 |
73.63 |
District Of Columbia M.D. IPA - High Self & Family |
JP2 |
2217.54 |
2458.04 |
1184.02 |
1274.02 |
194.67 |
District Of Columbia M.D. IPA - High Self Plus One |
JP3 |
1544.53 |
1712.04 |
1092.26 |
619.78 |
141.84 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
V41 |
495.69 |
486.57 |
364.93 |
121.64 |
-2.28 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
V42 |
1140.06 |
1119.11 |
839.33 |
279.78 |
-5.23 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
V43 |
1065.72 |
1046.13 |
784.60 |
261.53 |
-4.90 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
LR1 |
667.94 |
714.89 |
510.84 |
204.05 |
34.83 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
LR2 |
1582.99 |
1694.29 |
1184.02 |
510.27 |
65.47 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
LR3 |
1436.05 |
1536.99 |
1092.26 |
444.73 |
75.27 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
L91 |
437.06 |
521.50 |
391.13 |
130.37 |
21.11 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
L92 |
1225.49 |
1462.26 |
1096.70 |
365.56 |
59.19 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self Plus One |
L93 |
853.56 |
1018.46 |
763.85 |
254.61 |
41.22 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self |
AS1 |
New Plan |
525.81 |
394.36 |
131.45 |
New Plan |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self & Family |
AS2 |
New Plan |
1243.36 |
932.52 |
310.84 |
New Plan |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self Plus One |
AS3 |
New Plan |
1130.42 |
847.82 |
282.60 |
New Plan |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self |
Y81 |
New Plan |
506.74 |
380.06 |
126.68 |
New Plan |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self & Family |
Y82 |
New Plan |
1198.23 |
898.67 |
299.56 |
New Plan |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self Plus One |
Y83 |
New Plan |
1089.38 |
817.04 |
272.34 |
New Plan |
Florida Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Florida Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Florida Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Florida Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Florida Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Florida Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
810.79 |
829.23 |
510.84 |
318.39 |
6.32 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
1848.71 |
1890.72 |
1184.02 |
706.70 |
-3.82 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
1830.40 |
1872.00 |
1092.26 |
779.74 |
15.93 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
708.44 |
819.98 |
510.84 |
309.14 |
99.42 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
1622.25 |
1877.61 |
1184.02 |
693.59 |
209.53 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
1590.42 |
1840.78 |
1092.26 |
748.52 |
224.69 |
Florida Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Florida Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Florida Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Florida AvMed - HDHP Self |
WZ1 |
813.30 |
805.16 |
510.84 |
294.32 |
-20.26 |
Florida AvMed - HDHP Self & Family |
WZ2 |
2003.32 |
1871.35 |
1184.02 |
687.33 |
-177.80 |
Florida AvMed - HDHP Self Plus One |
WZ3 |
1561.60 |
1622.34 |
1092.26 |
530.08 |
35.07 |
Florida AvMed - Standard Self |
ML4 |
709.22 |
709.24 |
510.84 |
198.40 |
-12.10 |
Florida AvMed - Standard Self & Family |
ML5 |
1837.05 |
1726.81 |
1184.02 |
542.79 |
-156.07 |
Florida AvMed - Standard Self Plus One |
ML6 |
1418.43 |
1489.37 |
1092.26 |
397.11 |
42.50 |
Florida Capital Health Plan - High Self |
EA1 |
690.41 |
680.62 |
510.47 |
170.15 |
-21.54 |
Florida Capital Health Plan - High Self & Family |
EA2 |
1726.08 |
1577.33 |
1183.00 |
394.33 |
-193.56 |
Florida Capital Health Plan - High Self Plus One |
EA3 |
1484.41 |
1488.41 |
1092.26 |
396.15 |
-21.67 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self |
W94 |
485.23 |
513.59 |
385.19 |
128.40 |
7.09 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self & Family |
W95 |
1091.78 |
1155.57 |
866.68 |
288.89 |
15.95 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
W96 |
1043.25 |
1104.20 |
828.15 |
276.05 |
15.24 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self |
W91 |
573.58 |
607.10 |
455.33 |
151.77 |
8.38 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
W92 |
1290.58 |
1365.95 |
1024.46 |
341.49 |
18.85 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
W93 |
1233.20 |
1305.27 |
978.95 |
326.32 |
18.02 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self |
QP1 |
684.02 |
725.05 |
510.84 |
214.21 |
28.91 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
QP2 |
1541.09 |
1633.54 |
1184.02 |
449.52 |
46.62 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
QP3 |
1472.58 |
1560.93 |
1092.26 |
468.67 |
62.68 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self |
QP4 |
489.95 |
519.35 |
389.51 |
129.84 |
7.35 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self & Family |
QP5 |
1102.36 |
1168.48 |
876.36 |
292.12 |
16.53 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
QP6 |
1053.37 |
1116.57 |
837.43 |
279.14 |
15.80 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self |
MJ4 |
504.49 |
519.61 |
389.71 |
129.90 |
3.78 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self & Family |
MJ5 |
1135.10 |
1169.13 |
876.85 |
292.28 |
8.51 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
MJ6 |
1084.63 |
1117.18 |
837.89 |
279.29 |
8.13 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self |
MJ1 |
854.10 |
948.07 |
510.84 |
437.23 |
81.85 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
MJ2 |
1921.75 |
2133.15 |
1184.02 |
949.13 |
165.57 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
MJ3 |
1836.36 |
2038.36 |
1092.26 |
946.10 |
176.33 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self |
X24 |
470.30 |
493.18 |
369.89 |
123.29 |
5.72 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self & Family |
X25 |
1058.16 |
1109.66 |
832.25 |
277.41 |
12.87 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
X26 |
1011.14 |
1060.35 |
795.26 |
265.09 |
12.31 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self |
X21 |
555.92 |
582.99 |
437.24 |
145.75 |
6.77 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
X22 |
1250.82 |
1311.74 |
983.81 |
327.93 |
15.23 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
X23 |
1195.24 |
1253.44 |
940.08 |
313.36 |
14.55 |
Florida Humana Medical Plan, Inc. - Standard Self |
LL4 |
866.91 |
1074.95 |
510.84 |
564.11 |
195.92 |
Florida Humana Medical Plan, Inc. - Standard Self & Family |
LL5 |
1950.48 |
2418.61 |
1184.02 |
1234.59 |
422.30 |
Florida Humana Medical Plan, Inc. - Standard Self Plus One |
LL6 |
1863.81 |
2311.12 |
1092.26 |
1218.86 |
421.64 |
Florida Humana Medical Plan, Inc. - High Self |
LL1 |
1610.81 |
1659.15 |
510.84 |
1148.31 |
36.22 |
Florida Humana Medical Plan, Inc. - High Self & Family |
LL2 |
3624.31 |
3733.06 |
1184.02 |
2549.04 |
62.92 |
Florida Humana Medical Plan, Inc. - High Self Plus One |
LL3 |
3463.24 |
3567.14 |
1092.26 |
2474.88 |
78.23 |
Florida Humana Medical Plan, Inc. - High Self |
EE1 |
914.05 |
1115.14 |
510.84 |
604.30 |
188.97 |
Florida Humana Medical Plan, Inc. - High Self & Family |
EE2 |
2056.62 |
2509.07 |
1184.02 |
1325.05 |
406.62 |
Florida Humana Medical Plan, Inc. - High Self Plus One |
EE3 |
1965.25 |
2397.59 |
1092.26 |
1305.33 |
406.67 |
Florida Humana Medical Plan, Inc. - Standard Self |
EE4 |
817.31 |
997.12 |
510.84 |
486.28 |
167.69 |
Florida Humana Medical Plan, Inc. - Standard Self & Family |
EE5 |
1838.92 |
2243.50 |
1184.02 |
1059.48 |
358.75 |
Florida Humana Medical Plan, Inc. - Standard Self Plus One |
EE6 |
1757.19 |
2143.79 |
1092.26 |
1051.53 |
360.93 |
Florida Humana Medical Plan, Inc. - Standard Self |
E24 |
633.64 |
716.02 |
510.84 |
205.18 |
46.77 |
Florida Humana Medical Plan, Inc. - Standard Self & Family |
E25 |
1425.67 |
1611.00 |
1184.02 |
426.98 |
70.56 |
Florida Humana Medical Plan, Inc. - Standard Self Plus One |
E26 |
1362.29 |
1539.40 |
1092.26 |
447.14 |
106.57 |
Florida Humana Medical Plan, Inc. - High Self |
E21 |
985.77 |
1202.65 |
510.84 |
691.81 |
204.76 |
Florida Humana Medical Plan, Inc. - High Self & Family |
E22 |
2217.93 |
2705.86 |
1184.02 |
1521.84 |
442.10 |
Florida Humana Medical Plan, Inc. - High Self Plus One |
E23 |
2119.35 |
2585.61 |
1092.26 |
1493.35 |
440.59 |
Florida Humana Medical Plan, Inc. - High Self |
EX1 |
744.51 |
893.40 |
510.84 |
382.56 |
136.77 |
Florida Humana Medical Plan, Inc. - High Self & Family |
EX2 |
1675.09 |
2010.10 |
1184.02 |
826.08 |
289.18 |
Florida Humana Medical Plan, Inc. - High Self Plus One |
EX3 |
1600.63 |
1920.77 |
1092.26 |
828.51 |
294.47 |
Florida Humana Medical Plan, Inc. - Standard Self |
EX4 |
653.77 |
732.23 |
510.84 |
221.39 |
57.95 |
Florida Humana Medical Plan, Inc. - Standard Self & Family |
EX5 |
1470.97 |
1647.51 |
1184.02 |
463.49 |
95.75 |
Florida Humana Medical Plan, Inc. - Standard Self Plus One |
EX6 |
1405.60 |
1574.28 |
1092.26 |
482.02 |
130.62 |
Florida UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LS1 |
418.71 |
454.74 |
341.06 |
113.68 |
9.00 |
Florida UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LS2 |
963.08 |
1045.92 |
784.44 |
261.48 |
20.71 |
Florida UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LS3 |
900.25 |
977.71 |
733.28 |
244.43 |
19.37 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KK1 |
679.03 |
713.87 |
510.84 |
203.03 |
22.72 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KK2 |
1697.63 |
1784.71 |
1184.02 |
600.69 |
41.25 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KK3 |
1459.94 |
1534.87 |
1092.26 |
442.61 |
49.26 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
LV1 |
662.03 |
701.44 |
510.84 |
190.60 |
25.09 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
LV2 |
1986.10 |
2104.29 |
1184.02 |
920.27 |
72.36 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self Plus One |
LV3 |
1423.37 |
1508.07 |
1092.26 |
415.81 |
59.03 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self |
AS1 |
New Plan |
525.81 |
394.36 |
131.45 |
New Plan |
Florida UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self & Family |
AS2 |
New Plan |
1243.36 |
932.52 |
310.84 |
New Plan |
Florida UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self Plus One |
AS3 |
New Plan |
1130.42 |
847.82 |
282.60 |
New Plan |
Florida UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self |
Y81 |
New Plan |
506.74 |
380.06 |
126.68 |
New Plan |
Florida UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self & Family |
Y82 |
New Plan |
1198.23 |
898.67 |
299.56 |
New Plan |
Florida UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self Plus One |
Y83 |
New Plan |
1089.38 |
817.04 |
272.34 |
New Plan |
Georgia Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Georgia Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Georgia Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Georgia Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Georgia Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Georgia Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
810.79 |
829.23 |
510.84 |
318.39 |
6.32 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
1848.71 |
1890.72 |
1184.02 |
706.70 |
-3.82 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
1830.40 |
1872.00 |
1092.26 |
779.74 |
15.93 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
708.44 |
819.98 |
510.84 |
309.14 |
99.42 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
1622.25 |
1877.61 |
1184.02 |
693.59 |
209.53 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
1590.42 |
1840.78 |
1092.26 |
748.52 |
224.69 |
Georgia Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Georgia Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Georgia Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Georgia Aetna Open Access - High Self |
2U1 |
1584.29 |
1733.36 |
510.84 |
1222.52 |
136.95 |
Georgia Aetna Open Access - High Self & Family |
2U2 |
3649.36 |
3992.69 |
1184.02 |
2808.67 |
297.50 |
Georgia Aetna Open Access - High Self Plus One |
2U3 |
3613.22 |
3953.15 |
1092.26 |
2860.89 |
314.26 |
Georgia Blue Open Access POS - High Self |
QM1 |
595.40 |
625.17 |
468.88 |
156.29 |
7.44 |
Georgia Blue Open Access POS - High Self & Family |
QM2 |
1577.38 |
1640.47 |
1184.02 |
456.45 |
17.26 |
Georgia Blue Open Access POS - High Self Plus One |
QM3 |
1318.40 |
1377.74 |
1033.31 |
344.43 |
14.83 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self |
S94 |
520.65 |
551.89 |
413.92 |
137.97 |
7.81 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self & Family |
S95 |
1171.47 |
1241.74 |
931.31 |
310.43 |
17.56 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
S96 |
1119.41 |
1186.58 |
889.94 |
296.64 |
16.79 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self |
S91 |
653.92 |
693.14 |
510.84 |
182.30 |
18.82 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
S92 |
1471.32 |
1559.61 |
1169.71 |
389.90 |
22.07 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
S93 |
1405.93 |
1490.28 |
1092.26 |
398.02 |
46.54 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self |
AD4 |
658.52 |
737.53 |
510.84 |
226.69 |
62.06 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self & Family |
AD5 |
1481.61 |
1659.41 |
1184.02 |
475.39 |
104.99 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
AD6 |
1415.77 |
1585.68 |
1092.26 |
493.42 |
139.48 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self |
AD1 |
797.83 |
973.38 |
510.84 |
462.54 |
163.43 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
AD2 |
1795.13 |
2190.07 |
1184.02 |
1006.05 |
349.11 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
AD3 |
1715.35 |
2092.74 |
1092.26 |
1000.48 |
351.72 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self |
LM1 |
631.71 |
679.23 |
509.42 |
169.81 |
11.88 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
LM2 |
1421.42 |
1528.30 |
1146.23 |
382.07 |
26.72 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
LM3 |
1358.24 |
1460.36 |
1092.26 |
368.10 |
28.54 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self |
LM4 |
514.02 |
642.55 |
481.91 |
160.64 |
32.14 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self & Family |
LM5 |
1156.57 |
1445.71 |
1084.28 |
361.43 |
72.29 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
LM6 |
1105.17 |
1381.47 |
1036.10 |
345.37 |
69.08 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self |
RM1 |
594.99 |
648.53 |
486.40 |
162.13 |
13.38 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self & Family |
RM2 |
1338.74 |
1459.23 |
1094.42 |
364.81 |
30.13 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self Plus One |
RM3 |
1279.24 |
1394.36 |
1045.77 |
348.59 |
28.78 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self |
DN4 |
684.93 |
726.03 |
510.84 |
215.19 |
28.98 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self & Family |
DN5 |
1541.06 |
1633.52 |
1184.02 |
449.50 |
46.63 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self Plus One |
DN6 |
1472.58 |
1560.93 |
1092.26 |
468.67 |
62.68 |
Georgia Humana Employers Health Plan of Georgia, Inc. - High Self |
DN1 |
736.41 |
780.61 |
510.84 |
269.77 |
32.08 |
Georgia Humana Employers Health Plan of Georgia, Inc. - High Self & Family |
DN2 |
1656.94 |
1756.37 |
1184.02 |
572.35 |
53.60 |
Georgia Humana Employers Health Plan of Georgia, Inc. - High Self Plus One |
DN3 |
1583.31 |
1678.30 |
1092.26 |
586.04 |
69.32 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self |
RJ1 |
564.24 |
598.09 |
448.57 |
149.52 |
8.46 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self & Family |
RJ2 |
1269.56 |
1345.72 |
1009.29 |
336.43 |
19.04 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self Plus One |
RJ3 |
1213.12 |
1285.92 |
964.44 |
321.48 |
18.20 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self |
Q71 |
620.17 |
762.80 |
510.84 |
251.96 |
96.92 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self & Family |
Q72 |
1395.38 |
1716.33 |
1184.02 |
532.31 |
183.47 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self Plus One |
Q73 |
1333.35 |
1640.02 |
1092.26 |
547.76 |
214.42 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self |
CB4 |
976.91 |
1250.45 |
510.84 |
739.61 |
261.42 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self & Family |
CB5 |
2198.06 |
2813.50 |
1184.02 |
1629.48 |
569.61 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self Plus One |
CB6 |
2100.37 |
2688.47 |
1092.26 |
1596.21 |
562.43 |
Georgia Humana Employers Health Plan of Georgia, Inc. - High Self |
CB1 |
990.36 |
1148.57 |
510.84 |
637.73 |
146.09 |
Georgia Humana Employers Health Plan of Georgia, Inc. - High Self & Family |
CB2 |
2228.42 |
2584.40 |
1184.02 |
1400.38 |
310.15 |
Georgia Humana Employers Health Plan of Georgia, Inc. - High Self Plus One |
CB3 |
2129.34 |
2469.61 |
1092.26 |
1377.35 |
314.60 |
Georgia Humana Employers Health Plan of Georgia, Inc. - High Self |
DG1 |
1283.43 |
1321.93 |
510.84 |
811.09 |
26.38 |
Georgia Humana Employers Health Plan of Georgia, Inc. - High Self & Family |
DG2 |
2887.71 |
2974.34 |
1184.02 |
1790.32 |
40.80 |
Georgia Humana Employers Health Plan of Georgia, Inc. - High Self Plus One |
DG3 |
2759.40 |
2842.19 |
1092.26 |
1749.93 |
57.12 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self |
DG4 |
937.91 |
1171.84 |
510.84 |
661.00 |
221.81 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self & Family |
DG5 |
2110.29 |
2636.70 |
1184.02 |
1452.68 |
480.58 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self Plus One |
DG6 |
2016.50 |
2519.57 |
1092.26 |
1427.31 |
477.40 |
Georgia Kaiser Foundation Health Plan of Georgia, Inc. - High Self |
F81 |
696.09 |
730.04 |
510.84 |
219.20 |
21.83 |
Georgia Kaiser Foundation Health Plan of Georgia, Inc. - High Self & Family |
F82 |
1573.15 |
1649.87 |
1184.02 |
465.85 |
30.89 |
Georgia Kaiser Foundation Health Plan of Georgia, Inc. - High Self Plus One |
F83 |
1573.15 |
1649.87 |
1092.26 |
557.61 |
51.05 |
Georgia Kaiser Foundation Health Plan of Georgia, Inc. - Standard Self |
F84 |
526.20 |
552.33 |
414.25 |
138.08 |
6.53 |
Georgia Kaiser Foundation Health Plan of Georgia, Inc. - Standard Self & Family |
F85 |
1189.22 |
1248.26 |
936.20 |
312.06 |
14.76 |
Georgia Kaiser Foundation Health Plan of Georgia, Inc. - Standard Self Plus One |
F86 |
1189.22 |
1248.26 |
936.20 |
312.06 |
14.76 |
Georgia Kaiser Foundation Health Plan of Georgia, Inc. - Basic Self |
LA1 |
New Plan |
393.36 |
295.02 |
98.34 |
New Plan |
Georgia Kaiser Foundation Health Plan of Georgia, Inc. - Basic Self & Family |
LA2 |
New Plan |
888.98 |
666.74 |
222.24 |
New Plan |
Georgia Kaiser Foundation Health Plan of Georgia, Inc. - Basic Self Plus One |
LA3 |
New Plan |
888.98 |
666.74 |
222.24 |
New Plan |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
LV1 |
662.03 |
701.44 |
510.84 |
190.60 |
25.09 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
LV2 |
1986.10 |
2104.29 |
1184.02 |
920.27 |
72.36 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self Plus One |
LV3 |
1423.37 |
1508.07 |
1092.26 |
415.81 |
59.03 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self |
AS1 |
New Plan |
525.81 |
394.36 |
131.45 |
New Plan |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self & Family |
AS2 |
New Plan |
1243.36 |
932.52 |
310.84 |
New Plan |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self Plus One |
AS3 |
New Plan |
1130.42 |
847.82 |
282.60 |
New Plan |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self |
Y81 |
New Plan |
506.74 |
380.06 |
126.68 |
New Plan |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self & Family |
Y82 |
New Plan |
1198.23 |
898.67 |
299.56 |
New Plan |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self Plus One |
Y83 |
New Plan |
1089.38 |
817.04 |
272.34 |
New Plan |
Guam Calvo's SelectCare - Standard Self |
B44 |
403.50 |
396.74 |
297.56 |
99.18 |
-1.69 |
Guam Calvo's SelectCare - Standard Self & Family |
B45 |
1172.36 |
1152.73 |
864.55 |
288.18 |
-4.91 |
Guam Calvo's SelectCare - Standard Self Plus One |
B46 |
795.43 |
782.10 |
586.58 |
195.52 |
-3.34 |
Guam Calvo's SelectCare - High Self |
B41 |
518.09 |
491.55 |
368.66 |
122.89 |
-6.63 |
Guam Calvo's SelectCare - High Self & Family |
B42 |
1372.22 |
1301.89 |
976.42 |
325.47 |
-17.58 |
Guam Calvo's SelectCare - High Self Plus One |
B43 |
1011.03 |
959.23 |
719.42 |
239.81 |
-12.95 |
Guam TakeCare - HDHP Self |
KX1 |
103.72 |
124.24 |
93.18 |
31.06 |
5.13 |
Guam TakeCare - HDHP Self & Family |
KX2 |
278.05 |
339.32 |
254.49 |
84.83 |
15.32 |
Guam TakeCare - HDHP Self Plus One |
KX3 |
250.45 |
306.11 |
229.58 |
76.53 |
13.92 |
Guam TakeCare - Standard Self |
JK4 |
389.81 |
389.24 |
291.93 |
97.31 |
-0.14 |
Guam TakeCare - Standard Self & Family |
JK5 |
1103.87 |
1102.31 |
826.73 |
275.58 |
-0.39 |
Guam TakeCare - Standard Self Plus One |
JK6 |
768.24 |
767.15 |
575.36 |
191.79 |
-0.27 |
Guam TakeCare - High Self |
JK1 |
471.86 |
492.35 |
369.26 |
123.09 |
5.13 |
Guam TakeCare - High Self & Family |
JK2 |
1125.52 |
1174.40 |
880.80 |
293.60 |
12.22 |
Guam TakeCare - High Self Plus One |
JK3 |
932.23 |
972.73 |
729.55 |
243.18 |
10.12 |
Hawaii Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Hawaii Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Hawaii Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Hawaii Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Hawaii Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Hawaii Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
JS4 |
803.99 |
1073.48 |
510.84 |
562.64 |
257.37 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
JS5 |
1835.41 |
2450.59 |
1184.02 |
1266.57 |
569.35 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
JS6 |
1817.25 |
2426.32 |
1092.26 |
1334.06 |
583.40 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
JS1 |
1049.04 |
1003.99 |
510.84 |
493.15 |
-57.17 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
JS2 |
2391.35 |
2288.65 |
1184.02 |
1104.63 |
-148.53 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
JS3 |
2367.69 |
2265.99 |
1092.26 |
1173.73 |
-127.37 |
Hawaii Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Hawaii Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Hawaii Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Hawaii HMSA Plan - High Self |
871 |
606.95 |
631.24 |
473.43 |
157.81 |
6.07 |
Hawaii HMSA Plan - High Self & Family |
872 |
1364.44 |
1419.02 |
1064.27 |
354.75 |
13.64 |
Hawaii HMSA Plan - High Self Plus One |
873 |
1329.88 |
1383.07 |
1037.30 |
345.77 |
13.30 |
Hawaii HMSA Plan - Standard Self |
874 |
New Plan |
430.97 |
323.23 |
107.74 |
New Plan |
Hawaii HMSA Plan - Standard Self & Family |
875 |
New Plan |
968.83 |
726.62 |
242.21 |
New Plan |
Hawaii HMSA Plan - Standard Self Plus One |
876 |
New Plan |
944.23 |
708.17 |
236.06 |
New Plan |
Hawaii Kaiser Foundation Health Plan, Inc. Hawaii Region - High Self |
631 |
658.58 |
675.55 |
506.66 |
168.89 |
4.25 |
Hawaii Kaiser Foundation Health Plan, Inc. Hawaii Region - High Self & Family |
632 |
1468.63 |
1506.51 |
1129.88 |
376.63 |
9.47 |
Hawaii Kaiser Foundation Health Plan, Inc. Hawaii Region - High Self Plus One |
633 |
1468.63 |
1506.51 |
1092.26 |
414.25 |
12.21 |
Hawaii Kaiser Foundation Health Plan, Inc. Hawaii Region - Standard Self |
634 |
444.69 |
481.15 |
360.86 |
120.29 |
9.12 |
Hawaii Kaiser Foundation Health Plan, Inc. Hawaii Region - Standard Self & Family |
635 |
991.64 |
1072.98 |
804.74 |
268.24 |
20.33 |
Hawaii Kaiser Foundation Health Plan, Inc. Hawaii Region - Standard Self Plus One |
636 |
991.64 |
1072.98 |
804.74 |
268.24 |
20.33 |
Idaho Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Idaho Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Idaho Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Idaho Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Idaho Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Idaho Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
828.86 |
828.47 |
510.84 |
317.63 |
-12.51 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
1889.38 |
1888.45 |
1184.02 |
704.43 |
-46.76 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
1870.68 |
1869.92 |
1092.26 |
777.66 |
-26.43 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
616.53 |
807.04 |
510.84 |
296.20 |
142.07 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
1414.99 |
1852.18 |
1184.02 |
668.16 |
314.41 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
1387.25 |
1815.86 |
1092.26 |
723.60 |
376.79 |
Idaho Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Idaho Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Idaho Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Idaho Altius Health Plan - High Self |
9K1 |
935.24 |
1009.06 |
510.84 |
498.22 |
61.70 |
Idaho Altius Health Plan - High Self & Family |
9K2 |
2068.26 |
2231.52 |
1184.02 |
1047.50 |
117.43 |
Idaho Altius Health Plan - High Self Plus One |
9K3 |
2047.78 |
2209.42 |
1092.26 |
1117.16 |
135.97 |
Idaho Altius Health Plan - HDHP Self |
9K4 |
506.91 |
529.23 |
396.92 |
132.31 |
5.58 |
Idaho Altius Health Plan - HDHP Self & Family |
9K5 |
1059.41 |
1106.04 |
829.53 |
276.51 |
11.66 |
Idaho Altius Health Plan - HDHP Self Plus One |
9K6 |
1038.64 |
1084.37 |
813.28 |
271.09 |
11.43 |
Idaho Altius Health Plan - Standard Self |
DK4 |
712.44 |
761.30 |
510.84 |
250.46 |
36.74 |
Idaho Altius Health Plan - Standard Self & Family |
DK5 |
1573.30 |
1681.23 |
1184.02 |
497.21 |
62.10 |
Idaho Altius Health Plan - Standard Self Plus One |
DK6 |
1557.70 |
1664.56 |
1092.26 |
572.30 |
81.19 |
Idaho Kaiser Foundation Health Plan of Washington - Standard Self |
544 |
585.17 |
604.13 |
453.10 |
151.03 |
4.74 |
Idaho Kaiser Foundation Health Plan of Washington - Standard Self & Family |
545 |
1345.91 |
1389.53 |
1042.15 |
347.38 |
10.90 |
Idaho Kaiser Foundation Health Plan of Washington - Standard Self Plus One |
546 |
1345.91 |
1389.53 |
1042.15 |
347.38 |
10.90 |
Idaho Kaiser Foundation Health Plan of Washington - High Self |
541 |
815.40 |
845.74 |
510.84 |
334.90 |
18.22 |
Idaho Kaiser Foundation Health Plan of Washington - High Self & Family |
542 |
1793.91 |
1860.65 |
1184.02 |
676.63 |
20.91 |
Idaho Kaiser Foundation Health Plan of Washington - High Self Plus One |
543 |
1793.91 |
1860.65 |
1092.26 |
768.39 |
41.07 |
Illinois Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Illinois Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Illinois Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Illinois Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Illinois Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Illinois Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
828.86 |
828.47 |
510.84 |
317.63 |
-12.51 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
1889.38 |
1888.45 |
1184.02 |
704.43 |
-46.76 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
1870.68 |
1869.92 |
1092.26 |
777.66 |
-26.43 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
616.53 |
807.04 |
510.84 |
296.20 |
142.07 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
1414.99 |
1852.18 |
1184.02 |
668.16 |
314.41 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
1387.25 |
1815.86 |
1092.26 |
723.60 |
376.79 |
Illinois Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Illinois Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Illinois Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Illinois Blue Preferred - High Self |
9G1 |
782.36 |
833.21 |
510.84 |
322.37 |
38.73 |
Illinois Blue Preferred - High Self & Family |
9G2 |
1681.07 |
1858.87 |
1184.02 |
674.85 |
131.97 |
Illinois Blue Preferred - High Self Plus One |
9G3 |
1591.81 |
1760.59 |
1092.26 |
668.33 |
143.11 |
Illinois Blue Preferred - Standard Self |
9G4 |
558.72 |
600.62 |
450.47 |
150.15 |
10.47 |
Illinois Blue Preferred - Standard Self & Family |
9G5 |
1587.91 |
1707.01 |
1184.02 |
522.99 |
73.27 |
Illinois Blue Preferred - Standard Self Plus One |
9G6 |
1436.02 |
1543.71 |
1092.26 |
451.45 |
82.02 |
Illinois Health Alliance HMO - Standard Self |
K84 |
642.44 |
668.14 |
501.11 |
167.03 |
6.42 |
Illinois Health Alliance HMO - Standard Self & Family |
K85 |
1734.61 |
1803.99 |
1184.02 |
619.97 |
23.55 |
Illinois Health Alliance HMO - Standard Self Plus One |
K86 |
1488.24 |
1547.78 |
1092.26 |
455.52 |
33.87 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self |
GB4 |
616.37 |
758.14 |
510.84 |
247.30 |
93.21 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self & Family |
GB5 |
1386.82 |
1705.77 |
1184.02 |
521.75 |
175.05 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
GB6 |
1325.18 |
1629.96 |
1092.26 |
537.70 |
206.41 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self |
GB1 |
936.91 |
1180.53 |
510.84 |
669.69 |
231.50 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
GB2 |
2108.04 |
2656.14 |
1184.02 |
1472.12 |
502.27 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
GB3 |
2014.37 |
2538.12 |
1092.26 |
1445.86 |
498.08 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self |
MW4 |
608.81 |
754.91 |
510.84 |
244.07 |
91.87 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self & Family |
MW5 |
1369.79 |
1698.52 |
1184.02 |
514.50 |
172.05 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
MW6 |
1308.93 |
1623.05 |
1092.26 |
530.79 |
203.56 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self |
MW1 |
757.06 |
916.02 |
510.84 |
405.18 |
146.84 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
MW2 |
1703.41 |
2061.15 |
1184.02 |
877.13 |
311.91 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
MW3 |
1627.67 |
1969.50 |
1092.26 |
877.24 |
316.16 |
Illinois Humana Health Plan, Inc. - Standard Self |
754 |
855.66 |
951.90 |
510.84 |
441.06 |
84.12 |
Illinois Humana Health Plan, Inc. - Standard Self & Family |
755 |
1925.24 |
2141.77 |
1184.02 |
957.75 |
170.70 |
Illinois Humana Health Plan, Inc. - Standard Self Plus One |
756 |
1839.67 |
2046.59 |
1092.26 |
954.33 |
181.25 |
Illinois Humana Health Plan, Inc. - High Self |
751 |
1212.06 |
1238.94 |
510.84 |
728.10 |
14.76 |
Illinois Humana Health Plan, Inc. - High Self & Family |
752 |
2727.14 |
2787.61 |
1184.02 |
1603.59 |
14.64 |
Illinois Humana Health Plan, Inc. - High Self Plus One |
753 |
2605.92 |
2663.74 |
1092.26 |
1571.48 |
32.15 |
Illinois Humana Health Plan, Inc. - High Self |
9F1 |
1700.27 |
1938.32 |
510.84 |
1427.48 |
225.93 |
Illinois Humana Health Plan, Inc. - High Self & Family |
9F2 |
3825.60 |
4361.20 |
1184.02 |
3177.18 |
489.77 |
Illinois Humana Health Plan, Inc. - High Self Plus One |
9F3 |
3655.56 |
4167.35 |
1092.26 |
3075.09 |
486.12 |
Illinois Humana Health Plan, Inc. - Standard Self |
AB4 |
1094.77 |
1149.53 |
510.84 |
638.69 |
42.64 |
Illinois Humana Health Plan, Inc. - Standard Self & Family |
AB5 |
2463.28 |
2586.44 |
1184.02 |
1402.42 |
77.33 |
Illinois Humana Health Plan, Inc. - Standard Self Plus One |
AB6 |
2353.78 |
2471.50 |
1092.26 |
1379.24 |
92.05 |
Illinois Humana Health Plan, Inc. - Basic Self |
AB1 |
615.16 |
756.64 |
510.84 |
245.80 |
92.01 |
Illinois Humana Health Plan, Inc. - Basic Self & Family |
AB2 |
1384.15 |
1702.50 |
1184.02 |
518.48 |
172.44 |
Illinois Humana Health Plan, Inc. - Basic Self Plus One |
AB3 |
1322.64 |
1626.84 |
1092.26 |
534.58 |
203.92 |
Illinois Humana Health Plan, Inc. - Basic Self |
RW1 |
623.55 |
748.24 |
510.84 |
237.40 |
81.51 |
Illinois Humana Health Plan, Inc. - Basic Self & Family |
RW2 |
1402.96 |
1683.54 |
1184.02 |
499.52 |
148.78 |
Illinois Humana Health Plan, Inc. - Basic Self Plus One |
RW3 |
1340.63 |
1608.73 |
1092.26 |
516.47 |
181.31 |
Illinois MercyCare Health Plans - High Self |
EY1 |
764.05 |
785.92 |
510.84 |
275.08 |
9.75 |
Illinois MercyCare Health Plans - High Self & Family |
EY2 |
1994.01 |
2050.99 |
1184.02 |
866.97 |
11.15 |
Illinois MercyCare Health Plans - High Self Plus One |
EY3 |
1642.81 |
1689.78 |
1092.26 |
597.52 |
21.30 |
Illinois MercyCare Health Plans - Standard Self |
EY4 |
New Plan |
609.59 |
457.19 |
152.40 |
New Plan |
Illinois MercyCare Health Plans - Standard Self & Family |
EY5 |
New Plan |
1590.85 |
1184.02 |
406.83 |
New Plan |
Illinois MercyCare Health Plans - Standard Self Plus One |
EY6 |
New Plan |
1310.68 |
983.01 |
327.67 |
New Plan |
Illinois Union Health Service - High Self |
761 |
681.74 |
744.08 |
510.84 |
233.24 |
50.22 |
Illinois Union Health Service - High Self & Family |
762 |
1711.71 |
1901.64 |
1184.02 |
717.62 |
144.10 |
Illinois Union Health Service - High Self Plus One |
763 |
1511.23 |
1668.33 |
1092.26 |
576.07 |
131.43 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
L91 |
437.06 |
521.50 |
391.13 |
130.37 |
21.11 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
L92 |
1225.49 |
1462.26 |
1096.70 |
365.56 |
59.19 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self Plus One |
L93 |
853.56 |
1018.46 |
763.85 |
254.61 |
41.22 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self |
AS1 |
New Plan |
525.81 |
394.36 |
131.45 |
New Plan |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self & Family |
AS2 |
New Plan |
1243.36 |
932.52 |
310.84 |
New Plan |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self Plus One |
AS3 |
New Plan |
1130.42 |
847.82 |
282.60 |
New Plan |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self |
Y81 |
New Plan |
506.74 |
380.06 |
126.68 |
New Plan |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self & Family |
Y82 |
New Plan |
1198.23 |
898.67 |
299.56 |
New Plan |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self Plus One |
Y83 |
New Plan |
1089.38 |
817.04 |
272.34 |
New Plan |
Indiana Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Indiana Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Indiana Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Indiana Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Indiana Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Indiana Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
JS4 |
803.99 |
1073.48 |
510.84 |
562.64 |
257.37 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
JS5 |
1835.41 |
2450.59 |
1184.02 |
1266.57 |
569.35 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
JS6 |
1817.25 |
2426.32 |
1092.26 |
1334.06 |
583.40 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
JS1 |
1049.04 |
1003.99 |
510.84 |
493.15 |
-57.17 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
JS2 |
2391.35 |
2288.65 |
1184.02 |
1104.63 |
-148.53 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
JS3 |
2367.69 |
2265.99 |
1092.26 |
1173.73 |
-127.37 |
Indiana Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Indiana Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Indiana Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Indiana Health Alliance HMO - Standard Self |
K84 |
642.44 |
668.14 |
501.11 |
167.03 |
6.42 |
Indiana Health Alliance HMO - Standard Self & Family |
K85 |
1734.61 |
1803.99 |
1184.02 |
619.97 |
23.55 |
Indiana Health Alliance HMO - Standard Self Plus One |
K86 |
1488.24 |
1547.78 |
1092.26 |
455.52 |
33.87 |
Indiana Humana CoverageFirst - CDHP Self |
TC1 |
622.12 |
659.47 |
494.60 |
164.87 |
9.34 |
Indiana Humana CoverageFirst - CDHP Self & Family |
TC2 |
1399.75 |
1483.73 |
1112.80 |
370.93 |
20.99 |
Indiana Humana CoverageFirst - CDHP Self Plus One |
TC3 |
1337.55 |
1417.82 |
1063.37 |
354.45 |
20.06 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self |
MW4 |
608.81 |
754.91 |
510.84 |
244.07 |
91.87 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self & Family |
MW5 |
1369.79 |
1698.52 |
1184.02 |
514.50 |
172.05 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
MW6 |
1308.93 |
1623.05 |
1092.26 |
530.79 |
203.56 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self |
MW1 |
757.06 |
916.02 |
510.84 |
405.18 |
146.84 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
MW2 |
1703.41 |
2061.15 |
1184.02 |
877.13 |
311.91 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
MW3 |
1627.67 |
1969.50 |
1092.26 |
877.24 |
316.16 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self |
X34 |
570.27 |
615.12 |
461.34 |
153.78 |
11.21 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self & Family |
X35 |
1283.12 |
1384.05 |
1038.04 |
346.01 |
25.23 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
X36 |
1226.07 |
1322.53 |
991.90 |
330.63 |
24.11 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self |
X31 |
684.65 |
799.44 |
510.84 |
288.60 |
102.67 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
X32 |
1540.48 |
1798.77 |
1184.02 |
614.75 |
212.46 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
X33 |
1472.01 |
1718.82 |
1092.26 |
626.56 |
221.14 |
Indiana Humana Health Plan of Ohio, Inc. - High Self |
A61 |
1172.64 |
1500.98 |
510.84 |
990.14 |
316.22 |
Indiana Humana Health Plan of Ohio, Inc. - High Self & Family |
A62 |
2638.48 |
3377.23 |
1184.02 |
2193.21 |
692.92 |
Indiana Humana Health Plan of Ohio, Inc. - High Self Plus One |
A63 |
2521.22 |
3227.14 |
1092.26 |
2134.88 |
680.25 |
Indiana Humana Health Plan of Ohio, Inc. - Standard Self |
A64 |
930.28 |
1172.17 |
510.84 |
661.33 |
229.77 |
Indiana Humana Health Plan of Ohio, Inc. - Standard Self & Family |
A65 |
2093.17 |
2637.42 |
1184.02 |
1453.40 |
498.42 |
Indiana Humana Health Plan of Ohio, Inc. - Standard Self Plus One |
A66 |
2000.16 |
2520.20 |
1092.26 |
1427.94 |
494.37 |
Indiana Humana Health Plan, Inc. - Standard Self |
754 |
855.66 |
951.90 |
510.84 |
441.06 |
84.12 |
Indiana Humana Health Plan, Inc. - Standard Self & Family |
755 |
1925.24 |
2141.77 |
1184.02 |
957.75 |
170.70 |
Indiana Humana Health Plan, Inc. - Standard Self Plus One |
756 |
1839.67 |
2046.59 |
1092.26 |
954.33 |
181.25 |
Indiana Humana Health Plan, Inc. - High Self |
751 |
1212.06 |
1238.94 |
510.84 |
728.10 |
14.76 |
Indiana Humana Health Plan, Inc. - High Self & Family |
752 |
2727.14 |
2787.61 |
1184.02 |
1603.59 |
14.64 |
Indiana Humana Health Plan, Inc. - High Self Plus One |
753 |
2605.92 |
2663.74 |
1092.26 |
1571.48 |
32.15 |
Indiana Humana Health Plan, Inc. - High Self |
MH1 |
883.98 |
1104.96 |
510.84 |
594.12 |
208.86 |
Indiana Humana Health Plan, Inc. - High Self & Family |
MH2 |
1988.96 |
2486.19 |
1184.02 |
1302.17 |
451.40 |
Indiana Humana Health Plan, Inc. - High Self Plus One |
MH3 |
1900.56 |
2375.69 |
1092.26 |
1283.43 |
449.46 |
Indiana Humana Health Plan, Inc. - Standard Self |
MH4 |
722.39 |
859.65 |
510.84 |
348.81 |
125.14 |
Indiana Humana Health Plan, Inc. - Standard Self & Family |
MH5 |
1625.37 |
1934.18 |
1184.02 |
750.16 |
262.98 |
Indiana Humana Health Plan, Inc. - Standard Self Plus One |
MH6 |
1553.13 |
1848.23 |
1092.26 |
755.97 |
269.43 |
Iowa Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Iowa Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Iowa Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Iowa Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Iowa Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Iowa Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
828.86 |
828.47 |
510.84 |
317.63 |
-12.51 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
1889.38 |
1888.45 |
1184.02 |
704.43 |
-46.76 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
1870.68 |
1869.92 |
1092.26 |
777.66 |
-26.43 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
616.53 |
807.04 |
510.84 |
296.20 |
142.07 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
1414.99 |
1852.18 |
1184.02 |
668.16 |
314.41 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
1387.25 |
1815.86 |
1092.26 |
723.60 |
376.79 |
Iowa Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Iowa Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Iowa Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Iowa Health Alliance HMO - Standard Self |
K84 |
642.44 |
668.14 |
501.11 |
167.03 |
6.42 |
Iowa Health Alliance HMO - Standard Self & Family |
K85 |
1734.61 |
1803.99 |
1184.02 |
619.97 |
23.55 |
Iowa Health Alliance HMO - Standard Self Plus One |
K86 |
1488.24 |
1547.78 |
1092.26 |
455.52 |
33.87 |
Iowa HealthPartners - Standard Self |
V34 |
428.09 |
459.92 |
344.94 |
114.98 |
7.96 |
Iowa HealthPartners - Standard Self & Family |
V35 |
1042.82 |
1120.41 |
840.31 |
280.10 |
19.40 |
Iowa HealthPartners - Standard Self Plus One |
V36 |
946.08 |
1016.45 |
762.34 |
254.11 |
17.59 |
Iowa HealthPartners - High Self |
V31 |
790.31 |
712.31 |
510.84 |
201.47 |
-90.12 |
Iowa HealthPartners - High Self & Family |
V32 |
1925.21 |
1735.20 |
1184.02 |
551.18 |
-235.84 |
Iowa HealthPartners - High Self Plus One |
V33 |
1746.57 |
1574.21 |
1092.26 |
481.95 |
-198.03 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
N71 |
532.16 |
610.42 |
457.82 |
152.60 |
19.56 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
N72 |
1223.93 |
1403.98 |
1052.99 |
350.99 |
45.01 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
N73 |
1144.11 |
1312.42 |
984.32 |
328.10 |
42.07 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
LJ1 |
671.95 |
720.18 |
510.84 |
209.34 |
36.11 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
LJ2 |
1679.86 |
1800.48 |
1184.02 |
616.46 |
74.79 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
LJ3 |
1444.69 |
1548.41 |
1092.26 |
456.15 |
78.05 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self |
AS1 |
New Plan |
525.81 |
394.36 |
131.45 |
New Plan |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self & Family |
AS2 |
New Plan |
1243.36 |
932.52 |
310.84 |
New Plan |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self Plus One |
AS3 |
New Plan |
1130.42 |
847.82 |
282.60 |
New Plan |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self |
Y81 |
New Plan |
506.74 |
380.06 |
126.68 |
New Plan |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self & Family |
Y82 |
New Plan |
1198.23 |
898.67 |
299.56 |
New Plan |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self Plus One |
Y83 |
New Plan |
1089.38 |
817.04 |
272.34 |
New Plan |
Kansas Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Kansas Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Kansas Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Kansas Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Kansas Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Kansas Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
670.58 |
712.73 |
510.84 |
201.89 |
30.03 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
1535.86 |
1632.37 |
1184.02 |
448.35 |
50.68 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
1505.77 |
1600.37 |
1092.26 |
508.11 |
68.93 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
785.14 |
904.50 |
510.84 |
393.66 |
107.24 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
1790.88 |
2063.10 |
1184.02 |
879.08 |
226.39 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
1773.18 |
2042.71 |
1092.26 |
950.45 |
243.86 |
Kansas Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Kansas Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Kansas Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Kansas Aetna Open Access - High Self |
HA1 |
881.01 |
1099.93 |
510.84 |
589.09 |
206.80 |
Kansas Aetna Open Access - High Self & Family |
HA2 |
2081.11 |
2598.18 |
1184.02 |
1414.16 |
471.24 |
Kansas Aetna Open Access - High Self Plus One |
HA3 |
2060.54 |
2572.53 |
1092.26 |
1480.27 |
486.32 |
Kansas Aetna Open Access - Standard Self |
HA4 |
707.85 |
716.37 |
510.84 |
205.53 |
-3.60 |
Kansas Aetna Open Access - Standard Self & Family |
HA5 |
1670.78 |
1690.89 |
1184.02 |
506.87 |
-25.72 |
Kansas Aetna Open Access - Standard Self Plus One |
HA6 |
1654.25 |
1674.16 |
1092.26 |
581.90 |
-5.76 |
Kansas Humana CoverageFirst and Humana Value Plan - Value Self |
PH4 |
428.35 |
484.03 |
363.02 |
121.01 |
13.92 |
Kansas Humana CoverageFirst and Humana Value Plan - Value Self & Family |
PH5 |
963.82 |
1089.10 |
816.83 |
272.27 |
31.32 |
Kansas Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
PH6 |
920.96 |
1040.67 |
780.50 |
260.17 |
29.93 |
Kansas Humana CoverageFirst and Humana Value Plan - CDHP Self |
PH1 |
600.95 |
715.11 |
510.84 |
204.27 |
54.03 |
Kansas Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
PH2 |
1352.13 |
1609.03 |
1184.02 |
425.01 |
86.98 |
Kansas Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
PH3 |
1292.05 |
1537.51 |
1092.26 |
445.25 |
122.24 |
Kansas Humana Health Plan, Inc. - High Self |
MS1 |
1625.63 |
1723.17 |
510.84 |
1212.33 |
85.42 |
Kansas Humana Health Plan, Inc. - High Self & Family |
MS2 |
3657.66 |
3877.12 |
1184.02 |
2693.10 |
173.63 |
Kansas Humana Health Plan, Inc. - High Self Plus One |
MS3 |
3495.09 |
3704.81 |
1092.26 |
2612.55 |
184.05 |
Kansas Humana Health Plan, Inc. - Standard Self |
MS4 |
952.77 |
1067.00 |
510.84 |
556.16 |
102.11 |
Kansas Humana Health Plan, Inc. - Standard Self & Family |
MS5 |
2143.79 |
2400.78 |
1184.02 |
1216.76 |
211.16 |
Kansas Humana Health Plan, Inc. - Standard Self Plus One |
MS6 |
2048.50 |
2294.09 |
1092.26 |
1201.83 |
219.92 |
Kentucky Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Kentucky Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Kentucky Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Kentucky Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Kentucky Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Kentucky Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Kentucky Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
828.86 |
828.47 |
510.84 |
317.63 |
-12.51 |
Kentucky Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
1889.38 |
1888.45 |
1184.02 |
704.43 |
-46.76 |
Kentucky Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
1870.68 |
1869.92 |
1092.26 |
777.66 |
-26.43 |
Kentucky Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
616.53 |
807.04 |
510.84 |
296.20 |
142.07 |
Kentucky Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
1414.99 |
1852.18 |
1184.02 |
668.16 |
314.41 |
Kentucky Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
1387.25 |
1815.86 |
1092.26 |
723.60 |
376.79 |
Kentucky Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Kentucky Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Kentucky Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Kentucky Humana CoverageFirst - CDHP Self |
TC1 |
622.12 |
659.47 |
494.60 |
164.87 |
9.34 |
Kentucky Humana CoverageFirst - CDHP Self & Family |
TC2 |
1399.75 |
1483.73 |
1112.80 |
370.93 |
20.99 |
Kentucky Humana CoverageFirst - CDHP Self Plus One |
TC3 |
1337.55 |
1417.82 |
1063.37 |
354.45 |
20.06 |
Kentucky Humana CoverageFirst - CDHP Self |
6N1 |
633.64 |
766.70 |
510.84 |
255.86 |
97.45 |
Kentucky Humana CoverageFirst - CDHP Self & Family |
6N2 |
1425.69 |
1725.08 |
1184.02 |
541.06 |
184.64 |
Kentucky Humana CoverageFirst - CDHP Self Plus One |
6N3 |
1362.31 |
1648.40 |
1092.26 |
556.14 |
215.56 |
Kentucky Humana CoverageFirst and Humana Value Plan - Value Self |
X34 |
570.27 |
615.12 |
461.34 |
153.78 |
11.21 |
Kentucky Humana CoverageFirst and Humana Value Plan - Value Self & Family |
X35 |
1283.12 |
1384.05 |
1038.04 |
346.01 |
25.23 |
Kentucky Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
X36 |
1226.07 |
1322.53 |
991.90 |
330.63 |
24.11 |
Kentucky Humana CoverageFirst and Humana Value Plan - CDHP Self |
X31 |
684.65 |
799.44 |
510.84 |
288.60 |
102.67 |
Kentucky Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
X32 |
1540.48 |
1798.77 |
1184.02 |
614.75 |
212.46 |
Kentucky Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
X33 |
1472.01 |
1718.82 |
1092.26 |
626.56 |
221.14 |
Kentucky Humana Health Plan of Ohio, Inc. - High Self |
A61 |
1172.64 |
1500.98 |
510.84 |
990.14 |
316.22 |
Kentucky Humana Health Plan of Ohio, Inc. - High Self & Family |
A62 |
2638.48 |
3377.23 |
1184.02 |
2193.21 |
692.92 |
Kentucky Humana Health Plan of Ohio, Inc. - High Self Plus One |
A63 |
2521.22 |
3227.14 |
1092.26 |
2134.88 |
680.25 |
Kentucky Humana Health Plan of Ohio, Inc. - Standard Self |
A64 |
930.28 |
1172.17 |
510.84 |
661.33 |
229.77 |
Kentucky Humana Health Plan of Ohio, Inc. - Standard Self & Family |
A65 |
2093.17 |
2637.42 |
1184.02 |
1453.40 |
498.42 |
Kentucky Humana Health Plan of Ohio, Inc. - Standard Self Plus One |
A66 |
2000.16 |
2520.20 |
1092.26 |
1427.94 |
494.37 |
Kentucky Humana Health Plan of Ohio, Inc. - Basic Self |
W61 |
585.78 |
608.62 |
456.47 |
152.15 |
5.71 |
Kentucky Humana Health Plan of Ohio, Inc. - Basic Self & Family |
W62 |
1318.01 |
1369.44 |
1027.08 |
342.36 |
12.86 |
Kentucky Humana Health Plan of Ohio, Inc. - Basic Self Plus One |
W63 |
1259.42 |
1308.58 |
981.44 |
327.14 |
12.29 |
Kentucky Humana Health Plan, Inc. - High Self |
MI1 |
1123.14 |
1381.45 |
510.84 |
870.61 |
246.19 |
Kentucky Humana Health Plan, Inc. - High Self & Family |
MI2 |
2527.03 |
3108.24 |
1184.02 |
1924.22 |
535.38 |
Kentucky Humana Health Plan, Inc. - High Self Plus One |
MI3 |
2414.71 |
2970.09 |
1092.26 |
1877.83 |
529.71 |
Kentucky Humana Health Plan, Inc. - Standard Self |
MI4 |
811.92 |
885.00 |
510.84 |
374.16 |
60.96 |
Kentucky Humana Health Plan, Inc. - Standard Self & Family |
MI5 |
1826.80 |
1991.21 |
1184.02 |
807.19 |
118.58 |
Kentucky Humana Health Plan, Inc. - Standard Self Plus One |
MI6 |
1745.62 |
1902.75 |
1092.26 |
810.49 |
131.46 |
Kentucky Humana Health Plan, Inc. - High Self |
MH1 |
883.98 |
1104.96 |
510.84 |
594.12 |
208.86 |
Kentucky Humana Health Plan, Inc. - High Self & Family |
MH2 |
1988.96 |
2486.19 |
1184.02 |
1302.17 |
451.40 |
Kentucky Humana Health Plan, Inc. - High Self Plus One |
MH3 |
1900.56 |
2375.69 |
1092.26 |
1283.43 |
449.46 |
Kentucky Humana Health Plan, Inc. - Standard Self |
MH4 |
722.39 |
859.65 |
510.84 |
348.81 |
125.14 |
Kentucky Humana Health Plan, Inc. - Standard Self & Family |
MH5 |
1625.37 |
1934.18 |
1184.02 |
750.16 |
262.98 |
Kentucky Humana Health Plan, Inc. - Standard Self Plus One |
MH6 |
1553.13 |
1848.23 |
1092.26 |
755.97 |
269.43 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
N71 |
532.16 |
610.42 |
457.82 |
152.60 |
19.56 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
N72 |
1223.93 |
1403.98 |
1052.99 |
350.99 |
45.01 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
N73 |
1144.11 |
1312.42 |
984.32 |
328.10 |
42.07 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
LJ1 |
671.95 |
720.18 |
510.84 |
209.34 |
36.11 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
LJ2 |
1679.86 |
1800.48 |
1184.02 |
616.46 |
74.79 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
LJ3 |
1444.69 |
1548.41 |
1092.26 |
456.15 |
78.05 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self |
AS1 |
New Plan |
525.81 |
394.36 |
131.45 |
New Plan |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self & Family |
AS2 |
New Plan |
1243.36 |
932.52 |
310.84 |
New Plan |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self Plus One |
AS3 |
New Plan |
1130.42 |
847.82 |
282.60 |
New Plan |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self |
Y81 |
New Plan |
506.74 |
380.06 |
126.68 |
New Plan |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self & Family |
Y82 |
New Plan |
1198.23 |
898.67 |
299.56 |
New Plan |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self Plus One |
Y83 |
New Plan |
1089.38 |
817.04 |
272.34 |
New Plan |
Louisiana Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Louisiana Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Louisiana Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Louisiana Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Louisiana Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Louisiana Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Louisiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
810.79 |
829.23 |
510.84 |
318.39 |
6.32 |
Louisiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
1848.71 |
1890.72 |
1184.02 |
706.70 |
-3.82 |
Louisiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
1830.40 |
1872.00 |
1092.26 |
779.74 |
15.93 |
Louisiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
708.44 |
819.98 |
510.84 |
309.14 |
99.42 |
Louisiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
1622.25 |
1877.61 |
1184.02 |
693.59 |
209.53 |
Louisiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
1590.42 |
1840.78 |
1092.26 |
748.52 |
224.69 |
Louisiana Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Louisiana Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Louisiana Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - Standard Self |
BC4 |
596.57 |
674.14 |
505.61 |
168.53 |
19.39 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - Standard Self & Family |
BC5 |
1342.29 |
1516.80 |
1137.60 |
379.20 |
43.63 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - Standard Self Plus One |
BC6 |
1282.62 |
1449.37 |
1087.03 |
362.34 |
41.69 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - High Self |
BC1 |
751.10 |
901.33 |
510.84 |
390.49 |
138.11 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - High Self & Family |
BC2 |
1690.02 |
2028.02 |
1184.02 |
844.00 |
292.17 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - High Self Plus One |
BC3 |
1614.90 |
1937.89 |
1092.26 |
845.63 |
297.32 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - High Self |
AE1 |
864.05 |
1071.42 |
510.84 |
560.58 |
195.25 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - High Self & Family |
AE2 |
1944.06 |
2410.63 |
1184.02 |
1226.61 |
420.74 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - High Self Plus One |
AE3 |
1857.68 |
2303.51 |
1092.26 |
1211.25 |
420.16 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - Standard Self |
AE4 |
734.05 |
807.45 |
510.84 |
296.61 |
61.28 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - Standard Self & Family |
AE5 |
1651.63 |
1816.79 |
1184.02 |
632.77 |
119.33 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - Standard Self Plus One |
AE6 |
1578.22 |
1736.04 |
1092.26 |
643.78 |
132.15 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LS1 |
418.71 |
454.74 |
341.06 |
113.68 |
9.00 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LS2 |
963.08 |
1045.92 |
784.44 |
261.48 |
20.71 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LS3 |
900.25 |
977.71 |
733.28 |
244.43 |
19.37 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KK1 |
679.03 |
713.87 |
510.84 |
203.03 |
22.72 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KK2 |
1697.63 |
1784.71 |
1184.02 |
600.69 |
41.25 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KK3 |
1459.94 |
1534.87 |
1092.26 |
442.61 |
49.26 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self |
AS1 |
New Plan |
525.81 |
394.36 |
131.45 |
New Plan |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self & Family |
AS2 |
New Plan |
1243.36 |
932.52 |
310.84 |
New Plan |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self Plus One |
AS3 |
New Plan |
1130.42 |
847.82 |
282.60 |
New Plan |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self |
Y81 |
New Plan |
506.74 |
380.06 |
126.68 |
New Plan |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self & Family |
Y82 |
New Plan |
1198.23 |
898.67 |
299.56 |
New Plan |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self Plus One |
Y83 |
New Plan |
1089.38 |
817.04 |
272.34 |
New Plan |
Maine Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Maine Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Maine Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Maine Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Maine Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Maine Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Maine Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
619.08 |
759.61 |
510.84 |
248.77 |
94.00 |
Maine Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
1417.65 |
1739.51 |
1184.02 |
555.49 |
201.08 |
Maine Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
1389.85 |
1705.38 |
1092.26 |
613.12 |
265.66 |
Maine Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
916.80 |
1075.75 |
510.84 |
564.91 |
146.83 |
Maine Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
2090.83 |
2453.32 |
1184.02 |
1269.30 |
316.66 |
Maine Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
2070.12 |
2429.03 |
1092.26 |
1336.77 |
333.24 |
Maine Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Maine Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Maine Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Maryland Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Maryland Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Maryland Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Maryland Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Maryland Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Maryland Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Maryland Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
810.79 |
829.23 |
510.84 |
318.39 |
6.32 |
Maryland Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
1848.71 |
1890.72 |
1184.02 |
706.70 |
-3.82 |
Maryland Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
1830.40 |
1872.00 |
1092.26 |
779.74 |
15.93 |
Maryland Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
708.44 |
819.98 |
510.84 |
309.14 |
99.42 |
Maryland Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
1622.25 |
1877.61 |
1184.02 |
693.59 |
209.53 |
Maryland Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
1590.42 |
1840.78 |
1092.26 |
748.52 |
224.69 |
Maryland Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Maryland Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Maryland Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Maryland Aetna Open Access - High Self |
JN1 |
1119.13 |
1137.57 |
510.84 |
626.73 |
6.32 |
Maryland Aetna Open Access - High Self & Family |
JN2 |
2515.98 |
2557.43 |
1184.02 |
1373.41 |
-4.38 |
Maryland Aetna Open Access - High Self Plus One |
JN3 |
2491.04 |
2532.10 |
1092.26 |
1439.84 |
15.39 |
Maryland Aetna Open Access - Basic Self |
JN4 |
680.46 |
697.10 |
510.84 |
186.26 |
4.52 |
Maryland Aetna Open Access - Basic Self & Family |
JN5 |
1557.25 |
1595.34 |
1184.02 |
411.32 |
-7.74 |
Maryland Aetna Open Access - Basic Self Plus One |
JN6 |
1430.00 |
1464.99 |
1092.26 |
372.73 |
9.32 |
Maryland Aetna Saver - Saver Self |
QQ4 |
New Plan |
595.21 |
446.41 |
148.80 |
New Plan |
Maryland Aetna Saver - Saver Self & Family |
QQ5 |
New Plan |
1362.14 |
1021.61 |
340.53 |
New Plan |
Maryland Aetna Saver - Saver Self Plus One |
QQ6 |
New Plan |
1250.82 |
938.12 |
312.70 |
New Plan |
Maryland CareFirst BlueChoice - Standard Self |
2G4 |
797.68 |
845.54 |
510.84 |
334.70 |
35.74 |
Maryland CareFirst BlueChoice - Standard Self & Family |
2G5 |
1895.25 |
2008.96 |
1184.02 |
824.94 |
67.88 |
Maryland CareFirst BlueChoice - Standard Self Plus One |
2G6 |
1595.34 |
1691.06 |
1092.26 |
598.80 |
70.05 |
Maryland CareFirst BlueChoice - HDHP Self |
B61 |
518.27 |
570.09 |
427.57 |
142.52 |
12.95 |
Maryland CareFirst BlueChoice - HDHP Self & Family |
B62 |
1231.38 |
1354.51 |
1015.88 |
338.63 |
30.79 |
Maryland CareFirst BlueChoice - HDHP Self Plus One |
B63 |
1036.51 |
1140.17 |
855.13 |
285.04 |
25.91 |
Maryland CareFirst BlueChoice - Blue Value Plus Self |
B64 |
New Plan |
705.99 |
510.84 |
195.15 |
New Plan |
Maryland CareFirst BlueChoice - Blue Value Plus Self & Family |
B65 |
New Plan |
1677.46 |
1184.02 |
493.44 |
New Plan |
Maryland CareFirst BlueChoice - Blue Value Plus Self Plus One |
B66 |
New Plan |
1412.02 |
1059.02 |
353.00 |
New Plan |
Maryland Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. - Basic Self |
T71 |
420.12 |
420.12 |
315.09 |
105.03 |
0.00 |
Maryland Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. - Basic Self & Family |
T72 |
1026.16 |
1026.16 |
769.62 |
256.54 |
0.00 |
Maryland Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. - Basic Self Plus One |
T73 |
934.90 |
934.90 |
701.18 |
233.72 |
0.00 |
Maryland Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. - Standard Self |
E34 |
521.76 |
571.55 |
428.66 |
142.89 |
12.45 |
Maryland Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. - Standard Self & Family |
E35 |
1199.99 |
1314.50 |
985.88 |
328.62 |
28.62 |
Maryland Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. - Standard Self Plus One |
E36 |
1199.99 |
1314.50 |
985.88 |
328.62 |
28.62 |
Maryland Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. - High Self |
E31 |
692.68 |
722.82 |
510.84 |
211.98 |
18.02 |
Maryland Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. - High Self & Family |
E32 |
1593.15 |
1662.53 |
1184.02 |
478.51 |
23.55 |
Maryland Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. - High Self Plus One |
E33 |
1593.15 |
1662.53 |
1092.26 |
570.27 |
43.71 |
Maryland M.D. IPA - High Self |
JP1 |
790.86 |
876.61 |
510.84 |
365.77 |
73.63 |
Maryland M.D. IPA - High Self & Family |
JP2 |
2217.54 |
2458.04 |
1184.02 |
1274.02 |
194.67 |
Maryland M.D. IPA - High Self Plus One |
JP3 |
1544.53 |
1712.04 |
1092.26 |
619.78 |
141.84 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
V41 |
495.69 |
486.57 |
364.93 |
121.64 |
-2.28 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
V42 |
1140.06 |
1119.11 |
839.33 |
279.78 |
-5.23 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
V43 |
1065.72 |
1046.13 |
784.60 |
261.53 |
-4.90 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
LR1 |
667.94 |
714.89 |
510.84 |
204.05 |
34.83 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
LR2 |
1582.99 |
1694.29 |
1184.02 |
510.27 |
65.47 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
LR3 |
1436.05 |
1536.99 |
1092.26 |
444.73 |
75.27 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
L91 |
437.06 |
521.50 |
391.13 |
130.37 |
21.11 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
L92 |
1225.49 |
1462.26 |
1096.70 |
365.56 |
59.19 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self Plus One |
L93 |
853.56 |
1018.46 |
763.85 |
254.61 |
41.22 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self |
AS1 |
New Plan |
525.81 |
394.36 |
131.45 |
New Plan |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self & Family |
AS2 |
New Plan |
1243.36 |
932.52 |
310.84 |
New Plan |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self Plus One |
AS3 |
New Plan |
1130.42 |
847.82 |
282.60 |
New Plan |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self |
Y81 |
New Plan |
506.74 |
380.06 |
126.68 |
New Plan |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self & Family |
Y82 |
New Plan |
1198.23 |
898.67 |
299.56 |
New Plan |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self Plus One |
Y83 |
New Plan |
1089.38 |
817.04 |
272.34 |
New Plan |
Massachusetts Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Massachusetts Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Massachusetts Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Massachusetts Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Massachusetts Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Massachusetts Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
619.08 |
759.61 |
510.84 |
248.77 |
94.00 |
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
1417.65 |
1739.51 |
1184.02 |
555.49 |
201.08 |
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
1389.85 |
1705.38 |
1092.26 |
613.12 |
265.66 |
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
916.80 |
1075.75 |
510.84 |
564.91 |
146.83 |
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
2090.83 |
2453.32 |
1184.02 |
1269.30 |
316.66 |
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
2070.12 |
2429.03 |
1092.26 |
1336.77 |
333.24 |
Massachusetts Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Massachusetts Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Massachusetts Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Michigan Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Michigan Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Michigan Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Michigan Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Michigan Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Michigan Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Michigan Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
670.58 |
712.73 |
510.84 |
201.89 |
30.03 |
Michigan Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
1535.86 |
1632.37 |
1184.02 |
448.35 |
50.68 |
Michigan Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
1505.77 |
1600.37 |
1092.26 |
508.11 |
68.93 |
Michigan Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
785.14 |
904.50 |
510.84 |
393.66 |
107.24 |
Michigan Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
1790.88 |
2063.10 |
1184.02 |
879.08 |
226.39 |
Michigan Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
1773.18 |
2042.71 |
1092.26 |
950.45 |
243.86 |
Michigan Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Michigan Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Michigan Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Michigan Blue Care Network of Michigan - High Self |
LX1 |
734.72 |
742.86 |
510.84 |
232.02 |
-3.98 |
Michigan Blue Care Network of Michigan - High Self & Family |
LX2 |
1792.64 |
1812.59 |
1184.02 |
628.57 |
-25.88 |
Michigan Blue Care Network of Michigan - High Self Plus One |
LX3 |
1689.81 |
1708.57 |
1092.26 |
616.31 |
-6.91 |
Michigan Blue Care Network of Michigan - High Self |
K51 |
943.45 |
957.73 |
510.84 |
446.89 |
2.16 |
Michigan Blue Care Network of Michigan - High Self & Family |
K52 |
2301.95 |
2336.82 |
1184.02 |
1152.80 |
-10.96 |
Michigan Blue Care Network of Michigan - High Self Plus One |
K53 |
2169.90 |
2202.72 |
1092.26 |
1110.46 |
7.15 |
Michigan Health Alliance Plan - High Self |
521 |
763.84 |
787.89 |
510.84 |
277.05 |
11.93 |
Michigan Health Alliance Plan - High Self & Family |
522 |
1863.72 |
1922.44 |
1184.02 |
738.42 |
12.89 |
Michigan Health Alliance Plan - High Self Plus One |
523 |
1756.82 |
1812.14 |
1092.26 |
719.88 |
29.65 |
Michigan Health Alliance Plan - Standard Self |
GY4 |
598.35 |
614.23 |
460.67 |
153.56 |
3.97 |
Michigan Health Alliance Plan - Standard Self & Family |
GY5 |
1460.01 |
1498.77 |
1124.08 |
374.69 |
9.69 |
Michigan Health Alliance Plan - Standard Self Plus One |
GY6 |
1376.22 |
1412.78 |
1059.59 |
353.19 |
9.14 |
Michigan Priority Health - High Self |
LE1 |
912.10 |
919.58 |
510.84 |
408.74 |
-4.64 |
Michigan Priority Health - High Self & Family |
LE2 |
2143.44 |
2161.01 |
1184.02 |
976.99 |
-28.26 |
Michigan Priority Health - High Self Plus One |
LE3 |
2006.64 |
2023.06 |
1092.26 |
930.80 |
-9.25 |
Michigan Priority Health - Standard Self |
LE4 |
504.44 |
539.33 |
404.50 |
134.83 |
8.72 |
Michigan Priority Health - Standard Self & Family |
LE5 |
1185.45 |
1267.44 |
950.58 |
316.86 |
20.50 |
Michigan Priority Health - Standard Self Plus One |
LE6 |
1109.79 |
1186.53 |
889.90 |
296.63 |
19.18 |
Michigan Priority Health - Value Self |
Y41 |
New Plan |
473.24 |
354.93 |
118.31 |
New Plan |
Michigan Priority Health - Value Self & Family |
Y42 |
New Plan |
1112.13 |
834.10 |
278.03 |
New Plan |
Michigan Priority Health - Value Self Plus One |
Y43 |
New Plan |
1041.13 |
780.85 |
260.28 |
New Plan |
Minnesota Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Minnesota Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Minnesota Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Minnesota Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Minnesota Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Minnesota Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Minnesota Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
828.86 |
828.47 |
510.84 |
317.63 |
-12.51 |
Minnesota Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
1889.38 |
1888.45 |
1184.02 |
704.43 |
-46.76 |
Minnesota Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
1870.68 |
1869.92 |
1092.26 |
777.66 |
-26.43 |
Minnesota Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
616.53 |
807.04 |
510.84 |
296.20 |
142.07 |
Minnesota Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
1414.99 |
1852.18 |
1184.02 |
668.16 |
314.41 |
Minnesota Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
1387.25 |
1815.86 |
1092.26 |
723.60 |
376.79 |
Minnesota Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Minnesota Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Minnesota Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Minnesota HealthPartners - Standard Self |
V34 |
428.09 |
459.92 |
344.94 |
114.98 |
7.96 |
Minnesota HealthPartners - Standard Self & Family |
V35 |
1042.82 |
1120.41 |
840.31 |
280.10 |
19.40 |
Minnesota HealthPartners - Standard Self Plus One |
V36 |
946.08 |
1016.45 |
762.34 |
254.11 |
17.59 |
Minnesota HealthPartners - High Self |
V31 |
790.31 |
712.31 |
510.84 |
201.47 |
-90.12 |
Minnesota HealthPartners - High Self & Family |
V32 |
1925.21 |
1735.20 |
1184.02 |
551.18 |
-235.84 |
Minnesota HealthPartners - High Self Plus One |
V33 |
1746.57 |
1574.21 |
1092.26 |
481.95 |
-198.03 |
Mississippi Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Mississippi Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Mississippi Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Mississippi Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Mississippi Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Mississippi Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Mississippi Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
828.86 |
828.47 |
510.84 |
317.63 |
-12.51 |
Mississippi Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
1889.38 |
1888.45 |
1184.02 |
704.43 |
-46.76 |
Mississippi Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
1870.68 |
1869.92 |
1092.26 |
777.66 |
-26.43 |
Mississippi Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
616.53 |
807.04 |
510.84 |
296.20 |
142.07 |
Mississippi Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
1414.99 |
1852.18 |
1184.02 |
668.16 |
314.41 |
Mississippi Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
1387.25 |
1815.86 |
1092.26 |
723.60 |
376.79 |
Mississippi Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Mississippi Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Mississippi Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LS1 |
418.71 |
454.74 |
341.06 |
113.68 |
9.00 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LS2 |
963.08 |
1045.92 |
784.44 |
261.48 |
20.71 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LS3 |
900.25 |
977.71 |
733.28 |
244.43 |
19.37 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KK1 |
679.03 |
713.87 |
510.84 |
203.03 |
22.72 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KK2 |
1697.63 |
1784.71 |
1184.02 |
600.69 |
41.25 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KK3 |
1459.94 |
1534.87 |
1092.26 |
442.61 |
49.26 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self |
AS1 |
New Plan |
525.81 |
394.36 |
131.45 |
New Plan |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self & Family |
AS2 |
New Plan |
1243.36 |
932.52 |
310.84 |
New Plan |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self Plus One |
AS3 |
New Plan |
1130.42 |
847.82 |
282.60 |
New Plan |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self |
Y81 |
New Plan |
506.74 |
380.06 |
126.68 |
New Plan |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self & Family |
Y82 |
New Plan |
1198.23 |
898.67 |
299.56 |
New Plan |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self Plus One |
Y83 |
New Plan |
1089.38 |
817.04 |
272.34 |
New Plan |
Missouri Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Missouri Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Missouri Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Missouri Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Missouri Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Missouri Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Missouri Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
670.58 |
712.73 |
510.84 |
201.89 |
30.03 |
Missouri Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
1535.86 |
1632.37 |
1184.02 |
448.35 |
50.68 |
Missouri Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
1505.77 |
1600.37 |
1092.26 |
508.11 |
68.93 |
Missouri Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
785.14 |
904.50 |
510.84 |
393.66 |
107.24 |
Missouri Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
1790.88 |
2063.10 |
1184.02 |
879.08 |
226.39 |
Missouri Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
1773.18 |
2042.71 |
1092.26 |
950.45 |
243.86 |
Missouri Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Missouri Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Missouri Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Missouri Aetna Open Access - High Self |
HA1 |
881.01 |
1099.93 |
510.84 |
589.09 |
206.80 |
Missouri Aetna Open Access - High Self & Family |
HA2 |
2081.11 |
2598.18 |
1184.02 |
1414.16 |
471.24 |
Missouri Aetna Open Access - High Self Plus One |
HA3 |
2060.54 |
2572.53 |
1092.26 |
1480.27 |
486.32 |
Missouri Aetna Open Access - Standard Self |
HA4 |
707.85 |
716.37 |
510.84 |
205.53 |
-3.60 |
Missouri Aetna Open Access - Standard Self & Family |
HA5 |
1670.78 |
1690.89 |
1184.02 |
506.87 |
-25.72 |
Missouri Aetna Open Access - Standard Self Plus One |
HA6 |
1654.25 |
1674.16 |
1092.26 |
581.90 |
-5.76 |
Missouri Blue Preferred - High Self |
9G1 |
782.36 |
833.21 |
510.84 |
322.37 |
38.73 |
Missouri Blue Preferred - High Self & Family |
9G2 |
1681.07 |
1858.87 |
1184.02 |
674.85 |
131.97 |
Missouri Blue Preferred - High Self Plus One |
9G3 |
1591.81 |
1760.59 |
1092.26 |
668.33 |
143.11 |
Missouri Blue Preferred - Standard Self |
9G4 |
558.72 |
600.62 |
450.47 |
150.15 |
10.47 |
Missouri Blue Preferred - Standard Self & Family |
9G5 |
1587.91 |
1707.01 |
1184.02 |
522.99 |
73.27 |
Missouri Blue Preferred - Standard Self Plus One |
9G6 |
1436.02 |
1543.71 |
1092.26 |
451.45 |
82.02 |
Missouri Humana CoverageFirst and Humana Value Plan - Value Self |
PH4 |
428.35 |
484.03 |
363.02 |
121.01 |
13.92 |
Missouri Humana CoverageFirst and Humana Value Plan - Value Self & Family |
PH5 |
963.82 |
1089.10 |
816.83 |
272.27 |
31.32 |
Missouri Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
PH6 |
920.96 |
1040.67 |
780.50 |
260.17 |
29.93 |
Missouri Humana CoverageFirst and Humana Value Plan - CDHP Self |
PH1 |
600.95 |
715.11 |
510.84 |
204.27 |
54.03 |
Missouri Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
PH2 |
1352.13 |
1609.03 |
1184.02 |
425.01 |
86.98 |
Missouri Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
PH3 |
1292.05 |
1537.51 |
1092.26 |
445.25 |
122.24 |
Missouri Humana Health Plan, Inc. - High Self |
MS1 |
1625.63 |
1723.17 |
510.84 |
1212.33 |
85.42 |
Missouri Humana Health Plan, Inc. - High Self & Family |
MS2 |
3657.66 |
3877.12 |
1184.02 |
2693.10 |
173.63 |
Missouri Humana Health Plan, Inc. - High Self Plus One |
MS3 |
3495.09 |
3704.81 |
1092.26 |
2612.55 |
184.05 |
Missouri Humana Health Plan, Inc. - Standard Self |
MS4 |
952.77 |
1067.00 |
510.84 |
556.16 |
102.11 |
Missouri Humana Health Plan, Inc. - Standard Self & Family |
MS5 |
2143.79 |
2400.78 |
1184.02 |
1216.76 |
211.16 |
Missouri Humana Health Plan, Inc. - Standard Self Plus One |
MS6 |
2048.50 |
2294.09 |
1092.26 |
1201.83 |
219.92 |
Missouri UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self |
AS1 |
New Plan |
525.81 |
394.36 |
131.45 |
New Plan |
Missouri UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self & Family |
AS2 |
New Plan |
1243.36 |
932.52 |
310.84 |
New Plan |
Missouri UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self Plus One |
AS3 |
New Plan |
1130.42 |
847.82 |
282.60 |
New Plan |
Missouri UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self |
Y81 |
New Plan |
506.74 |
380.06 |
126.68 |
New Plan |
Missouri UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self & Family |
Y82 |
New Plan |
1198.23 |
898.67 |
299.56 |
New Plan |
Missouri UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self Plus One |
Y83 |
New Plan |
1089.38 |
817.04 |
272.34 |
New Plan |
Montana Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Montana Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Montana Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Montana Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Montana Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Montana Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Montana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
828.86 |
828.47 |
510.84 |
317.63 |
-12.51 |
Montana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
1889.38 |
1888.45 |
1184.02 |
704.43 |
-46.76 |
Montana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
1870.68 |
1869.92 |
1092.26 |
777.66 |
-26.43 |
Montana Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
616.53 |
807.04 |
510.84 |
296.20 |
142.07 |
Montana Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
1414.99 |
1852.18 |
1184.02 |
668.16 |
314.41 |
Montana Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
1387.25 |
1815.86 |
1092.26 |
723.60 |
376.79 |
Montana Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Montana Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Montana Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Nebraska Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Nebraska Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Nebraska Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Nebraska Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Nebraska Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Nebraska Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Nebraska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
828.86 |
828.47 |
510.84 |
317.63 |
-12.51 |
Nebraska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
1889.38 |
1888.45 |
1184.02 |
704.43 |
-46.76 |
Nebraska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
1870.68 |
1869.92 |
1092.26 |
777.66 |
-26.43 |
Nebraska Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
616.53 |
807.04 |
510.84 |
296.20 |
142.07 |
Nebraska Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
1414.99 |
1852.18 |
1184.02 |
668.16 |
314.41 |
Nebraska Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
1387.25 |
1815.86 |
1092.26 |
723.60 |
376.79 |
Nebraska Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Nebraska Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Nebraska Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Nevada Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
Nevada Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
Nevada Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
Nevada Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
Nevada Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
Nevada Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
Nevada Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
670.58 |
712.73 |
510.84 |
201.89 |
30.03 |
Nevada Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
1535.86 |
1632.37 |
1184.02 |
448.35 |
50.68 |
Nevada Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
1505.77 |
1600.37 |
1092.26 |
508.11 |
68.93 |
Nevada Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
785.14 |
904.50 |
510.84 |
393.66 |
107.24 |
Nevada Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
1790.88 |
2063.10 |
1184.02 |
879.08 |
226.39 |
Nevada Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
1773.18 |
2042.71 |
1092.26 |
950.45 |
243.86 |
Nevada Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
Nevada Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
Nevada Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
Nevada Health Plan of Nevada, Inc. - High Self |
NM1 |
658.54 |
706.98 |
510.84 |
196.14 |
31.51 |
Nevada Health Plan of Nevada, Inc. - High Self & Family |
NM2 |
1560.67 |
1675.48 |
1184.02 |
491.46 |
68.98 |
Nevada Health Plan of Nevada, Inc. - High Self Plus One |
NM3 |
1251.25 |
1343.29 |
1007.47 |
335.82 |
23.01 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LU1 |
450.32 |
443.84 |
332.88 |
110.96 |
-1.62 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LU2 |
1035.73 |
1020.85 |
765.64 |
255.21 |
-3.72 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LU3 |
968.20 |
954.27 |
715.70 |
238.57 |
-3.48 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KT1 |
679.19 |
724.77 |
510.84 |
213.93 |
33.46 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KT2 |
1697.95 |
1811.90 |
1184.02 |
627.88 |
68.12 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KT3 |
1460.23 |
1558.25 |
1092.26 |
465.99 |
72.35 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self |
WF1 |
New Plan |
522.86 |
392.15 |
130.71 |
New Plan |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self & Family |
WF2 |
New Plan |
1236.39 |
927.29 |
309.10 |
New Plan |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Plus Primary Advantage - High Self Plus One |
WF3 |
New Plan |
1124.05 |
843.04 |
281.01 |
New Plan |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self |
VD1 |
New Plan |
522.02 |
391.52 |
130.50 |
New Plan |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self & Family |
VD2 |
New Plan |
1234.37 |
925.78 |
308.59 |
New Plan |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Primary Advantage - High Self Plus One |
VD3 |
New Plan |
1122.23 |
841.67 |
280.56 |
New Plan |
New Hampshire Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
New Hampshire Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
New Hampshire Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
New Hampshire Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
New Hampshire Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
New Hampshire Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
619.08 |
759.61 |
510.84 |
248.77 |
94.00 |
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
1417.65 |
1739.51 |
1184.02 |
555.49 |
201.08 |
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
1389.85 |
1705.38 |
1092.26 |
613.12 |
265.66 |
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
916.80 |
1075.75 |
510.84 |
564.91 |
146.83 |
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
2090.83 |
2453.32 |
1184.02 |
1269.30 |
316.66 |
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
2070.12 |
2429.03 |
1092.26 |
1336.77 |
333.24 |
New Hampshire Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
New Hampshire Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
New Hampshire Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
New Jersey Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
New Jersey Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
New Jersey Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
New Jersey Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
New Jersey Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
New Jersey Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
New Jersey Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
619.08 |
759.61 |
510.84 |
248.77 |
94.00 |
New Jersey Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
1417.65 |
1739.51 |
1184.02 |
555.49 |
201.08 |
New Jersey Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
1389.85 |
1705.38 |
1092.26 |
613.12 |
265.66 |
New Jersey Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
916.80 |
1075.75 |
510.84 |
564.91 |
146.83 |
New Jersey Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
2090.83 |
2453.32 |
1184.02 |
1269.30 |
316.66 |
New Jersey Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
2070.12 |
2429.03 |
1092.26 |
1336.77 |
333.24 |
New Jersey Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
New Jersey Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
New Jersey Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
New Jersey Aetna Open Access - High Self |
JR1 |
1409.79 |
1544.75 |
510.84 |
1033.91 |
122.84 |
New Jersey Aetna Open Access - High Self & Family |
JR2 |
3256.46 |
3568.20 |
1184.02 |
2384.18 |
265.91 |
New Jersey Aetna Open Access - High Self Plus One |
JR3 |
3224.20 |
3532.84 |
1092.26 |
2440.58 |
282.97 |
New Jersey Aetna Open Access - Basic Self |
JR4 |
1163.41 |
1373.28 |
510.84 |
862.44 |
197.75 |
New Jersey Aetna Open Access - Basic Self & Family |
JR5 |
2696.33 |
3182.68 |
1184.02 |
1998.66 |
440.52 |
New Jersey Aetna Open Access - Basic Self Plus One |
JR6 |
2669.62 |
3151.16 |
1092.26 |
2058.90 |
455.87 |
New Jersey Aetna Open Access - Basic Self |
P34 |
1298.46 |
1310.08 |
510.84 |
799.24 |
-0.50 |
New Jersey Aetna Open Access - Basic Self & Family |
P35 |
3013.75 |
3040.68 |
1184.02 |
1856.66 |
-18.90 |
New Jersey Aetna Open Access - Basic Self Plus One |
P36 |
2983.89 |
3010.54 |
1092.26 |
1918.28 |
0.98 |
New Jersey Aetna Open Access - High Self |
P31 |
1485.21 |
1456.61 |
510.84 |
945.77 |
-40.72 |
New Jersey Aetna Open Access - High Self & Family |
P32 |
3600.91 |
3531.54 |
1184.02 |
2347.52 |
-115.20 |
New Jersey Aetna Open Access - High Self Plus One |
P33 |
3565.25 |
3496.55 |
1092.26 |
2404.29 |
-94.37 |
New Jersey GHI Health Plan - Standard Self |
804 |
925.97 |
1004.66 |
510.84 |
493.82 |
66.57 |
New Jersey GHI Health Plan - Standard Self & Family |
805 |
2246.47 |
2437.41 |
1184.02 |
1253.39 |
145.11 |
New Jersey GHI Health Plan - Standard Self Plus One |
806 |
2153.84 |
2336.92 |
1092.26 |
1244.66 |
157.41 |
New Jersey GHI Health Plan - HDHP Self |
811 |
New Plan |
676.35 |
507.26 |
169.09 |
New Plan |
New Jersey GHI Health Plan - HDHP Self & Family |
812 |
New Plan |
1478.71 |
1109.03 |
369.68 |
New Plan |
New Jersey GHI Health Plan - HDHP Self Plus One |
813 |
New Plan |
1450.09 |
1087.57 |
362.52 |
New Plan |
New Mexico Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
New Mexico Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
New Mexico Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
New Mexico Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
New Mexico Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
New Mexico Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
New Mexico Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
670.58 |
712.73 |
510.84 |
201.89 |
30.03 |
New Mexico Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
1535.86 |
1632.37 |
1184.02 |
448.35 |
50.68 |
New Mexico Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
1505.77 |
1600.37 |
1092.26 |
508.11 |
68.93 |
New Mexico Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
785.14 |
904.50 |
510.84 |
393.66 |
107.24 |
New Mexico Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
1790.88 |
2063.10 |
1184.02 |
879.08 |
226.39 |
New Mexico Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
1773.18 |
2042.71 |
1092.26 |
950.45 |
243.86 |
New Mexico Aetna HealthFund HDHP - HDHP Self |
224 |
659.71 |
728.80 |
510.84 |
217.96 |
53.03 |
New Mexico Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1455.20 |
1607.60 |
1184.02 |
423.58 |
59.78 |
New Mexico Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1426.69 |
1576.10 |
1092.26 |
483.84 |
123.74 |
New Mexico Presbyterian Health Plan - High Self |
P21 |
740.31 |
840.99 |
510.84 |
330.15 |
88.56 |
New Mexico Presbyterian Health Plan - High Self & Family |
P22 |
1739.75 |
1976.30 |
1184.02 |
792.28 |
190.72 |
New Mexico Presbyterian Health Plan - High Self Plus One |
P23 |
1680.53 |
1909.03 |
1092.26 |
816.77 |
202.83 |
New Mexico Presbyterian Health Plan - Standard Self |
PS4 |
622.66 |
710.28 |
510.84 |
199.44 |
43.78 |
New Mexico Presbyterian Health Plan - Standard Self & Family |
PS5 |
1463.28 |
1669.16 |
1184.02 |
485.14 |
119.32 |
New Mexico Presbyterian Health Plan - Standard Self Plus One |
PS6 |
1413.45 |
1612.35 |
1092.26 |
520.09 |
166.73 |
New Mexico Presbyterian Health Plan - Wellness Self |
PS1 |
New Plan |
619.88 |
464.91 |
154.97 |
New Plan |
New Mexico Presbyterian Health Plan - Wellness Self & Family |
PS2 |
New Plan |
1456.76 |
1092.57 |
364.19 |
New Plan |
New Mexico Presbyterian Health Plan - Wellness Self Plus One |
PS3 |
New Plan |
1407.19 |
1055.39 |
351.80 |
New Plan |
New Mexico True Health New Mexico - High Self |
EL1 |
New Plan |
620.17 |
465.13 |
155.04 |
New Plan |
New Mexico True Health New Mexico - High Self & Family |
EL2 |
New Plan |
1464.47 |
1098.35 |
366.12 |
New Plan |
New Mexico True Health New Mexico - High Self Plus One |
EL3 |
New Plan |
1388.03 |
1041.02 |
347.01 |
New Plan |
New York Aetna Advantage - Advantage Self |
Z24 |
New Plan |
463.84 |
347.88 |
115.96 |
New Plan |
New York Aetna Advantage - Advantage Self & Family |
Z25 |
New Plan |
1229.17 |
921.88 |
307.29 |
New Plan |
New York Aetna Advantage - Advantage Self Plus One |
Z26 |
New Plan |
1020.44 |
765.33 |
255.11 |
New Plan |
New York Aetna Direct - CDHP Self |
N61 |
557.33 |
612.65 |
459.49 |
153.16 |
13.83 |
New York Aetna Direct - CDHP Self & Family |
N62 |
1405.54 |
1545.01 |
1158.76 |
386.25 |
34.87 |
New York Aetna Direct - CDHP Self Plus One |
N63 |
1222.26 |
1343.55 |
1007.66 |
335.89 |
30.33 |
New York Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
619.08 |
759.61 |
510.84 |
248.77 |
94.00 |
New York Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |