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Healthcare

Tribal Premium Rates for the Federal Employees Health Benefits Program

FFS (Fee-for-Service/Nationwide Plans)

Plan - Option Enrollment Code 2020 Total Monthly Premium 2021 Monthly Premium Rates - Total Premium 2021 Monthly Premium Rates - Tribal Employer Pays 2021 Monthly Premium Rates - Employee Pays 2021 Monthly Premium Rates - Change in Employee Payment
Nationwide APWU Health Plan - CDHP Self 474 597.68 603.66 452.75 150.91 1.49
Nationwide APWU Health Plan - CDHP Self & Family 475 1417.09 1431.26 1073.45 357.81 3.54
Nationwide APWU Health Plan - CDHP Self Plus One 476 1299.00 1311.98 983.99 327.99 3.24
Nationwide APWU Health Plan - High Self 471 726.22 748.02 523.42 224.60 9.22
Nationwide APWU Health Plan - High Self & Family 472 1742.91 1795.19 1218.21 576.98 18.09
Nationwide APWU Health Plan - High Self Plus One 473 1525.03 1570.77 1121.16 449.61 16.84
Nationwide Blue Cross and Blue Shield Service Benefit Plan Basic Option - Basic Self 111 658.19 681.24 510.93 170.31 5.76
Nationwide Blue Cross and Blue Shield Service Benefit Plan Basic Option - Basic Self & Family 112 1598.33 1654.29 1218.21 436.08 21.77
Nationwide Blue Cross and Blue Shield Service Benefit Plan Basic Option - Basic Self Plus One 113 1479.25 1531.03 1121.16 409.87 22.88
Nationwide Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - FEP Blue Focus Self 131 460.59 460.59 345.44 115.15 0.00
Nationwide Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - FEP Blue Focus Self & Family 132 1089.18 1089.18 816.89 272.29 0.00
Nationwide Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - FEP Blue Focus Self Plus One 133 990.21 990.21 742.66 247.55 0.00
Nationwide Blue Cross and Blue Shield Service Benefit Plan Standard Option - Standard Self 104 764.14 790.90 523.42 267.48 14.18
Nationwide Blue Cross and Blue Shield Service Benefit Plan Standard Option - Standard Self & Family 105 1805.29 1868.47 1218.21 650.26 28.99
Nationwide Blue Cross and Blue Shield Service Benefit Plan Standard Option - Standard Self Plus One 106 1671.09 1729.59 1121.16 608.43 29.60
Nationwide Compass Rose Health Plan - High Self 421 731.10 753.03 523.42 229.61 9.35
Nationwide Compass Rose Health Plan - High Self & Family 422 1754.65 1807.28 1218.21 589.07 18.44
Nationwide Compass Rose Health Plan - High Self Plus One 423 1608.43 1656.68 1121.16 535.52 19.35
Nationwide GEHA Benefit Plan - High Self 311 739.25 757.73 523.42 234.31 5.90
Nationwide GEHA Benefit Plan - High Self & Family 312 1843.53 1898.82 1218.21 680.61 21.10
Nationwide GEHA Benefit Plan - High Self Plus One 313 1626.37 1667.01 1121.16 545.85 11.74
Nationwide GEHA Benefit Plan - Standard Self 314 524.72 543.10 407.33 135.77 4.59
Nationwide GEHA Benefit Plan - Standard Self & Family 315 1347.84 1428.70 1071.53 357.17 20.21
Nationwide GEHA Benefit Plan - Standard Self Plus One 316 1128.21 1167.70 875.78 291.92 9.87
Nationwide GEHA HDHP - HDHP Self 341 513.85 531.85 398.89 132.96 4.50
Nationwide GEHA HDHP - HDHP Self & Family 342 1300.35 1378.39 1033.79 344.60 19.51
Nationwide GEHA HDHP - HDHP Self Plus One 343 1104.81 1143.48 857.61 285.87 9.67
Nationwide GEHA Indemnity Benefit Plan - Elevate Plus Self 251 629.83 653.12 489.84 163.28 5.82
Nationwide GEHA Indemnity Benefit Plan - Elevate Plus Self & Family 252 1561.97 1619.74 1214.81 404.93 14.44
Nationwide GEHA Indemnity Benefit Plan - Elevate Plus Self Plus One 253 1461.18 1502.09 1121.16 380.93 12.01
Nationwide GEHA Indemnity Benefit Plan - Elevate Self 254 410.13 410.13 307.60 102.53 0.00
Nationwide GEHA Indemnity Benefit Plan - Elevate Self & Family 255 1148.40 1148.40 861.30 287.10 0.00
Nationwide GEHA Indemnity Benefit Plan - Elevate Self Plus One 256 943.32 943.32 707.49 235.83 0.00
Nationwide MHBP Consumer Option - HDHP Self 481 573.28 630.59 472.94 157.65 14.33
Nationwide MHBP Consumer Option - HDHP Self & Family 482 1332.07 1465.27 1098.95 366.32 33.30
Nationwide MHBP Consumer Option - HDHP Self Plus One 483 1268.65 1395.51 1046.63 348.88 31.72
Nationwide MHBP Standard Option - Standard Self 454 570.85 622.25 466.69 155.56 12.85
Nationwide MHBP Standard Option - Standard Self & Family 455 1326.65 1446.06 1084.55 361.51 29.85
Nationwide MHBP Standard Option - Standard Self Plus One 456 1314.02 1432.30 1074.23 358.07 29.57
Nationwide MHBP Value Plan - Value Self 414 453.31 462.39 346.79 115.60 2.27
Nationwide MHBP Value Plan - Value Self & Family 415 1095.53 1117.46 838.10 279.36 5.48
Nationwide MHBP Value Plan - Value Self Plus One 416 1074.08 1095.58 821.69 273.89 5.37
Nationwide NALC Health Benefit Plan - CDHP Self 324 473.53 473.53 355.15 118.38 0.00
Nationwide NALC Health Benefit Plan - CDHP Self & Family 325 1089.03 1099.93 824.95 274.98 2.72
Nationwide NALC Health Benefit Plan - CDHP Self Plus One 326 1044.68 1044.68 783.51 261.17 0.00
Nationwide NALC Health Benefit Plan - High Self 321 707.66 728.89 523.42 205.47 8.65
Nationwide NALC Health Benefit Plan - High Self & Family 322 1592.96 1648.70 1218.21 430.49 21.55
Nationwide NALC Health Benefit Plan - High Self Plus One 323 1565.27 1612.22 1121.16 491.06 18.05
Nationwide NALC Health Benefit Plan - Value Self KM1 388.64 388.64 291.48 97.16 0.00
Nationwide NALC Health Benefit Plan - Value Self & Family KM2 894.16 903.11 677.33 225.78 2.24
Nationwide NALC Health Benefit Plan - Value Self Plus One KM3 857.35 857.35 643.01 214.34 0.00
Nationwide SAMBA Health Benefit Plan - High Self 441 901.75 874.68 523.42 351.26 -39.65
Nationwide SAMBA Health Benefit Plan - High Self & Family 442 2164.15 2099.22 1218.21 881.01 -99.12
Nationwide SAMBA Health Benefit Plan - High Self Plus One 443 1983.82 1924.30 1121.16 803.14 -88.42
Nationwide SAMBA Health Benefit Plan - Standard Self 444 680.51 700.92 523.42 177.50 7.37
Nationwide SAMBA Health Benefit Plan - Standard Self & Family 445 1552.55 1599.13 1199.35 399.78 11.64
Nationwide SAMBA Health Benefit Plan - Standard Self Plus One 446 1464.67 1508.61 1121.16 387.45 15.04
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