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Healthcare Plan Information

Tribal Premium Rates for the Federal Employees Health Benefits Program

FFS (Fee-for-Service/Nationwide Plans)

Plan - Option Enrollment Code 2021 Total Monthly Premium 2022 Monthly Premium Rates - Total Premium 2022 Monthly Premium Rates - Tribal Employer Pays 2022 Monthly Premium Rates - Employee Pays 2022 Monthly Premium Rates - Change in Employee Payment
Nationwide APWU Health Plan - CDHP Self 474 603.66 603.66 452.75 150.91 0.00
Nationwide APWU Health Plan - CDHP Self & Family 475 1431.26 1431.26 1073.45 357.81 0.00
Nationwide APWU Health Plan - CDHP Self Plus One 476 1311.98 1311.98 983.99 327.99 0.00
Nationwide APWU Health Plan - High Self 471 748.02 761.04 530.53 230.51 5.91
Nationwide APWU Health Plan - High Self & Family 472 1795.19 1826.41 1243.95 582.46 5.48
Nationwide APWU Health Plan - High Self Plus One 473 1570.77 1598.11 1136.70 461.41 11.80
Nationwide Blue Cross and Blue Shield Service Benefit Plan Basic Option - Basic Self 111 681.24 694.94 521.21 173.73 3.42
Nationwide Blue Cross and Blue Shield Service Benefit Plan Basic Option - Basic Self & Family 112 1654.29 1703.91 1243.95 459.96 23.88
Nationwide Blue Cross and Blue Shield Service Benefit Plan Basic Option - Basic Self Plus One 113 1531.03 1561.65 1136.70 424.95 15.08
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 104 790.90 806.72 530.53 276.19 8.71
Nationwide Blue Cross and Blue Shield Service Benefit Plan Standard Option - Standard Self & Family 105 1868.47 1924.52 1243.95 680.57 30.31
Nationwide Blue Cross and Blue Shield Service Benefit Plan Standard Option - Standard Self Plus One 106 1729.59 1764.19 1136.70 627.49 19.06
Nationwide GEHA Benefit Plan - High Self 311 757.73 757.73 530.53 227.20 -7.11
Nationwide GEHA Benefit Plan - High Self & Family 312 1898.82 1898.82 1243.95 654.87 -25.74
Nationwide GEHA Benefit Plan - High Self Plus One 313 1667.01 1667.01 1136.70 530.31 -15.54
Nationwide GEHA Benefit Plan - Standard Self 314 543.10 543.10 407.33 135.77 0.00
Nationwide GEHA Benefit Plan - Standard Self & Family 315 1428.70 1428.70 1071.53 357.17 0.00
Nationwide GEHA Benefit Plan - Standard Self Plus One 316 1167.70 1167.70 875.78 291.92 0.00
Nationwide GEHA HDHP - HDHP Self 341 531.85 547.80 410.85 136.95 3.99
Nationwide GEHA HDHP - HDHP Self & Family 342 1378.39 1447.31 1085.48 361.83 17.23
Nationwide GEHA HDHP - HDHP Self Plus One 343 1143.48 1177.78 883.34 294.44 8.57
Nationwide GEHA Indemnity Benefit Plan - Elevate Plus Self 251 653.12 685.77 514.33 171.44 8.16
Nationwide GEHA Indemnity Benefit Plan - Elevate Plus Self & Family 252 1619.74 1652.15 1239.11 413.04 8.11
Nationwide GEHA Indemnity Benefit Plan - Elevate Plus Self Plus One 253 1502.09 1532.14 1136.70 395.44 14.51
Nationwide GEHA Indemnity Benefit Plan - Elevate Self 254 410.13 422.44 316.83 105.61 3.08
Nationwide GEHA Indemnity Benefit Plan - Elevate Self & Family 255 1148.40 1182.85 887.14 295.71 8.61
Nationwide GEHA Indemnity Benefit Plan - Elevate Self Plus One 256 943.32 971.62 728.72 242.90 7.07
Nationwide MHBP Consumer Option - HDHP Self 481 630.59 662.11 496.58 165.53 7.88
Nationwide MHBP Consumer Option - HDHP Self & Family 482 1465.27 1538.53 1153.90 384.63 18.31
Nationwide MHBP Consumer Option - HDHP Self Plus One 483 1395.51 1465.27 1098.95 366.32 17.44
Nationwide MHBP Standard Option - Standard Self 454 622.25 678.25 508.69 169.56 14.00
Nationwide MHBP Standard Option - Standard Self & Family 455 1446.06 1576.21 1182.16 394.05 32.54
Nationwide MHBP Standard Option - Standard Self Plus One 456 1432.30 1561.19 1136.70 424.49 66.42
Nationwide MHBP Value Plan - Value Self 414 462.39 485.05 363.79 121.26 5.66
Nationwide MHBP Value Plan - Value Self & Family 415 1117.46 1172.21 879.16 293.05 13.69
Nationwide MHBP Value Plan - Value Self Plus One 416 1095.58 1149.27 861.95 287.32 13.43
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 1099.93 1110.92 833.19 277.73 2.75
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 321 728.89 743.47 530.53 212.94 7.47
Nationwide NALC Health Benefit Plan - High Self & Family 322 1648.70 1681.66 1243.95 437.71 7.22
Nationwide NALC Health Benefit Plan - High Self Plus One 323 1612.22 1644.46 1136.70 507.76 16.70
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 903.11 912.15 684.11 228.04 2.26
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 441 874.68 874.68 530.53 344.15 -7.11
Nationwide SAMBA Health Benefit Plan - High Self & Family 442 2099.22 2099.22 1243.95 855.27 -25.74
Nationwide SAMBA Health Benefit Plan - High Self Plus One 443 1924.30 1924.30 1136.70 787.60 -15.54
Nationwide SAMBA Health Benefit Plan - Standard Self 444 700.92 707.94 530.53 177.41 -0.09
Nationwide SAMBA Health Benefit Plan - Standard Self & Family 445 1599.13 1615.12 1211.34 403.78 4.00
Nationwide SAMBA Health Benefit Plan - Standard Self Plus One 446 1508.61 1523.71 1136.70 387.01 -0.44
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