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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 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Alabama Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Alabama Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Alabama Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Alabama Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Alabama Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
851.74 |
870.65 |
530.53 |
340.12 |
11.80 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
1942.03 |
1985.10 |
1243.95 |
741.15 |
17.33 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
1922.81 |
1965.45 |
1136.70 |
828.75 |
27.10 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
821.82 |
895.53 |
530.53 |
365.00 |
66.60 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
1881.88 |
2050.64 |
1243.95 |
806.69 |
143.02 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
1844.96 |
2010.45 |
1136.70 |
873.75 |
149.95 |
Alabama Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Alabama Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Alabama Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Alabama UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
599.47 |
650.91 |
488.18 |
162.73 |
12.86 |
Alabama UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
1417.76 |
1539.46 |
1154.60 |
384.86 |
30.42 |
Alabama UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
1288.89 |
1399.49 |
1049.62 |
349.87 |
27.65 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LS1 |
485.85 |
624.67 |
468.50 |
156.17 |
34.71 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LS2 |
1117.50 |
1436.76 |
1077.57 |
359.19 |
79.82 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LS3 |
1044.59 |
1343.07 |
1007.30 |
335.77 |
74.62 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KK1 |
769.04 |
847.30 |
530.53 |
316.77 |
71.15 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KK2 |
1922.64 |
2118.24 |
1243.95 |
874.29 |
169.86 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KK3 |
1653.47 |
1821.69 |
1136.70 |
684.99 |
152.68 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
576.72 |
581.25 |
435.94 |
145.31 |
1.13 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
1363.94 |
1374.69 |
1031.02 |
343.67 |
2.69 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
1239.94 |
1249.71 |
937.28 |
312.43 |
2.45 |
Alaska Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Alaska Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Alaska Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Alaska Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Alaska Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Alaska Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
JS4 |
1094.58 |
1094.51 |
530.53 |
563.98 |
-7.18 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
JS5 |
2498.80 |
2498.64 |
1243.95 |
1254.69 |
-25.90 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
JS6 |
2474.07 |
2473.94 |
1136.70 |
1337.24 |
-15.67 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
JS1 |
1009.93 |
1037.34 |
530.53 |
506.81 |
20.30 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
JS2 |
2302.15 |
2364.66 |
1243.95 |
1120.71 |
36.77 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
JS3 |
2279.33 |
2341.24 |
1136.70 |
1204.54 |
46.37 |
Alaska Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Alaska Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Alaska Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Arizona Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Arizona Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Arizona Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Arizona Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Arizona Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Arizona Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
717.04 |
834.38 |
530.53 |
303.85 |
110.23 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
1642.27 |
1911.07 |
1243.95 |
667.12 |
243.06 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
1610.09 |
1873.63 |
1136.70 |
736.93 |
248.00 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
1058.76 |
1135.10 |
530.53 |
604.57 |
69.23 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
2415.08 |
2589.21 |
1243.95 |
1345.26 |
148.39 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
2391.20 |
2563.60 |
1136.70 |
1426.90 |
156.86 |
Arizona Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Arizona Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Arizona Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Arizona Aetna Open Access - High Self |
WQ1 |
1345.67 |
1438.67 |
530.53 |
908.14 |
85.89 |
Arizona Aetna Open Access - High Self & Family |
WQ2 |
3267.25 |
3493.06 |
1243.95 |
2249.11 |
200.07 |
Arizona Aetna Open Access - High Self Plus One |
WQ3 |
3234.86 |
3458.43 |
1136.70 |
2321.73 |
208.03 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self |
R61 |
812.24 |
873.15 |
530.53 |
342.62 |
53.80 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
R62 |
1827.50 |
1964.56 |
1243.95 |
720.61 |
111.32 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
R63 |
1746.29 |
1877.24 |
1136.70 |
740.54 |
115.41 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self |
R64 |
649.22 |
665.45 |
499.09 |
166.36 |
4.06 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self & Family |
R65 |
1460.72 |
1497.23 |
1122.92 |
374.31 |
9.13 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
R66 |
1395.81 |
1430.72 |
1073.04 |
357.68 |
8.73 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self |
R94 |
570.96 |
585.22 |
438.92 |
146.30 |
3.56 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self & Family |
R95 |
1284.62 |
1316.73 |
987.55 |
329.18 |
8.03 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
R96 |
1227.55 |
1258.25 |
943.69 |
314.56 |
7.67 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self |
R91 |
717.08 |
763.71 |
530.53 |
233.18 |
39.52 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
R92 |
1613.41 |
1718.28 |
1243.95 |
474.33 |
70.98 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
R93 |
1541.69 |
1641.90 |
1136.70 |
505.20 |
84.67 |
Arizona Humana HDHP - HDHP Self |
BV1 |
New Plan |
453.16 |
339.87 |
113.29 |
New Plan |
Arizona Humana HDHP - HDHP Self & Family |
BV2 |
New Plan |
1129.01 |
846.76 |
282.25 |
New Plan |
Arizona Humana HDHP - HDHP Self Plus One |
BV3 |
New Plan |
993.85 |
745.39 |
248.46 |
New Plan |
Arizona Humana HDHP - HDHP Self |
BY1 |
New Plan |
397.78 |
298.34 |
99.44 |
New Plan |
Arizona Humana HDHP - HDHP Self & Family |
BY2 |
New Plan |
990.51 |
742.88 |
247.63 |
New Plan |
Arizona Humana HDHP - HDHP Self Plus One |
BY3 |
New Plan |
871.98 |
653.99 |
217.99 |
New Plan |
Arizona Humana Health Plan, Inc. - Standard Self |
C74 |
893.86 |
916.20 |
530.53 |
385.67 |
15.23 |
Arizona Humana Health Plan, Inc. - Standard Self & Family |
C75 |
2011.17 |
2061.45 |
1243.95 |
817.50 |
24.54 |
Arizona Humana Health Plan, Inc. - Standard Self Plus One |
C76 |
1921.73 |
1969.83 |
1136.70 |
833.13 |
32.56 |
Arizona Humana Health Plan, Inc. - Standard Self |
BF4 |
1246.59 |
1246.59 |
530.53 |
716.06 |
-7.11 |
Arizona Humana Health Plan, Inc. - Standard Self & Family |
BF5 |
2804.84 |
2804.86 |
1243.95 |
1560.91 |
-25.72 |
Arizona Humana Health Plan, Inc. - Standard Self Plus One |
BF6 |
2680.21 |
2680.21 |
1136.70 |
1543.51 |
-15.54 |
Arizona UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
WF1 |
622.22 |
668.46 |
501.35 |
167.11 |
11.56 |
Arizona UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
WF2 |
1471.54 |
1580.91 |
1185.68 |
395.23 |
27.35 |
Arizona UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
WF3 |
1337.77 |
1437.17 |
1077.88 |
359.29 |
24.85 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LU1 |
528.17 |
672.10 |
504.08 |
168.02 |
35.98 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LU2 |
1214.76 |
1545.85 |
1159.39 |
386.46 |
82.77 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LU3 |
1135.55 |
1445.04 |
1083.78 |
361.26 |
77.37 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KT1 |
782.12 |
864.87 |
530.53 |
334.34 |
75.64 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KT2 |
1955.35 |
2162.16 |
1243.95 |
918.21 |
181.07 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KT3 |
1681.57 |
1859.46 |
1136.70 |
722.76 |
162.35 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
VD1 |
621.21 |
657.65 |
493.24 |
164.41 |
9.11 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
VD2 |
1469.13 |
1555.39 |
1166.54 |
388.85 |
21.57 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
VD3 |
1335.58 |
1413.97 |
1060.48 |
353.49 |
19.60 |
Arkansas Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Arkansas Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Arkansas Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Arkansas Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Arkansas Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Arkansas Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
851.74 |
870.65 |
530.53 |
340.12 |
11.80 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
1942.03 |
1985.10 |
1243.95 |
741.15 |
17.33 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
1922.81 |
1965.45 |
1136.70 |
828.75 |
27.10 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
821.82 |
895.53 |
530.53 |
365.00 |
66.60 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
1881.88 |
2050.64 |
1243.95 |
806.69 |
143.02 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
1844.96 |
2010.45 |
1136.70 |
873.75 |
149.95 |
Arkansas Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Arkansas Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Arkansas Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Arkansas QualChoice - High Self |
DH1 |
767.26 |
728.85 |
530.53 |
198.32 |
-45.52 |
Arkansas QualChoice - High Self & Family |
DH2 |
2001.20 |
1901.10 |
1243.95 |
657.15 |
-125.84 |
Arkansas QualChoice - High Self Plus One |
DH3 |
1490.43 |
1415.83 |
1061.87 |
353.96 |
-18.65 |
Arkansas QualChoice - Standard Self |
DH4 |
599.00 |
568.97 |
426.73 |
142.24 |
-7.51 |
Arkansas QualChoice - Standard Self & Family |
DH5 |
1562.43 |
1484.08 |
1113.06 |
371.02 |
-19.59 |
Arkansas QualChoice - Standard Self Plus One |
DH6 |
1163.63 |
1105.28 |
828.96 |
276.32 |
-14.59 |
Arkansas UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
599.47 |
650.91 |
488.18 |
162.73 |
12.86 |
Arkansas UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
1417.76 |
1539.46 |
1154.60 |
384.86 |
30.42 |
Arkansas UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
1288.89 |
1399.49 |
1049.62 |
349.87 |
27.65 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LS1 |
485.85 |
624.67 |
468.50 |
156.17 |
34.71 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LS2 |
1117.50 |
1436.76 |
1077.57 |
359.19 |
79.82 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LS3 |
1044.59 |
1343.07 |
1007.30 |
335.77 |
74.62 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KK1 |
769.04 |
847.30 |
530.53 |
316.77 |
71.15 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KK2 |
1922.64 |
2118.24 |
1243.95 |
874.29 |
169.86 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KK3 |
1653.47 |
1821.69 |
1136.70 |
684.99 |
152.68 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
576.72 |
581.25 |
435.94 |
145.31 |
1.13 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
1363.94 |
1374.69 |
1031.02 |
343.67 |
2.69 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
1239.94 |
1249.71 |
937.28 |
312.43 |
2.45 |
California Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
California Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
California Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
California Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
California Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
California Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
California Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
JS4 |
1094.58 |
1094.51 |
530.53 |
563.98 |
-7.18 |
California Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
JS5 |
2498.80 |
2498.64 |
1243.95 |
1254.69 |
-25.90 |
California Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
JS6 |
2474.07 |
2473.94 |
1136.70 |
1337.24 |
-15.67 |
California Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
JS1 |
1009.93 |
1037.34 |
530.53 |
506.81 |
20.30 |
California Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
JS2 |
2302.15 |
2364.66 |
1243.95 |
1120.71 |
36.77 |
California Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
JS3 |
2279.33 |
2341.24 |
1136.70 |
1204.54 |
46.37 |
California Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
California Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
California Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
California Aetna Open Access - High Self |
2X1 |
936.67 |
1039.33 |
530.53 |
508.80 |
95.55 |
California Aetna Open Access - High Self & Family |
2X2 |
2199.02 |
2440.04 |
1243.95 |
1196.09 |
215.28 |
California Aetna Open Access - High Self Plus One |
2X3 |
2155.90 |
2392.22 |
1136.70 |
1255.52 |
220.78 |
California Anthem Blue Cross Select HMO - High Self |
B31 |
774.13 |
777.23 |
530.53 |
246.70 |
-4.01 |
California Anthem Blue Cross Select HMO - High Self & Family |
B32 |
1768.91 |
1783.06 |
1243.95 |
539.11 |
-11.59 |
California Anthem Blue Cross Select HMO - High Self Plus One |
B33 |
1641.16 |
1646.08 |
1136.70 |
509.38 |
-10.62 |
California Blue Shield of California - Access + HMO Self |
SI1 |
858.87 |
884.61 |
530.53 |
354.08 |
18.63 |
California Blue Shield of California - Access + HMO Self & Family |
SI2 |
1975.39 |
2034.65 |
1243.95 |
790.70 |
33.52 |
California Blue Shield of California - Access + HMO Self Plus One |
SI3 |
1889.49 |
1946.19 |
1136.70 |
809.49 |
41.16 |
California Health Net of California - Basic Self |
P61 |
364.04 |
405.69 |
304.27 |
101.42 |
10.41 |
California Health Net of California - Basic Self & Family |
P62 |
873.73 |
973.74 |
730.31 |
243.43 |
25.00 |
California Health Net of California - Basic Self Plus One |
P63 |
800.93 |
892.56 |
669.42 |
223.14 |
22.91 |
California Health Net of California - High Self |
LP1 |
1012.98 |
1077.33 |
530.53 |
546.80 |
57.24 |
California Health Net of California - High Self & Family |
LP2 |
2431.17 |
2585.66 |
1243.95 |
1341.71 |
128.75 |
California Health Net of California - High Self Plus One |
LP3 |
2228.57 |
2370.18 |
1136.70 |
1233.48 |
126.07 |
California Health Net of California - High Self |
LB1 |
1550.64 |
1618.70 |
530.53 |
1088.17 |
60.95 |
California Health Net of California - High Self & Family |
LB2 |
3721.49 |
3884.86 |
1243.95 |
2640.91 |
137.63 |
California Health Net of California - High Self Plus One |
LB3 |
3411.35 |
3561.13 |
1136.70 |
2424.43 |
134.24 |
California Health Net of California - Basic Self |
T41 |
894.18 |
953.16 |
530.53 |
422.63 |
51.87 |
California Health Net of California - Basic Self & Family |
T42 |
2146.04 |
2287.61 |
1243.95 |
1043.66 |
115.83 |
California Health Net of California - Basic Self Plus One |
T43 |
1967.20 |
2096.94 |
1136.70 |
960.24 |
114.20 |
California Kaiser Permanente - Fresno California - Standard Self |
NZ4 |
590.11 |
590.11 |
442.58 |
147.53 |
0.00 |
California Kaiser Permanente - Fresno California - Standard Self & Family |
NZ5 |
1363.87 |
1363.87 |
1022.90 |
340.97 |
0.00 |
California Kaiser Permanente - Fresno California - Standard Self Plus One |
NZ6 |
1363.87 |
1363.87 |
1022.90 |
340.97 |
0.00 |
California Kaiser Permanente - Fresno California - High Self |
NZ1 |
802.99 |
813.45 |
530.53 |
282.92 |
3.35 |
California Kaiser Permanente - Fresno California - High Self & Family |
NZ2 |
1855.86 |
1880.06 |
1243.95 |
636.11 |
-1.54 |
California Kaiser Permanente - Fresno California - High Self Plus One |
NZ3 |
1855.86 |
1880.06 |
1136.70 |
743.36 |
8.66 |
California Kaiser Permanente - Northern California - Prosper Self |
KC1 |
652.08 |
658.56 |
493.92 |
164.64 |
1.62 |
California Kaiser Permanente - Northern California - Prosper Self & Family |
KC2 |
1525.85 |
1541.02 |
1155.77 |
385.25 |
3.79 |
California Kaiser Permanente - Northern California - Prosper Self Plus One |
KC3 |
1525.85 |
1541.02 |
1136.70 |
404.32 |
-0.37 |
California Kaiser Permanente - Northern California - High Self |
591 |
1014.54 |
1002.30 |
530.53 |
471.77 |
-19.35 |
California Kaiser Permanente - Northern California - High Self & Family |
592 |
2421.86 |
2392.59 |
1243.95 |
1148.64 |
-55.01 |
California Kaiser Permanente - Northern California - High Self Plus One |
593 |
2421.86 |
2392.59 |
1136.70 |
1255.89 |
-44.81 |
California Kaiser Permanente - Northern California - Standard Self |
594 |
822.68 |
814.88 |
530.53 |
284.35 |
-14.91 |
California Kaiser Permanente - Northern California - Standard Self & Family |
595 |
1925.11 |
1906.80 |
1243.95 |
662.85 |
-44.05 |
California Kaiser Permanente - Northern California - Standard Self Plus One |
596 |
1925.11 |
1906.80 |
1136.70 |
770.10 |
-33.85 |
California Kaiser Permanente - Southern California - Prosper Self |
FL1 |
New Plan |
365.63 |
274.22 |
91.41 |
New Plan |
California Kaiser Permanente - Southern California - Prosper Self & Family |
FL2 |
New Plan |
1023.75 |
767.81 |
255.94 |
New Plan |
California Kaiser Permanente - Southern California - Prosper Self Plus One |
FL3 |
New Plan |
840.97 |
630.73 |
210.24 |
New Plan |
California Kaiser Permanente - Southern California - Standard Self |
624 |
473.44 |
488.35 |
366.26 |
122.09 |
3.73 |
California Kaiser Permanente - Southern California - Standard Self & Family |
625 |
1094.21 |
1128.62 |
846.47 |
282.15 |
8.60 |
California Kaiser Permanente - Southern California - Standard Self Plus One |
626 |
1094.21 |
1128.62 |
846.47 |
282.15 |
8.60 |
California Kaiser Permanente - Southern California - High Self |
621 |
750.19 |
760.63 |
530.53 |
230.10 |
3.33 |
California Kaiser Permanente - Southern California - High Self & Family |
622 |
1733.83 |
1757.97 |
1243.95 |
514.02 |
-1.60 |
California Kaiser Permanente - Southern California - High Self Plus One |
623 |
1733.83 |
1757.97 |
1136.70 |
621.27 |
8.60 |
Colorado Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Colorado Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Colorado Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Colorado Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Colorado Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Colorado Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
717.04 |
834.38 |
530.53 |
303.85 |
110.23 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
1642.27 |
1911.07 |
1243.95 |
667.12 |
243.06 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
1610.09 |
1873.63 |
1136.70 |
736.93 |
248.00 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
1058.76 |
1135.10 |
530.53 |
604.57 |
69.23 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
2415.08 |
2589.21 |
1243.95 |
1345.26 |
148.39 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
2391.20 |
2563.60 |
1136.70 |
1426.90 |
156.86 |
Colorado Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Colorado Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Colorado Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Colorado BlueAdvantageHMO - High Self |
WW1 |
636.35 |
677.71 |
508.28 |
169.43 |
10.34 |
Colorado BlueAdvantageHMO - High Self & Family |
WW2 |
1549.49 |
1690.50 |
1243.95 |
446.55 |
59.18 |
Colorado BlueAdvantageHMO - High Self Plus One |
WW3 |
1447.66 |
1554.78 |
1136.70 |
418.08 |
56.17 |
Colorado BlueAdvantageHMO - HDHP Self |
WW4 |
New Plan |
639.75 |
479.81 |
159.94 |
New Plan |
Colorado BlueAdvantageHMO - HDHP Self & Family |
WW5 |
New Plan |
1557.77 |
1168.33 |
389.44 |
New Plan |
Colorado BlueAdvantageHMO - HDHP Self Plus One |
WW6 |
New Plan |
1455.42 |
1091.57 |
363.85 |
New Plan |
Colorado Humana Health Plan, Inc. - High Self |
NR1 |
961.18 |
970.80 |
530.53 |
440.27 |
2.51 |
Colorado Humana Health Plan, Inc. - High Self & Family |
NR2 |
2162.64 |
2184.28 |
1243.95 |
940.33 |
-4.10 |
Colorado Humana Health Plan, Inc. - High Self Plus One |
NR3 |
2066.52 |
2087.22 |
1136.70 |
950.52 |
5.16 |
Colorado Humana Health Plan, Inc. - Standard Self |
NR4 |
666.08 |
666.08 |
499.56 |
166.52 |
0.00 |
Colorado Humana Health Plan, Inc. - Standard Self & Family |
NR5 |
1498.73 |
1498.73 |
1124.05 |
374.68 |
0.00 |
Colorado Humana Health Plan, Inc. - Standard Self Plus One |
NR6 |
1432.08 |
1432.08 |
1074.06 |
358.02 |
0.00 |
Colorado Humana Health Plan, Inc. - Basic Self |
RZ1 |
532.24 |
518.94 |
389.21 |
129.73 |
-3.33 |
Colorado Humana Health Plan, Inc. - Basic Self & Family |
RZ2 |
1197.52 |
1167.57 |
875.68 |
291.89 |
-7.49 |
Colorado Humana Health Plan, Inc. - Basic Self Plus One |
RZ3 |
1144.33 |
1115.73 |
836.80 |
278.93 |
-7.15 |
Colorado Humana Health Plan, Inc. - High Self |
NT1 |
833.60 |
875.29 |
530.53 |
344.76 |
34.58 |
Colorado Humana Health Plan, Inc. - High Self & Family |
NT2 |
1875.66 |
1969.44 |
1243.95 |
725.49 |
68.04 |
Colorado Humana Health Plan, Inc. - High Self Plus One |
NT3 |
1792.27 |
1881.88 |
1136.70 |
745.18 |
74.07 |
Colorado Humana Health Plan, Inc. - Standard Self |
NT4 |
590.27 |
590.27 |
442.70 |
147.57 |
0.00 |
Colorado Humana Health Plan, Inc. - Standard Self & Family |
NT5 |
1328.12 |
1328.12 |
996.09 |
332.03 |
0.00 |
Colorado Humana Health Plan, Inc. - Standard Self Plus One |
NT6 |
1269.13 |
1269.13 |
951.85 |
317.28 |
0.00 |
Colorado Humana Health Plan, Inc. - Basic Self |
R21 |
621.40 |
605.89 |
454.42 |
151.47 |
-3.88 |
Colorado Humana Health Plan, Inc. - Basic Self & Family |
R22 |
1398.17 |
1363.22 |
1022.42 |
340.80 |
-8.74 |
Colorado Humana Health Plan, Inc. - Basic Self Plus One |
R23 |
1336.03 |
1302.62 |
976.97 |
325.65 |
-8.36 |
Colorado Kaiser Permanente - Colorado - Standard Self |
654 |
660.83 |
659.17 |
494.38 |
164.79 |
-0.42 |
Colorado Kaiser Permanente - Colorado - Standard Self & Family |
655 |
1493.46 |
1489.71 |
1117.28 |
372.43 |
-0.93 |
Colorado Kaiser Permanente - Colorado - Standard Self Plus One |
656 |
1493.46 |
1489.71 |
1117.28 |
372.43 |
-0.93 |
Colorado Kaiser Permanente - Colorado - High Self |
651 |
772.89 |
772.89 |
530.53 |
242.36 |
-7.11 |
Colorado Kaiser Permanente - Colorado - High Self & Family |
652 |
1746.75 |
1746.75 |
1243.95 |
502.80 |
-25.74 |
Colorado Kaiser Permanente - Colorado - High Self Plus One |
653 |
1746.75 |
1746.75 |
1136.70 |
610.05 |
-15.54 |
Colorado Kaiser Permanente - Colorado - Prosper Self |
N41 |
445.51 |
390.15 |
292.61 |
97.54 |
-13.84 |
Colorado Kaiser Permanente - Colorado - Prosper Self & Family |
N42 |
1095.94 |
959.77 |
719.83 |
239.94 |
-34.04 |
Colorado Kaiser Permanente - Colorado - Prosper Self Plus One |
N43 |
1006.85 |
881.73 |
661.30 |
220.43 |
-31.28 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LU1 |
528.17 |
672.10 |
504.08 |
168.02 |
35.98 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LU2 |
1214.76 |
1545.85 |
1159.39 |
386.46 |
82.77 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LU3 |
1135.55 |
1445.04 |
1083.78 |
361.26 |
77.37 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KT1 |
782.12 |
864.87 |
530.53 |
334.34 |
75.64 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KT2 |
1955.35 |
2162.16 |
1243.95 |
918.21 |
181.07 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KT3 |
1681.57 |
1859.46 |
1136.70 |
722.76 |
162.35 |
Connecticut Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Connecticut Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Connecticut Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Connecticut Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Connecticut Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Connecticut Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
839.63 |
927.77 |
530.53 |
397.24 |
81.03 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
1922.68 |
2124.50 |
1243.95 |
880.55 |
176.08 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
1884.96 |
2082.84 |
1136.70 |
946.14 |
182.34 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
1124.65 |
1156.37 |
530.53 |
625.84 |
24.61 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
2564.88 |
2637.12 |
1243.95 |
1393.17 |
46.50 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
2539.46 |
2611.01 |
1136.70 |
1474.31 |
56.01 |
Connecticut Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Connecticut Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Connecticut Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Delaware Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Delaware Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Delaware Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Delaware Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Delaware Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Delaware Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
839.63 |
927.77 |
530.53 |
397.24 |
81.03 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
1922.68 |
2124.50 |
1243.95 |
880.55 |
176.08 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
1884.96 |
2082.84 |
1136.70 |
946.14 |
182.34 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
1124.65 |
1156.37 |
530.53 |
625.84 |
24.61 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
2564.88 |
2637.12 |
1243.95 |
1393.17 |
46.50 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
2539.46 |
2611.01 |
1136.70 |
1474.31 |
56.01 |
Delaware Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Delaware Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Delaware Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Delaware Aetna Open Access - Basic Self |
P34 |
1505.53 |
1721.76 |
530.53 |
1191.23 |
209.12 |
Delaware Aetna Open Access - Basic Self & Family |
P35 |
3494.34 |
3996.29 |
1243.95 |
2752.34 |
476.21 |
Delaware Aetna Open Access - Basic Self Plus One |
P36 |
3459.73 |
3956.70 |
1136.70 |
2820.00 |
481.43 |
Delaware Aetna Open Access - High Self |
P31 |
1588.23 |
1762.54 |
530.53 |
1232.01 |
167.20 |
Delaware Aetna Open Access - High Self & Family |
P32 |
3850.71 |
4273.27 |
1243.95 |
3029.32 |
396.82 |
Delaware Aetna Open Access - High Self Plus One |
P33 |
3812.58 |
4230.98 |
1136.70 |
3094.28 |
402.86 |
District Of Columbia Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
District Of Columbia Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
District Of Columbia Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
District Of Columbia Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
District Of Columbia Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
District Of Columbia Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
851.74 |
870.65 |
530.53 |
340.12 |
11.80 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
1942.03 |
1985.10 |
1243.95 |
741.15 |
17.33 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
1922.81 |
1965.45 |
1136.70 |
828.75 |
27.10 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
821.82 |
895.53 |
530.53 |
365.00 |
66.60 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
1881.88 |
2050.64 |
1243.95 |
806.69 |
143.02 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
1844.96 |
2010.45 |
1136.70 |
873.75 |
149.95 |
District Of Columbia Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
District Of Columbia Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
District Of Columbia Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
District Of Columbia Aetna Open Access - High Self |
JN1 |
1176.57 |
1251.55 |
530.53 |
721.02 |
67.87 |
District Of Columbia Aetna Open Access - High Self & Family |
JN2 |
2645.05 |
2813.68 |
1243.95 |
1569.73 |
142.89 |
District Of Columbia Aetna Open Access - High Self Plus One |
JN3 |
2618.85 |
2785.79 |
1136.70 |
1649.09 |
151.40 |
District Of Columbia Aetna Open Access - Basic Self |
JN4 |
714.42 |
739.46 |
530.53 |
208.93 |
17.93 |
District Of Columbia Aetna Open Access - Basic Self & Family |
JN5 |
1634.92 |
1692.23 |
1243.95 |
448.28 |
31.57 |
District Of Columbia Aetna Open Access - Basic Self Plus One |
JN6 |
1501.33 |
1553.93 |
1136.70 |
417.23 |
37.06 |
District Of Columbia Aetna Saver (Open Access) - Saver Self |
QQ4 |
595.21 |
595.21 |
446.41 |
148.80 |
0.00 |
District Of Columbia Aetna Saver (Open Access) - Saver Self & Family |
QQ5 |
1362.12 |
1362.12 |
1021.59 |
340.53 |
0.00 |
District Of Columbia Aetna Saver (Open Access) - Saver Self Plus One |
QQ6 |
1250.82 |
1250.82 |
938.12 |
312.70 |
0.00 |
District Of Columbia CareFirst BlueChoice - Standard Self |
2G4 |
887.81 |
905.58 |
530.53 |
375.05 |
10.66 |
District Of Columbia CareFirst BlueChoice - Standard Self & Family |
2G5 |
2109.42 |
2151.59 |
1243.95 |
907.64 |
16.43 |
District Of Columbia CareFirst BlueChoice - Standard Self Plus One |
2G6 |
1775.61 |
1811.12 |
1136.70 |
674.42 |
19.97 |
District Of Columbia CareFirst BlueChoice - HDHP Self |
B61 |
570.09 |
604.31 |
453.23 |
151.08 |
8.56 |
District Of Columbia CareFirst BlueChoice - HDHP Self & Family |
B62 |
1354.51 |
1435.79 |
1076.84 |
358.95 |
20.32 |
District Of Columbia CareFirst BlueChoice - HDHP Self Plus One |
B63 |
1140.17 |
1208.57 |
906.43 |
302.14 |
17.10 |
District Of Columbia CareFirst BlueChoice - Blue Value Plus Self |
B64 |
723.67 |
723.67 |
530.53 |
193.14 |
-7.11 |
District Of Columbia CareFirst BlueChoice - Blue Value Plus Self & Family |
B65 |
1719.38 |
1719.38 |
1243.95 |
475.43 |
-25.74 |
District Of Columbia CareFirst BlueChoice - Blue Value Plus Self Plus One |
B66 |
1447.29 |
1447.29 |
1085.47 |
361.82 |
0.00 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - Prosper Self |
T71 |
427.72 |
368.90 |
276.68 |
92.22 |
-14.71 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - Prosper Self & Family |
T72 |
1099.52 |
1051.33 |
788.50 |
262.83 |
-12.05 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - Prosper Self Plus One |
T73 |
951.84 |
866.91 |
650.18 |
216.73 |
-21.23 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - Standard Self |
E34 |
598.28 |
607.25 |
455.44 |
151.81 |
2.24 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - Standard Self & Family |
E35 |
1376.05 |
1396.63 |
1047.47 |
349.16 |
5.15 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - Standard Self Plus One |
E36 |
1376.05 |
1396.63 |
1047.47 |
349.16 |
5.15 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - High Self |
E31 |
746.24 |
756.60 |
530.53 |
226.07 |
3.25 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - High Self & Family |
E32 |
1716.35 |
1740.20 |
1243.95 |
496.25 |
-1.89 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - High Self Plus One |
E33 |
1716.35 |
1740.20 |
1136.70 |
603.50 |
8.31 |
District Of Columbia M.D. IPA - High Self |
JP1 |
950.89 |
1011.99 |
530.53 |
481.46 |
53.99 |
District Of Columbia M.D. IPA - High Self & Family |
JP2 |
2666.28 |
2837.66 |
1243.95 |
1593.71 |
145.64 |
District Of Columbia M.D. IPA - High Self Plus One |
JP3 |
1857.09 |
1976.43 |
1136.70 |
839.73 |
103.80 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
599.47 |
650.91 |
488.18 |
162.73 |
12.86 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
1417.76 |
1539.46 |
1154.60 |
384.86 |
30.42 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
1288.89 |
1399.49 |
1049.62 |
349.87 |
27.65 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
V41 |
519.91 |
661.81 |
496.36 |
165.45 |
35.47 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
V42 |
1195.81 |
1514.20 |
1135.65 |
378.55 |
79.60 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
V43 |
1117.81 |
1422.92 |
1067.19 |
355.73 |
76.28 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
LR1 |
770.40 |
822.16 |
530.53 |
291.63 |
44.65 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
LR2 |
1825.83 |
1948.55 |
1243.95 |
704.60 |
96.98 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
LR3 |
1656.33 |
1767.68 |
1136.70 |
630.98 |
95.81 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
L91 |
554.62 |
663.76 |
497.82 |
165.94 |
27.29 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
L92 |
1555.15 |
1586.41 |
1189.81 |
396.60 |
7.81 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self Plus One |
L93 |
1083.18 |
1327.54 |
995.66 |
331.88 |
61.09 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
576.72 |
581.25 |
435.94 |
145.31 |
1.13 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
1363.94 |
1374.69 |
1031.02 |
343.67 |
2.69 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
1239.94 |
1249.71 |
937.28 |
312.43 |
2.45 |
Florida Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Florida Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Florida Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Florida Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Florida Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Florida Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
851.74 |
870.65 |
530.53 |
340.12 |
11.80 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
1942.03 |
1985.10 |
1243.95 |
741.15 |
17.33 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
1922.81 |
1965.45 |
1136.70 |
828.75 |
27.10 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
821.82 |
895.53 |
530.53 |
365.00 |
66.60 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
1881.88 |
2050.64 |
1243.95 |
806.69 |
143.02 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
1844.96 |
2010.45 |
1136.70 |
873.75 |
149.95 |
Florida Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Florida Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Florida Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Florida AvMed - HDHP Self |
WZ1 |
762.08 |
742.26 |
530.53 |
211.73 |
-26.93 |
Florida AvMed - HDHP Self & Family |
WZ2 |
1762.00 |
1714.01 |
1243.95 |
470.06 |
-73.73 |
Florida AvMed - HDHP Self Plus One |
WZ3 |
1528.67 |
1487.24 |
1115.43 |
371.81 |
-35.70 |
Florida AvMed - Standard Self |
ML4 |
820.97 |
801.88 |
530.53 |
271.35 |
-26.20 |
Florida AvMed - Standard Self & Family |
ML5 |
1998.92 |
1952.45 |
1243.95 |
708.50 |
-72.21 |
Florida AvMed - Standard Self Plus One |
ML6 |
1724.06 |
1683.98 |
1136.70 |
547.28 |
-55.62 |
Florida Capital Health Plan - High Self |
EA1 |
690.47 |
730.49 |
530.53 |
199.96 |
27.34 |
Florida Capital Health Plan - High Self & Family |
EA2 |
1600.19 |
1692.93 |
1243.95 |
448.98 |
48.93 |
Florida Capital Health Plan - High Self Plus One |
EA3 |
1509.99 |
1597.55 |
1136.70 |
460.85 |
72.02 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self |
W94 |
585.48 |
600.12 |
450.09 |
150.03 |
3.66 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self & Family |
W95 |
1317.33 |
1350.29 |
1012.72 |
337.57 |
8.24 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
W96 |
1258.79 |
1290.25 |
967.69 |
322.56 |
7.86 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self |
W91 |
692.10 |
726.70 |
530.53 |
196.17 |
23.15 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
W92 |
1557.18 |
1635.03 |
1226.27 |
408.76 |
19.47 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
W93 |
1487.98 |
1562.38 |
1136.70 |
425.68 |
53.69 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self |
QP1 |
768.56 |
826.22 |
530.53 |
295.69 |
50.55 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
QP2 |
1731.56 |
1861.38 |
1243.95 |
617.43 |
104.08 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
QP3 |
1654.58 |
1778.66 |
1136.70 |
641.96 |
108.54 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self |
QP4 |
550.51 |
550.51 |
412.88 |
137.63 |
0.00 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self & Family |
QP5 |
1238.60 |
1238.60 |
928.95 |
309.65 |
0.00 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
QP6 |
1183.56 |
1183.56 |
887.67 |
295.89 |
0.00 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self |
MJ4 |
561.19 |
561.19 |
420.89 |
140.30 |
0.00 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self & Family |
MJ5 |
1262.67 |
1346.87 |
1010.15 |
336.72 |
21.05 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
MJ6 |
1206.55 |
1206.55 |
904.91 |
301.64 |
0.00 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self |
MJ1 |
1023.92 |
1064.87 |
530.53 |
534.34 |
33.84 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
MJ2 |
2303.80 |
2395.92 |
1243.95 |
1151.97 |
66.38 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
MJ3 |
2201.44 |
2289.47 |
1136.70 |
1152.77 |
72.49 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self |
X24 |
512.89 |
546.26 |
409.70 |
136.56 |
8.34 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self & Family |
X25 |
1154.05 |
1338.33 |
1003.75 |
334.58 |
46.07 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
X26 |
1102.77 |
1174.44 |
880.83 |
293.61 |
17.92 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self |
X21 |
606.30 |
630.54 |
472.91 |
157.63 |
6.06 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
X22 |
1364.22 |
1418.80 |
1064.10 |
354.70 |
13.65 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
X23 |
1303.58 |
1355.73 |
1016.80 |
338.93 |
13.04 |
Florida Humana HDHP - HDHP Self |
BR1 |
New Plan |
426.44 |
319.83 |
106.61 |
New Plan |
Florida Humana HDHP - HDHP Self & Family |
BR2 |
New Plan |
1062.23 |
796.67 |
265.56 |
New Plan |
Florida Humana HDHP - HDHP Self Plus One |
BR3 |
New Plan |
935.07 |
701.30 |
233.77 |
New Plan |
Florida Humana HDHP - HDHP Self |
A41 |
New Plan |
478.40 |
358.80 |
119.60 |
New Plan |
Florida Humana HDHP - HDHP Self & Family |
A42 |
New Plan |
1192.12 |
894.09 |
298.03 |
New Plan |
Florida Humana HDHP - HDHP Self Plus One |
A43 |
New Plan |
1049.38 |
787.04 |
262.34 |
New Plan |
Florida Humana HDHP - HDHP Self |
FF1 |
New Plan |
406.51 |
304.88 |
101.63 |
New Plan |
Florida Humana HDHP - HDHP Self & Family |
FF2 |
New Plan |
1012.33 |
759.25 |
253.08 |
New Plan |
Florida Humana HDHP - HDHP Self Plus One |
FF3 |
New Plan |
891.17 |
668.38 |
222.79 |
New Plan |
Florida Humana HDHP - HDHP Self |
AP1 |
New Plan |
483.08 |
362.31 |
120.77 |
New Plan |
Florida Humana HDHP - HDHP Self & Family |
AP2 |
New Plan |
1203.76 |
902.82 |
300.94 |
New Plan |
Florida Humana HDHP - HDHP Self Plus One |
AP3 |
New Plan |
1059.63 |
794.72 |
264.91 |
New Plan |
Florida Humana Medical Plan, Inc. - Standard Self |
LL4 |
1193.21 |
1282.69 |
530.53 |
752.16 |
82.37 |
Florida Humana Medical Plan, Inc. - Standard Self & Family |
LL5 |
2684.65 |
2886.00 |
1243.95 |
1642.05 |
175.61 |
Florida Humana Medical Plan, Inc. - Standard Self Plus One |
LL6 |
2565.33 |
2757.73 |
1136.70 |
1621.03 |
176.86 |
Florida Humana Medical Plan, Inc. - High Self |
LL1 |
1708.94 |
1794.37 |
530.53 |
1263.84 |
78.32 |
Florida Humana Medical Plan, Inc. - High Self & Family |
LL2 |
3845.05 |
4037.30 |
1243.95 |
2793.35 |
166.51 |
Florida Humana Medical Plan, Inc. - High Self Plus One |
LL3 |
3674.15 |
3857.86 |
1136.70 |
2721.16 |
168.17 |
Florida Humana Medical Plan, Inc. - High Self |
EE1 |
1248.93 |
1323.88 |
530.53 |
793.35 |
67.84 |
Florida Humana Medical Plan, Inc. - High Self & Family |
EE2 |
2810.15 |
2978.78 |
1243.95 |
1734.83 |
142.89 |
Florida Humana Medical Plan, Inc. - High Self Plus One |
EE3 |
2685.30 |
2846.44 |
1136.70 |
1709.74 |
145.60 |
Florida Humana Medical Plan, Inc. - Standard Self |
EE4 |
1116.77 |
1183.78 |
530.53 |
653.25 |
59.90 |
Florida Humana Medical Plan, Inc. - Standard Self & Family |
EE5 |
2512.71 |
2663.48 |
1243.95 |
1419.53 |
125.03 |
Florida Humana Medical Plan, Inc. - Standard Self Plus One |
EE6 |
2401.04 |
2545.12 |
1136.70 |
1408.42 |
128.54 |
Florida Humana Medical Plan, Inc. - Standard Self |
E24 |
766.13 |
804.44 |
530.53 |
273.91 |
31.20 |
Florida Humana Medical Plan, Inc. - Standard Self & Family |
E25 |
1723.78 |
1809.97 |
1243.95 |
566.02 |
60.45 |
Florida Humana Medical Plan, Inc. - Standard Self Plus One |
E26 |
1647.14 |
1729.50 |
1136.70 |
592.80 |
66.82 |
Florida Humana Medical Plan, Inc. - High Self |
E21 |
1286.83 |
1351.18 |
530.53 |
820.65 |
57.24 |
Florida Humana Medical Plan, Inc. - High Self & Family |
E22 |
2895.27 |
3040.05 |
1243.95 |
1796.10 |
119.04 |
Florida Humana Medical Plan, Inc. - High Self Plus One |
E23 |
2766.60 |
2904.94 |
1136.70 |
1768.24 |
122.80 |
Florida Humana Medical Plan, Inc. - High Self |
EX1 |
1018.49 |
1069.40 |
530.53 |
538.87 |
43.80 |
Florida Humana Medical Plan, Inc. - High Self & Family |
EX2 |
2291.53 |
2406.11 |
1243.95 |
1162.16 |
88.84 |
Florida Humana Medical Plan, Inc. - High Self Plus One |
EX3 |
2189.68 |
2299.16 |
1136.70 |
1162.46 |
93.94 |
Florida Humana Medical Plan, Inc. - Standard Self |
EX4 |
834.73 |
897.33 |
530.53 |
366.80 |
55.49 |
Florida Humana Medical Plan, Inc. - Standard Self & Family |
EX5 |
1878.15 |
2019.01 |
1243.95 |
775.06 |
115.12 |
Florida Humana Medical Plan, Inc. - Standard Self Plus One |
EX6 |
1794.67 |
1929.27 |
1136.70 |
792.57 |
119.06 |
Florida UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
599.47 |
650.91 |
488.18 |
162.73 |
12.86 |
Florida UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
1417.76 |
1539.46 |
1154.60 |
384.86 |
30.42 |
Florida UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
1288.89 |
1399.49 |
1049.62 |
349.87 |
27.65 |
Florida UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LS1 |
485.85 |
624.67 |
468.50 |
156.17 |
34.71 |
Florida UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LS2 |
1117.50 |
1436.76 |
1077.57 |
359.19 |
79.82 |
Florida UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LS3 |
1044.59 |
1343.07 |
1007.30 |
335.77 |
74.62 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KK1 |
769.04 |
847.30 |
530.53 |
316.77 |
71.15 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KK2 |
1922.64 |
2118.24 |
1243.95 |
874.29 |
169.86 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KK3 |
1653.47 |
1821.69 |
1136.70 |
684.99 |
152.68 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
LV1 |
750.62 |
897.89 |
530.53 |
367.36 |
140.16 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
LV2 |
2251.90 |
2693.64 |
1243.95 |
1449.69 |
416.00 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self Plus One |
LV3 |
1613.89 |
1930.46 |
1136.70 |
793.76 |
301.03 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
576.72 |
581.25 |
435.94 |
145.31 |
1.13 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
1363.94 |
1374.69 |
1031.02 |
343.67 |
2.69 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
1239.94 |
1249.71 |
937.28 |
312.43 |
2.45 |
Georgia Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Georgia Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Georgia Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Georgia Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Georgia Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Georgia Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
851.74 |
870.65 |
530.53 |
340.12 |
11.80 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
1942.03 |
1985.10 |
1243.95 |
741.15 |
17.33 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
1922.81 |
1965.45 |
1136.70 |
828.75 |
27.10 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
821.82 |
895.53 |
530.53 |
365.00 |
66.60 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
1881.88 |
2050.64 |
1243.95 |
806.69 |
143.02 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
1844.96 |
2010.45 |
1136.70 |
873.75 |
149.95 |
Georgia Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Georgia Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Georgia Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Georgia Aetna Open Access - High Self |
2U1 |
1805.85 |
1729.63 |
530.53 |
1199.10 |
-83.33 |
Georgia Aetna Open Access - High Self & Family |
2U2 |
4159.72 |
3984.13 |
1243.95 |
2740.18 |
-201.33 |
Georgia Aetna Open Access - High Self Plus One |
2U3 |
4118.53 |
3944.68 |
1136.70 |
2807.98 |
-189.39 |
Georgia Blue Open Access POS - High Self |
QM1 |
656.41 |
701.72 |
526.29 |
175.43 |
11.33 |
Georgia Blue Open Access POS - High Self & Family |
QM2 |
1689.68 |
1843.44 |
1243.95 |
599.49 |
128.02 |
Georgia Blue Open Access POS - High Self Plus One |
QM3 |
1446.62 |
1585.48 |
1136.70 |
448.78 |
87.13 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self |
S94 |
612.60 |
658.56 |
493.92 |
164.64 |
11.49 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self & Family |
S95 |
1378.35 |
1481.72 |
1111.29 |
370.43 |
25.84 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
S96 |
1317.10 |
1415.87 |
1061.90 |
353.97 |
24.70 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self |
S91 |
769.41 |
827.10 |
530.53 |
296.57 |
50.58 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
S92 |
1731.15 |
1860.99 |
1243.95 |
617.04 |
104.10 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
S93 |
1654.21 |
1778.29 |
1136.70 |
641.59 |
108.54 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self |
AD4 |
826.04 |
826.04 |
530.53 |
295.51 |
-7.11 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self & Family |
AD5 |
1858.52 |
1858.50 |
1243.95 |
614.55 |
-25.76 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
AD6 |
1775.95 |
1775.93 |
1136.70 |
639.23 |
-15.56 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self |
AD1 |
1090.18 |
1166.51 |
530.53 |
635.98 |
69.22 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
AD2 |
2452.86 |
2624.61 |
1243.95 |
1380.66 |
146.01 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
AD3 |
2343.86 |
2507.98 |
1136.70 |
1371.28 |
148.58 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self |
LM1 |
747.13 |
784.51 |
530.53 |
253.98 |
30.27 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
LM2 |
1681.12 |
1765.14 |
1243.95 |
521.19 |
58.28 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
LM3 |
1606.41 |
1686.69 |
1136.70 |
549.99 |
64.74 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self |
LM4 |
706.81 |
742.13 |
530.53 |
211.60 |
28.21 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self & Family |
LM5 |
1590.29 |
1669.81 |
1243.95 |
425.86 |
28.29 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
LM6 |
1519.64 |
1595.60 |
1136.70 |
458.90 |
60.42 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self |
RM1 |
719.88 |
791.87 |
530.53 |
261.34 |
64.88 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self & Family |
RM2 |
1619.74 |
1781.72 |
1243.95 |
537.77 |
132.84 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self Plus One |
RM3 |
1547.74 |
1702.52 |
1136.70 |
565.82 |
139.24 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self |
DN4 |
813.15 |
874.16 |
530.53 |
343.63 |
53.90 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self & Family |
DN5 |
1829.53 |
1966.77 |
1243.95 |
722.82 |
111.50 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self Plus One |
DN6 |
1748.24 |
1879.39 |
1136.70 |
742.69 |
115.61 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self |
RJ1 |
669.85 |
703.34 |
527.51 |
175.83 |
8.37 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self & Family |
RJ2 |
1507.22 |
1582.53 |
1186.90 |
395.63 |
18.83 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self Plus One |
RJ3 |
1440.23 |
1512.18 |
1134.14 |
378.04 |
17.98 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self |
Q71 |
846.71 |
872.11 |
530.53 |
341.58 |
18.29 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self & Family |
Q72 |
1905.11 |
1962.26 |
1243.95 |
718.31 |
31.41 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self Plus One |
Q73 |
1820.43 |
1875.03 |
1136.70 |
738.33 |
39.06 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self |
CB4 |
1137.89 |
1251.68 |
530.53 |
721.15 |
106.68 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self & Family |
CB5 |
2560.31 |
2816.30 |
1243.95 |
1572.35 |
230.25 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self Plus One |
CB6 |
2446.51 |
2691.13 |
1136.70 |
1554.43 |
229.08 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self |
DG4 |
1300.76 |
1430.85 |
530.53 |
900.32 |
122.98 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self & Family |
DG5 |
2926.71 |
3219.43 |
1243.95 |
1975.48 |
266.98 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self Plus One |
DG6 |
2796.71 |
3076.41 |
1136.70 |
1939.71 |
264.16 |
Georgia Humana HDHP - HDHP Self |
AZ1 |
New Plan |
472.40 |
354.30 |
118.10 |
New Plan |
Georgia Humana HDHP - HDHP Self & Family |
AZ2 |
New Plan |
1177.06 |
882.80 |
294.26 |
New Plan |
Georgia Humana HDHP - HDHP Self Plus One |
AZ3 |
New Plan |
1036.14 |
777.11 |
259.03 |
New Plan |
Georgia Humana HDHP - HDHP Self |
B21 |
New Plan |
487.02 |
365.27 |
121.75 |
New Plan |
Georgia Humana HDHP - HDHP Self & Family |
B22 |
New Plan |
1213.62 |
910.22 |
303.40 |
New Plan |
Georgia Humana HDHP - HDHP Self Plus One |
B23 |
New Plan |
1068.30 |
801.23 |
267.07 |
New Plan |
Georgia Humana HDHP - HDHP Self |
AR1 |
New Plan |
477.45 |
358.09 |
119.36 |
New Plan |
Georgia Humana HDHP - HDHP Self & Family |
AR2 |
New Plan |
1189.72 |
892.29 |
297.43 |
New Plan |
Georgia Humana HDHP - HDHP Self Plus One |
AR3 |
New Plan |
1047.26 |
785.45 |
261.81 |
New Plan |
Georgia Kaiser Permanente - Georgia - High Self |
F81 |
751.10 |
769.71 |
530.53 |
239.18 |
11.50 |
Georgia Kaiser Permanente - Georgia - High Self & Family |
F82 |
1697.50 |
1739.57 |
1243.95 |
495.62 |
16.33 |
Georgia Kaiser Permanente - Georgia - High Self Plus One |
F83 |
1697.50 |
1739.57 |
1136.70 |
602.87 |
26.53 |
Georgia Kaiser Permanente - Georgia - Standard Self |
F84 |
581.10 |
600.71 |
450.53 |
150.18 |
4.91 |
Georgia Kaiser Permanente - Georgia - Standard Self & Family |
F85 |
1313.26 |
1357.59 |
1018.19 |
339.40 |
11.09 |
Georgia Kaiser Permanente - Georgia - Standard Self Plus One |
F86 |
1313.26 |
1357.59 |
1018.19 |
339.40 |
11.09 |
Georgia Kaiser Permanente - Georgia - Prosper Self |
LA1 |
418.90 |
398.65 |
298.99 |
99.66 |
-5.06 |
Georgia Kaiser Permanente - Georgia - Prosper Self & Family |
LA2 |
946.66 |
1034.97 |
776.23 |
258.74 |
22.08 |
Georgia Kaiser Permanente - Georgia - Prosper Self Plus One |
LA3 |
946.66 |
900.92 |
675.69 |
225.23 |
-11.43 |
Georgia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
599.47 |
650.91 |
488.18 |
162.73 |
12.86 |
Georgia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
1417.76 |
1539.46 |
1154.60 |
384.86 |
30.42 |
Georgia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
1288.89 |
1399.49 |
1049.62 |
349.87 |
27.65 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
LV1 |
750.62 |
897.89 |
530.53 |
367.36 |
140.16 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
LV2 |
2251.90 |
2693.64 |
1243.95 |
1449.69 |
416.00 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self Plus One |
LV3 |
1613.89 |
1930.46 |
1136.70 |
793.76 |
301.03 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
576.72 |
581.25 |
435.94 |
145.31 |
1.13 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
1363.94 |
1374.69 |
1031.02 |
343.67 |
2.69 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
1239.94 |
1249.71 |
937.28 |
312.43 |
2.45 |
Guam Calvo's SelectCare - Standard Self |
B44 |
429.78 |
378.91 |
284.18 |
94.73 |
-12.71 |
Guam Calvo's SelectCare - Standard Self & Family |
B45 |
1248.72 |
1100.91 |
825.68 |
275.23 |
-36.95 |
Guam Calvo's SelectCare - Standard Self Plus One |
B46 |
847.21 |
746.92 |
560.19 |
186.73 |
-25.07 |
Guam Calvo's SelectCare - High Self |
B41 |
521.69 |
535.95 |
401.96 |
133.99 |
3.57 |
Guam Calvo's SelectCare - High Self & Family |
B42 |
1381.77 |
1419.54 |
1064.66 |
354.88 |
9.44 |
Guam Calvo's SelectCare - High Self Plus One |
B43 |
1018.07 |
1045.89 |
784.42 |
261.47 |
6.95 |
Guam TakeCare - HDHP Self |
KX1 |
120.53 |
122.31 |
91.73 |
30.58 |
0.45 |
Guam TakeCare - HDHP Self & Family |
KX2 |
323.16 |
327.97 |
245.98 |
81.99 |
1.20 |
Guam TakeCare - HDHP Self Plus One |
KX3 |
290.94 |
295.23 |
221.42 |
73.81 |
1.08 |
Guam TakeCare - Standard Self |
JK4 |
404.45 |
405.77 |
304.33 |
101.44 |
0.33 |
Guam TakeCare - Standard Self & Family |
JK5 |
1145.39 |
1149.18 |
861.89 |
287.29 |
0.94 |
Guam TakeCare - Standard Self Plus One |
JK6 |
797.14 |
799.78 |
599.84 |
199.94 |
0.66 |
Guam TakeCare - High Self |
JK1 |
497.81 |
515.86 |
386.90 |
128.96 |
4.51 |
Guam TakeCare - High Self & Family |
JK2 |
1187.38 |
1230.43 |
922.82 |
307.61 |
10.77 |
Guam TakeCare - High Self Plus One |
JK3 |
983.49 |
1019.16 |
764.37 |
254.79 |
8.92 |
Hawaii Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Hawaii Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Hawaii Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Hawaii Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Hawaii Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Hawaii Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
JS4 |
1094.58 |
1094.51 |
530.53 |
563.98 |
-7.18 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
JS5 |
2498.80 |
2498.64 |
1243.95 |
1254.69 |
-25.90 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
JS6 |
2474.07 |
2473.94 |
1136.70 |
1337.24 |
-15.67 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
JS1 |
1009.93 |
1037.34 |
530.53 |
506.81 |
20.30 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
JS2 |
2302.15 |
2364.66 |
1243.95 |
1120.71 |
36.77 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
JS3 |
2279.33 |
2341.24 |
1136.70 |
1204.54 |
46.37 |
Hawaii Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Hawaii Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Hawaii Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Hawaii HMSA Plan - High Self |
871 |
631.24 |
631.24 |
473.43 |
157.81 |
0.00 |
Hawaii HMSA Plan - High Self & Family |
872 |
1419.02 |
1419.02 |
1064.27 |
354.75 |
0.00 |
Hawaii HMSA Plan - High Self Plus One |
873 |
1383.07 |
1383.07 |
1037.30 |
345.77 |
0.00 |
Hawaii HMSA Plan - Standard Self |
874 |
453.83 |
453.83 |
340.37 |
113.46 |
0.00 |
Hawaii HMSA Plan - Standard Self & Family |
875 |
1020.18 |
1020.18 |
765.14 |
255.04 |
0.00 |
Hawaii HMSA Plan - Standard Self Plus One |
876 |
994.28 |
994.28 |
745.71 |
248.57 |
0.00 |
Hawaii Kaiser Permanente - Hawaii - High Self |
631 |
675.55 |
675.55 |
506.66 |
168.89 |
0.00 |
Hawaii Kaiser Permanente - Hawaii - High Self & Family |
632 |
1506.51 |
1506.51 |
1129.88 |
376.63 |
0.00 |
Hawaii Kaiser Permanente - Hawaii - High Self Plus One |
633 |
1506.51 |
1506.51 |
1129.88 |
376.63 |
-8.72 |
Hawaii Kaiser Permanente - Hawaii - Standard Self |
634 |
505.18 |
485.38 |
364.04 |
121.34 |
-4.95 |
Hawaii Kaiser Permanente - Hawaii - Standard Self & Family |
635 |
1126.52 |
1082.38 |
811.79 |
270.59 |
-11.04 |
Hawaii Kaiser Permanente - Hawaii - Standard Self Plus One |
636 |
1126.52 |
1082.38 |
811.79 |
270.59 |
-11.04 |
Idaho Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Idaho Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Idaho Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Idaho Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Idaho Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Idaho Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
826.84 |
826.19 |
530.53 |
295.66 |
-7.76 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
1884.74 |
1883.22 |
1243.95 |
639.27 |
-27.26 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
1866.43 |
1864.96 |
1136.70 |
728.26 |
-17.01 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
817.48 |
833.73 |
530.53 |
303.20 |
9.14 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
1876.16 |
1913.45 |
1243.95 |
669.50 |
11.55 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
1839.39 |
1875.94 |
1136.70 |
739.24 |
21.01 |
Idaho Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Idaho Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Idaho Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Idaho Altius Health Plan - High Self |
9K1 |
1048.36 |
1150.85 |
530.53 |
620.32 |
95.38 |
Idaho Altius Health Plan - High Self & Family |
9K2 |
2318.46 |
2545.10 |
1243.95 |
1301.15 |
200.90 |
Idaho Altius Health Plan - High Self Plus One |
9K3 |
2295.50 |
2519.92 |
1136.70 |
1383.22 |
208.88 |
Idaho Altius Health Plan - HDHP Self |
9K4 |
672.49 |
759.22 |
530.53 |
228.69 |
60.57 |
Idaho Altius Health Plan - HDHP Self & Family |
9K5 |
1405.43 |
1586.72 |
1190.04 |
396.68 |
45.32 |
Idaho Altius Health Plan - HDHP Self Plus One |
9K6 |
1377.85 |
1555.56 |
1136.70 |
418.86 |
74.40 |
Idaho Altius Health Plan - Standard Self |
DK4 |
883.11 |
942.54 |
530.53 |
412.01 |
52.32 |
Idaho Altius Health Plan - Standard Self & Family |
DK5 |
1950.20 |
2081.43 |
1243.95 |
837.48 |
105.49 |
Idaho Altius Health Plan - Standard Self Plus One |
DK6 |
1930.87 |
2060.80 |
1136.70 |
924.10 |
114.39 |
Idaho Kaiser Permanente - Washington Core - Standard Self |
544 |
618.02 |
625.21 |
468.91 |
156.30 |
1.80 |
Idaho Kaiser Permanente - Washington Core - Standard Self & Family |
545 |
1421.44 |
1438.00 |
1078.50 |
359.50 |
4.14 |
Idaho Kaiser Permanente - Washington Core - Standard Self Plus One |
546 |
1421.44 |
1438.00 |
1078.50 |
359.50 |
4.14 |
Idaho Kaiser Permanente - Washington Core - High Self |
541 |
863.76 |
869.53 |
530.53 |
339.00 |
-1.34 |
Idaho Kaiser Permanente - Washington Core - High Self & Family |
542 |
1900.25 |
1912.93 |
1243.95 |
668.98 |
-13.06 |
Idaho Kaiser Permanente - Washington Core - High Self Plus One |
543 |
1900.25 |
1912.93 |
1136.70 |
776.23 |
-2.86 |
Idaho Kaiser Permanente - Washington Core - Prosper Self |
PT4 |
390.00 |
390.00 |
292.50 |
97.50 |
0.00 |
Idaho Kaiser Permanente - Washington Core - Prosper Self & Family |
PT5 |
1091.98 |
1091.98 |
818.99 |
272.99 |
0.00 |
Idaho Kaiser Permanente - Washington Core - Prosper Self Plus One |
PT6 |
944.67 |
944.67 |
708.50 |
236.17 |
0.00 |
Illinois Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Illinois Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Illinois Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Illinois Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Illinois Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Illinois Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
826.84 |
826.19 |
530.53 |
295.66 |
-7.76 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
1884.74 |
1883.22 |
1243.95 |
639.27 |
-27.26 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
1866.43 |
1864.96 |
1136.70 |
728.26 |
-17.01 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
817.48 |
833.73 |
530.53 |
303.20 |
9.14 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
1876.16 |
1913.45 |
1243.95 |
669.50 |
11.55 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
1839.39 |
1875.94 |
1136.70 |
739.24 |
21.01 |
Illinois Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Illinois Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Illinois Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Illinois Blue Preferred - High Self |
9G1 |
874.23 |
905.71 |
530.53 |
375.18 |
24.37 |
Illinois Blue Preferred - High Self & Family |
9G2 |
1984.52 |
2139.32 |
1243.95 |
895.37 |
129.06 |
Illinois Blue Preferred - High Self Plus One |
9G3 |
1862.12 |
2005.51 |
1136.70 |
868.81 |
127.85 |
Illinois Blue Preferred - Standard Self |
9G4 |
633.66 |
614.01 |
460.51 |
153.50 |
-4.91 |
Illinois Blue Preferred - Standard Self & Family |
9G5 |
1758.23 |
1791.62 |
1243.95 |
547.67 |
7.65 |
Illinois Blue Preferred - Standard Self Plus One |
9G6 |
1574.58 |
1598.20 |
1136.70 |
461.50 |
8.08 |
Illinois Health Alliance HMO - Standard Self |
K84 |
683.56 |
704.08 |
528.06 |
176.02 |
5.13 |
Illinois Health Alliance HMO - Standard Self & Family |
K85 |
1584.35 |
1631.89 |
1223.92 |
407.97 |
11.88 |
Illinois Health Alliance HMO - Standard Self Plus One |
K86 |
1461.61 |
1505.44 |
1129.08 |
376.36 |
10.96 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self |
GB4 |
788.47 |
827.91 |
530.53 |
297.38 |
32.33 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self & Family |
GB5 |
1774.00 |
1862.71 |
1243.95 |
618.76 |
62.97 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
GB6 |
1695.16 |
1779.92 |
1136.70 |
643.22 |
69.22 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self |
GB1 |
1227.74 |
1319.83 |
530.53 |
789.30 |
84.98 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
GB2 |
2762.39 |
2969.55 |
1243.95 |
1725.60 |
181.42 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
GB3 |
2639.65 |
2837.62 |
1136.70 |
1700.92 |
182.43 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self |
MW4 |
807.76 |
799.70 |
530.53 |
269.17 |
-15.17 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self & Family |
MW5 |
1817.40 |
1799.27 |
1243.95 |
555.32 |
-43.87 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
MW6 |
1736.67 |
1719.32 |
1136.70 |
582.62 |
-32.89 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self |
MW1 |
1025.96 |
1056.75 |
530.53 |
526.22 |
23.68 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
MW2 |
2308.48 |
2377.81 |
1243.95 |
1133.86 |
43.59 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
MW3 |
2205.86 |
2272.08 |
1136.70 |
1135.38 |
50.68 |
Illinois Humana HDHP - HDHP Self |
BB1 |
New Plan |
445.29 |
333.97 |
111.32 |
New Plan |
Illinois Humana HDHP - HDHP Self & Family |
BB2 |
New Plan |
1109.33 |
832.00 |
277.33 |
New Plan |
Illinois Humana HDHP - HDHP Self Plus One |
BB3 |
New Plan |
976.52 |
732.39 |
244.13 |
New Plan |
Illinois Humana HDHP - HDHP Self |
AW1 |
New Plan |
420.70 |
315.53 |
105.17 |
New Plan |
Illinois Humana HDHP - HDHP Self & Family |
AW2 |
New Plan |
1047.82 |
785.87 |
261.95 |
New Plan |
Illinois Humana HDHP - HDHP Self Plus One |
AW3 |
New Plan |
922.39 |
691.79 |
230.60 |
New Plan |
Illinois Humana Health Plan, Inc. - Standard Self |
754 |
1045.35 |
1055.80 |
530.53 |
525.27 |
3.34 |
Illinois Humana Health Plan, Inc. - Standard Self & Family |
755 |
2352.03 |
2375.56 |
1243.95 |
1131.61 |
-2.21 |
Illinois Humana Health Plan, Inc. - Standard Self Plus One |
756 |
2247.53 |
2270.00 |
1136.70 |
1133.30 |
6.93 |
Illinois Humana Health Plan, Inc. - High Self |
751 |
1369.01 |
1403.24 |
530.53 |
872.71 |
27.12 |
Illinois Humana Health Plan, Inc. - High Self & Family |
752 |
3080.33 |
3157.29 |
1243.95 |
1913.34 |
51.22 |
Illinois Humana Health Plan, Inc. - High Self Plus One |
753 |
2943.42 |
3016.98 |
1136.70 |
1880.28 |
58.02 |
Illinois Humana Health Plan, Inc. - High Self |
9F1 |
2015.85 |
2116.64 |
530.53 |
1586.11 |
93.68 |
Illinois Humana Health Plan, Inc. - High Self & Family |
9F2 |
4535.64 |
4762.44 |
1243.95 |
3518.49 |
201.06 |
Illinois Humana Health Plan, Inc. - High Self Plus One |
9F3 |
4334.03 |
4550.74 |
1136.70 |
3414.04 |
201.17 |
Illinois Humana Health Plan, Inc. - Standard Self |
AB4 |
1241.70 |
1447.46 |
530.53 |
916.93 |
198.65 |
Illinois Humana Health Plan, Inc. - Standard Self & Family |
AB5 |
2793.90 |
3256.85 |
1243.95 |
2012.90 |
437.21 |
Illinois Humana Health Plan, Inc. - Standard Self Plus One |
AB6 |
2669.72 |
3112.11 |
1136.70 |
1975.41 |
426.85 |
Illinois Humana Health Plan, Inc. - Basic Self |
AB1 |
786.91 |
845.93 |
530.53 |
315.40 |
51.91 |
Illinois Humana Health Plan, Inc. - Basic Self & Family |
AB2 |
1770.60 |
1903.40 |
1243.95 |
659.45 |
107.06 |
Illinois Humana Health Plan, Inc. - Basic Self Plus One |
AB3 |
1691.91 |
1818.81 |
1136.70 |
682.11 |
111.36 |
Illinois Humana Health Plan, Inc. - Basic Self |
RW1 |
819.04 |
839.50 |
530.53 |
308.97 |
13.35 |
Illinois Humana Health Plan, Inc. - Basic Self & Family |
RW2 |
1842.86 |
1888.88 |
1243.95 |
644.93 |
20.28 |
Illinois Humana Health Plan, Inc. - Basic Self Plus One |
RW3 |
1760.96 |
1804.92 |
1136.70 |
668.22 |
28.42 |
Illinois UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
599.47 |
650.91 |
488.18 |
162.73 |
12.86 |
Illinois UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
1417.76 |
1539.46 |
1154.60 |
384.86 |
30.42 |
Illinois UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
1288.89 |
1399.49 |
1049.62 |
349.87 |
27.65 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
L91 |
554.62 |
663.76 |
497.82 |
165.94 |
27.29 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
L92 |
1555.15 |
1586.41 |
1189.81 |
396.60 |
7.81 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self Plus One |
L93 |
1083.18 |
1327.54 |
995.66 |
331.88 |
61.09 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
576.72 |
581.25 |
435.94 |
145.31 |
1.13 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
1363.94 |
1374.69 |
1031.02 |
343.67 |
2.69 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
1239.94 |
1249.71 |
937.28 |
312.43 |
2.45 |
Indiana Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Indiana Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Indiana Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Indiana Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Indiana Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Indiana Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
JS4 |
1094.58 |
1094.51 |
530.53 |
563.98 |
-7.18 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
JS5 |
2498.80 |
2498.64 |
1243.95 |
1254.69 |
-25.90 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
JS6 |
2474.07 |
2473.94 |
1136.70 |
1337.24 |
-15.67 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
JS1 |
1009.93 |
1037.34 |
530.53 |
506.81 |
20.30 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
JS2 |
2302.15 |
2364.66 |
1243.95 |
1120.71 |
36.77 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
JS3 |
2279.33 |
2341.24 |
1136.70 |
1204.54 |
46.37 |
Indiana Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Indiana Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Indiana Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Indiana Health Alliance HMO - Standard Self |
K84 |
683.56 |
704.08 |
528.06 |
176.02 |
5.13 |
Indiana Health Alliance HMO - Standard Self & Family |
K85 |
1584.35 |
1631.89 |
1223.92 |
407.97 |
11.88 |
Indiana Health Alliance HMO - Standard Self Plus One |
K86 |
1461.61 |
1505.44 |
1129.08 |
376.36 |
10.96 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self |
MW4 |
807.76 |
799.70 |
530.53 |
269.17 |
-15.17 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self & Family |
MW5 |
1817.40 |
1799.27 |
1243.95 |
555.32 |
-43.87 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
MW6 |
1736.67 |
1719.32 |
1136.70 |
582.62 |
-32.89 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self |
MW1 |
1025.96 |
1056.75 |
530.53 |
526.22 |
23.68 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
MW2 |
2308.48 |
2377.81 |
1243.95 |
1133.86 |
43.59 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
MW3 |
2205.86 |
2272.08 |
1136.70 |
1135.38 |
50.68 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self |
TC1 |
738.57 |
757.06 |
530.53 |
226.53 |
11.38 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
TC2 |
1661.79 |
1703.33 |
1243.95 |
459.38 |
15.80 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
TC3 |
1587.95 |
1627.64 |
1136.70 |
490.94 |
24.15 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self |
TC4 |
New Plan |
579.74 |
434.81 |
144.93 |
New Plan |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self & Family |
TC5 |
New Plan |
1304.42 |
978.32 |
326.10 |
New Plan |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
TC6 |
New Plan |
1246.44 |
934.83 |
311.61 |
New Plan |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self |
X34 |
645.88 |
694.33 |
520.75 |
173.58 |
12.11 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self & Family |
X35 |
1453.25 |
1562.23 |
1171.67 |
390.56 |
27.25 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
X36 |
1388.66 |
1492.81 |
1119.61 |
373.20 |
26.04 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self |
X31 |
839.41 |
902.37 |
530.53 |
371.84 |
55.85 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
X32 |
1888.71 |
2030.34 |
1243.95 |
786.39 |
115.89 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
X33 |
1804.77 |
1940.12 |
1136.70 |
803.42 |
119.81 |
Indiana Humana HDHP - HDHP Self |
BB1 |
New Plan |
445.29 |
333.97 |
111.32 |
New Plan |
Indiana Humana HDHP - HDHP Self & Family |
BB2 |
New Plan |
1109.33 |
832.00 |
277.33 |
New Plan |
Indiana Humana HDHP - HDHP Self Plus One |
BB3 |
New Plan |
976.52 |
732.39 |
244.13 |
New Plan |
Indiana Humana HDHP - HDHP Self |
DT1 |
New Plan |
495.73 |
371.80 |
123.93 |
New Plan |
Indiana Humana HDHP - HDHP Self & Family |
DT2 |
New Plan |
1235.41 |
926.56 |
308.85 |
New Plan |
Indiana Humana HDHP - HDHP Self Plus One |
DT3 |
New Plan |
1087.47 |
815.60 |
271.87 |
New Plan |
Indiana Humana Health Plan of Ohio, Inc. - Standard Self |
A64 |
1230.78 |
1243.08 |
530.53 |
712.55 |
5.19 |
Indiana Humana Health Plan of Ohio, Inc. - Standard Self & Family |
A65 |
2769.30 |
2796.95 |
1243.95 |
1553.00 |
1.91 |
Indiana Humana Health Plan of Ohio, Inc. - Standard Self Plus One |
A66 |
2646.19 |
2672.63 |
1136.70 |
1535.93 |
10.90 |
Indiana Humana Health Plan, Inc. - Standard Self |
754 |
1045.35 |
1055.80 |
530.53 |
525.27 |
3.34 |
Indiana Humana Health Plan, Inc. - Standard Self & Family |
755 |
2352.03 |
2375.56 |
1243.95 |
1131.61 |
-2.21 |
Indiana Humana Health Plan, Inc. - Standard Self Plus One |
756 |
2247.53 |
2270.00 |
1136.70 |
1133.30 |
6.93 |
Indiana Humana Health Plan, Inc. - High Self |
751 |
1369.01 |
1403.24 |
530.53 |
872.71 |
27.12 |
Indiana Humana Health Plan, Inc. - High Self & Family |
752 |
3080.33 |
3157.29 |
1243.95 |
1913.34 |
51.22 |
Indiana Humana Health Plan, Inc. - High Self Plus One |
753 |
2943.42 |
3016.98 |
1136.70 |
1880.28 |
58.02 |
Indiana Humana Health Plan, Inc. - Standard Self |
MH4 |
945.62 |
992.90 |
530.53 |
462.37 |
40.17 |
Indiana Humana Health Plan, Inc. - Standard Self & Family |
MH5 |
2127.62 |
2233.96 |
1243.95 |
990.01 |
80.60 |
Indiana Humana Health Plan, Inc. - Standard Self Plus One |
MH6 |
2033.05 |
2134.67 |
1136.70 |
997.97 |
86.08 |
Iowa Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Iowa Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Iowa Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Iowa Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Iowa Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Iowa Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
826.84 |
826.19 |
530.53 |
295.66 |
-7.76 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
1884.74 |
1883.22 |
1243.95 |
639.27 |
-27.26 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
1866.43 |
1864.96 |
1136.70 |
728.26 |
-17.01 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
817.48 |
833.73 |
530.53 |
303.20 |
9.14 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
1876.16 |
1913.45 |
1243.95 |
669.50 |
11.55 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
1839.39 |
1875.94 |
1136.70 |
739.24 |
21.01 |
Iowa Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Iowa Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Iowa Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Iowa Health Alliance HMO - Standard Self |
K84 |
683.56 |
704.08 |
528.06 |
176.02 |
5.13 |
Iowa Health Alliance HMO - Standard Self & Family |
K85 |
1584.35 |
1631.89 |
1223.92 |
407.97 |
11.88 |
Iowa Health Alliance HMO - Standard Self Plus One |
K86 |
1461.61 |
1505.44 |
1129.08 |
376.36 |
10.96 |
Iowa HealthPartners - Standard Self |
V34 |
509.41 |
553.28 |
414.96 |
138.32 |
10.97 |
Iowa HealthPartners - Standard Self & Family |
V35 |
1240.94 |
1347.84 |
1010.88 |
336.96 |
26.73 |
Iowa HealthPartners - Standard Self Plus One |
V36 |
1125.80 |
1222.78 |
917.09 |
305.69 |
24.24 |
Iowa HealthPartners - High Self |
V31 |
668.07 |
692.14 |
519.11 |
173.03 |
6.01 |
Iowa HealthPartners - High Self & Family |
V32 |
1627.38 |
1686.01 |
1243.95 |
442.06 |
32.89 |
Iowa HealthPartners - High Self Plus One |
V33 |
1476.41 |
1529.58 |
1136.70 |
392.88 |
23.78 |
Iowa UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
599.47 |
650.91 |
488.18 |
162.73 |
12.86 |
Iowa UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
1417.76 |
1539.46 |
1154.60 |
384.86 |
30.42 |
Iowa UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
1288.89 |
1399.49 |
1049.62 |
349.87 |
27.65 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
N71 |
692.86 |
744.55 |
530.53 |
214.02 |
40.81 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
N72 |
1593.56 |
1712.45 |
1243.95 |
468.50 |
70.11 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
N73 |
1489.63 |
1600.76 |
1136.70 |
464.06 |
91.65 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
LJ1 |
776.84 |
873.95 |
530.53 |
343.42 |
90.00 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
LJ2 |
1942.11 |
2184.93 |
1243.95 |
940.98 |
217.08 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
LJ3 |
1670.22 |
1879.04 |
1136.70 |
742.34 |
193.28 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
576.72 |
581.25 |
435.94 |
145.31 |
1.13 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
1363.94 |
1374.69 |
1031.02 |
343.67 |
2.69 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
1239.94 |
1249.71 |
937.28 |
312.43 |
2.45 |
Kansas Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Kansas Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Kansas Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Kansas Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Kansas Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Kansas Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
717.04 |
834.38 |
530.53 |
303.85 |
110.23 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
1642.27 |
1911.07 |
1243.95 |
667.12 |
243.06 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
1610.09 |
1873.63 |
1136.70 |
736.93 |
248.00 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
1058.76 |
1135.10 |
530.53 |
604.57 |
69.23 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
2415.08 |
2589.21 |
1243.95 |
1345.26 |
148.39 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
2391.20 |
2563.60 |
1136.70 |
1426.90 |
156.86 |
Kansas Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Kansas Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Kansas Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Kansas Aetna Open Access - High Self |
HA1 |
1156.52 |
1188.98 |
530.53 |
658.45 |
25.35 |
Kansas Aetna Open Access - High Self & Family |
HA2 |
2731.91 |
2808.54 |
1243.95 |
1564.59 |
50.89 |
Kansas Aetna Open Access - High Self Plus One |
HA3 |
2704.89 |
2780.77 |
1136.70 |
1644.07 |
60.34 |
Kansas Aetna Open Access - Standard Self |
HA4 |
901.36 |
909.37 |
530.53 |
378.84 |
0.90 |
Kansas Aetna Open Access - Standard Self & Family |
HA5 |
2127.54 |
2146.47 |
1243.95 |
902.52 |
-6.81 |
Kansas Aetna Open Access - Standard Self Plus One |
HA6 |
2106.48 |
2125.26 |
1136.70 |
988.56 |
3.24 |
Kansas Humana CoverageFirst and Humana Value Plan - Value Self |
PH4 |
527.61 |
567.17 |
425.38 |
141.79 |
9.89 |
Kansas Humana CoverageFirst and Humana Value Plan - Value Self & Family |
PH5 |
1187.12 |
1276.15 |
957.11 |
319.04 |
22.26 |
Kansas Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
PH6 |
1134.36 |
1219.44 |
914.58 |
304.86 |
21.27 |
Kansas Humana CoverageFirst and Humana Value Plan - CDHP Self |
PH1 |
758.03 |
758.03 |
530.53 |
227.50 |
-7.11 |
Kansas Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
PH2 |
1705.58 |
1705.60 |
1243.95 |
461.65 |
-25.72 |
Kansas Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
PH3 |
1629.77 |
1629.79 |
1136.70 |
493.09 |
-15.52 |
Kansas Humana HDHP - HDHP Self |
BK1 |
New Plan |
403.13 |
302.35 |
100.78 |
New Plan |
Kansas Humana HDHP - HDHP Self & Family |
BK2 |
New Plan |
1003.93 |
752.95 |
250.98 |
New Plan |
Kansas Humana HDHP - HDHP Self Plus One |
BK3 |
New Plan |
883.78 |
662.84 |
220.94 |
New Plan |
Kansas Humana Health Plan, Inc. - Standard Self |
MS4 |
1200.59 |
1290.64 |
530.53 |
760.11 |
82.94 |
Kansas Humana Health Plan, Inc. - Standard Self & Family |
MS5 |
2701.34 |
2903.98 |
1243.95 |
1660.03 |
176.90 |
Kansas Humana Health Plan, Inc. - Standard Self Plus One |
MS6 |
2581.32 |
2774.94 |
1136.70 |
1638.24 |
178.08 |
Kentucky Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Kentucky Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Kentucky Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Kentucky Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Kentucky Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Kentucky Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Kentucky Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
826.84 |
826.19 |
530.53 |
295.66 |
-7.76 |
Kentucky Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
1884.74 |
1883.22 |
1243.95 |
639.27 |
-27.26 |
Kentucky Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
1866.43 |
1864.96 |
1136.70 |
728.26 |
-17.01 |
Kentucky Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
817.48 |
833.73 |
530.53 |
303.20 |
9.14 |
Kentucky Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
1876.16 |
1913.45 |
1243.95 |
669.50 |
11.55 |
Kentucky Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
1839.39 |
1875.94 |
1136.70 |
739.24 |
21.01 |
Kentucky Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Kentucky Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Kentucky Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Kentucky Humana CoverageFirst and Humana Value Plan - CDHP Self |
TC1 |
738.57 |
757.06 |
530.53 |
226.53 |
11.38 |
Kentucky Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
TC2 |
1661.79 |
1703.33 |
1243.95 |
459.38 |
15.80 |
Kentucky Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
TC3 |
1587.95 |
1627.64 |
1136.70 |
490.94 |
24.15 |
Kentucky Humana CoverageFirst and Humana Value Plan - Value Self |
TC4 |
New Plan |
579.74 |
434.81 |
144.93 |
New Plan |
Kentucky Humana CoverageFirst and Humana Value Plan - Value Self & Family |
TC5 |
New Plan |
1304.42 |
978.32 |
326.10 |
New Plan |
Kentucky Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
TC6 |
New Plan |
1246.44 |
934.83 |
311.61 |
New Plan |
Kentucky Humana CoverageFirst and Humana Value Plan - CDHP Self |
6N1 |
828.04 |
848.75 |
530.53 |
318.22 |
13.60 |
Kentucky Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
6N2 |
1863.07 |
1909.68 |
1243.95 |
665.73 |
20.87 |
Kentucky Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
6N3 |
1780.29 |
1824.81 |
1136.70 |
688.11 |
28.98 |
Kentucky Humana CoverageFirst and Humana Value Plan - Value Self |
6N4 |
New Plan |
633.82 |
475.37 |
158.45 |
New Plan |
Kentucky Humana CoverageFirst and Humana Value Plan - Value Self & Family |
6N5 |
New Plan |
1426.06 |
1069.55 |
356.51 |
New Plan |
Kentucky Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
6N6 |
New Plan |
1362.70 |
1022.03 |
340.67 |
New Plan |
Kentucky Humana CoverageFirst and Humana Value Plan - Value Self |
X34 |
645.88 |
694.33 |
520.75 |
173.58 |
12.11 |
Kentucky Humana CoverageFirst and Humana Value Plan - Value Self & Family |
X35 |
1453.25 |
1562.23 |
1171.67 |
390.56 |
27.25 |
Kentucky Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
X36 |
1388.66 |
1492.81 |
1119.61 |
373.20 |
26.04 |
Kentucky Humana CoverageFirst and Humana Value Plan - CDHP Self |
X31 |
839.41 |
902.37 |
530.53 |
371.84 |
55.85 |
Kentucky Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
X32 |
1888.71 |
2030.34 |
1243.95 |
786.39 |
115.89 |
Kentucky Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
X33 |
1804.77 |
1940.12 |
1136.70 |
803.42 |
119.81 |
Kentucky Humana HDHP - HDHP Self |
DT1 |
New Plan |
495.73 |
371.80 |
123.93 |
New Plan |
Kentucky Humana HDHP - HDHP Self & Family |
DT2 |
New Plan |
1235.41 |
926.56 |
308.85 |
New Plan |
Kentucky Humana HDHP - HDHP Self Plus One |
DT3 |
New Plan |
1087.47 |
815.60 |
271.87 |
New Plan |
Kentucky Humana Health Plan of Ohio, Inc. - Standard Self |
A64 |
1230.78 |
1243.08 |
530.53 |
712.55 |
5.19 |
Kentucky Humana Health Plan of Ohio, Inc. - Standard Self & Family |
A65 |
2769.30 |
2796.95 |
1243.95 |
1553.00 |
1.91 |
Kentucky Humana Health Plan of Ohio, Inc. - Standard Self Plus One |
A66 |
2646.19 |
2672.63 |
1136.70 |
1535.93 |
10.90 |
Kentucky Humana Health Plan of Ohio, Inc. - Basic Self |
W61 |
639.06 |
671.02 |
503.27 |
167.75 |
7.99 |
Kentucky Humana Health Plan of Ohio, Inc. - Basic Self & Family |
W62 |
1437.93 |
1509.82 |
1132.37 |
377.45 |
17.97 |
Kentucky Humana Health Plan of Ohio, Inc. - Basic Self Plus One |
W63 |
1374.01 |
1442.72 |
1082.04 |
360.68 |
17.18 |
Kentucky Humana Health Plan, Inc. - Standard Self |
MI4 |
920.40 |
929.59 |
530.53 |
399.06 |
2.08 |
Kentucky Humana Health Plan, Inc. - Standard Self & Family |
MI5 |
2070.86 |
2091.55 |
1243.95 |
847.60 |
-5.05 |
Kentucky Humana Health Plan, Inc. - Standard Self Plus One |
MI6 |
1978.84 |
1998.62 |
1136.70 |
861.92 |
4.24 |
Kentucky Humana Health Plan, Inc. - Standard Self |
MH4 |
945.62 |
992.90 |
530.53 |
462.37 |
40.17 |
Kentucky Humana Health Plan, Inc. - Standard Self & Family |
MH5 |
2127.62 |
2233.96 |
1243.95 |
990.01 |
80.60 |
Kentucky Humana Health Plan, Inc. - Standard Self Plus One |
MH6 |
2033.05 |
2134.67 |
1136.70 |
997.97 |
86.08 |
Kentucky UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
599.47 |
650.91 |
488.18 |
162.73 |
12.86 |
Kentucky UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
1417.76 |
1539.46 |
1154.60 |
384.86 |
30.42 |
Kentucky UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
1288.89 |
1399.49 |
1049.62 |
349.87 |
27.65 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
N71 |
692.86 |
744.55 |
530.53 |
214.02 |
40.81 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
N72 |
1593.56 |
1712.45 |
1243.95 |
468.50 |
70.11 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
N73 |
1489.63 |
1600.76 |
1136.70 |
464.06 |
91.65 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
LJ1 |
776.84 |
873.95 |
530.53 |
343.42 |
90.00 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
LJ2 |
1942.11 |
2184.93 |
1243.95 |
940.98 |
217.08 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
LJ3 |
1670.22 |
1879.04 |
1136.70 |
742.34 |
193.28 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
576.72 |
581.25 |
435.94 |
145.31 |
1.13 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
1363.94 |
1374.69 |
1031.02 |
343.67 |
2.69 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
1239.94 |
1249.71 |
937.28 |
312.43 |
2.45 |
Louisiana Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Louisiana Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Louisiana Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Louisiana Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Louisiana Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Louisiana Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Louisiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
851.74 |
870.65 |
530.53 |
340.12 |
11.80 |
Louisiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
1942.03 |
1985.10 |
1243.95 |
741.15 |
17.33 |
Louisiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
1922.81 |
1965.45 |
1136.70 |
828.75 |
27.10 |
Louisiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
821.82 |
895.53 |
530.53 |
365.00 |
66.60 |
Louisiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
1881.88 |
2050.64 |
1243.95 |
806.69 |
143.02 |
Louisiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
1844.96 |
2010.45 |
1136.70 |
873.75 |
149.95 |
Louisiana Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Louisiana Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Louisiana Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - Standard Self |
BC4 |
741.54 |
760.09 |
530.53 |
229.56 |
11.44 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - Standard Self & Family |
BC5 |
1668.46 |
1710.22 |
1243.95 |
466.27 |
16.02 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - Standard Self Plus One |
BC6 |
1594.30 |
1634.19 |
1136.70 |
497.49 |
24.35 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - High Self |
BC1 |
991.47 |
1031.12 |
530.53 |
500.59 |
32.54 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - High Self & Family |
BC2 |
2230.82 |
2320.07 |
1243.95 |
1076.12 |
63.51 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - High Self Plus One |
BC3 |
2131.68 |
2216.96 |
1136.70 |
1080.26 |
69.74 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - High Self |
AE1 |
1210.69 |
1271.25 |
530.53 |
740.72 |
53.45 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - High Self & Family |
AE2 |
2724.04 |
2860.22 |
1243.95 |
1616.27 |
110.44 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - High Self Plus One |
AE3 |
2602.99 |
2733.12 |
1136.70 |
1596.42 |
114.59 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - Standard Self |
AE4 |
912.43 |
939.79 |
530.53 |
409.26 |
20.25 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - Standard Self & Family |
AE5 |
2052.98 |
2114.58 |
1243.95 |
870.63 |
35.86 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - Standard Self Plus One |
AE6 |
1961.72 |
2020.59 |
1136.70 |
883.89 |
43.33 |
Louisiana UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
599.47 |
650.91 |
488.18 |
162.73 |
12.86 |
Louisiana UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
1417.76 |
1539.46 |
1154.60 |
384.86 |
30.42 |
Louisiana UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
1288.89 |
1399.49 |
1049.62 |
349.87 |
27.65 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LS1 |
485.85 |
624.67 |
468.50 |
156.17 |
34.71 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LS2 |
1117.50 |
1436.76 |
1077.57 |
359.19 |
79.82 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LS3 |
1044.59 |
1343.07 |
1007.30 |
335.77 |
74.62 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KK1 |
769.04 |
847.30 |
530.53 |
316.77 |
71.15 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KK2 |
1922.64 |
2118.24 |
1243.95 |
874.29 |
169.86 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KK3 |
1653.47 |
1821.69 |
1136.70 |
684.99 |
152.68 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
576.72 |
581.25 |
435.94 |
145.31 |
1.13 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
1363.94 |
1374.69 |
1031.02 |
343.67 |
2.69 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
1239.94 |
1249.71 |
937.28 |
312.43 |
2.45 |
Maine Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Maine Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Maine Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Maine Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Maine Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Maine Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Maine Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
839.63 |
927.77 |
530.53 |
397.24 |
81.03 |
Maine Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
1922.68 |
2124.50 |
1243.95 |
880.55 |
176.08 |
Maine Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
1884.96 |
2082.84 |
1136.70 |
946.14 |
182.34 |
Maine Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
1124.65 |
1156.37 |
530.53 |
625.84 |
24.61 |
Maine Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
2564.88 |
2637.12 |
1243.95 |
1393.17 |
46.50 |
Maine Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
2539.46 |
2611.01 |
1136.70 |
1474.31 |
56.01 |
Maine Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Maine Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Maine Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Maryland Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Maryland Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Maryland Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Maryland Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Maryland Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Maryland Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Maryland Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
851.74 |
870.65 |
530.53 |
340.12 |
11.80 |
Maryland Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
1942.03 |
1985.10 |
1243.95 |
741.15 |
17.33 |
Maryland Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
1922.81 |
1965.45 |
1136.70 |
828.75 |
27.10 |
Maryland Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
821.82 |
895.53 |
530.53 |
365.00 |
66.60 |
Maryland Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
1881.88 |
2050.64 |
1243.95 |
806.69 |
143.02 |
Maryland Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
1844.96 |
2010.45 |
1136.70 |
873.75 |
149.95 |
Maryland Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Maryland Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Maryland Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Maryland Aetna Open Access - High Self |
JN1 |
1176.57 |
1251.55 |
530.53 |
721.02 |
67.87 |
Maryland Aetna Open Access - High Self & Family |
JN2 |
2645.05 |
2813.68 |
1243.95 |
1569.73 |
142.89 |
Maryland Aetna Open Access - High Self Plus One |
JN3 |
2618.85 |
2785.79 |
1136.70 |
1649.09 |
151.40 |
Maryland Aetna Open Access - Basic Self |
JN4 |
714.42 |
739.46 |
530.53 |
208.93 |
17.93 |
Maryland Aetna Open Access - Basic Self & Family |
JN5 |
1634.92 |
1692.23 |
1243.95 |
448.28 |
31.57 |
Maryland Aetna Open Access - Basic Self Plus One |
JN6 |
1501.33 |
1553.93 |
1136.70 |
417.23 |
37.06 |
Maryland Aetna Saver (Open Access) - Saver Self |
QQ4 |
595.21 |
595.21 |
446.41 |
148.80 |
0.00 |
Maryland Aetna Saver (Open Access) - Saver Self & Family |
QQ5 |
1362.12 |
1362.12 |
1021.59 |
340.53 |
0.00 |
Maryland Aetna Saver (Open Access) - Saver Self Plus One |
QQ6 |
1250.82 |
1250.82 |
938.12 |
312.70 |
0.00 |
Maryland CareFirst BlueChoice - Standard Self |
2G4 |
887.81 |
905.58 |
530.53 |
375.05 |
10.66 |
Maryland CareFirst BlueChoice - Standard Self & Family |
2G5 |
2109.42 |
2151.59 |
1243.95 |
907.64 |
16.43 |
Maryland CareFirst BlueChoice - Standard Self Plus One |
2G6 |
1775.61 |
1811.12 |
1136.70 |
674.42 |
19.97 |
Maryland CareFirst BlueChoice - HDHP Self |
B61 |
570.09 |
604.31 |
453.23 |
151.08 |
8.56 |
Maryland CareFirst BlueChoice - HDHP Self & Family |
B62 |
1354.51 |
1435.79 |
1076.84 |
358.95 |
20.32 |
Maryland CareFirst BlueChoice - HDHP Self Plus One |
B63 |
1140.17 |
1208.57 |
906.43 |
302.14 |
17.10 |
Maryland CareFirst BlueChoice - Blue Value Plus Self |
B64 |
723.67 |
723.67 |
530.53 |
193.14 |
-7.11 |
Maryland CareFirst BlueChoice - Blue Value Plus Self & Family |
B65 |
1719.38 |
1719.38 |
1243.95 |
475.43 |
-25.74 |
Maryland CareFirst BlueChoice - Blue Value Plus Self Plus One |
B66 |
1447.29 |
1447.29 |
1085.47 |
361.82 |
0.00 |
Maryland Kaiser Permanente - Mid-Atlantic States - Prosper Self |
T71 |
427.72 |
368.90 |
276.68 |
92.22 |
-14.71 |
Maryland Kaiser Permanente - Mid-Atlantic States - Prosper Self & Family |
T72 |
1099.52 |
1051.33 |
788.50 |
262.83 |
-12.05 |
Maryland Kaiser Permanente - Mid-Atlantic States - Prosper Self Plus One |
T73 |
951.84 |
866.91 |
650.18 |
216.73 |
-21.23 |
Maryland Kaiser Permanente - Mid-Atlantic States - Standard Self |
E34 |
598.28 |
607.25 |
455.44 |
151.81 |
2.24 |
Maryland Kaiser Permanente - Mid-Atlantic States - Standard Self & Family |
E35 |
1376.05 |
1396.63 |
1047.47 |
349.16 |
5.15 |
Maryland Kaiser Permanente - Mid-Atlantic States - Standard Self Plus One |
E36 |
1376.05 |
1396.63 |
1047.47 |
349.16 |
5.15 |
Maryland Kaiser Permanente - Mid-Atlantic States - High Self |
E31 |
746.24 |
756.60 |
530.53 |
226.07 |
3.25 |
Maryland Kaiser Permanente - Mid-Atlantic States - High Self & Family |
E32 |
1716.35 |
1740.20 |
1243.95 |
496.25 |
-1.89 |
Maryland Kaiser Permanente - Mid-Atlantic States - High Self Plus One |
E33 |
1716.35 |
1740.20 |
1136.70 |
603.50 |
8.31 |
Maryland M.D. IPA - High Self |
JP1 |
950.89 |
1011.99 |
530.53 |
481.46 |
53.99 |
Maryland M.D. IPA - High Self & Family |
JP2 |
2666.28 |
2837.66 |
1243.95 |
1593.71 |
145.64 |
Maryland M.D. IPA - High Self Plus One |
JP3 |
1857.09 |
1976.43 |
1136.70 |
839.73 |
103.80 |
Maryland UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
599.47 |
650.91 |
488.18 |
162.73 |
12.86 |
Maryland UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
1417.76 |
1539.46 |
1154.60 |
384.86 |
30.42 |
Maryland UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
1288.89 |
1399.49 |
1049.62 |
349.87 |
27.65 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
V41 |
519.91 |
661.81 |
496.36 |
165.45 |
35.47 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
V42 |
1195.81 |
1514.20 |
1135.65 |
378.55 |
79.60 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
V43 |
1117.81 |
1422.92 |
1067.19 |
355.73 |
76.28 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
LR1 |
770.40 |
822.16 |
530.53 |
291.63 |
44.65 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
LR2 |
1825.83 |
1948.55 |
1243.95 |
704.60 |
96.98 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
LR3 |
1656.33 |
1767.68 |
1136.70 |
630.98 |
95.81 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
L91 |
554.62 |
663.76 |
497.82 |
165.94 |
27.29 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
L92 |
1555.15 |
1586.41 |
1189.81 |
396.60 |
7.81 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self Plus One |
L93 |
1083.18 |
1327.54 |
995.66 |
331.88 |
61.09 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
576.72 |
581.25 |
435.94 |
145.31 |
1.13 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
1363.94 |
1374.69 |
1031.02 |
343.67 |
2.69 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
1239.94 |
1249.71 |
937.28 |
312.43 |
2.45 |
Massachusetts Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Massachusetts Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Massachusetts Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Massachusetts Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Massachusetts Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Massachusetts Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
839.63 |
927.77 |
530.53 |
397.24 |
81.03 |
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
1922.68 |
2124.50 |
1243.95 |
880.55 |
176.08 |
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
1884.96 |
2082.84 |
1136.70 |
946.14 |
182.34 |
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
1124.65 |
1156.37 |
530.53 |
625.84 |
24.61 |
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
2564.88 |
2637.12 |
1243.95 |
1393.17 |
46.50 |
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
2539.46 |
2611.01 |
1136.70 |
1474.31 |
56.01 |
Massachusetts Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Massachusetts Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Massachusetts Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Michigan Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Michigan Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Michigan Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Michigan Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Michigan Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Michigan Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Michigan Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
717.04 |
834.38 |
530.53 |
303.85 |
110.23 |
Michigan Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
1642.27 |
1911.07 |
1243.95 |
667.12 |
243.06 |
Michigan Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
1610.09 |
1873.63 |
1136.70 |
736.93 |
248.00 |
Michigan Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
1058.76 |
1135.10 |
530.53 |
604.57 |
69.23 |
Michigan Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
2415.08 |
2589.21 |
1243.95 |
1345.26 |
148.39 |
Michigan Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
2391.20 |
2563.60 |
1136.70 |
1426.90 |
156.86 |
Michigan Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Michigan Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Michigan Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Michigan Blue Care Network of Michigan - High Self |
LX1 |
765.81 |
790.44 |
530.53 |
259.91 |
17.52 |
Michigan Blue Care Network of Michigan - High Self & Family |
LX2 |
1868.58 |
1928.70 |
1243.95 |
684.75 |
34.38 |
Michigan Blue Care Network of Michigan - High Self Plus One |
LX3 |
1761.39 |
1818.03 |
1136.70 |
681.33 |
41.10 |
Michigan Blue Care Network of Michigan - High Self |
K51 |
996.49 |
1042.12 |
530.53 |
511.59 |
38.52 |
Michigan Blue Care Network of Michigan - High Self & Family |
K52 |
2431.46 |
2542.76 |
1243.95 |
1298.81 |
85.56 |
Michigan Blue Care Network of Michigan - High Self Plus One |
K53 |
2291.97 |
2396.85 |
1136.70 |
1260.15 |
89.34 |
Michigan Health Alliance Plan - High Self |
521 |
842.18 |
910.11 |
530.53 |
379.58 |
60.82 |
Michigan Health Alliance Plan - High Self & Family |
522 |
2054.93 |
2220.62 |
1243.95 |
976.67 |
139.95 |
Michigan Health Alliance Plan - High Self Plus One |
523 |
1937.00 |
2093.22 |
1136.70 |
956.52 |
140.68 |
Michigan Health Alliance Plan - Standard Self |
GY4 |
557.55 |
530.16 |
397.62 |
132.54 |
-6.85 |
Michigan Health Alliance Plan - Standard Self & Family |
GY5 |
1360.41 |
1293.57 |
970.18 |
323.39 |
-16.71 |
Michigan Health Alliance Plan - Standard Self Plus One |
GY6 |
1282.34 |
1219.38 |
914.54 |
304.84 |
-15.74 |
Michigan Priority Health - High Self |
LE1 |
1037.29 |
1106.71 |
530.53 |
576.18 |
62.31 |
Michigan Priority Health - High Self & Family |
LE2 |
2437.63 |
2600.74 |
1243.95 |
1356.79 |
137.37 |
Michigan Priority Health - High Self Plus One |
LE3 |
2282.04 |
2434.73 |
1136.70 |
1298.03 |
137.15 |
Michigan Priority Health - Standard Self |
LE4 |
587.38 |
617.22 |
462.92 |
154.30 |
7.46 |
Michigan Priority Health - Standard Self & Family |
LE5 |
1380.32 |
1450.45 |
1087.84 |
362.61 |
17.53 |
Michigan Priority Health - Standard Self Plus One |
LE6 |
1292.22 |
1357.85 |
1018.39 |
339.46 |
16.41 |
Michigan Priority Health - Value Self |
Y41 |
473.24 |
473.24 |
354.93 |
118.31 |
0.00 |
Michigan Priority Health - Value Self & Family |
Y42 |
1112.13 |
1112.13 |
834.10 |
278.03 |
0.00 |
Michigan Priority Health - Value Self Plus One |
Y43 |
1041.13 |
1041.13 |
780.85 |
260.28 |
0.00 |
Minnesota Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Minnesota Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Minnesota Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Minnesota Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Minnesota Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Minnesota Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Minnesota Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
826.84 |
826.19 |
530.53 |
295.66 |
-7.76 |
Minnesota Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
1884.74 |
1883.22 |
1243.95 |
639.27 |
-27.26 |
Minnesota Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
1866.43 |
1864.96 |
1136.70 |
728.26 |
-17.01 |
Minnesota Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
817.48 |
833.73 |
530.53 |
303.20 |
9.14 |
Minnesota Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
1876.16 |
1913.45 |
1243.95 |
669.50 |
11.55 |
Minnesota Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
1839.39 |
1875.94 |
1136.70 |
739.24 |
21.01 |
Minnesota Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Minnesota Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Minnesota Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Minnesota HealthPartners - Standard Self |
V34 |
509.41 |
553.28 |
414.96 |
138.32 |
10.97 |
Minnesota HealthPartners - Standard Self & Family |
V35 |
1240.94 |
1347.84 |
1010.88 |
336.96 |
26.73 |
Minnesota HealthPartners - Standard Self Plus One |
V36 |
1125.80 |
1222.78 |
917.09 |
305.69 |
24.24 |
Minnesota HealthPartners - High Self |
V31 |
668.07 |
692.14 |
519.11 |
173.03 |
6.01 |
Minnesota HealthPartners - High Self & Family |
V32 |
1627.38 |
1686.01 |
1243.95 |
442.06 |
32.89 |
Minnesota HealthPartners - High Self Plus One |
V33 |
1476.41 |
1529.58 |
1136.70 |
392.88 |
23.78 |
Mississippi Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Mississippi Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Mississippi Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Mississippi Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Mississippi Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Mississippi Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Mississippi Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
826.84 |
826.19 |
530.53 |
295.66 |
-7.76 |
Mississippi Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
1884.74 |
1883.22 |
1243.95 |
639.27 |
-27.26 |
Mississippi Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
1866.43 |
1864.96 |
1136.70 |
728.26 |
-17.01 |
Mississippi Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
817.48 |
833.73 |
530.53 |
303.20 |
9.14 |
Mississippi Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
1876.16 |
1913.45 |
1243.95 |
669.50 |
11.55 |
Mississippi Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
1839.39 |
1875.94 |
1136.70 |
739.24 |
21.01 |
Mississippi Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Mississippi Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Mississippi Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Mississippi UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
599.47 |
650.91 |
488.18 |
162.73 |
12.86 |
Mississippi UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
1417.76 |
1539.46 |
1154.60 |
384.86 |
30.42 |
Mississippi UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
1288.89 |
1399.49 |
1049.62 |
349.87 |
27.65 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LS1 |
485.85 |
624.67 |
468.50 |
156.17 |
34.71 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LS2 |
1117.50 |
1436.76 |
1077.57 |
359.19 |
79.82 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LS3 |
1044.59 |
1343.07 |
1007.30 |
335.77 |
74.62 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KK1 |
769.04 |
847.30 |
530.53 |
316.77 |
71.15 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KK2 |
1922.64 |
2118.24 |
1243.95 |
874.29 |
169.86 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KK3 |
1653.47 |
1821.69 |
1136.70 |
684.99 |
152.68 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
576.72 |
581.25 |
435.94 |
145.31 |
1.13 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
1363.94 |
1374.69 |
1031.02 |
343.67 |
2.69 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
1239.94 |
1249.71 |
937.28 |
312.43 |
2.45 |
Missouri Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Missouri Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Missouri Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Missouri Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Missouri Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Missouri Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Missouri Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
717.04 |
834.38 |
530.53 |
303.85 |
110.23 |
Missouri Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
1642.27 |
1911.07 |
1243.95 |
667.12 |
243.06 |
Missouri Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
1610.09 |
1873.63 |
1136.70 |
736.93 |
248.00 |
Missouri Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
1058.76 |
1135.10 |
530.53 |
604.57 |
69.23 |
Missouri Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
2415.08 |
2589.21 |
1243.95 |
1345.26 |
148.39 |
Missouri Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
2391.20 |
2563.60 |
1136.70 |
1426.90 |
156.86 |
Missouri Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Missouri Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Missouri Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Missouri Aetna Open Access - High Self |
HA1 |
1156.52 |
1188.98 |
530.53 |
658.45 |
25.35 |
Missouri Aetna Open Access - High Self & Family |
HA2 |
2731.91 |
2808.54 |
1243.95 |
1564.59 |
50.89 |
Missouri Aetna Open Access - High Self Plus One |
HA3 |
2704.89 |
2780.77 |
1136.70 |
1644.07 |
60.34 |
Missouri Aetna Open Access - Standard Self |
HA4 |
901.36 |
909.37 |
530.53 |
378.84 |
0.90 |
Missouri Aetna Open Access - Standard Self & Family |
HA5 |
2127.54 |
2146.47 |
1243.95 |
902.52 |
-6.81 |
Missouri Aetna Open Access - Standard Self Plus One |
HA6 |
2106.48 |
2125.26 |
1136.70 |
988.56 |
3.24 |
Missouri Blue Preferred - High Self |
9G1 |
874.23 |
905.71 |
530.53 |
375.18 |
24.37 |
Missouri Blue Preferred - High Self & Family |
9G2 |
1984.52 |
2139.32 |
1243.95 |
895.37 |
129.06 |
Missouri Blue Preferred - High Self Plus One |
9G3 |
1862.12 |
2005.51 |
1136.70 |
868.81 |
127.85 |
Missouri Blue Preferred - Standard Self |
9G4 |
633.66 |
614.01 |
460.51 |
153.50 |
-4.91 |
Missouri Blue Preferred - Standard Self & Family |
9G5 |
1758.23 |
1791.62 |
1243.95 |
547.67 |
7.65 |
Missouri Blue Preferred - Standard Self Plus One |
9G6 |
1574.58 |
1598.20 |
1136.70 |
461.50 |
8.08 |
Missouri Humana CoverageFirst and Humana Value Plan - Value Self |
PH4 |
527.61 |
567.17 |
425.38 |
141.79 |
9.89 |
Missouri Humana CoverageFirst and Humana Value Plan - Value Self & Family |
PH5 |
1187.12 |
1276.15 |
957.11 |
319.04 |
22.26 |
Missouri Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
PH6 |
1134.36 |
1219.44 |
914.58 |
304.86 |
21.27 |
Missouri Humana CoverageFirst and Humana Value Plan - CDHP Self |
PH1 |
758.03 |
758.03 |
530.53 |
227.50 |
-7.11 |
Missouri Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
PH2 |
1705.58 |
1705.60 |
1243.95 |
461.65 |
-25.72 |
Missouri Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
PH3 |
1629.77 |
1629.79 |
1136.70 |
493.09 |
-15.52 |
Missouri Humana HDHP - HDHP Self |
BK1 |
New Plan |
403.13 |
302.35 |
100.78 |
New Plan |
Missouri Humana HDHP - HDHP Self & Family |
BK2 |
New Plan |
1003.93 |
752.95 |
250.98 |
New Plan |
Missouri Humana HDHP - HDHP Self Plus One |
BK3 |
New Plan |
883.78 |
662.84 |
220.94 |
New Plan |
Missouri Humana Health Plan, Inc. - Standard Self |
MS4 |
1200.59 |
1290.64 |
530.53 |
760.11 |
82.94 |
Missouri Humana Health Plan, Inc. - Standard Self & Family |
MS5 |
2701.34 |
2903.98 |
1243.95 |
1660.03 |
176.90 |
Missouri Humana Health Plan, Inc. - Standard Self Plus One |
MS6 |
2581.32 |
2774.94 |
1136.70 |
1638.24 |
178.08 |
Missouri UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
599.47 |
650.91 |
488.18 |
162.73 |
12.86 |
Missouri UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
1417.76 |
1539.46 |
1154.60 |
384.86 |
30.42 |
Missouri UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
1288.89 |
1399.49 |
1049.62 |
349.87 |
27.65 |
Missouri UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
576.72 |
581.25 |
435.94 |
145.31 |
1.13 |
Missouri UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
1363.94 |
1374.69 |
1031.02 |
343.67 |
2.69 |
Missouri UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
1239.94 |
1249.71 |
937.28 |
312.43 |
2.45 |
Montana Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Montana Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Montana Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Montana Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Montana Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Montana Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Montana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
826.84 |
826.19 |
530.53 |
295.66 |
-7.76 |
Montana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
1884.74 |
1883.22 |
1243.95 |
639.27 |
-27.26 |
Montana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
1866.43 |
1864.96 |
1136.70 |
728.26 |
-17.01 |
Montana Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
817.48 |
833.73 |
530.53 |
303.20 |
9.14 |
Montana Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
1876.16 |
1913.45 |
1243.95 |
669.50 |
11.55 |
Montana Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
1839.39 |
1875.94 |
1136.70 |
739.24 |
21.01 |
Montana Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Montana Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Montana Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Nebraska Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Nebraska Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Nebraska Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Nebraska Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Nebraska Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Nebraska Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Nebraska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
826.84 |
826.19 |
530.53 |
295.66 |
-7.76 |
Nebraska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
1884.74 |
1883.22 |
1243.95 |
639.27 |
-27.26 |
Nebraska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
1866.43 |
1864.96 |
1136.70 |
728.26 |
-17.01 |
Nebraska Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
817.48 |
833.73 |
530.53 |
303.20 |
9.14 |
Nebraska Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
1876.16 |
1913.45 |
1243.95 |
669.50 |
11.55 |
Nebraska Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
1839.39 |
1875.94 |
1136.70 |
739.24 |
21.01 |
Nebraska Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Nebraska Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Nebraska Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Nevada Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Nevada Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Nevada Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Nevada Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
Nevada Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
Nevada Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
Nevada Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
717.04 |
834.38 |
530.53 |
303.85 |
110.23 |
Nevada Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
1642.27 |
1911.07 |
1243.95 |
667.12 |
243.06 |
Nevada Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
1610.09 |
1873.63 |
1136.70 |
736.93 |
248.00 |
Nevada Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
1058.76 |
1135.10 |
530.53 |
604.57 |
69.23 |
Nevada Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
2415.08 |
2589.21 |
1243.95 |
1345.26 |
148.39 |
Nevada Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
2391.20 |
2563.60 |
1136.70 |
1426.90 |
156.86 |
Nevada Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
Nevada Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
Nevada Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
Nevada Health Plan of Nevada, Inc. - High Self |
NM1 |
741.17 |
830.16 |
530.53 |
299.63 |
81.88 |
Nevada Health Plan of Nevada, Inc. - High Self & Family |
NM2 |
1756.50 |
1967.40 |
1243.95 |
723.45 |
185.16 |
Nevada Health Plan of Nevada, Inc. - High Self Plus One |
NM3 |
1408.23 |
1577.31 |
1136.70 |
440.61 |
88.55 |
Nevada UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
WF1 |
622.22 |
668.46 |
501.35 |
167.11 |
11.56 |
Nevada UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
WF2 |
1471.54 |
1580.91 |
1185.68 |
395.23 |
27.35 |
Nevada UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
WF3 |
1337.77 |
1437.17 |
1077.88 |
359.29 |
24.85 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LU1 |
528.17 |
672.10 |
504.08 |
168.02 |
35.98 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LU2 |
1214.76 |
1545.85 |
1159.39 |
386.46 |
82.77 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LU3 |
1135.55 |
1445.04 |
1083.78 |
361.26 |
77.37 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KT1 |
782.12 |
864.87 |
530.53 |
334.34 |
75.64 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KT2 |
1955.35 |
2162.16 |
1243.95 |
918.21 |
181.07 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KT3 |
1681.57 |
1859.46 |
1136.70 |
722.76 |
162.35 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
VD1 |
621.21 |
657.65 |
493.24 |
164.41 |
9.11 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
VD2 |
1469.13 |
1555.39 |
1166.54 |
388.85 |
21.57 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
VD3 |
1335.58 |
1413.97 |
1060.48 |
353.49 |
19.60 |
New Hampshire Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
New Hampshire Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
New Hampshire Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
New Hampshire Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
New Hampshire Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
New Hampshire Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
839.63 |
927.77 |
530.53 |
397.24 |
81.03 |
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
1922.68 |
2124.50 |
1243.95 |
880.55 |
176.08 |
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
1884.96 |
2082.84 |
1136.70 |
946.14 |
182.34 |
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
1124.65 |
1156.37 |
530.53 |
625.84 |
24.61 |
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
2564.88 |
2637.12 |
1243.95 |
1393.17 |
46.50 |
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
2539.46 |
2611.01 |
1136.70 |
1474.31 |
56.01 |
New Hampshire Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
New Hampshire Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
New Hampshire Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
New Jersey Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
New Jersey Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
New Jersey Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
New Jersey Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
New Jersey Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
New Jersey Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
New Jersey Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
839.63 |
927.77 |
530.53 |
397.24 |
81.03 |
New Jersey Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
1922.68 |
2124.50 |
1243.95 |
880.55 |
176.08 |
New Jersey Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
1884.96 |
2082.84 |
1136.70 |
946.14 |
182.34 |
New Jersey Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
1124.65 |
1156.37 |
530.53 |
625.84 |
24.61 |
New Jersey Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
2564.88 |
2637.12 |
1243.95 |
1393.17 |
46.50 |
New Jersey Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
2539.46 |
2611.01 |
1136.70 |
1474.31 |
56.01 |
New Jersey Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
New Jersey Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
New Jersey Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
New Jersey Aetna Open Access - High Self |
JR1 |
1656.81 |
1655.18 |
530.53 |
1124.65 |
-8.74 |
New Jersey Aetna Open Access - High Self & Family |
JR2 |
3827.03 |
3823.24 |
1243.95 |
2579.29 |
-29.53 |
New Jersey Aetna Open Access - High Self Plus One |
JR3 |
3789.11 |
3785.41 |
1136.70 |
2648.71 |
-19.24 |
New Jersey Aetna Open Access - Basic Self |
JR4 |
1429.35 |
1428.27 |
530.53 |
897.74 |
-8.19 |
New Jersey Aetna Open Access - Basic Self & Family |
JR5 |
3312.70 |
3310.19 |
1243.95 |
2066.24 |
-28.25 |
New Jersey Aetna Open Access - Basic Self Plus One |
JR6 |
3279.88 |
3277.41 |
1136.70 |
2140.71 |
-18.01 |
New Jersey Aetna Open Access - Basic Self |
P34 |
1505.53 |
1721.76 |
530.53 |
1191.23 |
209.12 |
New Jersey Aetna Open Access - Basic Self & Family |
P35 |
3494.34 |
3996.29 |
1243.95 |
2752.34 |
476.21 |
New Jersey Aetna Open Access - Basic Self Plus One |
P36 |
3459.73 |
3956.70 |
1136.70 |
2820.00 |
481.43 |
New Jersey Aetna Open Access - High Self |
P31 |
1588.23 |
1762.54 |
530.53 |
1232.01 |
167.20 |
New Jersey Aetna Open Access - High Self & Family |
P32 |
3850.71 |
4273.27 |
1243.95 |
3029.32 |
396.82 |
New Jersey Aetna Open Access - High Self Plus One |
P33 |
3812.58 |
4230.98 |
1136.70 |
3094.28 |
402.86 |
New Jersey Emblemhealth Plan, Inc. - Standard Self |
804 |
1039.85 |
1039.85 |
530.53 |
509.32 |
-7.11 |
New Jersey Emblemhealth Plan, Inc. - Standard Self & Family |
805 |
2522.72 |
2522.72 |
1243.95 |
1278.77 |
-25.74 |
New Jersey Emblemhealth Plan, Inc. - Standard Self Plus One |
806 |
2418.74 |
2418.74 |
1136.70 |
1282.04 |
-15.54 |
New Mexico Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
New Mexico Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
New Mexico Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
New Mexico Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
New Mexico Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
New Mexico Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
1033.40 |
344.47 |
6.83 |
New Mexico Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
717.04 |
834.38 |
530.53 |
303.85 |
110.23 |
New Mexico Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
1642.27 |
1911.07 |
1243.95 |
667.12 |
243.06 |
New Mexico Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
1610.09 |
1873.63 |
1136.70 |
736.93 |
248.00 |
New Mexico Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
1058.76 |
1135.10 |
530.53 |
604.57 |
69.23 |
New Mexico Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
2415.08 |
2589.21 |
1243.95 |
1345.26 |
148.39 |
New Mexico Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
2391.20 |
2563.60 |
1136.70 |
1426.90 |
156.86 |
New Mexico Aetna HealthFund HDHP - HDHP Self |
224 |
786.02 |
824.31 |
530.53 |
293.78 |
31.18 |
New Mexico Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1733.83 |
1818.25 |
1243.95 |
574.30 |
58.68 |
New Mexico Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1699.88 |
1782.63 |
1136.70 |
645.93 |
67.21 |
New Mexico Presbyterian Health Plan - High Self |
P21 |
846.93 |
874.47 |
530.53 |
343.94 |
20.43 |
New Mexico Presbyterian Health Plan - High Self & Family |
P22 |
1990.34 |
2055.08 |
1243.95 |
811.13 |
39.00 |
New Mexico Presbyterian Health Plan - High Self Plus One |
P23 |
1922.59 |
1985.12 |
1136.70 |
848.42 |
46.99 |
New Mexico Presbyterian Health Plan - Standard Self |
PS4 |
706.31 |
725.23 |
530.53 |
194.70 |
11.81 |
New Mexico Presbyterian Health Plan - Standard Self & Family |
PS5 |
1659.84 |
1704.34 |
1243.95 |
460.39 |
18.76 |
New Mexico Presbyterian Health Plan - Standard Self Plus One |
PS6 |
1603.38 |
1646.36 |
1136.70 |
509.66 |
27.44 |
New Mexico Presbyterian Health Plan - Wellness Self |
PS1 |
632.06 |
653.81 |
490.36 |
163.45 |
5.44 |
New Mexico Presbyterian Health Plan - Wellness Self & Family |
PS2 |
1485.36 |
1536.43 |
1152.32 |
384.11 |
12.77 |
New Mexico Presbyterian Health Plan - Wellness Self Plus One |
PS3 |
1434.79 |
1484.17 |
1113.13 |
371.04 |
12.34 |
New York Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
New York Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
New York Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
New York Aetna Direct - CDHP Self |
N61 |
615.83 |
628.27 |
471.20 |
157.07 |
3.11 |
New York Aetna Direct - CDHP Self & Family |
N62 |
1553.07 |
1584.48 |
1188.36 |
396.12 |
7.85 |
New York Aetna Direct - CDHP Self Plus One |
N63 |
1350.55 |
1377.87 |
|