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    Premium Rates for the Federal Employees Health Benefits Program 
    FFS (Fee-for-Service/Nationwide Plans) 
    
        
            
                
                
                    
                    
                    
                    
                    
                    
                    
                    
                    
                    
             
         
        
                    
                        Nationwide APWU Health Plan  - CDHP Self 
                        474 
                                278.61 
                                295.32 
                                221.49 
                                73.83 
                                4.18 
                                603.66 
                                639.86 
                                479.90 
                                159.96 
                                9.05 
                     
                    
                        Nationwide APWU Health Plan  - CDHP Self & Family 
                        475 
                                660.58 
                                700.21 
                                525.16 
                                175.05 
                                9.91 
                                1431.26 
                                1517.12 
                                1137.84 
                                379.28 
                                21.47 
                     
                    
                        Nationwide APWU Health Plan  - CDHP Self Plus One 
                        476 
                                605.53 
                                641.86 
                                481.40 
                                160.46 
                                9.08 
                                1311.98 
                                1390.70 
                                1043.03 
                                347.67 
                                19.68 
                     
                    
                        Nationwide APWU Health Plan  - High Self 
                        471 
                                351.25 
                                380.72 
                                259.72 
                                121.00 
                                14.61 
                                761.04 
                                824.89 
                                562.73 
                                262.16 
                                31.65 
                     
                    
                        Nationwide APWU Health Plan  - High Self & Family 
                        472 
                                842.96 
                                913.68 
                                611.42 
                                302.26 
                                33.43 
                                1826.41 
                                1979.64 
                                1324.74 
                                654.90 
                                72.44 
                     
                    
                        Nationwide APWU Health Plan  - High Self Plus One 
                        473 
                                737.59 
                                799.47 
                                560.52 
                                238.95 
                                25.99 
                                1598.11 
                                1732.19 
                                1214.46 
                                517.73 
                                56.32 
                     
                    
                        Nationwide Blue Cross and Blue Shield Service Benefit Plan Basic Option - Basic Self 
                        111 
                                320.74 
                                346.39 
                                259.72 
                                86.67 
                                6.49 
                                694.94 
                                750.51 
                                562.73 
                                187.78 
                                14.05 
                     
                    
                        Nationwide Blue Cross and Blue Shield Service Benefit Plan Basic Option - Basic Self & Family 
                        112 
                                786.42 
                                849.33 
                                611.42 
                                237.91 
                                25.62 
                                1703.91 
                                1840.22 
                                1324.74 
                                515.48 
                                55.52 
                     
                    
                        Nationwide Blue Cross and Blue Shield Service Benefit Plan Basic Option - Basic Self Plus One 
                        113 
                                720.76 
                                778.42 
                                560.52 
                                217.90 
                                21.77 
                                1561.65 
                                1686.58 
                                1214.46 
                                472.12 
                                47.17 
                     
                    
                        Nationwide Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - FEP Blue Focus Self 
                        131 
                                212.58 
                                216.86 
                                162.65 
                                54.21 
                                1.07 
                                460.59 
                                469.86 
                                352.40 
                                117.46 
                                2.31 
                     
                    
                        Nationwide Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - FEP Blue Focus Self & Family 
                        132 
                                502.70 
                                512.78 
                                384.59 
                                128.19 
                                2.52 
                                1089.18 
                                1111.02 
                                833.27 
                                277.75 
                                5.46 
                     
                    
                        Nationwide Blue Cross and Blue Shield Service Benefit Plan FEP Blue Focus - FEP Blue Focus Self Plus One 
                        133 
                                457.02 
                                466.18 
                                349.64 
                                116.54 
                                2.29 
                                990.21 
                                1010.06 
                                757.55 
                                252.51 
                                4.96 
                     
                    
                        Nationwide Blue Cross and Blue Shield Service Benefit Plan Standard Option - Standard Self 
                        104 
                                372.33 
                                402.12 
                                259.72 
                                142.40 
                                14.93 
                                806.72 
                                871.26 
                                562.73 
                                308.53 
                                32.34 
                     
                    
                        Nationwide Blue Cross and Blue Shield Service Benefit Plan Standard Option - Standard Self & Family 
                        105 
                                888.24 
                                959.31 
                                611.42 
                                347.89 
                                33.78 
                                1924.52 
                                2078.51 
                                1324.74 
                                753.77 
                                73.20 
                     
                    
                        Nationwide Blue Cross and Blue Shield Service Benefit Plan Standard Option - Standard Self Plus One 
                        106 
                                814.24 
                                879.37 
                                560.52 
                                318.85 
                                29.24 
                                1764.19 
                                1905.30 
                                1214.46 
                                690.84 
                                63.35 
                     
                    
                        Nationwide Compass Rose Health Plan - High Self 
                        421 
                                351.02 
                                358.04 
                                259.72 
                                98.32 
                                -7.84 
                                760.54 
                                775.75 
                                562.73 
                                213.02 
                                -16.99 
                     
                    
                        Nationwide Compass Rose Health Plan - High Self & Family 
                        422 
                                842.47 
                                859.32 
                                611.42 
                                247.90 
                                -20.44 
                                1825.35 
                                1861.86 
                                1324.74 
                                537.12 
                                -44.28 
                     
                    
                        Nationwide Compass Rose Health Plan - High Self Plus One 
                        423 
                                772.26 
                                787.71 
                                560.52 
                                227.19 
                                -20.44 
                                1673.23 
                                1706.71 
                                1214.46 
                                492.25 
                                -44.28 
                     
                    
                        Nationwide Foreign Service Benefit Plan  - High Self 
                        401 
                                292.76 
                                313.25 
                                234.94 
                                78.31 
                                5.12 
                                634.31 
                                678.71 
                                509.03 
                                169.68 
                                11.10 
                     
                    
                        Nationwide Foreign Service Benefit Plan  - High Self & Family 
                        402 
                                724.22 
                                774.91 
                                581.18 
                                193.73 
                                12.68 
                                1569.14 
                                1678.97 
                                1259.23 
                                419.74 
                                27.46 
                     
                    
                        Nationwide Foreign Service Benefit Plan  - High Self Plus One 
                        403 
                                710.11 
                                759.81 
                                560.52 
                                199.29 
                                13.81 
                                1538.57 
                                1646.26 
                                1214.46 
                                431.80 
                                29.93 
                     
                    
                        Nationwide GEHA Benefit Plan - High Self 
                        311 
                                349.72 
                                365.46 
                                259.72 
                                105.74 
                                0.88 
                                757.73 
                                791.83 
                                562.73 
                                229.10 
                                1.90 
                     
                    
                        Nationwide GEHA Benefit Plan - High Self & Family 
                        312 
                                876.38 
                                915.81 
                                611.42 
                                304.39 
                                2.14 
                                1898.82 
                                1984.26 
                                1324.74 
                                659.52 
                                4.65 
                     
                    
                        Nationwide GEHA Benefit Plan - High Self Plus One 
                        313 
                                769.39 
                                804.01 
                                560.52 
                                243.49 
                                -1.27 
                                1667.01 
                                1742.02 
                                1214.46 
                                527.56 
                                -2.75 
                     
                    
                        Nationwide GEHA Benefit Plan - Standard Self 
                        314 
                                250.66 
                                275.10 
                                206.33 
                                68.77 
                                6.11 
                                543.10 
                                596.05 
                                447.04 
                                149.01 
                                13.24 
                     
                    
                        Nationwide GEHA Benefit Plan - Standard Self & Family 
                        315 
                                659.40 
                                723.69 
                                542.77 
                                180.92 
                                16.07 
                                1428.70 
                                1568.00 
                                1176.00 
                                392.00 
                                34.83 
                     
                    
                        Nationwide GEHA Benefit Plan - Standard Self Plus One 
                        316 
                                538.94 
                                591.49 
                                443.62 
                                147.87 
                                13.14 
                                1167.70 
                                1281.56 
                                961.17 
                                320.39 
                                28.47 
                     
                    
                        Nationwide GEHA HDHP - HDHP Self 
                        341 
                                252.83 
                                277.48 
                                208.11 
                                69.37 
                                6.16 
                                547.80 
                                601.21 
                                450.91 
                                150.30 
                                13.35 
                     
                    
                        Nationwide GEHA HDHP - HDHP Self & Family 
                        342 
                                667.99 
                                733.12 
                                549.84 
                                183.28 
                                16.28 
                                1447.31 
                                1588.43 
                                1191.32 
                                397.11 
                                35.28 
                     
                    
                        Nationwide GEHA HDHP - HDHP Self Plus One 
                        343 
                                543.59 
                                596.59 
                                447.44 
                                149.15 
                                13.25 
                                1177.78 
                                1292.61 
                                969.46 
                                323.15 
                                28.71 
                     
                    
                        Nationwide GEHA Indemnity Benefit Plan - Elevate Plus Self 
                        251 
                                316.51 
                                343.10 
                                257.33 
                                85.77 
                                6.64 
                                685.77 
                                743.38 
                                557.54 
                                185.84 
                                14.40 
                     
                    
                        Nationwide GEHA Indemnity Benefit Plan - Elevate Plus Self & Family 
                        252 
                                762.53 
                                821.25 
                                611.42 
                                209.83 
                                19.20 
                                1652.15 
                                1779.38 
                                1324.74 
                                454.64 
                                41.60 
                     
                    
                        Nationwide GEHA Indemnity Benefit Plan - Elevate Plus Self Plus One 
                        253 
                                707.14 
                                748.16 
                                560.52 
                                187.64 
                                5.13 
                                1532.14 
                                1621.01 
                                1214.46 
                                406.55 
                                11.11 
                     
                    
                        Nationwide GEHA Indemnity Benefit Plan - Elevate Self 
                        254 
                                194.97 
                                202.77 
                                152.08 
                                50.69 
                                1.95 
                                422.44 
                                439.34 
                                329.51 
                                109.83 
                                4.22 
                     
                    
                        Nationwide GEHA Indemnity Benefit Plan - Elevate Self & Family 
                        255 
                                545.93 
                                578.69 
                                434.02 
                                144.67 
                                8.19 
                                1182.85 
                                1253.83 
                                940.37 
                                313.46 
                                17.75 
                     
                    
                        Nationwide GEHA Indemnity Benefit Plan - Elevate Self Plus One 
                        256 
                                448.44 
                                475.34 
                                356.51 
                                118.83 
                                6.72 
                                971.62 
                                1029.90 
                                772.43 
                                257.47 
                                14.57 
                     
                    
                        Nationwide MHBP Consumer Option - HDHP Self 
                        481 
                                305.59 
                                314.77 
                                236.08 
                                78.69 
                                2.29 
                                662.11 
                                682.00 
                                511.50 
                                170.50 
                                4.97 
                     
                    
                        Nationwide MHBP Consumer Option - HDHP Self & Family 
                        482 
                                710.09 
                                731.39 
                                548.54 
                                182.85 
                                5.33 
                                1538.53 
                                1584.68 
                                1188.51 
                                396.17 
                                11.54 
                     
                    
                        Nationwide MHBP Consumer Option - HDHP Self Plus One 
                        483 
                                676.28 
                                696.57 
                                522.43 
                                174.14 
                                5.07 
                                1465.27 
                                1509.24 
                                1131.93 
                                377.31 
                                10.99 
                     
                    
                        Nationwide MHBP Standard Option - Standard Self 
                        454 
                                313.04 
                                322.43 
                                241.82 
                                80.61 
                                2.35 
                                678.25 
                                698.60 
                                523.95 
                                174.65 
                                5.09 
                     
                    
                        Nationwide MHBP Standard Option - Standard Self & Family 
                        455 
                                727.48 
                                749.31 
                                561.98 
                                187.33 
                                5.46 
                                1576.21 
                                1623.51 
                                1217.63 
                                405.88 
                                11.83 
                     
                    
                        Nationwide MHBP Standard Option - Standard Self Plus One 
                        456 
                                720.55 
                                742.18 
                                556.64 
                                185.54 
                                -10.38 
                                1561.19 
                                1608.06 
                                1206.05 
                                402.01 
                                -22.48 
                     
                    
                        Nationwide MHBP Value Plan - Value Self 
                        414 
                                223.87 
                                232.82 
                                174.62 
                                58.20 
                                2.23 
                                485.05 
                                504.44 
                                378.33 
                                126.11 
                                4.85 
                     
                    
                        Nationwide MHBP Value Plan - Value Self & Family 
                        415 
                                541.02 
                                562.66 
                                422.00 
                                140.66 
                                5.41 
                                1172.21 
                                1219.10 
                                914.33 
                                304.77 
                                11.72 
                     
                    
                        Nationwide MHBP Value Plan - Value Self Plus One 
                        416 
                                530.43 
                                551.65 
                                413.74 
                                137.91 
                                5.30 
                                1149.27 
                                1195.24 
                                896.43 
                                298.81 
                                11.49 
                     
                    
                        Nationwide NALC Health Benefit Plan  - CDHP Self 
                        324 
                                218.55 
                                222.91 
                                167.18 
                                55.73 
                                1.09 
                                473.53 
                                482.97 
                                362.23 
                                120.74 
                                2.36 
                     
                    
                        Nationwide NALC Health Benefit Plan  - CDHP Self & Family 
                        325 
                                512.73 
                                528.11 
                                396.08 
                                132.03 
                                3.85 
                                1110.92 
                                1144.24 
                                858.18 
                                286.06 
                                8.33 
                     
                    
                        Nationwide NALC Health Benefit Plan  - CDHP Self Plus One 
                        326 
                                482.16 
                                491.81 
                                368.86 
                                122.95 
                                2.41 
                                1044.68 
                                1065.59 
                                799.19 
                                266.40 
                                5.23 
                     
                    
                        Nationwide NALC Health Benefit Plan  - High Self 
                        321 
                                343.14 
                                362.70 
                                259.72 
                                102.98 
                                4.70 
                                743.47 
                                785.85 
                                562.73 
                                223.12 
                                10.18 
                     
                    
                        Nationwide NALC Health Benefit Plan  - High Self & Family 
                        322 
                                776.15 
                                822.72 
                                611.42 
                                211.30 
                                9.28 
                                1681.66 
                                1782.56 
                                1324.74 
                                457.82 
                                20.11 
                     
                    
                        Nationwide NALC Health Benefit Plan  - High Self Plus One 
                        323 
                                758.98 
                                802.25 
                                560.52 
                                241.73 
                                7.38 
                                1644.46 
                                1738.21 
                                1214.46 
                                523.75 
                                15.99 
                     
                    
                        Nationwide NALC Health Benefit Plan  - Value Self 
                        KM1 
                                179.37 
                                182.96 
                                137.22 
                                45.74 
                                0.90 
                                388.64 
                                396.41 
                                297.31 
                                99.10 
                                1.94 
                     
                    
                        Nationwide NALC Health Benefit Plan  - Value Self & Family 
                        KM2 
                                420.99 
                                433.62 
                                325.22 
                                108.40 
                                3.15 
                                912.15 
                                939.51 
                                704.63 
                                234.88 
                                6.84 
                     
                    
                        Nationwide NALC Health Benefit Plan  - Value Self Plus One 
                        KM3 
                                395.70 
                                403.61 
                                302.71 
                                100.90 
                                1.98 
                                857.35 
                                874.49 
                                655.87 
                                218.62 
                                4.28 
                     
                    
                        Nationwide Panama Canal Area Benefit Plan - High Self 
                        431 
                                325.92 
                                351.99 
                                259.72 
                                92.27 
                                10.79 
                                706.16 
                                762.65 
                                562.73 
                                199.92 
                                23.38 
                     
                    
                        Nationwide Panama Canal Area Benefit Plan - High Self & Family 
                        432 
                                686.68 
                                741.61 
                                556.21 
                                185.40 
                                13.73 
                                1487.81 
                                1606.82 
                                1205.12 
                                401.70 
                                29.75 
                     
                    
                        Nationwide Panama Canal Area Benefit Plan - High Self Plus One 
                        433 
                                656.57 
                                709.10 
                                531.83 
                                177.27 
                                13.13 
                                1422.57 
                                1536.38 
                                1152.29 
                                384.09 
                                28.45 
                     
                    
                        Nationwide Rural Carrier Benefit Plan - High Self 
                        381 
                                375.67 
                                390.70 
                                259.72 
                                130.98 
                                0.17 
                                813.95 
                                846.52 
                                562.73 
                                283.79 
                                0.37 
                     
                    
                        Nationwide Rural Carrier Benefit Plan - High Self & Family 
                        382 
                                811.02 
                                854.65 
                                611.42 
                                243.23 
                                6.34 
                                1757.21 
                                1851.74 
                                1324.74 
                                527.00 
                                13.74 
                     
                    
                        Nationwide Rural Carrier Benefit Plan - High Self Plus One 
                        383 
                                772.12 
                                813.66 
                                560.52 
                                253.14 
                                5.65 
                                1672.93 
                                1762.93 
                                1214.46 
                                548.47 
                                12.24 
                     
                    
                        Nationwide SAMBA Health Benefit Plan - High Self 
                        441 
                                403.70 
                                415.81 
                                259.72 
                                156.09 
                                -2.75 
                                874.68 
                                900.92 
                                562.73 
                                338.19 
                                -5.96 
                     
                    
                        Nationwide SAMBA Health Benefit Plan - High Self & Family 
                        442 
                                968.87 
                                997.94 
                                611.42 
                                386.52 
                                -8.22 
                                2099.22 
                                2162.20 
                                1324.74 
                                837.46 
                                -17.81 
                     
                    
                        Nationwide SAMBA Health Benefit Plan - High Self Plus One 
                        443 
                                888.14 
                                914.78 
                                560.52 
                                354.26 
                                -9.25 
                                1924.30 
                                1982.02 
                                1214.46 
                                767.56 
                                -20.04 
                     
                    
                        Nationwide SAMBA Health Benefit Plan - Standard Self 
                        444 
                                326.74 
                                336.54 
                                252.41 
                                84.13 
                                2.25 
                                707.94 
                                729.17 
                                546.88 
                                182.29 
                                4.88 
                     
                    
                        Nationwide SAMBA Health Benefit Plan - Standard Self & Family 
                        445 
                                745.44 
                                767.80 
                                575.85 
                                191.95 
                                5.59 
                                1615.12 
                                1663.57 
                                1247.68 
                                415.89 
                                12.11 
                     
                    
                        Nationwide SAMBA Health Benefit Plan - Standard Self Plus One 
                        446 
                                703.25 
                                724.34 
                                543.26 
                                181.08 
                                2.46 
                                1523.71 
                                1569.40 
                                1177.05 
                                392.35 
                                5.34 
                     
         
    
 
    
				 
			 
		 
		
		
			
				
					U.S. Office of Personnel Management 
					1900 E Street, NW, Washington, DC 20415
					202-606-1800
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