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Premium Rates for the Federal Employees Health Benefits Program
HMO (Regional Plans with Specific Service Areas)
Alabama Aetna Advantage - Advantage Self |
Z24 |
230.78 |
230.78 |
173.09 |
57.69 |
0.00 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Alabama Aetna Advantage - Advantage Self & Family |
Z25 |
611.54 |
611.54 |
458.66 |
152.88 |
0.00 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Alabama Aetna Advantage - Advantage Self Plus One |
Z26 |
507.70 |
507.70 |
380.78 |
126.92 |
0.00 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Alabama Aetna Direct - CDHP Self |
N61 |
289.97 |
296.04 |
222.03 |
74.01 |
1.52 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Alabama Aetna Direct - CDHP Self & Family |
N62 |
731.30 |
746.57 |
559.93 |
186.64 |
3.82 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Alabama Aetna Direct - CDHP Self Plus One |
N63 |
635.94 |
649.23 |
486.92 |
162.31 |
3.33 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
401.84 |
451.48 |
259.72 |
191.76 |
34.78 |
870.65 |
978.21 |
562.73 |
415.48 |
75.36 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
916.20 |
1029.43 |
611.42 |
418.01 |
75.94 |
1985.10 |
2230.43 |
1324.74 |
905.69 |
164.54 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
907.13 |
1019.23 |
560.52 |
458.71 |
76.21 |
1965.45 |
2208.33 |
1214.46 |
993.87 |
165.12 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
413.32 |
465.36 |
259.72 |
205.64 |
37.18 |
895.53 |
1008.28 |
562.73 |
445.55 |
80.55 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
946.45 |
1065.64 |
611.42 |
454.22 |
81.90 |
2050.64 |
2308.89 |
1324.74 |
984.15 |
177.46 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
927.90 |
1044.73 |
560.52 |
484.21 |
80.94 |
2010.45 |
2263.58 |
1214.46 |
1049.12 |
175.37 |
Alabama Aetna HealthFund HDHP - HDHP Self |
224 |
380.45 |
384.30 |
259.72 |
124.58 |
-11.01 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Alabama Aetna HealthFund HDHP - HDHP Self & Family |
225 |
839.19 |
847.69 |
611.42 |
236.27 |
-28.79 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Alabama Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
822.75 |
831.10 |
560.52 |
270.58 |
-27.54 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Alabama UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
300.42 |
328.52 |
246.39 |
82.13 |
7.03 |
650.91 |
711.79 |
533.84 |
177.95 |
15.22 |
Alabama UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
710.52 |
776.94 |
582.71 |
194.23 |
16.60 |
1539.46 |
1683.37 |
1262.53 |
420.84 |
35.98 |
Alabama UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
645.92 |
706.31 |
529.73 |
176.58 |
15.10 |
1399.49 |
1530.34 |
1147.76 |
382.58 |
32.71 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LS1 |
288.31 |
304.08 |
228.06 |
76.02 |
3.94 |
624.67 |
658.84 |
494.13 |
164.71 |
8.54 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LS2 |
663.12 |
695.62 |
521.72 |
173.90 |
8.12 |
1436.76 |
1507.18 |
1130.39 |
376.79 |
17.60 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LS3 |
619.88 |
653.78 |
490.34 |
163.44 |
8.47 |
1343.07 |
1416.52 |
1062.39 |
354.13 |
18.36 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KK1 |
391.06 |
434.30 |
259.72 |
174.58 |
28.38 |
847.30 |
940.98 |
562.73 |
378.25 |
61.48 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KK2 |
977.65 |
1085.78 |
611.42 |
474.36 |
70.84 |
2118.24 |
2352.52 |
1324.74 |
1027.78 |
153.49 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KK3 |
840.78 |
933.77 |
560.52 |
373.25 |
57.10 |
1821.69 |
2023.17 |
1214.46 |
808.71 |
123.72 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
268.27 |
311.73 |
233.80 |
77.93 |
10.86 |
581.25 |
675.42 |
506.57 |
168.85 |
23.54 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
634.47 |
737.24 |
552.93 |
184.31 |
25.69 |
1374.69 |
1597.35 |
1198.01 |
399.34 |
55.67 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
576.79 |
670.22 |
502.67 |
167.55 |
23.35 |
1249.71 |
1452.14 |
1089.11 |
363.03 |
50.60 |
Alaska Aetna Advantage - Advantage Self |
Z24 |
230.78 |
230.78 |
173.09 |
57.69 |
0.00 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Alaska Aetna Advantage - Advantage Self & Family |
Z25 |
611.54 |
611.54 |
458.66 |
152.88 |
0.00 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Alaska Aetna Advantage - Advantage Self Plus One |
Z26 |
507.70 |
507.70 |
380.78 |
126.92 |
0.00 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Alaska Aetna Direct - CDHP Self |
N61 |
289.97 |
296.04 |
222.03 |
74.01 |
1.52 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Alaska Aetna Direct - CDHP Self & Family |
N62 |
731.30 |
746.57 |
559.93 |
186.64 |
3.82 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Alaska Aetna Direct - CDHP Self Plus One |
N63 |
635.94 |
649.23 |
486.92 |
162.31 |
3.33 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
JS4 |
505.16 |
510.91 |
259.72 |
251.19 |
-9.11 |
1094.51 |
1106.97 |
562.73 |
544.24 |
-19.74 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
JS5 |
1153.22 |
1166.33 |
611.42 |
554.91 |
-24.18 |
2498.64 |
2527.05 |
1324.74 |
1202.31 |
-52.38 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
JS6 |
1141.82 |
1154.80 |
560.52 |
594.28 |
-22.91 |
2473.94 |
2502.07 |
1214.46 |
1287.61 |
-49.63 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
JS1 |
478.77 |
538.34 |
259.72 |
278.62 |
44.71 |
1037.34 |
1166.40 |
562.73 |
603.67 |
96.86 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
JS2 |
1091.38 |
1227.18 |
611.42 |
615.76 |
98.51 |
2364.66 |
2658.89 |
1324.74 |
1334.15 |
213.44 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
JS3 |
1080.57 |
1215.02 |
560.52 |
654.50 |
98.56 |
2341.24 |
2632.54 |
1214.46 |
1418.08 |
213.54 |
Alaska Aetna HealthFund HDHP - HDHP Self |
224 |
380.45 |
384.30 |
259.72 |
124.58 |
-11.01 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Alaska Aetna HealthFund HDHP - HDHP Self & Family |
225 |
839.19 |
847.69 |
611.42 |
236.27 |
-28.79 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Alaska Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
822.75 |
831.10 |
560.52 |
270.58 |
-27.54 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Arizona Aetna Advantage - Advantage Self |
Z24 |
230.78 |
230.78 |
173.09 |
57.69 |
0.00 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Arizona Aetna Advantage - Advantage Self & Family |
Z25 |
611.54 |
611.54 |
458.66 |
152.88 |
0.00 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Arizona Aetna Advantage - Advantage Self Plus One |
Z26 |
507.70 |
507.70 |
380.78 |
126.92 |
0.00 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Arizona Aetna Direct - CDHP Self |
N61 |
289.97 |
296.04 |
222.03 |
74.01 |
1.52 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Arizona Aetna Direct - CDHP Self & Family |
N62 |
731.30 |
746.57 |
559.93 |
186.64 |
3.82 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Arizona Aetna Direct - CDHP Self Plus One |
N63 |
635.94 |
649.23 |
486.92 |
162.31 |
3.33 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
385.10 |
403.41 |
259.72 |
143.69 |
3.45 |
834.38 |
874.06 |
562.73 |
311.33 |
7.48 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
882.03 |
923.97 |
611.42 |
312.55 |
4.65 |
1911.07 |
2001.94 |
1324.74 |
677.20 |
10.08 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
864.75 |
905.86 |
560.52 |
345.34 |
5.22 |
1873.63 |
1962.70 |
1214.46 |
748.24 |
11.31 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
523.89 |
531.88 |
259.72 |
272.16 |
-6.87 |
1135.10 |
1152.41 |
562.73 |
589.68 |
-14.89 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
1195.02 |
1213.22 |
611.42 |
601.80 |
-19.09 |
2589.21 |
2628.64 |
1324.74 |
1303.90 |
-41.36 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
1183.20 |
1201.22 |
560.52 |
640.70 |
-17.87 |
2563.60 |
2602.64 |
1214.46 |
1388.18 |
-38.72 |
Arizona Aetna HealthFund HDHP - HDHP Self |
224 |
380.45 |
384.30 |
259.72 |
124.58 |
-11.01 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Arizona Aetna HealthFund HDHP - HDHP Self & Family |
225 |
839.19 |
847.69 |
611.42 |
236.27 |
-28.79 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Arizona Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
822.75 |
831.10 |
560.52 |
270.58 |
-27.54 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Arizona Aetna Open Access - High Self |
WQ1 |
664.00 |
667.30 |
259.72 |
407.58 |
-11.56 |
1438.67 |
1445.82 |
562.73 |
883.09 |
-25.05 |
Arizona Aetna Open Access - High Self & Family |
WQ2 |
1612.18 |
1620.18 |
611.42 |
1008.76 |
-29.29 |
3493.06 |
3510.39 |
1324.74 |
2185.65 |
-63.46 |
Arizona Aetna Open Access - High Self Plus One |
WQ3 |
1596.20 |
1604.14 |
560.52 |
1043.62 |
-27.95 |
3458.43 |
3475.64 |
1214.46 |
2261.18 |
-60.55 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self |
R61 |
402.99 |
412.79 |
259.72 |
153.07 |
-5.06 |
873.15 |
894.38 |
562.73 |
331.65 |
-10.97 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
R62 |
906.72 |
928.76 |
611.42 |
317.34 |
-15.25 |
1964.56 |
2012.31 |
1324.74 |
687.57 |
-33.04 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
R63 |
866.42 |
887.48 |
560.52 |
326.96 |
-14.83 |
1877.24 |
1922.87 |
1214.46 |
708.41 |
-32.13 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self |
R64 |
307.13 |
316.10 |
237.08 |
79.02 |
2.24 |
665.45 |
684.88 |
513.66 |
171.22 |
4.86 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self & Family |
R65 |
691.03 |
711.18 |
533.39 |
177.79 |
5.03 |
1497.23 |
1540.89 |
1155.67 |
385.22 |
10.91 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
R66 |
660.33 |
679.60 |
509.70 |
169.90 |
4.82 |
1430.72 |
1472.47 |
1104.35 |
368.12 |
10.44 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self |
R94 |
270.10 |
280.90 |
210.68 |
70.22 |
2.70 |
585.22 |
608.62 |
456.47 |
152.15 |
5.85 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self & Family |
R95 |
607.72 |
632.03 |
474.02 |
158.01 |
6.08 |
1316.73 |
1369.40 |
1027.05 |
342.35 |
13.17 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
R96 |
580.73 |
603.96 |
452.97 |
150.99 |
5.81 |
1258.25 |
1308.58 |
981.44 |
327.14 |
12.58 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self |
R91 |
352.48 |
370.10 |
259.72 |
110.38 |
2.76 |
763.71 |
801.88 |
562.73 |
239.15 |
5.97 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
R92 |
793.05 |
832.71 |
611.42 |
221.29 |
2.37 |
1718.28 |
1804.21 |
1324.74 |
479.47 |
5.14 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
R93 |
757.80 |
795.68 |
560.52 |
235.16 |
1.99 |
1641.90 |
1723.97 |
1214.46 |
509.51 |
4.31 |
Arizona Humana HDHP - HDHP Self |
BV1 |
209.15 |
215.43 |
161.57 |
53.86 |
1.57 |
453.16 |
466.77 |
350.08 |
116.69 |
3.40 |
Arizona Humana HDHP - HDHP Self & Family |
BV2 |
521.08 |
536.71 |
402.53 |
134.18 |
3.91 |
1129.01 |
1162.87 |
872.15 |
290.72 |
8.47 |
Arizona Humana HDHP - HDHP Self Plus One |
BV3 |
458.70 |
472.46 |
354.35 |
118.11 |
3.44 |
993.85 |
1023.66 |
767.75 |
255.91 |
7.45 |
Arizona Humana HDHP - HDHP Self |
BY1 |
183.59 |
189.10 |
141.83 |
47.27 |
1.37 |
397.78 |
409.72 |
307.29 |
102.43 |
2.99 |
Arizona Humana HDHP - HDHP Self & Family |
BY2 |
457.16 |
470.88 |
353.16 |
117.72 |
3.43 |
990.51 |
1020.24 |
765.18 |
255.06 |
7.43 |
Arizona Humana HDHP - HDHP Self Plus One |
BY3 |
402.45 |
414.52 |
310.89 |
103.63 |
3.02 |
871.98 |
898.13 |
673.60 |
224.53 |
6.54 |
Arizona Humana Health Plan, Inc. - Standard Self |
C74 |
422.86 |
459.96 |
259.72 |
200.24 |
22.24 |
916.20 |
996.58 |
562.73 |
433.85 |
48.18 |
Arizona Humana Health Plan, Inc. - Standard Self & Family |
C75 |
951.44 |
1034.90 |
611.42 |
423.48 |
46.17 |
2061.45 |
2242.28 |
1324.74 |
917.54 |
100.04 |
Arizona Humana Health Plan, Inc. - Standard Self Plus One |
C76 |
909.15 |
988.89 |
560.52 |
428.37 |
43.85 |
1969.83 |
2142.60 |
1214.46 |
928.14 |
95.01 |
Arizona Humana Health Plan, Inc. - Standard Self |
BF4 |
575.35 |
592.61 |
259.72 |
332.89 |
2.40 |
1246.59 |
1283.99 |
562.73 |
721.26 |
5.20 |
Arizona Humana Health Plan, Inc. - Standard Self & Family |
BF5 |
1294.55 |
1333.38 |
611.42 |
721.96 |
1.54 |
2804.86 |
2888.99 |
1324.74 |
1564.25 |
3.34 |
Arizona Humana Health Plan, Inc. - Standard Self Plus One |
BF6 |
1237.02 |
1274.14 |
560.52 |
713.62 |
1.23 |
2680.21 |
2760.64 |
1214.46 |
1546.18 |
2.67 |
Arizona UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
WF1 |
308.52 |
327.56 |
245.67 |
81.89 |
4.76 |
668.46 |
709.71 |
532.28 |
177.43 |
10.32 |
Arizona UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
WF2 |
729.65 |
774.68 |
581.01 |
193.67 |
11.26 |
1580.91 |
1678.47 |
1258.85 |
419.62 |
24.39 |
Arizona UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
WF3 |
663.31 |
704.25 |
528.19 |
176.06 |
10.23 |
1437.17 |
1525.88 |
1144.41 |
381.47 |
22.18 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LU1 |
310.20 |
327.06 |
245.30 |
81.76 |
4.21 |
672.10 |
708.63 |
531.47 |
177.16 |
9.14 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LU2 |
713.47 |
752.20 |
564.15 |
188.05 |
9.68 |
1545.85 |
1629.77 |
1222.33 |
407.44 |
20.98 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LU3 |
666.94 |
703.16 |
527.37 |
175.79 |
9.06 |
1445.04 |
1523.51 |
1142.63 |
380.88 |
19.62 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KT1 |
399.17 |
444.67 |
259.72 |
184.95 |
30.64 |
864.87 |
963.45 |
562.73 |
400.72 |
66.38 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KT2 |
997.92 |
1111.67 |
611.42 |
500.25 |
76.46 |
2162.16 |
2408.62 |
1324.74 |
1083.88 |
165.67 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KT3 |
858.21 |
956.03 |
560.52 |
395.51 |
61.93 |
1859.46 |
2071.40 |
1214.46 |
856.94 |
134.18 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
VD1 |
303.53 |
292.77 |
219.58 |
73.19 |
-2.69 |
657.65 |
634.34 |
475.76 |
158.58 |
-5.83 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
VD2 |
717.87 |
692.39 |
519.29 |
173.10 |
-6.37 |
1555.39 |
1500.18 |
1125.14 |
375.04 |
-13.81 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
VD3 |
652.60 |
629.45 |
472.09 |
157.36 |
-5.79 |
1413.97 |
1363.81 |
1022.86 |
340.95 |
-12.54 |
Arkansas Aetna Advantage - Advantage Self |
Z24 |
230.78 |
230.78 |
173.09 |
57.69 |
0.00 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Arkansas Aetna Advantage - Advantage Self & Family |
Z25 |
611.54 |
611.54 |
458.66 |
152.88 |
0.00 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Arkansas Aetna Advantage - Advantage Self Plus One |
Z26 |
507.70 |
507.70 |
380.78 |
126.92 |
0.00 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Arkansas Aetna Direct - CDHP Self |
N61 |
289.97 |
296.04 |
222.03 |
74.01 |
1.52 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Arkansas Aetna Direct - CDHP Self & Family |
N62 |
731.30 |
746.57 |
559.93 |
186.64 |
3.82 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Arkansas Aetna Direct - CDHP Self Plus One |
N63 |
635.94 |
649.23 |
486.92 |
162.31 |
3.33 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
401.84 |
451.48 |
259.72 |
191.76 |
34.78 |
870.65 |
978.21 |
562.73 |
415.48 |
75.36 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
916.20 |
1029.43 |
611.42 |
418.01 |
75.94 |
1985.10 |
2230.43 |
1324.74 |
905.69 |
164.54 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
907.13 |
1019.23 |
560.52 |
458.71 |
76.21 |
1965.45 |
2208.33 |
1214.46 |
993.87 |
165.12 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
413.32 |
465.36 |
259.72 |
205.64 |
37.18 |
895.53 |
1008.28 |
562.73 |
445.55 |
80.55 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
946.45 |
1065.64 |
611.42 |
454.22 |
81.90 |
2050.64 |
2308.89 |
1324.74 |
984.15 |
177.46 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
927.90 |
1044.73 |
560.52 |
484.21 |
80.94 |
2010.45 |
2263.58 |
1214.46 |
1049.12 |
175.37 |
Arkansas Aetna HealthFund HDHP - HDHP Self |
224 |
380.45 |
384.30 |
259.72 |
124.58 |
-11.01 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Arkansas Aetna HealthFund HDHP - HDHP Self & Family |
225 |
839.19 |
847.69 |
611.42 |
236.27 |
-28.79 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Arkansas Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
822.75 |
831.10 |
560.52 |
270.58 |
-27.54 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Arkansas QualChoice - High Self |
DH1 |
336.39 |
366.68 |
259.72 |
106.96 |
15.43 |
728.85 |
794.47 |
562.73 |
231.74 |
33.42 |
Arkansas QualChoice - High Self & Family |
DH2 |
877.43 |
956.45 |
611.42 |
345.03 |
41.73 |
1901.10 |
2072.31 |
1324.74 |
747.57 |
90.42 |
Arkansas QualChoice - High Self Plus One |
DH3 |
653.46 |
712.32 |
534.24 |
178.08 |
14.72 |
1415.83 |
1543.36 |
1157.52 |
385.84 |
31.88 |
Arkansas QualChoice - Standard Self |
DH4 |
262.60 |
286.23 |
214.67 |
71.56 |
5.91 |
568.97 |
620.17 |
465.13 |
155.04 |
12.80 |
Arkansas QualChoice - Standard Self & Family |
DH5 |
684.96 |
746.61 |
559.96 |
186.65 |
15.41 |
1484.08 |
1617.66 |
1213.25 |
404.41 |
33.39 |
Arkansas QualChoice - Standard Self Plus One |
DH6 |
510.13 |
556.05 |
417.04 |
139.01 |
11.48 |
1105.28 |
1204.78 |
903.59 |
301.19 |
24.87 |
Arkansas UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
300.42 |
328.52 |
246.39 |
82.13 |
7.03 |
650.91 |
711.79 |
533.84 |
177.95 |
15.22 |
Arkansas UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
710.52 |
776.94 |
582.71 |
194.23 |
16.60 |
1539.46 |
1683.37 |
1262.53 |
420.84 |
35.98 |
Arkansas UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
645.92 |
706.31 |
529.73 |
176.58 |
15.10 |
1399.49 |
1530.34 |
1147.76 |
382.58 |
32.71 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LS1 |
288.31 |
304.08 |
228.06 |
76.02 |
3.94 |
624.67 |
658.84 |
494.13 |
164.71 |
8.54 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LS2 |
663.12 |
695.62 |
521.72 |
173.90 |
8.12 |
1436.76 |
1507.18 |
1130.39 |
376.79 |
17.60 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LS3 |
619.88 |
653.78 |
490.34 |
163.44 |
8.47 |
1343.07 |
1416.52 |
1062.39 |
354.13 |
18.36 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KK1 |
391.06 |
434.30 |
259.72 |
174.58 |
28.38 |
847.30 |
940.98 |
562.73 |
378.25 |
61.48 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KK2 |
977.65 |
1085.78 |
611.42 |
474.36 |
70.84 |
2118.24 |
2352.52 |
1324.74 |
1027.78 |
153.49 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KK3 |
840.78 |
933.77 |
560.52 |
373.25 |
57.10 |
1821.69 |
2023.17 |
1214.46 |
808.71 |
123.72 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
268.27 |
311.73 |
233.80 |
77.93 |
10.86 |
581.25 |
675.42 |
506.57 |
168.85 |
23.54 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
634.47 |
737.24 |
552.93 |
184.31 |
25.69 |
1374.69 |
1597.35 |
1198.01 |
399.34 |
55.67 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
576.79 |
670.22 |
502.67 |
167.55 |
23.35 |
1249.71 |
1452.14 |
1089.11 |
363.03 |
50.60 |
California Aetna Advantage - Advantage Self |
Z24 |
230.78 |
230.78 |
173.09 |
57.69 |
0.00 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
California Aetna Advantage - Advantage Self & Family |
Z25 |
611.54 |
611.54 |
458.66 |
152.88 |
0.00 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
California Aetna Advantage - Advantage Self Plus One |
Z26 |
507.70 |
507.70 |
380.78 |
126.92 |
0.00 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
California Aetna Direct - CDHP Self |
N61 |
289.97 |
296.04 |
222.03 |
74.01 |
1.52 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
California Aetna Direct - CDHP Self & Family |
N62 |
731.30 |
746.57 |
559.93 |
186.64 |
3.82 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
California Aetna Direct - CDHP Self Plus One |
N63 |
635.94 |
649.23 |
486.92 |
162.31 |
3.33 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
California Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
JS4 |
505.16 |
510.91 |
259.72 |
251.19 |
-9.11 |
1094.51 |
1106.97 |
562.73 |
544.24 |
-19.74 |
California Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
JS5 |
1153.22 |
1166.33 |
611.42 |
554.91 |
-24.18 |
2498.64 |
2527.05 |
1324.74 |
1202.31 |
-52.38 |
California Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
JS6 |
1141.82 |
1154.80 |
560.52 |
594.28 |
-22.91 |
2473.94 |
2502.07 |
1214.46 |
1287.61 |
-49.63 |
California Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
JS1 |
478.77 |
538.34 |
259.72 |
278.62 |
44.71 |
1037.34 |
1166.40 |
562.73 |
603.67 |
96.86 |
California Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
JS2 |
1091.38 |
1227.18 |
611.42 |
615.76 |
98.51 |
2364.66 |
2658.89 |
1324.74 |
1334.15 |
213.44 |
California Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
JS3 |
1080.57 |
1215.02 |
560.52 |
654.50 |
98.56 |
2341.24 |
2632.54 |
1214.46 |
1418.08 |
213.54 |
California Aetna HealthFund HDHP - HDHP Self |
224 |
380.45 |
384.30 |
259.72 |
124.58 |
-11.01 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
California Aetna HealthFund HDHP - HDHP Self & Family |
225 |
839.19 |
847.69 |
611.42 |
236.27 |
-28.79 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
California Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
822.75 |
831.10 |
560.52 |
270.58 |
-27.54 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
California Aetna Open Access - High Self |
2X1 |
479.69 |
506.96 |
259.72 |
247.24 |
12.41 |
1039.33 |
1098.41 |
562.73 |
535.68 |
26.88 |
California Aetna Open Access - High Self & Family |
2X2 |
1126.17 |
1190.18 |
611.42 |
578.76 |
26.72 |
2440.04 |
2578.72 |
1324.74 |
1253.98 |
57.89 |
California Aetna Open Access - High Self Plus One |
2X3 |
1104.10 |
1166.85 |
560.52 |
606.33 |
26.86 |
2392.22 |
2528.18 |
1214.46 |
1313.72 |
58.20 |
California Anthem Blue Cross Select HMO - High Self |
B31 |
358.72 |
351.55 |
259.72 |
91.83 |
-22.03 |
777.23 |
761.69 |
562.73 |
198.96 |
-47.74 |
California Anthem Blue Cross Select HMO - High Self & Family |
B32 |
822.95 |
814.73 |
611.05 |
203.68 |
-45.14 |
1783.06 |
1765.25 |
1323.94 |
441.31 |
-97.80 |
California Anthem Blue Cross Select HMO - High Self Plus One |
B33 |
759.73 |
746.05 |
559.54 |
186.51 |
-48.59 |
1646.08 |
1616.44 |
1212.33 |
404.11 |
-105.27 |
California Blue Shield of California - Access + HMO Self |
SI1 |
408.28 |
440.95 |
259.72 |
181.23 |
17.81 |
884.61 |
955.39 |
562.73 |
392.66 |
38.58 |
California Blue Shield of California - Access + HMO Self & Family |
SI2 |
939.07 |
1014.20 |
611.42 |
402.78 |
37.84 |
2034.65 |
2197.43 |
1324.74 |
872.69 |
81.99 |
California Blue Shield of California - Access + HMO Self Plus One |
SI3 |
898.24 |
970.10 |
560.52 |
409.58 |
35.97 |
1946.19 |
2101.88 |
1214.46 |
887.42 |
77.93 |
California Health Net of California - Basic Self |
P61 |
187.24 |
187.27 |
140.45 |
46.82 |
0.01 |
405.69 |
405.75 |
304.31 |
101.44 |
0.02 |
California Health Net of California - Basic Self & Family |
P62 |
449.42 |
449.47 |
337.10 |
112.37 |
0.02 |
973.74 |
973.85 |
730.39 |
243.46 |
0.03 |
California Health Net of California - Basic Self Plus One |
P63 |
411.95 |
412.01 |
309.01 |
103.00 |
0.01 |
892.56 |
892.69 |
669.52 |
223.17 |
0.03 |
California Health Net of California - Standard Self |
P64 |
New Plan |
338.22 |
253.67 |
84.55 |
New Plan |
New Plan |
732.81 |
549.61 |
183.20 |
New Plan |
California Health Net of California - Standard Self & Family |
P65 |
New Plan |
811.72 |
608.79 |
202.93 |
New Plan |
New Plan |
1758.73 |
1319.05 |
439.68 |
New Plan |
California Health Net of California - Standard Self Plus One |
P66 |
New Plan |
744.08 |
558.06 |
186.02 |
New Plan |
New Plan |
1612.17 |
1209.13 |
403.04 |
New Plan |
California Health Net of California - High Self |
LP1 |
497.23 |
501.43 |
259.72 |
241.71 |
-10.66 |
1077.33 |
1086.43 |
562.73 |
523.70 |
-23.10 |
California Health Net of California - High Self & Family |
LP2 |
1193.38 |
1203.43 |
611.42 |
592.01 |
-27.24 |
2585.66 |
2607.43 |
1324.74 |
1282.69 |
-59.02 |
California Health Net of California - High Self Plus One |
LP3 |
1093.93 |
1103.14 |
560.52 |
542.62 |
-26.68 |
2370.18 |
2390.14 |
1214.46 |
1175.68 |
-57.80 |
California Health Net of California - High Self |
LB1 |
747.09 |
779.47 |
259.72 |
519.75 |
17.52 |
1618.70 |
1688.85 |
562.73 |
1126.12 |
37.95 |
California Health Net of California - High Self & Family |
LB2 |
1793.01 |
1870.72 |
611.42 |
1259.30 |
40.42 |
3884.86 |
4053.23 |
1324.74 |
2728.49 |
87.58 |
California Health Net of California - High Self Plus One |
LB3 |
1643.60 |
1714.82 |
560.52 |
1154.30 |
35.33 |
3561.13 |
3715.44 |
1214.46 |
2500.98 |
76.55 |
California Health Net of California - Basic Self |
T41 |
439.92 |
436.89 |
259.72 |
177.17 |
-17.89 |
953.16 |
946.60 |
562.73 |
383.87 |
-38.76 |
California Health Net of California - Basic Self & Family |
T42 |
1055.82 |
1048.54 |
611.42 |
437.12 |
-44.57 |
2287.61 |
2271.84 |
1324.74 |
947.10 |
-96.56 |
California Health Net of California - Basic Self Plus One |
T43 |
967.82 |
961.16 |
560.52 |
400.64 |
-42.55 |
2096.94 |
2082.51 |
1214.46 |
868.05 |
-92.19 |
California Kaiser Permanente - Fresno California - Standard Self |
NZ4 |
272.36 |
271.43 |
203.57 |
67.86 |
-0.23 |
590.11 |
588.10 |
441.08 |
147.02 |
-0.51 |
California Kaiser Permanente - Fresno California - Standard Self & Family |
NZ5 |
629.48 |
627.33 |
470.50 |
156.83 |
-0.54 |
1363.87 |
1359.22 |
1019.42 |
339.80 |
-1.17 |
California Kaiser Permanente - Fresno California - Standard Self Plus One |
NZ6 |
629.48 |
627.33 |
470.50 |
156.83 |
-0.54 |
1363.87 |
1359.22 |
1019.42 |
339.80 |
-1.17 |
California Kaiser Permanente - Fresno California - High Self |
NZ1 |
375.44 |
377.88 |
259.72 |
118.16 |
-12.42 |
813.45 |
818.74 |
562.73 |
256.01 |
-26.91 |
California Kaiser Permanente - Fresno California - High Self & Family |
NZ2 |
867.72 |
873.35 |
611.42 |
261.93 |
-31.66 |
1880.06 |
1892.26 |
1324.74 |
567.52 |
-68.59 |
California Kaiser Permanente - Fresno California - High Self Plus One |
NZ3 |
867.72 |
873.35 |
560.52 |
312.83 |
-30.26 |
1880.06 |
1892.26 |
1214.46 |
677.80 |
-65.56 |
California Kaiser Permanente - Northern California - Prosper Self |
KC1 |
303.95 |
300.14 |
225.11 |
75.03 |
-0.96 |
658.56 |
650.30 |
487.73 |
162.57 |
-2.07 |
California Kaiser Permanente - Northern California - Prosper Self & Family |
KC2 |
711.24 |
702.31 |
526.73 |
175.58 |
-2.23 |
1541.02 |
1521.67 |
1141.25 |
380.42 |
-4.83 |
California Kaiser Permanente - Northern California - Prosper Self Plus One |
KC3 |
711.24 |
702.31 |
526.73 |
175.58 |
-11.03 |
1541.02 |
1521.67 |
1141.25 |
380.42 |
-23.90 |
California Kaiser Permanente - Northern California - High Self |
591 |
462.60 |
458.22 |
259.72 |
198.50 |
-19.24 |
1002.30 |
992.81 |
562.73 |
430.08 |
-41.69 |
California Kaiser Permanente - Northern California - High Self & Family |
592 |
1104.27 |
1093.82 |
611.42 |
482.40 |
-47.74 |
2392.59 |
2369.94 |
1324.74 |
1045.20 |
-103.44 |
California Kaiser Permanente - Northern California - High Self Plus One |
593 |
1104.27 |
1093.82 |
560.52 |
533.30 |
-46.34 |
2392.59 |
2369.94 |
1214.46 |
1155.48 |
-100.41 |
California Kaiser Permanente - Northern California - Standard Self |
594 |
376.10 |
372.07 |
259.72 |
112.35 |
-18.89 |
814.88 |
806.15 |
562.73 |
243.42 |
-40.93 |
California Kaiser Permanente - Northern California - Standard Self & Family |
595 |
880.06 |
870.66 |
611.42 |
259.24 |
-46.69 |
1906.80 |
1886.43 |
1324.74 |
561.69 |
-101.16 |
California Kaiser Permanente - Northern California - Standard Self Plus One |
596 |
880.06 |
870.66 |
560.52 |
310.14 |
-45.29 |
1906.80 |
1886.43 |
1214.46 |
671.97 |
-98.13 |
California Kaiser Permanente - Southern California - Prosper Self |
FL1 |
168.75 |
168.62 |
126.47 |
42.15 |
-0.04 |
365.63 |
365.34 |
274.01 |
91.33 |
-0.08 |
California Kaiser Permanente - Southern California - Prosper Self & Family |
FL2 |
472.50 |
472.13 |
354.10 |
118.03 |
-0.09 |
1023.75 |
1022.95 |
767.21 |
255.74 |
-0.20 |
California Kaiser Permanente - Southern California - Prosper Self Plus One |
FL3 |
388.14 |
387.83 |
290.87 |
96.96 |
-0.07 |
840.97 |
840.30 |
630.23 |
210.07 |
-0.17 |
California Kaiser Permanente - Southern California - Standard Self |
624 |
225.39 |
243.70 |
182.78 |
60.92 |
4.57 |
488.35 |
528.02 |
396.02 |
132.00 |
9.91 |
California Kaiser Permanente - Southern California - Standard Self & Family |
625 |
520.90 |
563.23 |
422.42 |
140.81 |
10.59 |
1128.62 |
1220.33 |
915.25 |
305.08 |
22.93 |
California Kaiser Permanente - Southern California - Standard Self Plus One |
626 |
520.90 |
563.23 |
422.42 |
140.81 |
10.59 |
1128.62 |
1220.33 |
915.25 |
305.08 |
22.93 |
California Kaiser Permanente - Southern California - High Self |
621 |
351.06 |
359.65 |
259.72 |
99.93 |
-6.27 |
760.63 |
779.24 |
562.73 |
216.51 |
-13.59 |
California Kaiser Permanente - Southern California - High Self & Family |
622 |
811.37 |
831.22 |
611.42 |
219.80 |
-17.44 |
1757.97 |
1800.98 |
1324.74 |
476.24 |
-37.78 |
California Kaiser Permanente - Southern California - High Self Plus One |
623 |
811.37 |
831.22 |
560.52 |
270.70 |
-16.04 |
1757.97 |
1800.98 |
1214.46 |
586.52 |
-34.75 |
Colorado Aetna Advantage - Advantage Self |
Z24 |
230.78 |
230.78 |
173.09 |
57.69 |
0.00 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Colorado Aetna Advantage - Advantage Self & Family |
Z25 |
611.54 |
611.54 |
458.66 |
152.88 |
0.00 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Colorado Aetna Advantage - Advantage Self Plus One |
Z26 |
507.70 |
507.70 |
380.78 |
126.92 |
0.00 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Colorado Aetna Direct - CDHP Self |
N61 |
289.97 |
296.04 |
222.03 |
74.01 |
1.52 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Colorado Aetna Direct - CDHP Self & Family |
N62 |
731.30 |
746.57 |
559.93 |
186.64 |
3.82 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Colorado Aetna Direct - CDHP Self Plus One |
N63 |
635.94 |
649.23 |
486.92 |
162.31 |
3.33 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
385.10 |
403.41 |
259.72 |
143.69 |
3.45 |
834.38 |
874.06 |
562.73 |
311.33 |
7.48 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
882.03 |
923.97 |
611.42 |
312.55 |
4.65 |
1911.07 |
2001.94 |
1324.74 |
677.20 |
10.08 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
864.75 |
905.86 |
560.52 |
345.34 |
5.22 |
1873.63 |
1962.70 |
1214.46 |
748.24 |
11.31 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
523.89 |
531.88 |
259.72 |
272.16 |
-6.87 |
1135.10 |
1152.41 |
562.73 |
589.68 |
-14.89 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
1195.02 |
1213.22 |
611.42 |
601.80 |
-19.09 |
2589.21 |
2628.64 |
1324.74 |
1303.90 |
-41.36 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
1183.20 |
1201.22 |
560.52 |
640.70 |
-17.87 |
2563.60 |
2602.64 |
1214.46 |
1388.18 |
-38.72 |
Colorado Aetna HealthFund HDHP - HDHP Self |
224 |
380.45 |
384.30 |
259.72 |
124.58 |
-11.01 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Colorado Aetna HealthFund HDHP - HDHP Self & Family |
225 |
839.19 |
847.69 |
611.42 |
236.27 |
-28.79 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Colorado Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
822.75 |
831.10 |
560.52 |
270.58 |
-27.54 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Colorado Humana Health Plan, Inc. - High Self |
NR1 |
448.06 |
463.75 |
259.72 |
204.03 |
0.83 |
970.80 |
1004.79 |
562.73 |
442.06 |
1.79 |
Colorado Humana Health Plan, Inc. - High Self & Family |
NR2 |
1008.13 |
1043.43 |
611.42 |
432.01 |
-1.99 |
2184.28 |
2260.77 |
1324.74 |
936.03 |
-4.30 |
Colorado Humana Health Plan, Inc. - High Self Plus One |
NR3 |
963.33 |
997.06 |
560.52 |
436.54 |
-2.16 |
2087.22 |
2160.30 |
1214.46 |
945.84 |
-4.68 |
Colorado Humana Health Plan, Inc. - Standard Self |
NR4 |
307.42 |
346.20 |
259.65 |
86.55 |
9.70 |
666.08 |
750.10 |
562.58 |
187.52 |
21.00 |
Colorado Humana Health Plan, Inc. - Standard Self & Family |
NR5 |
691.72 |
778.95 |
584.21 |
194.74 |
21.81 |
1498.73 |
1687.73 |
1265.80 |
421.93 |
47.25 |
Colorado Humana Health Plan, Inc. - Standard Self Plus One |
NR6 |
660.96 |
744.32 |
558.24 |
186.08 |
20.84 |
1432.08 |
1612.69 |
1209.52 |
403.17 |
45.15 |
Colorado Humana Health Plan, Inc. - Basic Self |
RZ1 |
239.51 |
268.55 |
201.41 |
67.14 |
7.26 |
518.94 |
581.86 |
436.40 |
145.46 |
15.73 |
Colorado Humana Health Plan, Inc. - Basic Self & Family |
RZ2 |
538.88 |
604.20 |
453.15 |
151.05 |
16.33 |
1167.57 |
1309.10 |
981.83 |
327.27 |
35.38 |
Colorado Humana Health Plan, Inc. - Basic Self Plus One |
RZ3 |
514.95 |
577.37 |
433.03 |
144.34 |
15.60 |
1115.73 |
1250.97 |
938.23 |
312.74 |
33.81 |
Colorado Humana Health Plan, Inc. - High Self |
NT1 |
403.98 |
420.46 |
259.72 |
160.74 |
1.62 |
875.29 |
911.00 |
562.73 |
348.27 |
3.51 |
Colorado Humana Health Plan, Inc. - High Self & Family |
NT2 |
908.97 |
946.06 |
611.42 |
334.64 |
-0.20 |
1969.44 |
2049.80 |
1324.74 |
725.06 |
-0.43 |
Colorado Humana Health Plan, Inc. - High Self Plus One |
NT3 |
868.56 |
904.00 |
560.52 |
343.48 |
-0.45 |
1881.88 |
1958.67 |
1214.46 |
744.21 |
-0.97 |
Colorado Humana Health Plan, Inc. - Standard Self |
NT4 |
272.43 |
295.44 |
221.58 |
73.86 |
5.75 |
590.27 |
640.12 |
480.09 |
160.03 |
12.46 |
Colorado Humana Health Plan, Inc. - Standard Self & Family |
NT5 |
612.98 |
664.77 |
498.58 |
166.19 |
12.95 |
1328.12 |
1440.34 |
1080.26 |
360.08 |
28.05 |
Colorado Humana Health Plan, Inc. - Standard Self Plus One |
NT6 |
585.75 |
635.24 |
476.43 |
158.81 |
12.37 |
1269.13 |
1376.35 |
1032.26 |
344.09 |
26.81 |
Colorado Humana Health Plan, Inc. - Basic Self |
R21 |
279.64 |
314.90 |
236.18 |
78.72 |
8.81 |
605.89 |
682.28 |
511.71 |
170.57 |
19.10 |
Colorado Humana Health Plan, Inc. - Basic Self & Family |
R22 |
629.18 |
708.53 |
531.40 |
177.13 |
19.84 |
1363.22 |
1535.15 |
1151.36 |
383.79 |
42.99 |
Colorado Humana Health Plan, Inc. - Basic Self Plus One |
R23 |
601.21 |
677.03 |
507.77 |
169.26 |
18.96 |
1302.62 |
1466.90 |
1100.18 |
366.72 |
41.07 |
Colorado Kaiser Permanente - Colorado - Standard Self |
654 |
304.23 |
310.93 |
233.20 |
77.73 |
1.67 |
659.17 |
673.68 |
505.26 |
168.42 |
3.63 |
Colorado Kaiser Permanente - Colorado - Standard Self & Family |
655 |
687.56 |
702.69 |
527.02 |
175.67 |
3.78 |
1489.71 |
1522.50 |
1141.88 |
380.62 |
8.19 |
Colorado Kaiser Permanente - Colorado - Standard Self Plus One |
656 |
687.56 |
702.69 |
527.02 |
175.67 |
3.78 |
1489.71 |
1522.50 |
1141.88 |
380.62 |
8.19 |
Colorado Kaiser Permanente - Colorado - High Self |
651 |
356.72 |
362.95 |
259.72 |
103.23 |
-8.63 |
772.89 |
786.39 |
562.73 |
223.66 |
-18.70 |
Colorado Kaiser Permanente - Colorado - High Self & Family |
652 |
806.19 |
820.28 |
611.42 |
208.86 |
-23.20 |
1746.75 |
1777.27 |
1324.74 |
452.53 |
-50.27 |
Colorado Kaiser Permanente - Colorado - High Self Plus One |
653 |
806.19 |
820.28 |
560.52 |
259.76 |
-21.80 |
1746.75 |
1777.27 |
1214.46 |
562.81 |
-47.24 |
Colorado Kaiser Permanente - Colorado - Prosper Self |
N41 |
180.07 |
193.26 |
144.95 |
48.31 |
3.29 |
390.15 |
418.73 |
314.05 |
104.68 |
7.14 |
Colorado Kaiser Permanente - Colorado - Prosper Self & Family |
N42 |
442.97 |
475.45 |
356.59 |
118.86 |
8.12 |
959.77 |
1030.14 |
772.61 |
257.53 |
17.59 |
Colorado Kaiser Permanente - Colorado - Prosper Self Plus One |
N43 |
406.95 |
436.79 |
327.59 |
109.20 |
7.46 |
881.73 |
946.38 |
709.79 |
236.59 |
16.16 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LU1 |
310.20 |
327.06 |
245.30 |
81.76 |
4.21 |
672.10 |
708.63 |
531.47 |
177.16 |
9.14 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LU2 |
713.47 |
752.20 |
564.15 |
188.05 |
9.68 |
1545.85 |
1629.77 |
1222.33 |
407.44 |
20.98 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LU3 |
666.94 |
703.16 |
527.37 |
175.79 |
9.06 |
1445.04 |
1523.51 |
1142.63 |
380.88 |
19.62 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KT1 |
399.17 |
444.67 |
259.72 |
184.95 |
30.64 |
864.87 |
963.45 |
562.73 |
400.72 |
66.38 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KT2 |
997.92 |
1111.67 |
611.42 |
500.25 |
76.46 |
2162.16 |
2408.62 |
1324.74 |
1083.88 |
165.67 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KT3 |
858.21 |
956.03 |
560.52 |
395.51 |
61.93 |
1859.46 |
2071.40 |
1214.46 |
856.94 |
134.18 |
Connecticut Aetna Advantage - Advantage Self |
Z24 |
230.78 |
230.78 |
173.09 |
57.69 |
0.00 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Connecticut Aetna Advantage - Advantage Self & Family |
Z25 |
611.54 |
611.54 |
458.66 |
152.88 |
0.00 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Connecticut Aetna Advantage - Advantage Self Plus One |
Z26 |
507.70 |
507.70 |
380.78 |
126.92 |
0.00 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Connecticut Aetna Direct - CDHP Self |
N61 |
289.97 |
296.04 |
222.03 |
74.01 |
1.52 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Connecticut Aetna Direct - CDHP Self & Family |
N62 |
731.30 |
746.57 |
559.93 |
186.64 |
3.82 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Connecticut Aetna Direct - CDHP Self Plus One |
N63 |
635.94 |
649.23 |
486.92 |
162.31 |
3.33 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
428.20 |
504.82 |
259.72 |
245.10 |
61.76 |
927.77 |
1093.78 |
562.73 |
531.05 |
133.81 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
980.54 |
1155.97 |
611.42 |
544.55 |
138.14 |
2124.50 |
2504.60 |
1324.74 |
1179.86 |
299.31 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
961.31 |
1133.30 |
560.52 |
572.78 |
136.10 |
2082.84 |
2455.48 |
1214.46 |
1241.02 |
294.88 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
533.71 |
580.26 |
259.72 |
320.54 |
31.69 |
1156.37 |
1257.23 |
562.73 |
694.50 |
68.66 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
1217.13 |
1323.31 |
611.42 |
711.89 |
68.89 |
2637.12 |
2867.17 |
1324.74 |
1542.43 |
149.26 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
1205.08 |
1310.20 |
560.52 |
749.68 |
69.23 |
2611.01 |
2838.77 |
1214.46 |
1624.31 |
150.00 |
Connecticut Aetna HealthFund HDHP - HDHP Self |
224 |
380.45 |
384.30 |
259.72 |
124.58 |
-11.01 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Connecticut Aetna HealthFund HDHP - HDHP Self & Family |
225 |
839.19 |
847.69 |
611.42 |
236.27 |
-28.79 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Connecticut Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
822.75 |
831.10 |
560.52 |
270.58 |
-27.54 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Delaware Aetna Advantage - Advantage Self |
Z24 |
230.78 |
230.78 |
173.09 |
57.69 |
0.00 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Delaware Aetna Advantage - Advantage Self & Family |
Z25 |
611.54 |
611.54 |
458.66 |
152.88 |
0.00 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Delaware Aetna Advantage - Advantage Self Plus One |
Z26 |
507.70 |
507.70 |
380.78 |
126.92 |
0.00 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Delaware Aetna Direct - CDHP Self |
N61 |
289.97 |
296.04 |
222.03 |
74.01 |
1.52 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Delaware Aetna Direct - CDHP Self & Family |
N62 |
731.30 |
746.57 |
559.93 |
186.64 |
3.82 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Delaware Aetna Direct - CDHP Self Plus One |
N63 |
635.94 |
649.23 |
486.92 |
162.31 |
3.33 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
428.20 |
504.82 |
259.72 |
245.10 |
61.76 |
927.77 |
1093.78 |
562.73 |
531.05 |
133.81 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
980.54 |
1155.97 |
611.42 |
544.55 |
138.14 |
2124.50 |
2504.60 |
1324.74 |
1179.86 |
299.31 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
961.31 |
1133.30 |
560.52 |
572.78 |
136.10 |
2082.84 |
2455.48 |
1214.46 |
1241.02 |
294.88 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
533.71 |
580.26 |
259.72 |
320.54 |
31.69 |
1156.37 |
1257.23 |
562.73 |
694.50 |
68.66 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
1217.13 |
1323.31 |
611.42 |
711.89 |
68.89 |
2637.12 |
2867.17 |
1324.74 |
1542.43 |
149.26 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
1205.08 |
1310.20 |
560.52 |
749.68 |
69.23 |
2611.01 |
2838.77 |
1214.46 |
1624.31 |
150.00 |
Delaware Aetna HealthFund HDHP - HDHP Self |
224 |
380.45 |
384.30 |
259.72 |
124.58 |
-11.01 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Delaware Aetna HealthFund HDHP - HDHP Self & Family |
225 |
839.19 |
847.69 |
611.42 |
236.27 |
-28.79 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Delaware Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
822.75 |
831.10 |
560.52 |
270.58 |
-27.54 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Delaware Aetna Open Access - Basic Self |
P34 |
794.66 |
809.55 |
259.72 |
549.83 |
0.03 |
1721.76 |
1754.03 |
562.73 |
1191.30 |
0.07 |
Delaware Aetna Open Access - Basic Self & Family |
P35 |
1844.44 |
1878.97 |
611.42 |
1267.55 |
-2.76 |
3996.29 |
4071.10 |
1324.74 |
2746.36 |
-5.98 |
Delaware Aetna Open Access - Basic Self Plus One |
P36 |
1826.17 |
1860.34 |
560.52 |
1299.82 |
-1.72 |
3956.70 |
4030.74 |
1214.46 |
2816.28 |
-3.72 |
Delaware Aetna Open Access - High Self |
P31 |
813.48 |
802.14 |
259.72 |
542.42 |
-26.20 |
1762.54 |
1737.97 |
562.73 |
1175.24 |
-56.77 |
Delaware Aetna Open Access - High Self & Family |
P32 |
1972.28 |
1944.79 |
611.42 |
1333.37 |
-64.78 |
4273.27 |
4213.71 |
1324.74 |
2888.97 |
-140.35 |
Delaware Aetna Open Access - High Self Plus One |
P33 |
1952.76 |
1925.54 |
560.52 |
1365.02 |
-63.11 |
4230.98 |
4172.00 |
1214.46 |
2957.54 |
-136.74 |
District Of Columbia Aetna Advantage - Advantage Self |
Z24 |
230.78 |
230.78 |
173.09 |
57.69 |
0.00 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
District Of Columbia Aetna Advantage - Advantage Self & Family |
Z25 |
611.54 |
611.54 |
458.66 |
152.88 |
0.00 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
District Of Columbia Aetna Advantage - Advantage Self Plus One |
Z26 |
507.70 |
507.70 |
380.78 |
126.92 |
0.00 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
District Of Columbia Aetna Direct - CDHP Self |
N61 |
289.97 |
296.04 |
222.03 |
74.01 |
1.52 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
District Of Columbia Aetna Direct - CDHP Self & Family |
N62 |
731.30 |
746.57 |
559.93 |
186.64 |
3.82 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
District Of Columbia Aetna Direct - CDHP Self Plus One |
N63 |
635.94 |
649.23 |
486.92 |
162.31 |
3.33 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
401.84 |
451.48 |
259.72 |
191.76 |
34.78 |
870.65 |
978.21 |
562.73 |
415.48 |
75.36 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
916.20 |
1029.43 |
611.42 |
418.01 |
75.94 |
1985.10 |
2230.43 |
1324.74 |
905.69 |
164.54 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
907.13 |
1019.23 |
560.52 |
458.71 |
76.21 |
1965.45 |
2208.33 |
1214.46 |
993.87 |
165.12 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
413.32 |
465.36 |
259.72 |
205.64 |
37.18 |
895.53 |
1008.28 |
562.73 |
445.55 |
80.55 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
946.45 |
1065.64 |
611.42 |
454.22 |
81.90 |
2050.64 |
2308.89 |
1324.74 |
984.15 |
177.46 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
927.90 |
1044.73 |
560.52 |
484.21 |
80.94 |
2010.45 |
2263.58 |
1214.46 |
1049.12 |
175.37 |
District Of Columbia Aetna HealthFund HDHP - HDHP Self |
224 |
380.45 |
384.30 |
259.72 |
124.58 |
-11.01 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
District Of Columbia Aetna HealthFund HDHP - HDHP Self & Family |
225 |
839.19 |
847.69 |
611.42 |
236.27 |
-28.79 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
District Of Columbia Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
822.75 |
831.10 |
560.52 |
270.58 |
-27.54 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
District Of Columbia Aetna Open Access - High Self |
JN1 |
577.64 |
613.31 |
259.72 |
353.59 |
20.81 |
1251.55 |
1328.84 |
562.73 |
766.11 |
45.09 |
District Of Columbia Aetna Open Access - High Self & Family |
JN2 |
1298.62 |
1378.80 |
611.42 |
767.38 |
42.89 |
2813.68 |
2987.40 |
1324.74 |
1662.66 |
92.93 |
District Of Columbia Aetna Open Access - High Self Plus One |
JN3 |
1285.75 |
1365.14 |
560.52 |
804.62 |
43.50 |
2785.79 |
2957.80 |
1214.46 |
1743.34 |
94.25 |
District Of Columbia Aetna Open Access - Basic Self |
JN4 |
341.29 |
355.72 |
259.72 |
96.00 |
-0.43 |
739.46 |
770.73 |
562.73 |
208.00 |
-0.93 |
District Of Columbia Aetna Open Access - Basic Self & Family |
JN5 |
781.03 |
814.07 |
610.55 |
203.52 |
-3.38 |
1692.23 |
1763.82 |
1322.87 |
440.95 |
-7.33 |
District Of Columbia Aetna Open Access - Basic Self Plus One |
JN6 |
717.20 |
747.54 |
560.52 |
187.02 |
-5.55 |
1553.93 |
1619.67 |
1214.46 |
405.21 |
-12.02 |
District Of Columbia Aetna Saver (Open Access) - Saver Self |
QQ4 |
274.71 |
283.18 |
212.39 |
70.79 |
2.11 |
595.21 |
613.56 |
460.17 |
153.39 |
4.59 |
District Of Columbia Aetna Saver (Open Access) - Saver Self & Family |
QQ5 |
628.67 |
648.09 |
486.07 |
162.02 |
4.85 |
1362.12 |
1404.20 |
1053.15 |
351.05 |
10.52 |
District Of Columbia Aetna Saver (Open Access) - Saver Self Plus One |
QQ6 |
577.30 |
595.13 |
446.35 |
148.78 |
4.46 |
1250.82 |
1289.45 |
967.09 |
322.36 |
9.66 |
District Of Columbia CareFirst BlueChoice - Standard Self |
2G4 |
417.96 |
472.28 |
259.72 |
212.56 |
39.46 |
905.58 |
1023.27 |
562.73 |
460.54 |
85.49 |
District Of Columbia CareFirst BlueChoice - Standard Self & Family |
2G5 |
993.04 |
1122.14 |
611.42 |
510.72 |
91.81 |
2151.59 |
2431.30 |
1324.74 |
1106.56 |
198.92 |
District Of Columbia CareFirst BlueChoice - Standard Self Plus One |
2G6 |
835.90 |
944.57 |
560.52 |
384.05 |
72.78 |
1811.12 |
2046.57 |
1214.46 |
832.11 |
157.69 |
District Of Columbia CareFirst BlueChoice - HDHP Self |
B61 |
278.91 |
319.34 |
239.51 |
79.83 |
10.10 |
604.31 |
691.90 |
518.93 |
172.97 |
21.89 |
District Of Columbia CareFirst BlueChoice - HDHP Self & Family |
B62 |
662.67 |
758.75 |
569.06 |
189.69 |
24.02 |
1435.79 |
1643.96 |
1232.97 |
410.99 |
52.04 |
District Of Columbia CareFirst BlueChoice - HDHP Self Plus One |
B63 |
557.80 |
638.70 |
479.03 |
159.67 |
20.22 |
1208.57 |
1383.85 |
1037.89 |
345.96 |
43.82 |
District Of Columbia CareFirst BlueChoice - Blue Value Plus Self |
B64 |
334.00 |
350.69 |
259.72 |
90.97 |
1.83 |
723.67 |
759.83 |
562.73 |
197.10 |
3.96 |
District Of Columbia CareFirst BlueChoice - Blue Value Plus Self & Family |
B65 |
793.56 |
833.24 |
611.42 |
221.82 |
2.39 |
1719.38 |
1805.35 |
1324.74 |
480.61 |
5.18 |
District Of Columbia CareFirst BlueChoice - Blue Value Plus Self Plus One |
B66 |
667.98 |
701.39 |
526.04 |
175.35 |
8.36 |
1447.29 |
1519.68 |
1139.76 |
379.92 |
18.10 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - Prosper Self |
T71 |
170.26 |
175.26 |
131.45 |
43.81 |
1.25 |
368.90 |
379.73 |
284.80 |
94.93 |
2.71 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - Prosper Self & Family |
T72 |
485.23 |
493.08 |
369.81 |
123.27 |
1.96 |
1051.33 |
1068.34 |
801.26 |
267.08 |
4.25 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - Prosper Self Plus One |
T73 |
400.11 |
418.70 |
314.03 |
104.67 |
4.64 |
866.91 |
907.18 |
680.39 |
226.79 |
10.06 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - Standard Self |
E34 |
280.27 |
293.20 |
219.90 |
73.30 |
3.23 |
607.25 |
635.27 |
476.45 |
158.82 |
7.01 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - Standard Self & Family |
E35 |
644.60 |
674.35 |
505.76 |
168.59 |
7.44 |
1396.63 |
1461.09 |
1095.82 |
365.27 |
16.11 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - Standard Self Plus One |
E36 |
644.60 |
674.35 |
505.76 |
168.59 |
7.44 |
1396.63 |
1461.09 |
1095.82 |
365.27 |
16.11 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - High Self |
E31 |
349.20 |
365.03 |
259.72 |
105.31 |
0.97 |
756.60 |
790.90 |
562.73 |
228.17 |
2.10 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - High Self & Family |
E32 |
803.17 |
839.55 |
611.42 |
228.13 |
-0.91 |
1740.20 |
1819.03 |
1324.74 |
494.29 |
-1.96 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - High Self Plus One |
E33 |
803.17 |
839.55 |
560.52 |
279.03 |
0.49 |
1740.20 |
1819.03 |
1214.46 |
604.57 |
1.07 |
District Of Columbia M.D. IPA - High Self |
JP1 |
467.07 |
491.90 |
259.72 |
232.18 |
9.97 |
1011.99 |
1065.78 |
562.73 |
503.05 |
21.59 |
District Of Columbia M.D. IPA - High Self & Family |
JP2 |
1309.69 |
1379.28 |
611.42 |
767.86 |
32.30 |
2837.66 |
2988.44 |
1324.74 |
1663.70 |
69.99 |
District Of Columbia M.D. IPA - High Self Plus One |
JP3 |
912.20 |
960.67 |
560.52 |
400.15 |
12.58 |
1976.43 |
2081.45 |
1214.46 |
866.99 |
27.26 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
300.42 |
328.52 |
246.39 |
82.13 |
7.03 |
650.91 |
711.79 |
533.84 |
177.95 |
15.22 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
710.52 |
776.94 |
582.71 |
194.23 |
16.60 |
1539.46 |
1683.37 |
1262.53 |
420.84 |
35.98 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
645.92 |
706.31 |
529.73 |
176.58 |
15.10 |
1399.49 |
1530.34 |
1147.76 |
382.58 |
32.71 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
V41 |
305.45 |
307.01 |
230.26 |
76.75 |
0.39 |
661.81 |
665.19 |
498.89 |
166.30 |
0.85 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
V42 |
698.86 |
706.09 |
529.57 |
176.52 |
1.81 |
1514.20 |
1529.86 |
1147.40 |
382.46 |
3.91 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
V43 |
656.73 |
660.06 |
495.05 |
165.01 |
0.83 |
1422.92 |
1430.13 |
1072.60 |
357.53 |
1.80 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
LR1 |
379.46 |
419.08 |
259.72 |
159.36 |
24.76 |
822.16 |
908.01 |
562.73 |
345.28 |
53.65 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
LR2 |
899.33 |
993.20 |
611.42 |
381.78 |
56.58 |
1948.55 |
2151.93 |
1324.74 |
827.19 |
122.59 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
LR3 |
815.85 |
901.00 |
560.52 |
340.48 |
49.26 |
1767.68 |
1952.17 |
1214.46 |
737.71 |
106.73 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
L91 |
306.35 |
321.69 |
241.27 |
80.42 |
3.83 |
663.76 |
697.00 |
522.75 |
174.25 |
8.31 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
L92 |
732.19 |
772.06 |
579.05 |
193.01 |
9.96 |
1586.41 |
1672.80 |
1254.60 |
418.20 |
21.60 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self Plus One |
L93 |
612.71 |
683.61 |
512.71 |
170.90 |
17.72 |
1327.54 |
1481.16 |
1110.87 |
370.29 |
38.41 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
268.27 |
311.73 |
233.80 |
77.93 |
10.86 |
581.25 |
675.42 |
506.57 |
168.85 |
23.54 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
634.47 |
737.24 |
552.93 |
184.31 |
25.69 |
1374.69 |
1597.35 |
1198.01 |
399.34 |
55.67 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
576.79 |
670.22 |
502.67 |
167.55 |
23.35 |
1249.71 |
1452.14 |
1089.11 |
363.03 |
50.60 |
Florida Aetna Advantage - Advantage Self |
Z24 |
230.78 |
230.78 |
173.09 |
57.69 |
0.00 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Florida Aetna Advantage - Advantage Self & Family |
Z25 |
611.54 |
611.54 |
458.66 |
152.88 |
0.00 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Florida Aetna Advantage - Advantage Self Plus One |
Z26 |
507.70 |
507.70 |
380.78 |
126.92 |
0.00 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Florida Aetna Direct - CDHP Self |
N61 |
289.97 |
296.04 |
222.03 |
74.01 |
1.52 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Florida Aetna Direct - CDHP Self & Family |
N62 |
731.30 |
746.57 |
559.93 |
186.64 |
3.82 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Florida Aetna Direct - CDHP Self Plus One |
N63 |
635.94 |
649.23 |
486.92 |
162.31 |
3.33 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
401.84 |
451.48 |
259.72 |
191.76 |
34.78 |
870.65 |
978.21 |
562.73 |
415.48 |
75.36 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
916.20 |
1029.43 |
611.42 |
418.01 |
75.94 |
1985.10 |
2230.43 |
1324.74 |
905.69 |
164.54 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
907.13 |
1019.23 |
560.52 |
458.71 |
76.21 |
1965.45 |
2208.33 |
1214.46 |
993.87 |
165.12 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
413.32 |
465.36 |
259.72 |
205.64 |
37.18 |
895.53 |
1008.28 |
562.73 |
445.55 |
80.55 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
946.45 |
1065.64 |
611.42 |
454.22 |
81.90 |
2050.64 |
2308.89 |
1324.74 |
984.15 |
177.46 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
927.90 |
1044.73 |
560.52 |
484.21 |
80.94 |
2010.45 |
2263.58 |
1214.46 |
1049.12 |
175.37 |
Florida Aetna HealthFund HDHP - HDHP Self |
224 |
380.45 |
384.30 |
259.72 |
124.58 |
-11.01 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Florida Aetna HealthFund HDHP - HDHP Self & Family |
225 |
839.19 |
847.69 |
611.42 |
236.27 |
-28.79 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Florida Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
822.75 |
831.10 |
560.52 |
270.58 |
-27.54 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Florida AvMed - HDHP Self |
WZ1 |
342.58 |
399.79 |
259.72 |
140.07 |
42.35 |
742.26 |
866.21 |
562.73 |
303.48 |
91.75 |
Florida AvMed - HDHP Self & Family |
WZ2 |
791.08 |
930.45 |
611.42 |
319.03 |
102.08 |
1714.01 |
2015.98 |
1324.74 |
691.24 |
221.18 |
Florida AvMed - HDHP Self Plus One |
WZ3 |
686.42 |
806.61 |
560.52 |
246.09 |
74.49 |
1487.24 |
1747.66 |
1214.46 |
533.20 |
161.39 |
Florida AvMed - Standard Self |
ML4 |
370.10 |
436.76 |
259.72 |
177.04 |
51.80 |
801.88 |
946.31 |
562.73 |
383.58 |
112.23 |
Florida AvMed - Standard Self & Family |
ML5 |
901.13 |
1063.43 |
611.42 |
452.01 |
125.01 |
1952.45 |
2304.10 |
1324.74 |
979.36 |
270.86 |
Florida AvMed - Standard Self Plus One |
ML6 |
777.22 |
917.21 |
560.52 |
356.69 |
104.10 |
1683.98 |
1987.29 |
1214.46 |
772.83 |
225.55 |
Florida Capital Health Plan - High Self |
EA1 |
337.15 |
348.02 |
259.72 |
88.30 |
-3.99 |
730.49 |
754.04 |
562.73 |
191.31 |
-8.65 |
Florida Capital Health Plan - High Self & Family |
EA2 |
781.35 |
806.52 |
604.89 |
201.63 |
-5.59 |
1692.93 |
1747.46 |
1310.60 |
436.86 |
-12.12 |
Florida Capital Health Plan - High Self Plus One |
EA3 |
737.33 |
761.08 |
560.52 |
200.56 |
-12.14 |
1597.55 |
1649.01 |
1214.46 |
434.55 |
-26.30 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self |
W94 |
276.98 |
302.66 |
227.00 |
75.66 |
6.42 |
600.12 |
655.76 |
491.82 |
163.94 |
13.91 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self & Family |
W95 |
623.21 |
680.98 |
510.74 |
170.24 |
14.44 |
1350.29 |
1475.46 |
1106.60 |
368.86 |
31.29 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
W96 |
595.50 |
650.71 |
488.03 |
162.68 |
13.81 |
1290.25 |
1409.87 |
1057.40 |
352.47 |
29.91 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self |
W91 |
335.40 |
351.76 |
259.72 |
92.04 |
1.50 |
726.70 |
762.15 |
562.73 |
199.42 |
3.25 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
W92 |
754.63 |
791.43 |
593.57 |
197.86 |
9.20 |
1635.03 |
1714.77 |
1286.08 |
428.69 |
19.93 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
W93 |
721.10 |
756.28 |
560.52 |
195.76 |
-0.71 |
1562.38 |
1638.61 |
1214.46 |
424.15 |
-1.53 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self |
QP1 |
381.33 |
402.88 |
259.72 |
143.16 |
6.69 |
826.22 |
872.91 |
562.73 |
310.18 |
14.49 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
QP2 |
859.10 |
907.65 |
611.42 |
296.23 |
11.26 |
1861.38 |
1966.58 |
1324.74 |
641.84 |
24.41 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
QP3 |
820.92 |
867.30 |
560.52 |
306.78 |
10.49 |
1778.66 |
1879.15 |
1214.46 |
664.69 |
22.73 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self |
QP4 |
254.08 |
264.60 |
198.45 |
66.15 |
2.63 |
550.51 |
573.30 |
429.98 |
143.32 |
5.69 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self & Family |
QP5 |
571.66 |
595.31 |
446.48 |
148.83 |
5.92 |
1238.60 |
1289.84 |
967.38 |
322.46 |
12.81 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
QP6 |
546.26 |
568.86 |
426.65 |
142.21 |
5.65 |
1183.56 |
1232.53 |
924.40 |
308.13 |
12.24 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self |
MJ4 |
259.01 |
273.26 |
204.95 |
68.31 |
3.56 |
561.19 |
592.06 |
444.05 |
148.01 |
7.71 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self & Family |
MJ5 |
621.63 |
655.81 |
491.86 |
163.95 |
8.54 |
1346.87 |
1420.92 |
1065.69 |
355.23 |
18.51 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
MJ6 |
556.87 |
587.50 |
440.63 |
146.87 |
7.65 |
1206.55 |
1272.92 |
954.69 |
318.23 |
16.59 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self |
MJ1 |
491.48 |
513.30 |
259.72 |
253.58 |
6.96 |
1064.87 |
1112.15 |
562.73 |
549.42 |
15.08 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
MJ2 |
1105.81 |
1154.90 |
611.42 |
543.48 |
11.80 |
2395.92 |
2502.28 |
1324.74 |
1177.54 |
25.57 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
MJ3 |
1056.68 |
1103.59 |
560.52 |
543.07 |
11.02 |
2289.47 |
2391.11 |
1214.46 |
1176.65 |
23.88 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self |
X24 |
252.12 |
265.86 |
199.40 |
66.46 |
3.43 |
546.26 |
576.03 |
432.02 |
144.01 |
7.45 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self & Family |
X25 |
617.69 |
651.34 |
488.51 |
162.83 |
8.41 |
1338.33 |
1411.24 |
1058.43 |
352.81 |
18.23 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
X26 |
542.05 |
571.58 |
428.69 |
142.89 |
7.38 |
1174.44 |
1238.42 |
928.82 |
309.60 |
15.99 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self |
X21 |
291.02 |
311.40 |
233.55 |
77.85 |
5.10 |
630.54 |
674.70 |
506.03 |
168.67 |
11.04 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
X22 |
654.83 |
700.66 |
525.50 |
175.16 |
11.45 |
1418.80 |
1518.10 |
1138.58 |
379.52 |
24.82 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
X23 |
625.72 |
669.52 |
502.14 |
167.38 |
10.95 |
1355.73 |
1450.63 |
1087.97 |
362.66 |
23.73 |
Florida Humana HDHP - HDHP Self |
BR1 |
196.82 |
202.73 |
152.05 |
50.68 |
1.48 |
426.44 |
439.25 |
329.44 |
109.81 |
3.20 |
Florida Humana HDHP - HDHP Self & Family |
BR2 |
490.26 |
504.96 |
378.72 |
126.24 |
3.68 |
1062.23 |
1094.08 |
820.56 |
273.52 |
7.96 |
Florida Humana HDHP - HDHP Self Plus One |
BR3 |
431.57 |
444.52 |
333.39 |
111.13 |
3.24 |
935.07 |
963.13 |
722.35 |
240.78 |
7.01 |
Florida Humana HDHP - HDHP Self |
A41 |
220.80 |
227.43 |
170.57 |
56.86 |
1.66 |
478.40 |
492.77 |
369.58 |
123.19 |
3.59 |
Florida Humana HDHP - HDHP Self & Family |
A42 |
550.21 |
566.72 |
425.04 |
141.68 |
4.13 |
1192.12 |
1227.89 |
920.92 |
306.97 |
8.94 |
Florida Humana HDHP - HDHP Self Plus One |
A43 |
484.33 |
498.86 |
374.15 |
124.71 |
3.63 |
1049.38 |
1080.86 |
810.65 |
270.21 |
7.87 |
Florida Humana HDHP - HDHP Self |
FF1 |
187.62 |
193.24 |
144.93 |
48.31 |
1.41 |
406.51 |
418.69 |
314.02 |
104.67 |
3.04 |
Florida Humana HDHP - HDHP Self & Family |
FF2 |
467.23 |
481.25 |
360.94 |
120.31 |
3.50 |
1012.33 |
1042.71 |
782.03 |
260.68 |
7.60 |
Florida Humana HDHP - HDHP Self Plus One |
FF3 |
411.31 |
423.64 |
317.73 |
105.91 |
3.08 |
891.17 |
917.89 |
688.42 |
229.47 |
6.68 |
Florida Humana HDHP - HDHP Self |
AP1 |
222.96 |
229.64 |
172.23 |
57.41 |
1.67 |
483.08 |
497.55 |
373.16 |
124.39 |
3.62 |
Florida Humana HDHP - HDHP Self & Family |
AP2 |
555.58 |
572.25 |
429.19 |
143.06 |
4.17 |
1203.76 |
1239.88 |
929.91 |
309.97 |
9.03 |
Florida Humana HDHP - HDHP Self Plus One |
AP3 |
489.06 |
503.73 |
377.80 |
125.93 |
3.67 |
1059.63 |
1091.42 |
818.57 |
272.85 |
7.94 |
Florida Humana Medical Plan, Inc. - Standard Self |
LL4 |
592.01 |
655.77 |
259.72 |
396.05 |
48.90 |
1282.69 |
1420.84 |
562.73 |
858.11 |
105.95 |
Florida Humana Medical Plan, Inc. - Standard Self & Family |
LL5 |
1332.00 |
1475.46 |
611.42 |
864.04 |
106.17 |
2886.00 |
3196.83 |
1324.74 |
1872.09 |
230.04 |
Florida Humana Medical Plan, Inc. - Standard Self Plus One |
LL6 |
1272.80 |
1409.89 |
560.52 |
849.37 |
101.20 |
2757.73 |
3054.76 |
1214.46 |
1840.30 |
219.27 |
Florida Humana Medical Plan, Inc. - High Self |
LL1 |
828.17 |
932.78 |
259.72 |
673.06 |
89.75 |
1794.37 |
2021.02 |
562.73 |
1458.29 |
194.45 |
Florida Humana Medical Plan, Inc. - High Self & Family |
LL2 |
1863.37 |
2098.72 |
611.42 |
1487.30 |
198.06 |
4037.30 |
4547.23 |
1324.74 |
3222.49 |
429.14 |
Florida Humana Medical Plan, Inc. - High Self Plus One |
LL3 |
1780.55 |
2005.45 |
560.52 |
1444.93 |
189.01 |
3857.86 |
4345.14 |
1214.46 |
3130.68 |
409.52 |
Florida Humana Medical Plan, Inc. - High Self |
EE1 |
611.02 |
685.67 |
259.72 |
425.95 |
59.79 |
1323.88 |
1485.62 |
562.73 |
922.89 |
129.54 |
Florida Humana Medical Plan, Inc. - High Self & Family |
EE2 |
1374.82 |
1542.79 |
611.42 |
931.37 |
130.68 |
2978.78 |
3342.71 |
1324.74 |
2017.97 |
283.14 |
Florida Humana Medical Plan, Inc. - High Self Plus One |
EE3 |
1313.74 |
1474.25 |
560.52 |
913.73 |
124.62 |
2846.44 |
3194.21 |
1214.46 |
1979.75 |
270.01 |
Florida Humana Medical Plan, Inc. - Standard Self |
EE4 |
546.36 |
617.40 |
259.72 |
357.68 |
56.18 |
1183.78 |
1337.70 |
562.73 |
774.97 |
121.72 |
Florida Humana Medical Plan, Inc. - Standard Self & Family |
EE5 |
1229.30 |
1389.13 |
611.42 |
777.71 |
122.54 |
2663.48 |
3009.78 |
1324.74 |
1685.04 |
265.51 |
Florida Humana Medical Plan, Inc. - Standard Self Plus One |
EE6 |
1174.67 |
1327.38 |
560.52 |
766.86 |
116.82 |
2545.12 |
2875.99 |
1214.46 |
1661.53 |
253.11 |
Florida Humana Medical Plan, Inc. - Standard Self |
E24 |
371.28 |
398.53 |
259.72 |
138.81 |
12.39 |
804.44 |
863.48 |
562.73 |
300.75 |
26.84 |
Florida Humana Medical Plan, Inc. - Standard Self & Family |
E25 |
835.37 |
896.68 |
611.42 |
285.26 |
24.02 |
1809.97 |
1942.81 |
1324.74 |
618.07 |
52.05 |
Florida Humana Medical Plan, Inc. - Standard Self Plus One |
E26 |
798.23 |
856.81 |
560.52 |
296.29 |
22.69 |
1729.50 |
1856.42 |
1214.46 |
641.96 |
49.16 |
Florida Humana Medical Plan, Inc. - High Self |
E21 |
623.62 |
650.30 |
259.72 |
390.58 |
11.82 |
1351.18 |
1408.98 |
562.73 |
846.25 |
25.60 |
Florida Humana Medical Plan, Inc. - High Self & Family |
E22 |
1403.10 |
1463.13 |
611.42 |
851.71 |
22.74 |
3040.05 |
3170.12 |
1324.74 |
1845.38 |
49.28 |
Florida Humana Medical Plan, Inc. - High Self Plus One |
E23 |
1340.74 |
1398.10 |
560.52 |
837.58 |
21.47 |
2904.94 |
3029.22 |
1214.46 |
1814.76 |
46.52 |
Florida Humana Medical Plan, Inc. - High Self |
EX1 |
493.57 |
508.33 |
259.72 |
248.61 |
-0.10 |
1069.40 |
1101.38 |
562.73 |
538.65 |
-0.22 |
Florida Humana Medical Plan, Inc. - High Self & Family |
EX2 |
1110.51 |
1143.71 |
611.42 |
532.29 |
-4.09 |
2406.11 |
2478.04 |
1324.74 |
1153.30 |
-8.86 |
Florida Humana Medical Plan, Inc. - High Self Plus One |
EX3 |
1061.15 |
1092.87 |
560.52 |
532.35 |
-4.17 |
2299.16 |
2367.89 |
1214.46 |
1153.43 |
-9.03 |
Florida Humana Medical Plan, Inc. - Standard Self |
EX4 |
414.15 |
432.87 |
259.72 |
173.15 |
3.86 |
897.33 |
937.89 |
562.73 |
375.16 |
8.36 |
Florida Humana Medical Plan, Inc. - Standard Self & Family |
EX5 |
931.85 |
973.98 |
611.42 |
362.56 |
4.84 |
2019.01 |
2110.29 |
1324.74 |
785.55 |
10.49 |
Florida Humana Medical Plan, Inc. - Standard Self Plus One |
EX6 |
890.43 |
930.69 |
560.52 |
370.17 |
4.37 |
1929.27 |
2016.50 |
1214.46 |
802.04 |
9.47 |
Florida UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
300.42 |
328.52 |
246.39 |
82.13 |
7.03 |
650.91 |
711.79 |
533.84 |
177.95 |
15.22 |
Florida UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
710.52 |
776.94 |
582.71 |
194.23 |
16.60 |
1539.46 |
1683.37 |
1262.53 |
420.84 |
35.98 |
Florida UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
645.92 |
706.31 |
529.73 |
176.58 |
15.10 |
1399.49 |
1530.34 |
1147.76 |
382.58 |
32.71 |
Florida UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LS1 |
288.31 |
304.08 |
228.06 |
76.02 |
3.94 |
624.67 |
658.84 |
494.13 |
164.71 |
8.54 |
Florida UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LS2 |
663.12 |
695.62 |
521.72 |
173.90 |
8.12 |
1436.76 |
1507.18 |
1130.39 |
376.79 |
17.60 |
Florida UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LS3 |
619.88 |
653.78 |
490.34 |
163.44 |
8.47 |
1343.07 |
1416.52 |
1062.39 |
354.13 |
18.36 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KK1 |
391.06 |
434.30 |
259.72 |
174.58 |
28.38 |
847.30 |
940.98 |
562.73 |
378.25 |
61.48 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KK2 |
977.65 |
1085.78 |
611.42 |
474.36 |
70.84 |
2118.24 |
2352.52 |
1324.74 |
1027.78 |
153.49 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KK3 |
840.78 |
933.77 |
560.52 |
373.25 |
57.10 |
1821.69 |
2023.17 |
1214.46 |
808.71 |
123.72 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
LV1 |
414.41 |
464.05 |
259.72 |
204.33 |
34.78 |
897.89 |
1005.44 |
562.73 |
442.71 |
75.35 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
LV2 |
1243.22 |
1392.14 |
611.42 |
780.72 |
111.63 |
2693.64 |
3016.30 |
1324.74 |
1691.56 |
241.87 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self Plus One |
LV3 |
890.98 |
997.70 |
560.52 |
437.18 |
70.83 |
1930.46 |
2161.68 |
1214.46 |
947.22 |
153.46 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
268.27 |
311.73 |
233.80 |
77.93 |
10.86 |
581.25 |
675.42 |
506.57 |
168.85 |
23.54 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
634.47 |
737.24 |
552.93 |
184.31 |
25.69 |
1374.69 |
1597.35 |
1198.01 |
399.34 |
55.67 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
576.79 |
670.22 |
502.67 |
167.55 |
23.35 |
1249.71 |
1452.14 |
1089.11 |
363.03 |
50.60 |
Georgia Aetna Advantage - Advantage Self |
Z24 |
230.78 |
230.78 |
173.09 |
57.69 |
0.00 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Georgia Aetna Advantage - Advantage Self & Family |
Z25 |
611.54 |
611.54 |
458.66 |
152.88 |
0.00 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Georgia Aetna Advantage - Advantage Self Plus One |
Z26 |
507.70 |
507.70 |
380.78 |
126.92 |
0.00 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Georgia Aetna Direct - CDHP Self |
N61 |
289.97 |
296.04 |
222.03 |
74.01 |
1.52 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Georgia Aetna Direct - CDHP Self & Family |
N62 |
731.30 |
746.57 |
559.93 |
186.64 |
3.82 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Georgia Aetna Direct - CDHP Self Plus One |
N63 |
635.94 |
649.23 |
486.92 |
162.31 |
3.33 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
401.84 |
451.48 |
259.72 |
191.76 |
34.78 |
870.65 |
978.21 |
562.73 |
415.48 |
75.36 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
916.20 |
1029.43 |
611.42 |
418.01 |
75.94 |
1985.10 |
2230.43 |
1324.74 |
905.69 |
164.54 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
907.13 |
1019.23 |
560.52 |
458.71 |
76.21 |
1965.45 |
2208.33 |
1214.46 |
993.87 |
165.12 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
413.32 |
465.36 |
259.72 |
205.64 |
37.18 |
895.53 |
1008.28 |
562.73 |
445.55 |
80.55 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
946.45 |
1065.64 |
611.42 |
454.22 |
81.90 |
2050.64 |
2308.89 |
1324.74 |
984.15 |
177.46 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
927.90 |
1044.73 |
560.52 |
484.21 |
80.94 |
2010.45 |
2263.58 |
1214.46 |
1049.12 |
175.37 |
Georgia Aetna HealthFund HDHP - HDHP Self |
224 |
380.45 |
384.30 |
259.72 |
124.58 |
-11.01 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Georgia Aetna HealthFund HDHP - HDHP Self & Family |
225 |
839.19 |
847.69 |
611.42 |
236.27 |
-28.79 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Georgia Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
822.75 |
831.10 |
560.52 |
270.58 |
-27.54 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Georgia Aetna Open Access - High Self |
2U1 |
798.29 |
822.76 |
259.72 |
563.04 |
9.61 |
1729.63 |
1782.65 |
562.73 |
1219.92 |
20.82 |
Georgia Aetna Open Access - High Self & Family |
2U2 |
1838.83 |
1895.20 |
611.42 |
1283.78 |
19.08 |
3984.13 |
4106.27 |
1324.74 |
2781.53 |
41.35 |
Georgia Aetna Open Access - High Self Plus One |
2U3 |
1820.62 |
1876.44 |
560.52 |
1315.92 |
19.93 |
3944.68 |
4065.62 |
1214.46 |
2851.16 |
43.18 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self |
S94 |
303.95 |
326.75 |
245.06 |
81.69 |
5.70 |
658.56 |
707.96 |
530.97 |
176.99 |
12.35 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self & Family |
S95 |
683.87 |
735.17 |
551.38 |
183.79 |
12.82 |
1481.72 |
1592.87 |
1194.65 |
398.22 |
27.79 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
S96 |
653.48 |
702.50 |
526.88 |
175.62 |
12.25 |
1415.87 |
1522.08 |
1141.56 |
380.52 |
26.55 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self |
S91 |
381.74 |
385.56 |
259.72 |
125.84 |
-11.04 |
827.10 |
835.38 |
562.73 |
272.65 |
-23.92 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
S92 |
858.92 |
867.51 |
611.42 |
256.09 |
-28.70 |
1860.99 |
1879.61 |
1324.74 |
554.87 |
-62.17 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
S93 |
820.75 |
828.95 |
560.52 |
268.43 |
-27.69 |
1778.29 |
1796.06 |
1214.46 |
581.60 |
-59.99 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self |
AD4 |
381.25 |
404.13 |
259.72 |
144.41 |
8.02 |
826.04 |
875.62 |
562.73 |
312.89 |
17.38 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self & Family |
AD5 |
857.77 |
909.25 |
611.42 |
297.83 |
14.19 |
1858.50 |
1970.04 |
1324.74 |
645.30 |
30.75 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
AD6 |
819.66 |
868.84 |
560.52 |
308.32 |
13.29 |
1775.93 |
1882.49 |
1214.46 |
668.03 |
28.80 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self |
AD1 |
538.39 |
576.08 |
259.72 |
316.36 |
22.83 |
1166.51 |
1248.17 |
562.73 |
685.44 |
49.46 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
AD2 |
1211.36 |
1296.16 |
611.42 |
684.74 |
47.51 |
2624.61 |
2808.35 |
1324.74 |
1483.61 |
102.95 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
AD3 |
1157.53 |
1238.55 |
560.52 |
678.03 |
45.13 |
2507.98 |
2683.53 |
1214.46 |
1469.07 |
97.79 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self |
LM1 |
362.08 |
387.36 |
259.72 |
127.64 |
10.42 |
784.51 |
839.28 |
562.73 |
276.55 |
22.57 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
LM2 |
814.68 |
871.57 |
611.42 |
260.15 |
19.60 |
1765.14 |
1888.40 |
1324.74 |
563.66 |
42.47 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
LM3 |
778.47 |
832.83 |
560.52 |
272.31 |
18.47 |
1686.69 |
1804.47 |
1214.46 |
590.01 |
40.02 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self |
LM4 |
342.52 |
362.87 |
259.72 |
103.15 |
5.49 |
742.13 |
786.22 |
562.73 |
223.49 |
11.89 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self & Family |
LM5 |
770.68 |
816.46 |
611.42 |
205.04 |
8.49 |
1669.81 |
1769.00 |
1324.74 |
444.26 |
18.40 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
LM6 |
736.43 |
780.19 |
560.52 |
219.67 |
7.87 |
1595.60 |
1690.41 |
1214.46 |
475.95 |
17.05 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self |
RM1 |
365.48 |
411.85 |
259.72 |
152.13 |
31.51 |
791.87 |
892.34 |
562.73 |
329.61 |
68.27 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self & Family |
RM2 |
822.33 |
926.67 |
611.42 |
315.25 |
67.05 |
1781.72 |
2007.79 |
1324.74 |
683.05 |
145.28 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self Plus One |
RM3 |
785.78 |
885.49 |
560.52 |
324.97 |
63.82 |
1702.52 |
1918.56 |
1214.46 |
704.10 |
138.28 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self |
DN4 |
403.46 |
455.22 |
259.72 |
195.50 |
36.90 |
874.16 |
986.31 |
562.73 |
423.58 |
79.95 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self & Family |
DN5 |
907.74 |
1024.20 |
611.42 |
412.78 |
79.17 |
1966.77 |
2219.10 |
1324.74 |
894.36 |
171.54 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self Plus One |
DN6 |
867.41 |
978.69 |
560.52 |
418.17 |
75.39 |
1879.39 |
2120.50 |
1214.46 |
906.04 |
163.35 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self |
RJ1 |
324.62 |
367.58 |
259.72 |
107.86 |
26.71 |
703.34 |
796.42 |
562.73 |
233.69 |
57.86 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self & Family |
RJ2 |
730.40 |
827.07 |
611.42 |
215.65 |
33.05 |
1582.53 |
1791.99 |
1324.74 |
467.25 |
71.62 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self Plus One |
RJ3 |
697.93 |
790.31 |
560.52 |
229.79 |
55.31 |
1512.18 |
1712.34 |
1214.46 |
497.88 |
119.84 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self |
Q71 |
402.51 |
481.71 |
259.72 |
221.99 |
64.34 |
872.11 |
1043.71 |
562.73 |
480.98 |
139.40 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self & Family |
Q72 |
905.66 |
1083.85 |
611.42 |
472.43 |
140.90 |
1962.26 |
2348.34 |
1324.74 |
1023.60 |
305.29 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self Plus One |
Q73 |
865.40 |
1035.66 |
560.52 |
475.14 |
134.37 |
1875.03 |
2243.93 |
1214.46 |
1029.47 |
291.14 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self |
CB4 |
577.70 |
635.47 |
259.72 |
375.75 |
42.91 |
1251.68 |
1376.85 |
562.73 |
814.12 |
92.97 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self & Family |
CB5 |
1299.83 |
1429.80 |
611.42 |
818.38 |
92.68 |
2816.30 |
3097.90 |
1324.74 |
1773.16 |
200.81 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self Plus One |
CB6 |
1242.06 |
1366.26 |
560.52 |
805.74 |
88.31 |
2691.13 |
2960.23 |
1214.46 |
1745.77 |
191.34 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self |
DG4 |
660.39 |
690.10 |
259.72 |
430.38 |
14.85 |
1430.85 |
1495.22 |
562.73 |
932.49 |
32.17 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self & Family |
DG5 |
1485.89 |
1552.75 |
611.42 |
941.33 |
29.57 |
3219.43 |
3364.29 |
1324.74 |
2039.55 |
64.07 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self Plus One |
DG6 |
1419.88 |
1483.78 |
560.52 |
923.26 |
28.01 |
3076.41 |
3214.86 |
1214.46 |
2000.40 |
60.69 |
Georgia Humana HDHP - HDHP Self |
AZ1 |
218.03 |
224.57 |
168.43 |
56.14 |
1.63 |
472.40 |
486.57 |
364.93 |
121.64 |
3.54 |
Georgia Humana HDHP - HDHP Self & Family |
AZ2 |
543.26 |
559.56 |
419.67 |
139.89 |
4.08 |
1177.06 |
1212.38 |
909.29 |
303.09 |
8.83 |
Georgia Humana HDHP - HDHP Self Plus One |
AZ3 |
478.22 |
492.56 |
369.42 |
123.14 |
3.59 |
1036.14 |
1067.21 |
800.41 |
266.80 |
7.77 |
Georgia Humana HDHP - HDHP Self |
B21 |
224.78 |
231.51 |
173.63 |
57.88 |
1.69 |
487.02 |
501.61 |
376.21 |
125.40 |
3.65 |
Georgia Humana HDHP - HDHP Self & Family |
B22 |
560.13 |
576.94 |
432.71 |
144.23 |
4.20 |
1213.62 |
1250.04 |
937.53 |
312.51 |
9.11 |
Georgia Humana HDHP - HDHP Self Plus One |
B23 |
493.06 |
507.85 |
380.89 |
126.96 |
3.70 |
1068.30 |
1100.34 |
825.26 |
275.08 |
8.01 |
Georgia Humana HDHP - HDHP Self |
AR1 |
220.36 |
226.97 |
170.23 |
56.74 |
1.65 |
477.45 |
491.77 |
368.83 |
122.94 |
3.58 |
Georgia Humana HDHP - HDHP Self & Family |
AR2 |
549.10 |
565.57 |
424.18 |
141.39 |
4.12 |
1189.72 |
1225.40 |
919.05 |
306.35 |
8.92 |
Georgia Humana HDHP - HDHP Self Plus One |
AR3 |
483.35 |
497.85 |
373.39 |
124.46 |
3.62 |
1047.26 |
1078.68 |
809.01 |
269.67 |
7.86 |
Georgia Kaiser Permanente - Georgia - High Self |
F81 |
355.25 |
372.76 |
259.72 |
113.04 |
2.65 |
769.71 |
807.65 |
562.73 |
244.92 |
5.74 |
Georgia Kaiser Permanente - Georgia - High Self & Family |
F82 |
802.88 |
842.43 |
611.42 |
231.01 |
2.26 |
1739.57 |
1825.27 |
1324.74 |
500.53 |
4.91 |
Georgia Kaiser Permanente - Georgia - High Self Plus One |
F83 |
802.88 |
842.43 |
560.52 |
281.91 |
3.66 |
1739.57 |
1825.27 |
1214.46 |
610.81 |
7.94 |
Georgia Kaiser Permanente - Georgia - Standard Self |
F84 |
277.25 |
291.73 |
218.80 |
72.93 |
3.62 |
600.71 |
632.08 |
474.06 |
158.02 |
7.84 |
Georgia Kaiser Permanente - Georgia - Standard Self & Family |
F85 |
626.58 |
659.32 |
494.49 |
164.83 |
8.19 |
1357.59 |
1428.53 |
1071.40 |
357.13 |
17.73 |
Georgia Kaiser Permanente - Georgia - Standard Self Plus One |
F86 |
626.58 |
659.32 |
494.49 |
164.83 |
8.19 |
1357.59 |
1428.53 |
1071.40 |
357.13 |
17.73 |
Georgia Kaiser Permanente - Georgia - Prosper Self |
LA1 |
183.99 |
200.53 |
150.40 |
50.13 |
4.13 |
398.65 |
434.48 |
325.86 |
108.62 |
8.96 |
Georgia Kaiser Permanente - Georgia - Prosper Self & Family |
LA2 |
477.68 |
520.66 |
390.50 |
130.16 |
10.74 |
1034.97 |
1128.10 |
846.08 |
282.02 |
23.28 |
Georgia Kaiser Permanente - Georgia - Prosper Self Plus One |
LA3 |
415.81 |
453.22 |
339.92 |
113.30 |
9.35 |
900.92 |
981.98 |
736.49 |
245.49 |
20.26 |
Georgia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
300.42 |
328.52 |
246.39 |
82.13 |
7.03 |
650.91 |
711.79 |
533.84 |
177.95 |
15.22 |
Georgia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
710.52 |
776.94 |
582.71 |
194.23 |
16.60 |
1539.46 |
1683.37 |
1262.53 |
420.84 |
35.98 |
Georgia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
645.92 |
706.31 |
529.73 |
176.58 |
15.10 |
1399.49 |
1530.34 |
1147.76 |
382.58 |
32.71 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
LV1 |
414.41 |
464.05 |
259.72 |
204.33 |
34.78 |
897.89 |
1005.44 |
562.73 |
442.71 |
75.35 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
LV2 |
1243.22 |
1392.14 |
611.42 |
780.72 |
111.63 |
2693.64 |
3016.30 |
1324.74 |
1691.56 |
241.87 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self Plus One |
LV3 |
890.98 |
997.70 |
560.52 |
437.18 |
70.83 |
1930.46 |
2161.68 |
1214.46 |
947.22 |
153.46 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
268.27 |
311.73 |
233.80 |
77.93 |
10.86 |
581.25 |
675.42 |
506.57 |
168.85 |
23.54 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
634.47 |
737.24 |
552.93 |
184.31 |
25.69 |
1374.69 |
1597.35 |
1198.01 |
399.34 |
55.67 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
576.79 |
670.22 |
502.67 |
167.55 |
23.35 |
1249.71 |
1452.14 |
1089.11 |
363.03 |
50.60 |
Guam Calvo's SelectCare - Standard Self |
B44 |
174.88 |
186.75 |
140.06 |
46.69 |
2.97 |
378.91 |
404.63 |
303.47 |
101.16 |
6.43 |
Guam Calvo's SelectCare - Standard Self & Family |
B45 |
508.11 |
542.61 |
406.96 |
135.65 |
8.62 |
1100.91 |
1175.66 |
881.75 |
293.91 |
18.68 |
Guam Calvo's SelectCare - Standard Self Plus One |
B46 |
344.73 |
368.14 |
276.11 |
92.03 |
5.85 |
746.92 |
797.64 |
598.23 |
199.41 |
12.68 |
Guam Calvo's SelectCare - High Self |
B41 |
247.36 |
254.53 |
190.90 |
63.63 |
1.79 |
535.95 |
551.48 |
413.61 |
137.87 |
3.88 |
Guam Calvo's SelectCare - High Self & Family |
B42 |
655.17 |
674.17 |
505.63 |
168.54 |
4.75 |
1419.54 |
1460.70 |
1095.53 |
365.17 |
10.29 |
Guam Calvo's SelectCare - High Self Plus One |
B43 |
482.72 |
496.74 |
372.56 |
124.18 |
3.50 |
1045.89 |
1076.27 |
807.20 |
269.07 |
7.60 |
Guam TakeCare - HDHP Self |
KX1 |
56.45 |
55.36 |
41.52 |
13.84 |
-0.27 |
122.31 |
119.95 |
89.96 |
29.99 |
-0.59 |
Guam TakeCare - HDHP Self & Family |
KX2 |
151.37 |
148.40 |
111.30 |
37.10 |
-0.74 |
327.97 |
321.53 |
241.15 |
80.38 |
-1.61 |
Guam TakeCare - HDHP Self Plus One |
KX3 |
136.26 |
133.62 |
100.22 |
33.40 |
-0.66 |
295.23 |
289.51 |
217.13 |
72.38 |
-1.43 |
Guam TakeCare - Standard Self |
JK4 |
187.28 |
203.66 |
152.75 |
50.91 |
4.09 |
405.77 |
441.26 |
330.95 |
110.31 |
8.87 |
Guam TakeCare - Standard Self & Family |
JK5 |
530.39 |
576.78 |
432.59 |
144.19 |
11.59 |
1149.18 |
1249.69 |
937.27 |
312.42 |
25.13 |
Guam TakeCare - Standard Self Plus One |
JK6 |
369.13 |
401.42 |
301.07 |
100.35 |
8.07 |
799.78 |
869.74 |
652.31 |
217.43 |
17.49 |
Guam TakeCare - High Self |
JK1 |
238.09 |
260.67 |
195.50 |
65.17 |
5.65 |
515.86 |
564.79 |
423.59 |
141.20 |
12.24 |
Guam TakeCare - High Self & Family |
JK2 |
567.89 |
621.73 |
466.30 |
155.43 |
13.46 |
1230.43 |
1347.08 |
1010.31 |
336.77 |
29.16 |
Guam TakeCare - High Self Plus One |
JK3 |
470.38 |
514.98 |
386.24 |
128.74 |
11.15 |
1019.16 |
1115.79 |
836.84 |
278.95 |
24.16 |
Hawaii Aetna Advantage - Advantage Self |
Z24 |
230.78 |
230.78 |
173.09 |
57.69 |
0.00 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Hawaii Aetna Advantage - Advantage Self & Family |
Z25 |
611.54 |
611.54 |
458.66 |
152.88 |
0.00 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Hawaii Aetna Advantage - Advantage Self Plus One |
Z26 |
507.70 |
507.70 |
380.78 |
126.92 |
0.00 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Hawaii Aetna Direct - CDHP Self |
N61 |
289.97 |
296.04 |
222.03 |
74.01 |
1.52 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Hawaii Aetna Direct - CDHP Self & Family |
N62 |
731.30 |
746.57 |
559.93 |
186.64 |
3.82 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Hawaii Aetna Direct - CDHP Self Plus One |
N63 |
635.94 |
649.23 |
486.92 |
162.31 |
3.33 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
JS4 |
505.16 |
510.91 |
259.72 |
251.19 |
-9.11 |
1094.51 |
1106.97 |
562.73 |
544.24 |
-19.74 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
JS5 |
1153.22 |
1166.33 |
611.42 |
554.91 |
-24.18 |
2498.64 |
2527.05 |
1324.74 |
1202.31 |
-52.38 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
JS6 |
1141.82 |
1154.80 |
560.52 |
594.28 |
-22.91 |
2473.94 |
2502.07 |
1214.46 |
1287.61 |
-49.63 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
JS1 |
478.77 |
538.34 |
259.72 |
278.62 |
44.71 |
1037.34 |
1166.40 |
562.73 |
603.67 |
96.86 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
JS2 |
1091.38 |
1227.18 |
611.42 |
615.76 |
98.51 |
2364.66 |
2658.89 |
1324.74 |
1334.15 |
213.44 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
JS3 |
1080.57 |
1215.02 |
560.52 |
654.50 |
98.56 |
2341.24 |
2632.54 |
1214.46 |
1418.08 |
213.54 |
Hawaii Aetna HealthFund HDHP - HDHP Self |
224 |
380.45 |
384.30 |
259.72 |
124.58 |
-11.01 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Hawaii Aetna HealthFund HDHP - HDHP Self & Family |
225 |
839.19 |
847.69 |
611.42 |
236.27 |
-28.79 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Hawaii Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
822.75 |
831.10 |
560.52 |
270.58 |
-27.54 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Hawaii HMSA Plan - High Self |
871 |
291.34 |
291.34 |
218.51 |
72.83 |
0.00 |
631.24 |
631.24 |
473.43 |
157.81 |
0.00 |
Hawaii HMSA Plan - High Self & Family |
872 |
654.93 |
654.93 |
491.20 |
163.73 |
0.00 |
1419.02 |
1419.02 |
1064.27 |
354.75 |
0.00 |
Hawaii HMSA Plan - High Self Plus One |
873 |
638.34 |
638.34 |
478.76 |
159.58 |
0.00 |
1383.07 |
1383.07 |
1037.30 |
345.77 |
0.00 |
Hawaii HMSA Plan - Standard Self |
874 |
209.46 |
209.46 |
157.10 |
52.36 |
0.00 |
453.83 |
453.83 |
340.37 |
113.46 |
0.00 |
Hawaii HMSA Plan - Standard Self & Family |
875 |
470.85 |
470.85 |
353.14 |
117.71 |
0.00 |
1020.18 |
1020.18 |
765.14 |
255.04 |
0.00 |
Hawaii HMSA Plan - Standard Self Plus One |
876 |
458.90 |
458.90 |
344.18 |
114.72 |
0.00 |
994.28 |
994.28 |
745.71 |
248.57 |
0.00 |
Hawaii Kaiser Permanente - Hawaii - High Self |
631 |
311.79 |
320.68 |
240.51 |
80.17 |
2.22 |
675.55 |
694.81 |
521.11 |
173.70 |
4.81 |
Hawaii Kaiser Permanente - Hawaii - High Self & Family |
632 |
695.31 |
715.14 |
536.36 |
178.78 |
4.95 |
1506.51 |
1549.47 |
1162.10 |
387.37 |
10.74 |
Hawaii Kaiser Permanente - Hawaii - High Self Plus One |
633 |
695.31 |
715.14 |
536.36 |
178.78 |
4.95 |
1506.51 |
1549.47 |
1162.10 |
387.37 |
10.74 |
Hawaii Kaiser Permanente - Hawaii - Standard Self |
634 |
224.02 |
224.02 |
168.02 |
56.00 |
0.00 |
485.38 |
485.38 |
364.04 |
121.34 |
0.00 |
Hawaii Kaiser Permanente - Hawaii - Standard Self & Family |
635 |
499.56 |
499.56 |
374.67 |
124.89 |
0.00 |
1082.38 |
1082.38 |
811.79 |
270.59 |
0.00 |
Hawaii Kaiser Permanente - Hawaii - Standard Self Plus One |
636 |
499.56 |
499.56 |
374.67 |
124.89 |
0.00 |
1082.38 |
1082.38 |
811.79 |
270.59 |
0.00 |
Idaho Aetna Advantage - Advantage Self |
Z24 |
230.78 |
230.78 |
173.09 |
57.69 |
0.00 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Idaho Aetna Advantage - Advantage Self & Family |
Z25 |
611.54 |
611.54 |
458.66 |
152.88 |
0.00 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Idaho Aetna Advantage - Advantage Self Plus One |
Z26 |
507.70 |
507.70 |
380.78 |
126.92 |
0.00 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Idaho Aetna Direct - CDHP Self |
N61 |
289.97 |
296.04 |
222.03 |
74.01 |
1.52 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Idaho Aetna Direct - CDHP Self & Family |
N62 |
731.30 |
746.57 |
559.93 |
186.64 |
3.82 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Idaho Aetna Direct - CDHP Self Plus One |
N63 |
635.94 |
649.23 |
486.92 |
162.31 |
3.33 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
381.32 |
399.20 |
259.72 |
139.48 |
3.02 |
826.19 |
864.93 |
562.73 |
302.20 |
6.54 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
869.18 |
909.93 |
611.42 |
298.51 |
3.46 |
1883.22 |
1971.52 |
1324.74 |
646.78 |
7.51 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
860.75 |
901.11 |
560.52 |
340.59 |
4.47 |
1864.96 |
1952.41 |
1214.46 |
737.95 |
9.69 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
384.80 |
415.92 |
259.72 |
156.20 |
16.26 |
833.73 |
901.16 |
562.73 |
338.43 |
35.23 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
883.13 |
954.51 |
611.42 |
343.09 |
34.09 |
1913.45 |
2068.11 |
1324.74 |
743.37 |
73.87 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
865.82 |
935.81 |
560.52 |
375.29 |
34.10 |
1875.94 |
2027.59 |
1214.46 |
813.13 |
73.89 |
Idaho Aetna HealthFund HDHP - HDHP Self |
224 |
380.45 |
384.30 |
259.72 |
124.58 |
-11.01 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Idaho Aetna HealthFund HDHP - HDHP Self & Family |
225 |
839.19 |
847.69 |
611.42 |
236.27 |
-28.79 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Idaho Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
822.75 |
831.10 |
560.52 |
270.58 |
-27.54 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Idaho Altius Health Plan - High Self |
9K1 |
531.16 |
560.64 |
259.72 |
300.92 |
14.62 |
1150.85 |
1214.72 |
562.73 |
651.99 |
31.67 |
Idaho Altius Health Plan - High Self & Family |
9K2 |
1174.66 |
1239.87 |
611.42 |
628.45 |
27.92 |
2545.10 |
2686.39 |
1324.74 |
1361.65 |
60.50 |
Idaho Altius Health Plan - High Self Plus One |
9K3 |
1163.04 |
1227.61 |
560.52 |
667.09 |
28.68 |
2519.92 |
2659.82 |
1214.46 |
1445.36 |
62.14 |
Idaho Altius Health Plan - HDHP Self |
9K4 |
350.41 |
366.87 |
259.72 |
107.15 |
1.60 |
759.22 |
794.89 |
562.73 |
232.16 |
3.47 |
Idaho Altius Health Plan - HDHP Self & Family |
9K5 |
732.33 |
766.73 |
575.05 |
191.68 |
8.60 |
1586.72 |
1661.25 |
1245.94 |
415.31 |
18.63 |
Idaho Altius Health Plan - HDHP Self Plus One |
9K6 |
717.95 |
751.67 |
560.52 |
191.15 |
-2.17 |
1555.56 |
1628.62 |
1214.46 |
414.16 |
-4.70 |
Idaho Altius Health Plan - Standard Self |
DK4 |
435.02 |
458.47 |
259.72 |
198.75 |
8.59 |
942.54 |
993.35 |
562.73 |
430.62 |
18.61 |
Idaho Altius Health Plan - Standard Self & Family |
DK5 |
960.66 |
1012.47 |
611.42 |
401.05 |
14.52 |
2081.43 |
2193.69 |
1324.74 |
868.95 |
31.47 |
Idaho Altius Health Plan - Standard Self Plus One |
DK6 |
951.14 |
1002.44 |
560.52 |
441.92 |
15.41 |
2060.80 |
2171.95 |
1214.46 |
957.49 |
33.39 |
Idaho Kaiser Permanente - Washington Core - Standard Self |
544 |
288.56 |
295.78 |
221.84 |
73.94 |
1.80 |
625.21 |
640.86 |
480.65 |
160.21 |
3.91 |
Idaho Kaiser Permanente - Washington Core - Standard Self & Family |
545 |
663.69 |
680.28 |
510.21 |
170.07 |
4.15 |
1438.00 |
1473.94 |
1105.46 |
368.48 |
8.98 |
Idaho Kaiser Permanente - Washington Core - Standard Self Plus One |
546 |
663.69 |
680.28 |
510.21 |
170.07 |
4.15 |
1438.00 |
1473.94 |
1105.46 |
368.48 |
8.98 |
Idaho Kaiser Permanente - Washington Core - High Self |
541 |
401.32 |
416.67 |
259.72 |
156.95 |
0.49 |
869.53 |
902.79 |
562.73 |
340.06 |
1.06 |
Idaho Kaiser Permanente - Washington Core - High Self & Family |
542 |
882.89 |
916.67 |
611.42 |
305.25 |
-3.51 |
1912.93 |
1986.12 |
1324.74 |
661.38 |
-7.60 |
Idaho Kaiser Permanente - Washington Core - High Self Plus One |
543 |
882.89 |
916.67 |
560.52 |
356.15 |
-2.11 |
1912.93 |
1986.12 |
1214.46 |
771.66 |
-4.57 |
Idaho Kaiser Permanente - Washington Core - Prosper Self |
PT4 |
180.00 |
180.00 |
135.00 |
45.00 |
0.00 |
390.00 |
390.00 |
292.50 |
97.50 |
0.00 |
Idaho Kaiser Permanente - Washington Core - Prosper Self & Family |
PT5 |
503.99 |
503.99 |
377.99 |
126.00 |
0.00 |
1091.98 |
1091.98 |
818.99 |
272.99 |
0.00 |
Idaho Kaiser Permanente - Washington Core - Prosper Self Plus One |
PT6 |
436.00 |
436.00 |
327.00 |
109.00 |
0.00 |
944.67 |
944.67 |
708.50 |
236.17 |
0.00 |
Illinois Aetna Advantage - Advantage Self |
Z24 |
230.78 |
230.78 |
173.09 |
57.69 |
0.00 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Illinois Aetna Advantage - Advantage Self & Family |
Z25 |
611.54 |
611.54 |
458.66 |
152.88 |
0.00 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Illinois Aetna Advantage - Advantage Self Plus One |
Z26 |
507.70 |
507.70 |
380.78 |
126.92 |
0.00 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Illinois Aetna Direct - CDHP Self |
N61 |
289.97 |
296.04 |
222.03 |
74.01 |
1.52 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Illinois Aetna Direct - CDHP Self & Family |
N62 |
731.30 |
746.57 |
559.93 |
186.64 |
3.82 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Illinois Aetna Direct - CDHP Self Plus One |
N63 |
635.94 |
649.23 |
486.92 |
162.31 |
3.33 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
381.32 |
399.20 |
259.72 |
139.48 |
3.02 |
826.19 |
864.93 |
562.73 |
302.20 |
6.54 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
869.18 |
909.93 |
611.42 |
298.51 |
3.46 |
1883.22 |
1971.52 |
1324.74 |
646.78 |
7.51 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
860.75 |
901.11 |
560.52 |
340.59 |
4.47 |
1864.96 |
1952.41 |
1214.46 |
737.95 |
9.69 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
384.80 |
415.92 |
259.72 |
156.20 |
16.26 |
833.73 |
901.16 |
562.73 |
338.43 |
35.23 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
883.13 |
954.51 |
611.42 |
343.09 |
34.09 |
1913.45 |
2068.11 |
1324.74 |
743.37 |
73.87 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
865.82 |
935.81 |
560.52 |
375.29 |
34.10 |
1875.94 |
2027.59 |
1214.46 |
813.13 |
73.89 |
Illinois Aetna HealthFund HDHP - HDHP Self |
224 |
380.45 |
384.30 |
259.72 |
124.58 |
-11.01 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Illinois Aetna HealthFund HDHP - HDHP Self & Family |
225 |
839.19 |
847.69 |
611.42 |
236.27 |
-28.79 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Illinois Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
822.75 |
831.10 |
560.52 |
270.58 |
-27.54 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Illinois Health Alliance HMO - Standard Self |
K84 |
324.96 |
363.96 |
259.72 |
104.24 |
23.00 |
704.08 |
788.58 |
562.73 |
225.85 |
49.83 |
Illinois Health Alliance HMO - Standard Self & Family |
K85 |
753.18 |
853.37 |
611.42 |
241.95 |
53.66 |
1631.89 |
1848.97 |
1324.74 |
524.23 |
116.26 |
Illinois Health Alliance HMO - Standard Self Plus One |
K86 |
694.82 |
779.79 |
560.52 |
219.27 |
45.57 |
1505.44 |
1689.55 |
1214.46 |
475.09 |
98.73 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self |
GB4 |
382.11 |
385.92 |
259.72 |
126.20 |
-11.05 |
827.91 |
836.16 |
562.73 |
273.43 |
-23.95 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self & Family |
GB5 |
859.71 |
868.30 |
611.42 |
256.88 |
-28.70 |
1862.71 |
1881.32 |
1324.74 |
556.58 |
-62.18 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
GB6 |
821.50 |
829.69 |
560.52 |
269.17 |
-27.70 |
1779.92 |
1797.66 |
1214.46 |
583.20 |
-60.02 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self |
GB1 |
609.15 |
615.24 |
259.72 |
355.52 |
-8.77 |
1319.83 |
1333.02 |
562.73 |
770.29 |
-19.01 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
GB2 |
1370.56 |
1384.26 |
611.42 |
772.84 |
-23.59 |
2969.55 |
2999.23 |
1324.74 |
1674.49 |
-51.11 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
GB3 |
1309.67 |
1322.77 |
560.52 |
762.25 |
-22.79 |
2837.62 |
2866.00 |
1214.46 |
1651.54 |
-49.38 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self |
MW4 |
369.09 |
376.47 |
259.72 |
116.75 |
-7.48 |
799.70 |
815.69 |
562.73 |
252.96 |
-16.21 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self & Family |
MW5 |
830.43 |
847.05 |
611.42 |
235.63 |
-20.67 |
1799.27 |
1835.28 |
1324.74 |
510.54 |
-44.78 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
MW6 |
793.53 |
809.42 |
560.52 |
248.90 |
-20.00 |
1719.32 |
1753.74 |
1214.46 |
539.28 |
-43.34 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self |
MW1 |
487.73 |
506.54 |
259.72 |
246.82 |
3.95 |
1056.75 |
1097.50 |
562.73 |
534.77 |
8.55 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
MW2 |
1097.45 |
1139.79 |
611.42 |
528.37 |
5.05 |
2377.81 |
2469.55 |
1324.74 |
1144.81 |
10.95 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
MW3 |
1048.65 |
1089.11 |
560.52 |
528.59 |
4.57 |
2272.08 |
2359.74 |
1214.46 |
1145.28 |
9.90 |
Illinois Humana HDHP - HDHP Self |
BB1 |
205.52 |
211.69 |
158.77 |
52.92 |
1.54 |
445.29 |
458.66 |
344.00 |
114.66 |
3.34 |
Illinois Humana HDHP - HDHP Self & Family |
BB2 |
512.00 |
527.36 |
395.52 |
131.84 |
3.84 |
1109.33 |
1142.61 |
856.96 |
285.65 |
8.32 |
Illinois Humana HDHP - HDHP Self Plus One |
BB3 |
450.70 |
464.22 |
348.17 |
116.05 |
3.38 |
976.52 |
1005.81 |
754.36 |
251.45 |
7.32 |
Illinois Humana HDHP - HDHP Self |
AW1 |
194.17 |
199.99 |
149.99 |
50.00 |
1.46 |
420.70 |
433.31 |
324.98 |
108.33 |
3.16 |
Illinois Humana HDHP - HDHP Self & Family |
AW2 |
483.61 |
498.12 |
373.59 |
124.53 |
3.63 |
1047.82 |
1079.26 |
809.45 |
269.81 |
7.86 |
Illinois Humana HDHP - HDHP Self Plus One |
AW3 |
425.72 |
438.50 |
328.88 |
109.62 |
3.19 |
922.39 |
950.08 |
712.56 |
237.52 |
6.92 |
Illinois Humana Health Plan, Inc. - Standard Self |
754 |
487.29 |
535.58 |
259.72 |
275.86 |
33.43 |
1055.80 |
1160.42 |
562.73 |
597.69 |
72.42 |
Illinois Humana Health Plan, Inc. - Standard Self & Family |
755 |
1096.41 |
1205.07 |
611.42 |
593.65 |
71.37 |
2375.56 |
2610.99 |
1324.74 |
1286.25 |
154.64 |
Illinois Humana Health Plan, Inc. - Standard Self Plus One |
756 |
1047.69 |
1151.51 |
560.52 |
590.99 |
67.93 |
2270.00 |
2494.94 |
1214.46 |
1280.48 |
147.18 |
Illinois Humana Health Plan, Inc. - High Self |
751 |
647.65 |
667.08 |
259.72 |
407.36 |
4.57 |
1403.24 |
1445.34 |
562.73 |
882.61 |
9.90 |
Illinois Humana Health Plan, Inc. - High Self & Family |
752 |
1457.21 |
1500.92 |
611.42 |
889.50 |
6.42 |
3157.29 |
3251.99 |
1324.74 |
1927.25 |
13.91 |
Illinois Humana Health Plan, Inc. - High Self Plus One |
753 |
1392.45 |
1434.21 |
560.52 |
873.69 |
5.87 |
3016.98 |
3107.46 |
1214.46 |
1893.00 |
12.72 |
Illinois Humana Health Plan, Inc. - High Self |
9F1 |
976.91 |
1242.34 |
259.72 |
982.62 |
250.57 |
2116.64 |
2691.74 |
562.73 |
2129.01 |
542.90 |
Illinois Humana Health Plan, Inc. - High Self & Family |
9F2 |
2198.05 |
2795.26 |
611.42 |
2183.84 |
559.92 |
4762.44 |
6056.40 |
1324.74 |
4731.66 |
1213.17 |
Illinois Humana Health Plan, Inc. - High Self Plus One |
9F3 |
2100.34 |
2671.00 |
560.52 |
2110.48 |
534.77 |
4550.74 |
5787.17 |
1214.46 |
4572.71 |
1158.67 |
Illinois Humana Health Plan, Inc. - Standard Self |
AB4 |
668.06 |
699.12 |
259.72 |
439.40 |
16.20 |
1447.46 |
1514.76 |
562.73 |
952.03 |
35.10 |
Illinois Humana Health Plan, Inc. - Standard Self & Family |
AB5 |
1503.16 |
1573.05 |
611.42 |
961.63 |
32.60 |
3256.85 |
3408.28 |
1324.74 |
2083.54 |
70.64 |
Illinois Humana Health Plan, Inc. - Standard Self Plus One |
AB6 |
1436.36 |
1503.14 |
560.52 |
942.62 |
30.89 |
3112.11 |
3256.80 |
1214.46 |
2042.34 |
66.93 |
Illinois Humana Health Plan, Inc. - Basic Self |
AB1 |
390.43 |
437.77 |
259.72 |
178.05 |
32.48 |
845.93 |
948.50 |
562.73 |
385.77 |
70.37 |
Illinois Humana Health Plan, Inc. - Basic Self & Family |
AB2 |
878.49 |
985.00 |
611.42 |
373.58 |
69.22 |
1903.40 |
2134.17 |
1324.74 |
809.43 |
149.98 |
Illinois Humana Health Plan, Inc. - Basic Self Plus One |
AB3 |
839.45 |
941.23 |
560.52 |
380.71 |
65.89 |
1818.81 |
2039.33 |
1214.46 |
824.87 |
142.76 |
Illinois Humana Health Plan, Inc. - Basic Self |
RW1 |
387.46 |
431.44 |
259.72 |
171.72 |
29.12 |
839.50 |
934.79 |
562.73 |
372.06 |
63.09 |
Illinois Humana Health Plan, Inc. - Basic Self & Family |
RW2 |
871.79 |
970.74 |
611.42 |
359.32 |
61.66 |
1888.88 |
2103.27 |
1324.74 |
778.53 |
133.60 |
Illinois Humana Health Plan, Inc. - Basic Self Plus One |
RW3 |
833.04 |
927.59 |
560.52 |
367.07 |
58.66 |
1804.92 |
2009.78 |
1214.46 |
795.32 |
127.10 |
Illinois UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
300.42 |
328.52 |
246.39 |
82.13 |
7.03 |
650.91 |
711.79 |
533.84 |
177.95 |
15.22 |
Illinois UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
710.52 |
776.94 |
582.71 |
194.23 |
16.60 |
1539.46 |
1683.37 |
1262.53 |
420.84 |
35.98 |
Illinois UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
645.92 |
706.31 |
529.73 |
176.58 |
15.10 |
1399.49 |
1530.34 |
1147.76 |
382.58 |
32.71 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
L91 |
306.35 |
321.69 |
241.27 |
80.42 |
3.83 |
663.76 |
697.00 |
522.75 |
174.25 |
8.31 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
L92 |
732.19 |
772.06 |
579.05 |
193.01 |
9.96 |
1586.41 |
1672.80 |
1254.60 |
418.20 |
21.60 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self Plus One |
L93 |
612.71 |
683.61 |
512.71 |
170.90 |
17.72 |
1327.54 |
1481.16 |
1110.87 |
370.29 |
38.41 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
268.27 |
311.73 |
233.80 |
77.93 |
10.86 |
581.25 |
675.42 |
506.57 |
168.85 |
23.54 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
634.47 |
737.24 |
552.93 |
184.31 |
25.69 |
1374.69 |
1597.35 |
1198.01 |
399.34 |
55.67 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
576.79 |
670.22 |
502.67 |
167.55 |
23.35 |
1249.71 |
1452.14 |
1089.11 |
363.03 |
50.60 |
Indiana Aetna Advantage - Advantage Self |
Z24 |
230.78 |
230.78 |
173.09 |
57.69 |
0.00 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Indiana Aetna Advantage - Advantage Self & Family |
Z25 |
611.54 |
611.54 |
458.66 |
152.88 |
0.00 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Indiana Aetna Advantage - Advantage Self Plus One |
Z26 |
507.70 |
507.70 |
380.78 |
126.92 |
0.00 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Indiana Aetna Direct - CDHP Self |
N61 |
289.97 |
296.04 |
222.03 |
74.01 |
1.52 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Indiana Aetna Direct - CDHP Self & Family |
N62 |
731.30 |
746.57 |
559.93 |
186.64 |
3.82 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Indiana Aetna Direct - CDHP Self Plus One |
N63 |
635.94 |
649.23 |
486.92 |
162.31 |
3.33 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
JS4 |
505.16 |
510.91 |
259.72 |
251.19 |
-9.11 |
1094.51 |
1106.97 |
562.73 |
544.24 |
-19.74 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
JS5 |
1153.22 |
1166.33 |
611.42 |
554.91 |
-24.18 |
2498.64 |
2527.05 |
1324.74 |
1202.31 |
-52.38 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
JS6 |
1141.82 |
1154.80 |
560.52 |
594.28 |
-22.91 |
2473.94 |
2502.07 |
1214.46 |
1287.61 |
-49.63 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
JS1 |
478.77 |
538.34 |
259.72 |
278.62 |
44.71 |
1037.34 |
1166.40 |
562.73 |
603.67 |
96.86 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
JS2 |
1091.38 |
1227.18 |
611.42 |
615.76 |
98.51 |
2364.66 |
2658.89 |
1324.74 |
1334.15 |
213.44 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
JS3 |
1080.57 |
1215.02 |
560.52 |
654.50 |
98.56 |
2341.24 |
2632.54 |
1214.46 |
1418.08 |
213.54 |
Indiana Aetna HealthFund HDHP - HDHP Self |
224 |
380.45 |
384.30 |
259.72 |
124.58 |
-11.01 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Indiana Aetna HealthFund HDHP - HDHP Self & Family |
225 |
839.19 |
847.69 |
611.42 |
236.27 |
-28.79 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Indiana Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
822.75 |
831.10 |
560.52 |
270.58 |
-27.54 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Indiana Health Alliance HMO - Standard Self |
K84 |
324.96 |
363.96 |
259.72 |
104.24 |
23.00 |
704.08 |
788.58 |
562.73 |
225.85 |
49.83 |
Indiana Health Alliance HMO - Standard Self & Family |
K85 |
753.18 |
853.37 |
611.42 |
241.95 |
53.66 |
1631.89 |
1848.97 |
1324.74 |
524.23 |
116.26 |
Indiana Health Alliance HMO - Standard Self Plus One |
K86 |
694.82 |
779.79 |
560.52 |
219.27 |
45.57 |
1505.44 |
1689.55 |
1214.46 |
475.09 |
98.73 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self |
MW4 |
369.09 |
376.47 |
259.72 |
116.75 |
-7.48 |
799.70 |
815.69 |
562.73 |
252.96 |
-16.21 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self & Family |
MW5 |
830.43 |
847.05 |
611.42 |
235.63 |
-20.67 |
1799.27 |
1835.28 |
1324.74 |
510.54 |
-44.78 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
MW6 |
793.53 |
809.42 |
560.52 |
248.90 |
-20.00 |
1719.32 |
1753.74 |
1214.46 |
539.28 |
-43.34 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self |
MW1 |
487.73 |
506.54 |
259.72 |
246.82 |
3.95 |
1056.75 |
1097.50 |
562.73 |
534.77 |
8.55 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
MW2 |
1097.45 |
1139.79 |
611.42 |
528.37 |
5.05 |
2377.81 |
2469.55 |
1324.74 |
1144.81 |
10.95 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
MW3 |
1048.65 |
1089.11 |
560.52 |
528.59 |
4.57 |
2272.08 |
2359.74 |
1214.46 |
1145.28 |
9.90 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self |
TC1 |
349.41 |
372.12 |
259.72 |
112.40 |
7.85 |
757.06 |
806.26 |
562.73 |
243.53 |
17.00 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
TC2 |
786.15 |
837.24 |
611.42 |
225.82 |
13.80 |
1703.33 |
1814.02 |
1324.74 |
489.28 |
29.90 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
TC3 |
751.22 |
800.05 |
560.52 |
239.53 |
12.94 |
1627.64 |
1733.44 |
1214.46 |
518.98 |
28.04 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self |
TC4 |
267.57 |
288.97 |
216.73 |
72.24 |
5.35 |
579.74 |
626.10 |
469.58 |
156.52 |
11.59 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self & Family |
TC5 |
602.04 |
650.20 |
487.65 |
162.55 |
12.04 |
1304.42 |
1408.77 |
1056.58 |
352.19 |
26.09 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
TC6 |
575.28 |
621.30 |
465.98 |
155.32 |
11.50 |
1246.44 |
1346.15 |
1009.61 |
336.54 |
24.93 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self |
X34 |
320.46 |
338.08 |
253.56 |
84.52 |
4.41 |
694.33 |
732.51 |
549.38 |
183.13 |
9.55 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self & Family |
X35 |
721.03 |
760.69 |
570.52 |
190.17 |
9.91 |
1562.23 |
1648.16 |
1236.12 |
412.04 |
21.48 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
X36 |
688.99 |
726.89 |
545.17 |
181.72 |
9.47 |
1492.81 |
1574.93 |
1181.20 |
393.73 |
20.53 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self |
X31 |
416.48 |
439.39 |
259.72 |
179.67 |
8.05 |
902.37 |
952.01 |
562.73 |
389.28 |
17.44 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
X32 |
937.08 |
988.62 |
611.42 |
377.20 |
14.25 |
2030.34 |
2142.01 |
1324.74 |
817.27 |
30.88 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
X33 |
895.44 |
944.69 |
560.52 |
384.17 |
13.36 |
1940.12 |
2046.83 |
1214.46 |
832.37 |
28.95 |
Indiana Humana HDHP - HDHP Self |
BB1 |
205.52 |
211.69 |
158.77 |
52.92 |
1.54 |
445.29 |
458.66 |
344.00 |
114.66 |
3.34 |
Indiana Humana HDHP - HDHP Self & Family |
BB2 |
512.00 |
527.36 |
395.52 |
131.84 |
3.84 |
1109.33 |
1142.61 |
856.96 |
285.65 |
8.32 |
Indiana Humana HDHP - HDHP Self Plus One |
BB3 |
450.70 |
464.22 |
348.17 |
116.05 |
3.38 |
976.52 |
1005.81 |
754.36 |
251.45 |
7.32 |
Indiana Humana HDHP - HDHP Self |
DT1 |
228.80 |
235.66 |
176.75 |
58.91 |
1.71 |
495.73 |
510.60 |
382.95 |
127.65 |
3.72 |
Indiana Humana HDHP - HDHP Self & Family |
DT2 |
570.19 |
587.30 |
440.48 |
146.82 |
4.27 |
1235.41 |
1272.48 |
954.36 |
318.12 |
9.27 |
Indiana Humana HDHP - HDHP Self Plus One |
DT3 |
501.91 |
516.97 |
387.73 |
129.24 |
3.76 |
1087.47 |
1120.10 |
840.08 |
280.02 |
8.15 |
Indiana Humana HDHP - HDHP Self |
FZ1 |
New Plan |
190.93 |
143.20 |
47.73 |
New Plan |
New Plan |
413.68 |
310.26 |
103.42 |
New Plan |
Indiana Humana HDHP - HDHP Self & Family |
FZ2 |
New Plan |
475.46 |
356.60 |
118.86 |
New Plan |
New Plan |
1030.16 |
772.62 |
257.54 |
New Plan |
Indiana Humana HDHP - HDHP Self Plus One |
FZ3 |
New Plan |
418.55 |
313.91 |
104.64 |
New Plan |
New Plan |
906.86 |
680.15 |
226.71 |
New Plan |
Indiana Humana Health Plan of Ohio, Inc. - Standard Self |
A64 |
573.73 |
602.06 |
259.72 |
342.34 |
13.47 |
1243.08 |
1304.46 |
562.73 |
741.73 |
29.18 |
Indiana Humana Health Plan of Ohio, Inc. - Standard Self & Family |
A65 |
1290.90 |
1354.64 |
611.42 |
743.22 |
26.45 |
2796.95 |
2935.05 |
1324.74 |
1610.31 |
57.31 |
Indiana Humana Health Plan of Ohio, Inc. - Standard Self Plus One |
A66 |
1233.52 |
1294.44 |
560.52 |
733.92 |
25.03 |
2672.63 |
2804.62 |
1214.46 |
1590.16 |
54.23 |
Indiana Humana Health Plan, Inc. - Standard Self |
754 |
487.29 |
535.58 |
259.72 |
275.86 |
33.43 |
1055.80 |
1160.42 |
562.73 |
597.69 |
72.42 |
Indiana Humana Health Plan, Inc. - Standard Self & Family |
755 |
1096.41 |
1205.07 |
611.42 |
593.65 |
71.37 |
2375.56 |
2610.99 |
1324.74 |
1286.25 |
154.64 |
Indiana Humana Health Plan, Inc. - Standard Self Plus One |
756 |
1047.69 |
1151.51 |
560.52 |
590.99 |
67.93 |
2270.00 |
2494.94 |
1214.46 |
1280.48 |
147.18 |
Indiana Humana Health Plan, Inc. - High Self |
751 |
647.65 |
667.08 |
259.72 |
407.36 |
4.57 |
1403.24 |
1445.34 |
562.73 |
882.61 |
9.90 |
Indiana Humana Health Plan, Inc. - High Self & Family |
752 |
1457.21 |
1500.92 |
611.42 |
889.50 |
6.42 |
3157.29 |
3251.99 |
1324.74 |
1927.25 |
13.91 |
Indiana Humana Health Plan, Inc. - High Self Plus One |
753 |
1392.45 |
1434.21 |
560.52 |
873.69 |
5.87 |
3016.98 |
3107.46 |
1214.46 |
1893.00 |
12.72 |
Indiana Humana Health Plan, Inc. - Standard Self |
MH4 |
458.26 |
507.10 |
259.72 |
247.38 |
33.98 |
992.90 |
1098.72 |
562.73 |
535.99 |
73.62 |
Indiana Humana Health Plan, Inc. - Standard Self & Family |
MH5 |
1031.06 |
1140.97 |
611.42 |
529.55 |
72.62 |
2233.96 |
2472.10 |
1324.74 |
1147.36 |
157.35 |
Indiana Humana Health Plan, Inc. - Standard Self Plus One |
MH6 |
985.23 |
1090.25 |
560.52 |
529.73 |
69.13 |
2134.67 |
2362.21 |
1214.46 |
1147.75 |
149.78 |
Indiana Indiana University Health Plans Select - High Self |
FS1 |
New Plan |
279.80 |
209.85 |
69.95 |
New Plan |
New Plan |
606.23 |
454.67 |
151.56 |
New Plan |
Indiana Indiana University Health Plans Select - High Self & Family |
FS2 |
New Plan |
783.44 |
587.58 |
195.86 |
New Plan |
New Plan |
1697.45 |
1273.09 |
424.36 |
New Plan |
Indiana Indiana University Health Plans Select - High Self Plus One |
FS3 |
New Plan |
615.57 |
461.68 |
153.89 |
New Plan |
New Plan |
1333.74 |
1000.31 |
333.43 |
New Plan |
Iowa Aetna Advantage - Advantage Self |
Z24 |
230.78 |
230.78 |
173.09 |
57.69 |
0.00 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Iowa Aetna Advantage - Advantage Self & Family |
Z25 |
611.54 |
611.54 |
458.66 |
152.88 |
0.00 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Iowa Aetna Advantage - Advantage Self Plus One |
Z26 |
507.70 |
507.70 |
380.78 |
126.92 |
0.00 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Iowa Aetna Direct - CDHP Self |
N61 |
289.97 |
296.04 |
222.03 |
74.01 |
1.52 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Iowa Aetna Direct - CDHP Self & Family |
N62 |
731.30 |
746.57 |
559.93 |
186.64 |
3.82 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Iowa Aetna Direct - CDHP Self Plus One |
N63 |
635.94 |
649.23 |
486.92 |
162.31 |
3.33 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
381.32 |
399.20 |
259.72 |
139.48 |
3.02 |
826.19 |
864.93 |
562.73 |
302.20 |
6.54 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
869.18 |
909.93 |
611.42 |
298.51 |
3.46 |
1883.22 |
1971.52 |
1324.74 |
646.78 |
7.51 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
860.75 |
901.11 |
560.52 |
340.59 |
4.47 |
1864.96 |
1952.41 |
1214.46 |
737.95 |
9.69 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
384.80 |
415.92 |
259.72 |
156.20 |
16.26 |
833.73 |
901.16 |
562.73 |
338.43 |
35.23 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
883.13 |
954.51 |
611.42 |
343.09 |
34.09 |
1913.45 |
2068.11 |
1324.74 |
743.37 |
73.87 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
865.82 |
935.81 |
560.52 |
375.29 |
34.10 |
1875.94 |
2027.59 |
1214.46 |
813.13 |
73.89 |
Iowa Aetna HealthFund HDHP - HDHP Self |
224 |
380.45 |
384.30 |
259.72 |
124.58 |
-11.01 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Iowa Aetna HealthFund HDHP - HDHP Self & Family |
225 |
839.19 |
847.69 |
611.42 |
236.27 |
-28.79 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Iowa Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
822.75 |
831.10 |
560.52 |
270.58 |
-27.54 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Iowa Health Alliance HMO - Standard Self |
K84 |
324.96 |
363.96 |
259.72 |
104.24 |
23.00 |
704.08 |
788.58 |
562.73 |
225.85 |
49.83 |
Iowa Health Alliance HMO - Standard Self & Family |
K85 |
753.18 |
853.37 |
611.42 |
241.95 |
53.66 |
1631.89 |
1848.97 |
1324.74 |
524.23 |
116.26 |
Iowa Health Alliance HMO - Standard Self Plus One |
K86 |
694.82 |
779.79 |
560.52 |
219.27 |
45.57 |
1505.44 |
1689.55 |
1214.46 |
475.09 |
98.73 |
Iowa HealthPartners - Standard Self |
V34 |
255.36 |
255.36 |
191.52 |
63.84 |
0.00 |
553.28 |
553.28 |
414.96 |
138.32 |
0.00 |
Iowa HealthPartners - Standard Self & Family |
V35 |
622.08 |
622.08 |
466.56 |
155.52 |
0.00 |
1347.84 |
1347.84 |
1010.88 |
336.96 |
0.00 |
Iowa HealthPartners - Standard Self Plus One |
V36 |
564.36 |
564.36 |
423.27 |
141.09 |
0.00 |
1222.78 |
1222.78 |
917.09 |
305.69 |
0.00 |
Iowa HealthPartners - High Self |
V31 |
319.45 |
340.23 |
255.17 |
85.06 |
5.20 |
692.14 |
737.17 |
552.88 |
184.29 |
11.26 |
Iowa HealthPartners - High Self & Family |
V32 |
778.16 |
828.80 |
611.42 |
217.38 |
13.35 |
1686.01 |
1795.73 |
1324.74 |
470.99 |
28.93 |
Iowa HealthPartners - High Self Plus One |
V33 |
705.96 |
751.90 |
560.52 |
191.38 |
10.05 |
1529.58 |
1629.12 |
1214.46 |
414.66 |
21.78 |
Iowa UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
300.42 |
328.52 |
246.39 |
82.13 |
7.03 |
650.91 |
711.79 |
533.84 |
177.95 |
15.22 |
Iowa UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
710.52 |
776.94 |
582.71 |
194.23 |
16.60 |
1539.46 |
1683.37 |
1262.53 |
420.84 |
35.98 |
Iowa UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
645.92 |
706.31 |
529.73 |
176.58 |
15.10 |
1399.49 |
1530.34 |
1147.76 |
382.58 |
32.71 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
N71 |
343.64 |
349.77 |
259.72 |
90.05 |
-8.73 |
744.55 |
757.84 |
562.73 |
195.11 |
-18.91 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
N72 |
790.36 |
804.49 |
603.37 |
201.12 |
-15.11 |
1712.45 |
1743.06 |
1307.30 |
435.76 |
-32.74 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
N73 |
738.81 |
752.03 |
560.52 |
191.51 |
-22.67 |
1600.76 |
1629.40 |
1214.46 |
414.94 |
-49.12 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
LJ1 |
403.36 |
450.21 |
259.72 |
190.49 |
31.99 |
873.95 |
975.46 |
562.73 |
412.73 |
69.31 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
LJ2 |
1008.43 |
1125.52 |
611.42 |
514.10 |
79.80 |
2184.93 |
2438.63 |
1324.74 |
1113.89 |
172.91 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
LJ3 |
867.25 |
967.94 |
560.52 |
407.42 |
64.80 |
1879.04 |
2097.20 |
1214.46 |
882.74 |
140.40 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
268.27 |
311.73 |
233.80 |
77.93 |
10.86 |
581.25 |
675.42 |
506.57 |
168.85 |
23.54 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
634.47 |
737.24 |
552.93 |
184.31 |
25.69 |
1374.69 |
1597.35 |
1198.01 |
399.34 |
55.67 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
576.79 |
670.22 |
502.67 |
167.55 |
23.35 |
1249.71 |
1452.14 |
1089.11 |
363.03 |
50.60 |
Kansas Aetna Advantage - Advantage Self |
Z24 |
230.78 |
230.78 |
173.09 |
57.69 |
0.00 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Kansas Aetna Advantage - Advantage Self & Family |
Z25 |
611.54 |
611.54 |
458.66 |
152.88 |
0.00 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Kansas Aetna Advantage - Advantage Self Plus One |
Z26 |
507.70 |
507.70 |
380.78 |
126.92 |
0.00 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Kansas Aetna Direct - CDHP Self |
N61 |
289.97 |
296.04 |
222.03 |
74.01 |
1.52 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Kansas Aetna Direct - CDHP Self & Family |
N62 |
731.30 |
746.57 |
559.93 |
186.64 |
3.82 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Kansas Aetna Direct - CDHP Self Plus One |
N63 |
635.94 |
649.23 |
486.92 |
162.31 |
3.33 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
385.10 |
403.41 |
259.72 |
143.69 |
3.45 |
834.38 |
874.06 |
562.73 |
311.33 |
7.48 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
882.03 |
923.97 |
611.42 |
312.55 |
4.65 |
1911.07 |
2001.94 |
1324.74 |
677.20 |
10.08 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
864.75 |
905.86 |
560.52 |
345.34 |
5.22 |
1873.63 |
1962.70 |
1214.46 |
748.24 |
11.31 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
523.89 |
531.88 |
259.72 |
272.16 |
-6.87 |
1135.10 |
1152.41 |
562.73 |
589.68 |
-14.89 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
1195.02 |
1213.22 |
611.42 |
601.80 |
-19.09 |
2589.21 |
2628.64 |
1324.74 |
1303.90 |
-41.36 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
1183.20 |
1201.22 |
560.52 |
640.70 |
-17.87 |
2563.60 |
2602.64 |
1214.46 |
1388.18 |
-38.72 |
Kansas Aetna HealthFund HDHP - HDHP Self |
224 |
380.45 |
384.30 |
259.72 |
124.58 |
-11.01 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Kansas Aetna HealthFund HDHP - HDHP Self & Family |
|