Click here to skip navigation
This website uses features which update page content based on user actions. If you are using assistive technology to view web content, please ensure your settings allow for the page content to update after initial load (this is sometimes called "forms mode").
Additionally, if you are using assistive technology and would like to be notified of items via alert boxes, please
follow this link to enable alert boxes for your profile.
This website uses features which update page content based on user actions. If you are using assistive technology to view web content, please ensure your settings allow for the page content to update after initial load (this is sometimes called "forms mode").
Alert box notification is currently enabled, please
follow this link to disable alert boxes for your profile.
Tribal Premium Rates for the Federal Employees Health Benefits Program
HMO (Regional Plans with Specific Service Areas)
Alabama Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Alabama Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Alabama Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Alabama Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Alabama Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Alabama Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
870.65 |
978.21 |
562.73 |
415.48 |
75.36 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
1985.10 |
2230.43 |
1324.74 |
905.69 |
164.54 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
1965.45 |
2208.33 |
1214.46 |
993.87 |
165.12 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
895.53 |
1008.28 |
562.73 |
445.55 |
80.55 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
2050.64 |
2308.89 |
1324.74 |
984.15 |
177.46 |
Alabama Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
2010.45 |
2263.58 |
1214.46 |
1049.12 |
175.37 |
Alabama Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Alabama Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Alabama Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Alabama UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
650.91 |
711.79 |
533.84 |
177.95 |
15.22 |
Alabama UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
1539.46 |
1683.37 |
1262.53 |
420.84 |
35.98 |
Alabama UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
1399.49 |
1530.34 |
1147.76 |
382.58 |
32.71 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LS1 |
624.67 |
658.84 |
494.13 |
164.71 |
8.54 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LS2 |
1436.76 |
1507.18 |
1130.39 |
376.79 |
17.60 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LS3 |
1343.07 |
1416.52 |
1062.39 |
354.13 |
18.36 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KK1 |
847.30 |
940.98 |
562.73 |
378.25 |
61.48 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KK2 |
2118.24 |
2352.52 |
1324.74 |
1027.78 |
153.49 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KK3 |
1821.69 |
2023.17 |
1214.46 |
808.71 |
123.72 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
581.25 |
675.42 |
506.57 |
168.85 |
23.54 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
1374.69 |
1597.35 |
1198.01 |
399.34 |
55.67 |
Alabama UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
1249.71 |
1452.14 |
1089.11 |
363.03 |
50.60 |
Alaska Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Alaska Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Alaska Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Alaska Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Alaska Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Alaska Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
JS4 |
1094.51 |
1106.97 |
562.73 |
544.24 |
-19.74 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
JS5 |
2498.64 |
2527.05 |
1324.74 |
1202.31 |
-52.38 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
JS6 |
2473.94 |
2502.07 |
1214.46 |
1287.61 |
-49.63 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
JS1 |
1037.34 |
1166.40 |
562.73 |
603.67 |
96.86 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
JS2 |
2364.66 |
2658.89 |
1324.74 |
1334.15 |
213.44 |
Alaska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
JS3 |
2341.24 |
2632.54 |
1214.46 |
1418.08 |
213.54 |
Alaska Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Alaska Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Alaska Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Arizona Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Arizona Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Arizona Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Arizona Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Arizona Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Arizona Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
834.38 |
874.06 |
562.73 |
311.33 |
7.48 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
1911.07 |
2001.94 |
1324.74 |
677.20 |
10.08 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
1873.63 |
1962.70 |
1214.46 |
748.24 |
11.31 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
1135.10 |
1152.41 |
562.73 |
589.68 |
-14.89 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
2589.21 |
2628.64 |
1324.74 |
1303.90 |
-41.36 |
Arizona Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
2563.60 |
2602.64 |
1214.46 |
1388.18 |
-38.72 |
Arizona Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Arizona Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Arizona Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Arizona Aetna Open Access - High Self |
WQ1 |
1438.67 |
1445.82 |
562.73 |
883.09 |
-25.05 |
Arizona Aetna Open Access - High Self & Family |
WQ2 |
3493.06 |
3510.39 |
1324.74 |
2185.65 |
-63.46 |
Arizona Aetna Open Access - High Self Plus One |
WQ3 |
3458.43 |
3475.64 |
1214.46 |
2261.18 |
-60.55 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self |
R61 |
873.15 |
894.38 |
562.73 |
331.65 |
-10.97 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
R62 |
1964.56 |
2012.31 |
1324.74 |
687.57 |
-33.04 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
R63 |
1877.24 |
1922.87 |
1214.46 |
708.41 |
-32.13 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self |
R64 |
665.45 |
684.88 |
513.66 |
171.22 |
4.86 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self & Family |
R65 |
1497.23 |
1540.89 |
1155.67 |
385.22 |
10.91 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
R66 |
1430.72 |
1472.47 |
1104.35 |
368.12 |
10.44 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self |
R94 |
585.22 |
608.62 |
456.47 |
152.15 |
5.85 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self & Family |
R95 |
1316.73 |
1369.40 |
1027.05 |
342.35 |
13.17 |
Arizona Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
R96 |
1258.25 |
1308.58 |
981.44 |
327.14 |
12.58 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self |
R91 |
763.71 |
801.88 |
562.73 |
239.15 |
5.97 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
R92 |
1718.28 |
1804.21 |
1324.74 |
479.47 |
5.14 |
Arizona Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
R93 |
1641.90 |
1723.97 |
1214.46 |
509.51 |
4.31 |
Arizona Humana HDHP - HDHP Self |
BV1 |
453.16 |
466.77 |
350.08 |
116.69 |
3.40 |
Arizona Humana HDHP - HDHP Self & Family |
BV2 |
1129.01 |
1162.87 |
872.15 |
290.72 |
8.47 |
Arizona Humana HDHP - HDHP Self Plus One |
BV3 |
993.85 |
1023.66 |
767.75 |
255.91 |
7.45 |
Arizona Humana HDHP - HDHP Self |
BY1 |
397.78 |
409.72 |
307.29 |
102.43 |
2.99 |
Arizona Humana HDHP - HDHP Self & Family |
BY2 |
990.51 |
1020.24 |
765.18 |
255.06 |
7.43 |
Arizona Humana HDHP - HDHP Self Plus One |
BY3 |
871.98 |
898.13 |
673.60 |
224.53 |
6.54 |
Arizona Humana Health Plan, Inc. - Standard Self |
C74 |
916.20 |
996.58 |
562.73 |
433.85 |
48.18 |
Arizona Humana Health Plan, Inc. - Standard Self & Family |
C75 |
2061.45 |
2242.28 |
1324.74 |
917.54 |
100.04 |
Arizona Humana Health Plan, Inc. - Standard Self Plus One |
C76 |
1969.83 |
2142.60 |
1214.46 |
928.14 |
95.01 |
Arizona Humana Health Plan, Inc. - Standard Self |
BF4 |
1246.59 |
1283.99 |
562.73 |
721.26 |
5.20 |
Arizona Humana Health Plan, Inc. - Standard Self & Family |
BF5 |
2804.86 |
2888.99 |
1324.74 |
1564.25 |
3.34 |
Arizona Humana Health Plan, Inc. - Standard Self Plus One |
BF6 |
2680.21 |
2760.64 |
1214.46 |
1546.18 |
2.67 |
Arizona UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
WF1 |
668.46 |
709.71 |
532.28 |
177.43 |
10.32 |
Arizona UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
WF2 |
1580.91 |
1678.47 |
1258.85 |
419.62 |
24.39 |
Arizona UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
WF3 |
1437.17 |
1525.88 |
1144.41 |
381.47 |
22.18 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LU1 |
672.10 |
708.63 |
531.47 |
177.16 |
9.14 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LU2 |
1545.85 |
1629.77 |
1222.33 |
407.44 |
20.98 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LU3 |
1445.04 |
1523.51 |
1142.63 |
380.88 |
19.62 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KT1 |
864.87 |
963.45 |
562.73 |
400.72 |
66.38 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KT2 |
2162.16 |
2408.62 |
1324.74 |
1083.88 |
165.67 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KT3 |
1859.46 |
2071.40 |
1214.46 |
856.94 |
134.18 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
VD1 |
657.65 |
634.34 |
475.76 |
158.58 |
-5.83 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
VD2 |
1555.39 |
1500.18 |
1125.14 |
375.04 |
-13.81 |
Arizona UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
VD3 |
1413.97 |
1363.81 |
1022.86 |
340.95 |
-12.54 |
Arkansas Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Arkansas Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Arkansas Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Arkansas Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Arkansas Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Arkansas Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
870.65 |
978.21 |
562.73 |
415.48 |
75.36 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
1985.10 |
2230.43 |
1324.74 |
905.69 |
164.54 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
1965.45 |
2208.33 |
1214.46 |
993.87 |
165.12 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
895.53 |
1008.28 |
562.73 |
445.55 |
80.55 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
2050.64 |
2308.89 |
1324.74 |
984.15 |
177.46 |
Arkansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
2010.45 |
2263.58 |
1214.46 |
1049.12 |
175.37 |
Arkansas Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Arkansas Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Arkansas Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Arkansas QualChoice - High Self |
DH1 |
728.85 |
794.47 |
562.73 |
231.74 |
33.42 |
Arkansas QualChoice - High Self & Family |
DH2 |
1901.10 |
2072.31 |
1324.74 |
747.57 |
90.42 |
Arkansas QualChoice - High Self Plus One |
DH3 |
1415.83 |
1543.36 |
1157.52 |
385.84 |
31.88 |
Arkansas QualChoice - Standard Self |
DH4 |
568.97 |
620.17 |
465.13 |
155.04 |
12.80 |
Arkansas QualChoice - Standard Self & Family |
DH5 |
1484.08 |
1617.66 |
1213.25 |
404.41 |
33.39 |
Arkansas QualChoice - Standard Self Plus One |
DH6 |
1105.28 |
1204.78 |
903.59 |
301.19 |
24.87 |
Arkansas UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
650.91 |
711.79 |
533.84 |
177.95 |
15.22 |
Arkansas UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
1539.46 |
1683.37 |
1262.53 |
420.84 |
35.98 |
Arkansas UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
1399.49 |
1530.34 |
1147.76 |
382.58 |
32.71 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LS1 |
624.67 |
658.84 |
494.13 |
164.71 |
8.54 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LS2 |
1436.76 |
1507.18 |
1130.39 |
376.79 |
17.60 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LS3 |
1343.07 |
1416.52 |
1062.39 |
354.13 |
18.36 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KK1 |
847.30 |
940.98 |
562.73 |
378.25 |
61.48 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KK2 |
2118.24 |
2352.52 |
1324.74 |
1027.78 |
153.49 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KK3 |
1821.69 |
2023.17 |
1214.46 |
808.71 |
123.72 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
581.25 |
675.42 |
506.57 |
168.85 |
23.54 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
1374.69 |
1597.35 |
1198.01 |
399.34 |
55.67 |
Arkansas UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
1249.71 |
1452.14 |
1089.11 |
363.03 |
50.60 |
California Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
California Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
California Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
California Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
California Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
California Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
California Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
JS4 |
1094.51 |
1106.97 |
562.73 |
544.24 |
-19.74 |
California Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
JS5 |
2498.64 |
2527.05 |
1324.74 |
1202.31 |
-52.38 |
California Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
JS6 |
2473.94 |
2502.07 |
1214.46 |
1287.61 |
-49.63 |
California Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
JS1 |
1037.34 |
1166.40 |
562.73 |
603.67 |
96.86 |
California Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
JS2 |
2364.66 |
2658.89 |
1324.74 |
1334.15 |
213.44 |
California Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
JS3 |
2341.24 |
2632.54 |
1214.46 |
1418.08 |
213.54 |
California Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
California Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
California Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
California Aetna Open Access - High Self |
2X1 |
1039.33 |
1098.41 |
562.73 |
535.68 |
26.88 |
California Aetna Open Access - High Self & Family |
2X2 |
2440.04 |
2578.72 |
1324.74 |
1253.98 |
57.89 |
California Aetna Open Access - High Self Plus One |
2X3 |
2392.22 |
2528.18 |
1214.46 |
1313.72 |
58.20 |
California Anthem Blue Cross Select HMO - High Self |
B31 |
777.23 |
761.69 |
562.73 |
198.96 |
-47.74 |
California Anthem Blue Cross Select HMO - High Self & Family |
B32 |
1783.06 |
1765.25 |
1323.94 |
441.31 |
-97.80 |
California Anthem Blue Cross Select HMO - High Self Plus One |
B33 |
1646.08 |
1616.44 |
1212.33 |
404.11 |
-105.27 |
California Blue Shield of California - Access + HMO Self |
SI1 |
884.61 |
955.39 |
562.73 |
392.66 |
38.58 |
California Blue Shield of California - Access + HMO Self & Family |
SI2 |
2034.65 |
2197.43 |
1324.74 |
872.69 |
81.99 |
California Blue Shield of California - Access + HMO Self Plus One |
SI3 |
1946.19 |
2101.88 |
1214.46 |
887.42 |
77.93 |
California Health Net of California - Basic Self |
P61 |
405.69 |
405.75 |
304.31 |
101.44 |
0.02 |
California Health Net of California - Basic Self & Family |
P62 |
973.74 |
973.85 |
730.39 |
243.46 |
0.03 |
California Health Net of California - Basic Self Plus One |
P63 |
892.56 |
892.69 |
669.52 |
223.17 |
0.03 |
California Health Net of California - Standard Self |
P64 |
New Plan |
732.81 |
549.61 |
183.20 |
New Plan |
California Health Net of California - Standard Self & Family |
P65 |
New Plan |
1758.73 |
1319.05 |
439.68 |
New Plan |
California Health Net of California - Standard Self Plus One |
P66 |
New Plan |
1612.17 |
1209.13 |
403.04 |
New Plan |
California Health Net of California - High Self |
LP1 |
1077.33 |
1086.43 |
562.73 |
523.70 |
-23.10 |
California Health Net of California - High Self & Family |
LP2 |
2585.66 |
2607.43 |
1324.74 |
1282.69 |
-59.02 |
California Health Net of California - High Self Plus One |
LP3 |
2370.18 |
2390.14 |
1214.46 |
1175.68 |
-57.80 |
California Health Net of California - High Self |
LB1 |
1618.70 |
1688.85 |
562.73 |
1126.12 |
37.95 |
California Health Net of California - High Self & Family |
LB2 |
3884.86 |
4053.23 |
1324.74 |
2728.49 |
87.58 |
California Health Net of California - High Self Plus One |
LB3 |
3561.13 |
3715.44 |
1214.46 |
2500.98 |
76.55 |
California Health Net of California - Basic Self |
T41 |
953.16 |
946.60 |
562.73 |
383.87 |
-38.76 |
California Health Net of California - Basic Self & Family |
T42 |
2287.61 |
2271.84 |
1324.74 |
947.10 |
-96.56 |
California Health Net of California - Basic Self Plus One |
T43 |
2096.94 |
2082.51 |
1214.46 |
868.05 |
-92.19 |
California Kaiser Permanente - Fresno California - Standard Self |
NZ4 |
590.11 |
588.10 |
441.08 |
147.02 |
-0.51 |
California Kaiser Permanente - Fresno California - Standard Self & Family |
NZ5 |
1363.87 |
1359.22 |
1019.42 |
339.80 |
-1.17 |
California Kaiser Permanente - Fresno California - Standard Self Plus One |
NZ6 |
1363.87 |
1359.22 |
1019.42 |
339.80 |
-1.17 |
California Kaiser Permanente - Fresno California - High Self |
NZ1 |
813.45 |
818.74 |
562.73 |
256.01 |
-26.91 |
California Kaiser Permanente - Fresno California - High Self & Family |
NZ2 |
1880.06 |
1892.26 |
1324.74 |
567.52 |
-68.59 |
California Kaiser Permanente - Fresno California - High Self Plus One |
NZ3 |
1880.06 |
1892.26 |
1214.46 |
677.80 |
-65.56 |
California Kaiser Permanente - Northern California - Prosper Self |
KC1 |
658.56 |
650.30 |
487.73 |
162.57 |
-2.07 |
California Kaiser Permanente - Northern California - Prosper Self & Family |
KC2 |
1541.02 |
1521.67 |
1141.25 |
380.42 |
-4.83 |
California Kaiser Permanente - Northern California - Prosper Self Plus One |
KC3 |
1541.02 |
1521.67 |
1141.25 |
380.42 |
-23.90 |
California Kaiser Permanente - Northern California - High Self |
591 |
1002.30 |
992.81 |
562.73 |
430.08 |
-41.69 |
California Kaiser Permanente - Northern California - High Self & Family |
592 |
2392.59 |
2369.94 |
1324.74 |
1045.20 |
-103.44 |
California Kaiser Permanente - Northern California - High Self Plus One |
593 |
2392.59 |
2369.94 |
1214.46 |
1155.48 |
-100.41 |
California Kaiser Permanente - Northern California - Standard Self |
594 |
814.88 |
806.15 |
562.73 |
243.42 |
-40.93 |
California Kaiser Permanente - Northern California - Standard Self & Family |
595 |
1906.80 |
1886.43 |
1324.74 |
561.69 |
-101.16 |
California Kaiser Permanente - Northern California - Standard Self Plus One |
596 |
1906.80 |
1886.43 |
1214.46 |
671.97 |
-98.13 |
California Kaiser Permanente - Southern California - Prosper Self |
FL1 |
365.63 |
365.34 |
274.01 |
91.33 |
-0.08 |
California Kaiser Permanente - Southern California - Prosper Self & Family |
FL2 |
1023.75 |
1022.95 |
767.21 |
255.74 |
-0.20 |
California Kaiser Permanente - Southern California - Prosper Self Plus One |
FL3 |
840.97 |
840.30 |
630.23 |
210.07 |
-0.17 |
California Kaiser Permanente - Southern California - Standard Self |
624 |
488.35 |
528.02 |
396.02 |
132.00 |
9.91 |
California Kaiser Permanente - Southern California - Standard Self & Family |
625 |
1128.62 |
1220.33 |
915.25 |
305.08 |
22.93 |
California Kaiser Permanente - Southern California - Standard Self Plus One |
626 |
1128.62 |
1220.33 |
915.25 |
305.08 |
22.93 |
California Kaiser Permanente - Southern California - High Self |
621 |
760.63 |
779.24 |
562.73 |
216.51 |
-13.59 |
California Kaiser Permanente - Southern California - High Self & Family |
622 |
1757.97 |
1800.98 |
1324.74 |
476.24 |
-37.78 |
California Kaiser Permanente - Southern California - High Self Plus One |
623 |
1757.97 |
1800.98 |
1214.46 |
586.52 |
-34.75 |
Colorado Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Colorado Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Colorado Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Colorado Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Colorado Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Colorado Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
834.38 |
874.06 |
562.73 |
311.33 |
7.48 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
1911.07 |
2001.94 |
1324.74 |
677.20 |
10.08 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
1873.63 |
1962.70 |
1214.46 |
748.24 |
11.31 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
1135.10 |
1152.41 |
562.73 |
589.68 |
-14.89 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
2589.21 |
2628.64 |
1324.74 |
1303.90 |
-41.36 |
Colorado Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
2563.60 |
2602.64 |
1214.46 |
1388.18 |
-38.72 |
Colorado Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Colorado Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Colorado Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Colorado Humana Health Plan, Inc. - High Self |
NR1 |
970.80 |
1004.79 |
562.73 |
442.06 |
1.79 |
Colorado Humana Health Plan, Inc. - High Self & Family |
NR2 |
2184.28 |
2260.77 |
1324.74 |
936.03 |
-4.30 |
Colorado Humana Health Plan, Inc. - High Self Plus One |
NR3 |
2087.22 |
2160.30 |
1214.46 |
945.84 |
-4.68 |
Colorado Humana Health Plan, Inc. - Standard Self |
NR4 |
666.08 |
750.10 |
562.58 |
187.52 |
21.00 |
Colorado Humana Health Plan, Inc. - Standard Self & Family |
NR5 |
1498.73 |
1687.73 |
1265.80 |
421.93 |
47.25 |
Colorado Humana Health Plan, Inc. - Standard Self Plus One |
NR6 |
1432.08 |
1612.69 |
1209.52 |
403.17 |
45.15 |
Colorado Humana Health Plan, Inc. - Basic Self |
RZ1 |
518.94 |
581.86 |
436.40 |
145.46 |
15.73 |
Colorado Humana Health Plan, Inc. - Basic Self & Family |
RZ2 |
1167.57 |
1309.10 |
981.83 |
327.27 |
35.38 |
Colorado Humana Health Plan, Inc. - Basic Self Plus One |
RZ3 |
1115.73 |
1250.97 |
938.23 |
312.74 |
33.81 |
Colorado Humana Health Plan, Inc. - High Self |
NT1 |
875.29 |
911.00 |
562.73 |
348.27 |
3.51 |
Colorado Humana Health Plan, Inc. - High Self & Family |
NT2 |
1969.44 |
2049.80 |
1324.74 |
725.06 |
-0.43 |
Colorado Humana Health Plan, Inc. - High Self Plus One |
NT3 |
1881.88 |
1958.67 |
1214.46 |
744.21 |
-0.97 |
Colorado Humana Health Plan, Inc. - Standard Self |
NT4 |
590.27 |
640.12 |
480.09 |
160.03 |
12.46 |
Colorado Humana Health Plan, Inc. - Standard Self & Family |
NT5 |
1328.12 |
1440.34 |
1080.26 |
360.08 |
28.05 |
Colorado Humana Health Plan, Inc. - Standard Self Plus One |
NT6 |
1269.13 |
1376.35 |
1032.26 |
344.09 |
26.81 |
Colorado Humana Health Plan, Inc. - Basic Self |
R21 |
605.89 |
682.28 |
511.71 |
170.57 |
19.10 |
Colorado Humana Health Plan, Inc. - Basic Self & Family |
R22 |
1363.22 |
1535.15 |
1151.36 |
383.79 |
42.99 |
Colorado Humana Health Plan, Inc. - Basic Self Plus One |
R23 |
1302.62 |
1466.90 |
1100.18 |
366.72 |
41.07 |
Colorado Kaiser Permanente - Colorado - Standard Self |
654 |
659.17 |
673.68 |
505.26 |
168.42 |
3.63 |
Colorado Kaiser Permanente - Colorado - Standard Self & Family |
655 |
1489.71 |
1522.50 |
1141.88 |
380.62 |
8.19 |
Colorado Kaiser Permanente - Colorado - Standard Self Plus One |
656 |
1489.71 |
1522.50 |
1141.88 |
380.62 |
8.19 |
Colorado Kaiser Permanente - Colorado - High Self |
651 |
772.89 |
786.39 |
562.73 |
223.66 |
-18.70 |
Colorado Kaiser Permanente - Colorado - High Self & Family |
652 |
1746.75 |
1777.27 |
1324.74 |
452.53 |
-50.27 |
Colorado Kaiser Permanente - Colorado - High Self Plus One |
653 |
1746.75 |
1777.27 |
1214.46 |
562.81 |
-47.24 |
Colorado Kaiser Permanente - Colorado - Prosper Self |
N41 |
390.15 |
418.73 |
314.05 |
104.68 |
7.14 |
Colorado Kaiser Permanente - Colorado - Prosper Self & Family |
N42 |
959.77 |
1030.14 |
772.61 |
257.53 |
17.59 |
Colorado Kaiser Permanente - Colorado - Prosper Self Plus One |
N43 |
881.73 |
946.38 |
709.79 |
236.59 |
16.16 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LU1 |
672.10 |
708.63 |
531.47 |
177.16 |
9.14 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LU2 |
1545.85 |
1629.77 |
1222.33 |
407.44 |
20.98 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LU3 |
1445.04 |
1523.51 |
1142.63 |
380.88 |
19.62 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KT1 |
864.87 |
963.45 |
562.73 |
400.72 |
66.38 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KT2 |
2162.16 |
2408.62 |
1324.74 |
1083.88 |
165.67 |
Colorado UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KT3 |
1859.46 |
2071.40 |
1214.46 |
856.94 |
134.18 |
Connecticut Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Connecticut Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Connecticut Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Connecticut Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Connecticut Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Connecticut Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
927.77 |
1093.78 |
562.73 |
531.05 |
133.81 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
2124.50 |
2504.60 |
1324.74 |
1179.86 |
299.31 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
2082.84 |
2455.48 |
1214.46 |
1241.02 |
294.88 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
1156.37 |
1257.23 |
562.73 |
694.50 |
68.66 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
2637.12 |
2867.17 |
1324.74 |
1542.43 |
149.26 |
Connecticut Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
2611.01 |
2838.77 |
1214.46 |
1624.31 |
150.00 |
Connecticut Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Connecticut Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Connecticut Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Delaware Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Delaware Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Delaware Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Delaware Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Delaware Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Delaware Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
927.77 |
1093.78 |
562.73 |
531.05 |
133.81 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
2124.50 |
2504.60 |
1324.74 |
1179.86 |
299.31 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
2082.84 |
2455.48 |
1214.46 |
1241.02 |
294.88 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
1156.37 |
1257.23 |
562.73 |
694.50 |
68.66 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
2637.12 |
2867.17 |
1324.74 |
1542.43 |
149.26 |
Delaware Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
2611.01 |
2838.77 |
1214.46 |
1624.31 |
150.00 |
Delaware Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Delaware Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Delaware Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Delaware Aetna Open Access - Basic Self |
P34 |
1721.76 |
1754.03 |
562.73 |
1191.30 |
0.07 |
Delaware Aetna Open Access - Basic Self & Family |
P35 |
3996.29 |
4071.10 |
1324.74 |
2746.36 |
-5.98 |
Delaware Aetna Open Access - Basic Self Plus One |
P36 |
3956.70 |
4030.74 |
1214.46 |
2816.28 |
-3.72 |
Delaware Aetna Open Access - High Self |
P31 |
1762.54 |
1737.97 |
562.73 |
1175.24 |
-56.77 |
Delaware Aetna Open Access - High Self & Family |
P32 |
4273.27 |
4213.71 |
1324.74 |
2888.97 |
-140.35 |
Delaware Aetna Open Access - High Self Plus One |
P33 |
4230.98 |
4172.00 |
1214.46 |
2957.54 |
-136.74 |
District Of Columbia Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
District Of Columbia Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
District Of Columbia Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
District Of Columbia Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
District Of Columbia Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
District Of Columbia Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
870.65 |
978.21 |
562.73 |
415.48 |
75.36 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
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 |
1965.45 |
2208.33 |
1214.46 |
993.87 |
165.12 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
895.53 |
1008.28 |
562.73 |
445.55 |
80.55 |
District Of Columbia Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
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 |
2010.45 |
2263.58 |
1214.46 |
1049.12 |
175.37 |
District Of Columbia Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
District Of Columbia Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
District Of Columbia Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
District Of Columbia Aetna Open Access - High Self |
JN1 |
1251.55 |
1328.84 |
562.73 |
766.11 |
45.09 |
District Of Columbia Aetna Open Access - High Self & Family |
JN2 |
2813.68 |
2987.40 |
1324.74 |
1662.66 |
92.93 |
District Of Columbia Aetna Open Access - High Self Plus One |
JN3 |
2785.79 |
2957.80 |
1214.46 |
1743.34 |
94.25 |
District Of Columbia Aetna Open Access - Basic Self |
JN4 |
739.46 |
770.73 |
562.73 |
208.00 |
-0.93 |
District Of Columbia Aetna Open Access - Basic Self & Family |
JN5 |
1692.23 |
1763.82 |
1322.87 |
440.95 |
-7.33 |
District Of Columbia Aetna Open Access - Basic Self Plus One |
JN6 |
1553.93 |
1619.67 |
1214.46 |
405.21 |
-12.02 |
District Of Columbia Aetna Saver (Open Access) - Saver Self |
QQ4 |
595.21 |
613.56 |
460.17 |
153.39 |
4.59 |
District Of Columbia Aetna Saver (Open Access) - Saver Self & Family |
QQ5 |
1362.12 |
1404.20 |
1053.15 |
351.05 |
10.52 |
District Of Columbia Aetna Saver (Open Access) - Saver Self Plus One |
QQ6 |
1250.82 |
1289.45 |
967.09 |
322.36 |
9.66 |
District Of Columbia CareFirst BlueChoice - Standard Self |
2G4 |
905.58 |
1023.27 |
562.73 |
460.54 |
85.49 |
District Of Columbia CareFirst BlueChoice - Standard Self & Family |
2G5 |
2151.59 |
2431.30 |
1324.74 |
1106.56 |
198.92 |
District Of Columbia CareFirst BlueChoice - Standard Self Plus One |
2G6 |
1811.12 |
2046.57 |
1214.46 |
832.11 |
157.69 |
District Of Columbia CareFirst BlueChoice - HDHP Self |
B61 |
604.31 |
691.90 |
518.93 |
172.97 |
21.89 |
District Of Columbia CareFirst BlueChoice - HDHP Self & Family |
B62 |
1435.79 |
1643.96 |
1232.97 |
410.99 |
52.04 |
District Of Columbia CareFirst BlueChoice - HDHP Self Plus One |
B63 |
1208.57 |
1383.85 |
1037.89 |
345.96 |
43.82 |
District Of Columbia CareFirst BlueChoice - Blue Value Plus Self |
B64 |
723.67 |
759.83 |
562.73 |
197.10 |
3.96 |
District Of Columbia CareFirst BlueChoice - Blue Value Plus Self & Family |
B65 |
1719.38 |
1805.35 |
1324.74 |
480.61 |
5.18 |
District Of Columbia CareFirst BlueChoice - Blue Value Plus Self Plus One |
B66 |
1447.29 |
1519.68 |
1139.76 |
379.92 |
18.10 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - Prosper Self |
T71 |
368.90 |
379.73 |
284.80 |
94.93 |
2.71 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - Prosper Self & Family |
T72 |
1051.33 |
1068.34 |
801.26 |
267.08 |
4.25 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - Prosper Self Plus One |
T73 |
866.91 |
907.18 |
680.39 |
226.79 |
10.06 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - Standard Self |
E34 |
607.25 |
635.27 |
476.45 |
158.82 |
7.01 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - Standard Self & Family |
E35 |
1396.63 |
1461.09 |
1095.82 |
365.27 |
16.11 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - Standard Self Plus One |
E36 |
1396.63 |
1461.09 |
1095.82 |
365.27 |
16.11 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - High Self |
E31 |
756.60 |
790.90 |
562.73 |
228.17 |
2.10 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - High Self & Family |
E32 |
1740.20 |
1819.03 |
1324.74 |
494.29 |
-1.96 |
District Of Columbia Kaiser Permanente - Mid-Atlantic States - High Self Plus One |
E33 |
1740.20 |
1819.03 |
1214.46 |
604.57 |
1.07 |
District Of Columbia M.D. IPA - High Self |
JP1 |
1011.99 |
1065.78 |
562.73 |
503.05 |
21.59 |
District Of Columbia M.D. IPA - High Self & Family |
JP2 |
2837.66 |
2988.44 |
1324.74 |
1663.70 |
69.99 |
District Of Columbia M.D. IPA - High Self Plus One |
JP3 |
1976.43 |
2081.45 |
1214.46 |
866.99 |
27.26 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
650.91 |
711.79 |
533.84 |
177.95 |
15.22 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
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 |
1399.49 |
1530.34 |
1147.76 |
382.58 |
32.71 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
V41 |
661.81 |
665.19 |
498.89 |
166.30 |
0.85 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
V42 |
1514.20 |
1529.86 |
1147.40 |
382.46 |
3.91 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
V43 |
1422.92 |
1430.13 |
1072.60 |
357.53 |
1.80 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
LR1 |
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 |
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 |
1767.68 |
1952.17 |
1214.46 |
737.71 |
106.73 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
L91 |
663.76 |
697.00 |
522.75 |
174.25 |
8.31 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
L92 |
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 |
1327.54 |
1481.16 |
1110.87 |
370.29 |
38.41 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
581.25 |
675.42 |
506.57 |
168.85 |
23.54 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
1374.69 |
1597.35 |
1198.01 |
399.34 |
55.67 |
District Of Columbia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
1249.71 |
1452.14 |
1089.11 |
363.03 |
50.60 |
Florida Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Florida Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Florida Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Florida Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Florida Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Florida Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
870.65 |
978.21 |
562.73 |
415.48 |
75.36 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
1985.10 |
2230.43 |
1324.74 |
905.69 |
164.54 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
1965.45 |
2208.33 |
1214.46 |
993.87 |
165.12 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
895.53 |
1008.28 |
562.73 |
445.55 |
80.55 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
2050.64 |
2308.89 |
1324.74 |
984.15 |
177.46 |
Florida Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
2010.45 |
2263.58 |
1214.46 |
1049.12 |
175.37 |
Florida Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Florida Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Florida Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Florida AvMed - HDHP Self |
WZ1 |
742.26 |
866.21 |
562.73 |
303.48 |
91.75 |
Florida AvMed - HDHP Self & Family |
WZ2 |
1714.01 |
2015.98 |
1324.74 |
691.24 |
221.18 |
Florida AvMed - HDHP Self Plus One |
WZ3 |
1487.24 |
1747.66 |
1214.46 |
533.20 |
161.39 |
Florida AvMed - Standard Self |
ML4 |
801.88 |
946.31 |
562.73 |
383.58 |
112.23 |
Florida AvMed - Standard Self & Family |
ML5 |
1952.45 |
2304.10 |
1324.74 |
979.36 |
270.86 |
Florida AvMed - Standard Self Plus One |
ML6 |
1683.98 |
1987.29 |
1214.46 |
772.83 |
225.55 |
Florida Capital Health Plan - High Self |
EA1 |
730.49 |
754.04 |
562.73 |
191.31 |
-8.65 |
Florida Capital Health Plan - High Self & Family |
EA2 |
1692.93 |
1747.46 |
1310.60 |
436.86 |
-12.12 |
Florida Capital Health Plan - High Self Plus One |
EA3 |
1597.55 |
1649.01 |
1214.46 |
434.55 |
-26.30 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self |
W94 |
600.12 |
655.76 |
491.82 |
163.94 |
13.91 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self & Family |
W95 |
1350.29 |
1475.46 |
1106.60 |
368.86 |
31.29 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
W96 |
1290.25 |
1409.87 |
1057.40 |
352.47 |
29.91 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self |
W91 |
726.70 |
762.15 |
562.73 |
199.42 |
3.25 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
W92 |
1635.03 |
1714.77 |
1286.08 |
428.69 |
19.93 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
W93 |
1562.38 |
1638.61 |
1214.46 |
424.15 |
-1.53 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self |
QP1 |
826.22 |
872.91 |
562.73 |
310.18 |
14.49 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
QP2 |
1861.38 |
1966.58 |
1324.74 |
641.84 |
24.41 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
QP3 |
1778.66 |
1879.15 |
1214.46 |
664.69 |
22.73 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self |
QP4 |
550.51 |
573.30 |
429.98 |
143.32 |
5.69 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self & Family |
QP5 |
1238.60 |
1289.84 |
967.38 |
322.46 |
12.81 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
QP6 |
1183.56 |
1232.53 |
924.40 |
308.13 |
12.24 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self |
MJ4 |
561.19 |
592.06 |
444.05 |
148.01 |
7.71 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self & Family |
MJ5 |
1346.87 |
1420.92 |
1065.69 |
355.23 |
18.51 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
MJ6 |
1206.55 |
1272.92 |
954.69 |
318.23 |
16.59 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self |
MJ1 |
1064.87 |
1112.15 |
562.73 |
549.42 |
15.08 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
MJ2 |
2395.92 |
2502.28 |
1324.74 |
1177.54 |
25.57 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
MJ3 |
2289.47 |
2391.11 |
1214.46 |
1176.65 |
23.88 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self |
X24 |
546.26 |
576.03 |
432.02 |
144.01 |
7.45 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self & Family |
X25 |
1338.33 |
1411.24 |
1058.43 |
352.81 |
18.23 |
Florida Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
X26 |
1174.44 |
1238.42 |
928.82 |
309.60 |
15.99 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self |
X21 |
630.54 |
674.70 |
506.03 |
168.67 |
11.04 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
X22 |
1418.80 |
1518.10 |
1138.58 |
379.52 |
24.82 |
Florida Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
X23 |
1355.73 |
1450.63 |
1087.97 |
362.66 |
23.73 |
Florida Humana HDHP - HDHP Self |
BR1 |
426.44 |
439.25 |
329.44 |
109.81 |
3.20 |
Florida Humana HDHP - HDHP Self & Family |
BR2 |
1062.23 |
1094.08 |
820.56 |
273.52 |
7.96 |
Florida Humana HDHP - HDHP Self Plus One |
BR3 |
935.07 |
963.13 |
722.35 |
240.78 |
7.01 |
Florida Humana HDHP - HDHP Self |
A41 |
478.40 |
492.77 |
369.58 |
123.19 |
3.59 |
Florida Humana HDHP - HDHP Self & Family |
A42 |
1192.12 |
1227.89 |
920.92 |
306.97 |
8.94 |
Florida Humana HDHP - HDHP Self Plus One |
A43 |
1049.38 |
1080.86 |
810.65 |
270.21 |
7.87 |
Florida Humana HDHP - HDHP Self |
FF1 |
406.51 |
418.69 |
314.02 |
104.67 |
3.04 |
Florida Humana HDHP - HDHP Self & Family |
FF2 |
1012.33 |
1042.71 |
782.03 |
260.68 |
7.60 |
Florida Humana HDHP - HDHP Self Plus One |
FF3 |
891.17 |
917.89 |
688.42 |
229.47 |
6.68 |
Florida Humana HDHP - HDHP Self |
AP1 |
483.08 |
497.55 |
373.16 |
124.39 |
3.62 |
Florida Humana HDHP - HDHP Self & Family |
AP2 |
1203.76 |
1239.88 |
929.91 |
309.97 |
9.03 |
Florida Humana HDHP - HDHP Self Plus One |
AP3 |
1059.63 |
1091.42 |
818.57 |
272.85 |
7.94 |
Florida Humana Medical Plan, Inc. - Standard Self |
LL4 |
1282.69 |
1420.84 |
562.73 |
858.11 |
105.95 |
Florida Humana Medical Plan, Inc. - Standard Self & Family |
LL5 |
2886.00 |
3196.83 |
1324.74 |
1872.09 |
230.04 |
Florida Humana Medical Plan, Inc. - Standard Self Plus One |
LL6 |
2757.73 |
3054.76 |
1214.46 |
1840.30 |
219.27 |
Florida Humana Medical Plan, Inc. - High Self |
LL1 |
1794.37 |
2021.02 |
562.73 |
1458.29 |
194.45 |
Florida Humana Medical Plan, Inc. - High Self & Family |
LL2 |
4037.30 |
4547.23 |
1324.74 |
3222.49 |
429.14 |
Florida Humana Medical Plan, Inc. - High Self Plus One |
LL3 |
3857.86 |
4345.14 |
1214.46 |
3130.68 |
409.52 |
Florida Humana Medical Plan, Inc. - High Self |
EE1 |
1323.88 |
1485.62 |
562.73 |
922.89 |
129.54 |
Florida Humana Medical Plan, Inc. - High Self & Family |
EE2 |
2978.78 |
3342.71 |
1324.74 |
2017.97 |
283.14 |
Florida Humana Medical Plan, Inc. - High Self Plus One |
EE3 |
2846.44 |
3194.21 |
1214.46 |
1979.75 |
270.01 |
Florida Humana Medical Plan, Inc. - Standard Self |
EE4 |
1183.78 |
1337.70 |
562.73 |
774.97 |
121.72 |
Florida Humana Medical Plan, Inc. - Standard Self & Family |
EE5 |
2663.48 |
3009.78 |
1324.74 |
1685.04 |
265.51 |
Florida Humana Medical Plan, Inc. - Standard Self Plus One |
EE6 |
2545.12 |
2875.99 |
1214.46 |
1661.53 |
253.11 |
Florida Humana Medical Plan, Inc. - Standard Self |
E24 |
804.44 |
863.48 |
562.73 |
300.75 |
26.84 |
Florida Humana Medical Plan, Inc. - Standard Self & Family |
E25 |
1809.97 |
1942.81 |
1324.74 |
618.07 |
52.05 |
Florida Humana Medical Plan, Inc. - Standard Self Plus One |
E26 |
1729.50 |
1856.42 |
1214.46 |
641.96 |
49.16 |
Florida Humana Medical Plan, Inc. - High Self |
E21 |
1351.18 |
1408.98 |
562.73 |
846.25 |
25.60 |
Florida Humana Medical Plan, Inc. - High Self & Family |
E22 |
3040.05 |
3170.12 |
1324.74 |
1845.38 |
49.28 |
Florida Humana Medical Plan, Inc. - High Self Plus One |
E23 |
2904.94 |
3029.22 |
1214.46 |
1814.76 |
46.52 |
Florida Humana Medical Plan, Inc. - High Self |
EX1 |
1069.40 |
1101.38 |
562.73 |
538.65 |
-0.22 |
Florida Humana Medical Plan, Inc. - High Self & Family |
EX2 |
2406.11 |
2478.04 |
1324.74 |
1153.30 |
-8.86 |
Florida Humana Medical Plan, Inc. - High Self Plus One |
EX3 |
2299.16 |
2367.89 |
1214.46 |
1153.43 |
-9.03 |
Florida Humana Medical Plan, Inc. - Standard Self |
EX4 |
897.33 |
937.89 |
562.73 |
375.16 |
8.36 |
Florida Humana Medical Plan, Inc. - Standard Self & Family |
EX5 |
2019.01 |
2110.29 |
1324.74 |
785.55 |
10.49 |
Florida Humana Medical Plan, Inc. - Standard Self Plus One |
EX6 |
1929.27 |
2016.50 |
1214.46 |
802.04 |
9.47 |
Florida UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
650.91 |
711.79 |
533.84 |
177.95 |
15.22 |
Florida UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
1539.46 |
1683.37 |
1262.53 |
420.84 |
35.98 |
Florida UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
1399.49 |
1530.34 |
1147.76 |
382.58 |
32.71 |
Florida UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LS1 |
624.67 |
658.84 |
494.13 |
164.71 |
8.54 |
Florida UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LS2 |
1436.76 |
1507.18 |
1130.39 |
376.79 |
17.60 |
Florida UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LS3 |
1343.07 |
1416.52 |
1062.39 |
354.13 |
18.36 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KK1 |
847.30 |
940.98 |
562.73 |
378.25 |
61.48 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KK2 |
2118.24 |
2352.52 |
1324.74 |
1027.78 |
153.49 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KK3 |
1821.69 |
2023.17 |
1214.46 |
808.71 |
123.72 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
LV1 |
897.89 |
1005.44 |
562.73 |
442.71 |
75.35 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
LV2 |
2693.64 |
3016.30 |
1324.74 |
1691.56 |
241.87 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self Plus One |
LV3 |
1930.46 |
2161.68 |
1214.46 |
947.22 |
153.46 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
581.25 |
675.42 |
506.57 |
168.85 |
23.54 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
1374.69 |
1597.35 |
1198.01 |
399.34 |
55.67 |
Florida UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
1249.71 |
1452.14 |
1089.11 |
363.03 |
50.60 |
Georgia Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Georgia Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Georgia Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Georgia Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Georgia Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Georgia Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
870.65 |
978.21 |
562.73 |
415.48 |
75.36 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
1985.10 |
2230.43 |
1324.74 |
905.69 |
164.54 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
1965.45 |
2208.33 |
1214.46 |
993.87 |
165.12 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
895.53 |
1008.28 |
562.73 |
445.55 |
80.55 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
2050.64 |
2308.89 |
1324.74 |
984.15 |
177.46 |
Georgia Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
2010.45 |
2263.58 |
1214.46 |
1049.12 |
175.37 |
Georgia Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Georgia Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Georgia Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Georgia Aetna Open Access - High Self |
2U1 |
1729.63 |
1782.65 |
562.73 |
1219.92 |
20.82 |
Georgia Aetna Open Access - High Self & Family |
2U2 |
3984.13 |
4106.27 |
1324.74 |
2781.53 |
41.35 |
Georgia Aetna Open Access - High Self Plus One |
2U3 |
3944.68 |
4065.62 |
1214.46 |
2851.16 |
43.18 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self |
S94 |
658.56 |
707.96 |
530.97 |
176.99 |
12.35 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self & Family |
S95 |
1481.72 |
1592.87 |
1194.65 |
398.22 |
27.79 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
S96 |
1415.87 |
1522.08 |
1141.56 |
380.52 |
26.55 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self |
S91 |
827.10 |
835.38 |
562.73 |
272.65 |
-23.92 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
S92 |
1860.99 |
1879.61 |
1324.74 |
554.87 |
-62.17 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
S93 |
1778.29 |
1796.06 |
1214.46 |
581.60 |
-59.99 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self |
AD4 |
826.04 |
875.62 |
562.73 |
312.89 |
17.38 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self & Family |
AD5 |
1858.50 |
1970.04 |
1324.74 |
645.30 |
30.75 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
AD6 |
1775.93 |
1882.49 |
1214.46 |
668.03 |
28.80 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self |
AD1 |
1166.51 |
1248.17 |
562.73 |
685.44 |
49.46 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
AD2 |
2624.61 |
2808.35 |
1324.74 |
1483.61 |
102.95 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
AD3 |
2507.98 |
2683.53 |
1214.46 |
1469.07 |
97.79 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self |
LM1 |
784.51 |
839.28 |
562.73 |
276.55 |
22.57 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
LM2 |
1765.14 |
1888.40 |
1324.74 |
563.66 |
42.47 |
Georgia Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
LM3 |
1686.69 |
1804.47 |
1214.46 |
590.01 |
40.02 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self |
LM4 |
742.13 |
786.22 |
562.73 |
223.49 |
11.89 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self & Family |
LM5 |
1669.81 |
1769.00 |
1324.74 |
444.26 |
18.40 |
Georgia Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
LM6 |
1595.60 |
1690.41 |
1214.46 |
475.95 |
17.05 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self |
RM1 |
791.87 |
892.34 |
562.73 |
329.61 |
68.27 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self & Family |
RM2 |
1781.72 |
2007.79 |
1324.74 |
683.05 |
145.28 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self Plus One |
RM3 |
1702.52 |
1918.56 |
1214.46 |
704.10 |
138.28 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self |
DN4 |
874.16 |
986.31 |
562.73 |
423.58 |
79.95 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self & Family |
DN5 |
1966.77 |
2219.10 |
1324.74 |
894.36 |
171.54 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self Plus One |
DN6 |
1879.39 |
2120.50 |
1214.46 |
906.04 |
163.35 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self |
RJ1 |
703.34 |
796.42 |
562.73 |
233.69 |
57.86 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self & Family |
RJ2 |
1582.53 |
1791.99 |
1324.74 |
467.25 |
71.62 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self Plus One |
RJ3 |
1512.18 |
1712.34 |
1214.46 |
497.88 |
119.84 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self |
Q71 |
872.11 |
1043.71 |
562.73 |
480.98 |
139.40 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self & Family |
Q72 |
1962.26 |
2348.34 |
1324.74 |
1023.60 |
305.29 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Basic Self Plus One |
Q73 |
1875.03 |
2243.93 |
1214.46 |
1029.47 |
291.14 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self |
CB4 |
1251.68 |
1376.85 |
562.73 |
814.12 |
92.97 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self & Family |
CB5 |
2816.30 |
3097.90 |
1324.74 |
1773.16 |
200.81 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self Plus One |
CB6 |
2691.13 |
2960.23 |
1214.46 |
1745.77 |
191.34 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self |
DG4 |
1430.85 |
1495.22 |
562.73 |
932.49 |
32.17 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self & Family |
DG5 |
3219.43 |
3364.29 |
1324.74 |
2039.55 |
64.07 |
Georgia Humana Employers Health Plan of Georgia, Inc. - Standard Self Plus One |
DG6 |
3076.41 |
3214.86 |
1214.46 |
2000.40 |
60.69 |
Georgia Humana HDHP - HDHP Self |
AZ1 |
472.40 |
486.57 |
364.93 |
121.64 |
3.54 |
Georgia Humana HDHP - HDHP Self & Family |
AZ2 |
1177.06 |
1212.38 |
909.29 |
303.09 |
8.83 |
Georgia Humana HDHP - HDHP Self Plus One |
AZ3 |
1036.14 |
1067.21 |
800.41 |
266.80 |
7.77 |
Georgia Humana HDHP - HDHP Self |
B21 |
487.02 |
501.61 |
376.21 |
125.40 |
3.65 |
Georgia Humana HDHP - HDHP Self & Family |
B22 |
1213.62 |
1250.04 |
937.53 |
312.51 |
9.11 |
Georgia Humana HDHP - HDHP Self Plus One |
B23 |
1068.30 |
1100.34 |
825.26 |
275.08 |
8.01 |
Georgia Humana HDHP - HDHP Self |
AR1 |
477.45 |
491.77 |
368.83 |
122.94 |
3.58 |
Georgia Humana HDHP - HDHP Self & Family |
AR2 |
1189.72 |
1225.40 |
919.05 |
306.35 |
8.92 |
Georgia Humana HDHP - HDHP Self Plus One |
AR3 |
1047.26 |
1078.68 |
809.01 |
269.67 |
7.86 |
Georgia Kaiser Permanente - Georgia - High Self |
F81 |
769.71 |
807.65 |
562.73 |
244.92 |
5.74 |
Georgia Kaiser Permanente - Georgia - High Self & Family |
F82 |
1739.57 |
1825.27 |
1324.74 |
500.53 |
4.91 |
Georgia Kaiser Permanente - Georgia - High Self Plus One |
F83 |
1739.57 |
1825.27 |
1214.46 |
610.81 |
7.94 |
Georgia Kaiser Permanente - Georgia - Standard Self |
F84 |
600.71 |
632.08 |
474.06 |
158.02 |
7.84 |
Georgia Kaiser Permanente - Georgia - Standard Self & Family |
F85 |
1357.59 |
1428.53 |
1071.40 |
357.13 |
17.73 |
Georgia Kaiser Permanente - Georgia - Standard Self Plus One |
F86 |
1357.59 |
1428.53 |
1071.40 |
357.13 |
17.73 |
Georgia Kaiser Permanente - Georgia - Prosper Self |
LA1 |
398.65 |
434.48 |
325.86 |
108.62 |
8.96 |
Georgia Kaiser Permanente - Georgia - Prosper Self & Family |
LA2 |
1034.97 |
1128.10 |
846.08 |
282.02 |
23.28 |
Georgia Kaiser Permanente - Georgia - Prosper Self Plus One |
LA3 |
900.92 |
981.98 |
736.49 |
245.49 |
20.26 |
Georgia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
650.91 |
711.79 |
533.84 |
177.95 |
15.22 |
Georgia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
1539.46 |
1683.37 |
1262.53 |
420.84 |
35.98 |
Georgia UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
1399.49 |
1530.34 |
1147.76 |
382.58 |
32.71 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
LV1 |
897.89 |
1005.44 |
562.73 |
442.71 |
75.35 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
LV2 |
2693.64 |
3016.30 |
1324.74 |
1691.56 |
241.87 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self Plus One |
LV3 |
1930.46 |
2161.68 |
1214.46 |
947.22 |
153.46 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
581.25 |
675.42 |
506.57 |
168.85 |
23.54 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
1374.69 |
1597.35 |
1198.01 |
399.34 |
55.67 |
Georgia UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
1249.71 |
1452.14 |
1089.11 |
363.03 |
50.60 |
Guam Calvo's SelectCare - Standard Self |
B44 |
378.91 |
404.63 |
303.47 |
101.16 |
6.43 |
Guam Calvo's SelectCare - Standard Self & Family |
B45 |
1100.91 |
1175.66 |
881.75 |
293.91 |
18.68 |
Guam Calvo's SelectCare - Standard Self Plus One |
B46 |
746.92 |
797.64 |
598.23 |
199.41 |
12.68 |
Guam Calvo's SelectCare - High Self |
B41 |
535.95 |
551.48 |
413.61 |
137.87 |
3.88 |
Guam Calvo's SelectCare - High Self & Family |
B42 |
1419.54 |
1460.70 |
1095.53 |
365.17 |
10.29 |
Guam Calvo's SelectCare - High Self Plus One |
B43 |
1045.89 |
1076.27 |
807.20 |
269.07 |
7.60 |
Guam TakeCare - HDHP Self |
KX1 |
122.31 |
119.95 |
89.96 |
29.99 |
-0.59 |
Guam TakeCare - HDHP Self & Family |
KX2 |
327.97 |
321.53 |
241.15 |
80.38 |
-1.61 |
Guam TakeCare - HDHP Self Plus One |
KX3 |
295.23 |
289.51 |
217.13 |
72.38 |
-1.43 |
Guam TakeCare - Standard Self |
JK4 |
405.77 |
441.26 |
330.95 |
110.31 |
8.87 |
Guam TakeCare - Standard Self & Family |
JK5 |
1149.18 |
1249.69 |
937.27 |
312.42 |
25.13 |
Guam TakeCare - Standard Self Plus One |
JK6 |
799.78 |
869.74 |
652.31 |
217.43 |
17.49 |
Guam TakeCare - High Self |
JK1 |
515.86 |
564.79 |
423.59 |
141.20 |
12.24 |
Guam TakeCare - High Self & Family |
JK2 |
1230.43 |
1347.08 |
1010.31 |
336.77 |
29.16 |
Guam TakeCare - High Self Plus One |
JK3 |
1019.16 |
1115.79 |
836.84 |
278.95 |
24.16 |
Hawaii Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Hawaii Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Hawaii Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Hawaii Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Hawaii Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Hawaii Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
JS4 |
1094.51 |
1106.97 |
562.73 |
544.24 |
-19.74 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
JS5 |
2498.64 |
2527.05 |
1324.74 |
1202.31 |
-52.38 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
JS6 |
2473.94 |
2502.07 |
1214.46 |
1287.61 |
-49.63 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
JS1 |
1037.34 |
1166.40 |
562.73 |
603.67 |
96.86 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
JS2 |
2364.66 |
2658.89 |
1324.74 |
1334.15 |
213.44 |
Hawaii Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
JS3 |
2341.24 |
2632.54 |
1214.46 |
1418.08 |
213.54 |
Hawaii Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Hawaii Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Hawaii Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Hawaii HMSA Plan - High Self |
871 |
631.24 |
631.24 |
473.43 |
157.81 |
0.00 |
Hawaii HMSA Plan - High Self & Family |
872 |
1419.02 |
1419.02 |
1064.27 |
354.75 |
0.00 |
Hawaii HMSA Plan - High Self Plus One |
873 |
1383.07 |
1383.07 |
1037.30 |
345.77 |
0.00 |
Hawaii HMSA Plan - Standard Self |
874 |
453.83 |
453.83 |
340.37 |
113.46 |
0.00 |
Hawaii HMSA Plan - Standard Self & Family |
875 |
1020.18 |
1020.18 |
765.14 |
255.04 |
0.00 |
Hawaii HMSA Plan - Standard Self Plus One |
876 |
994.28 |
994.28 |
745.71 |
248.57 |
0.00 |
Hawaii Kaiser Permanente - Hawaii - High Self |
631 |
675.55 |
694.81 |
521.11 |
173.70 |
4.81 |
Hawaii Kaiser Permanente - Hawaii - High Self & Family |
632 |
1506.51 |
1549.47 |
1162.10 |
387.37 |
10.74 |
Hawaii Kaiser Permanente - Hawaii - High Self Plus One |
633 |
1506.51 |
1549.47 |
1162.10 |
387.37 |
10.74 |
Hawaii Kaiser Permanente - Hawaii - Standard Self |
634 |
485.38 |
485.38 |
364.04 |
121.34 |
0.00 |
Hawaii Kaiser Permanente - Hawaii - Standard Self & Family |
635 |
1082.38 |
1082.38 |
811.79 |
270.59 |
0.00 |
Hawaii Kaiser Permanente - Hawaii - Standard Self Plus One |
636 |
1082.38 |
1082.38 |
811.79 |
270.59 |
0.00 |
Idaho Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Idaho Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Idaho Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Idaho Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Idaho Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Idaho Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
826.19 |
864.93 |
562.73 |
302.20 |
6.54 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
1883.22 |
1971.52 |
1324.74 |
646.78 |
7.51 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
1864.96 |
1952.41 |
1214.46 |
737.95 |
9.69 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
833.73 |
901.16 |
562.73 |
338.43 |
35.23 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
1913.45 |
2068.11 |
1324.74 |
743.37 |
73.87 |
Idaho Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
1875.94 |
2027.59 |
1214.46 |
813.13 |
73.89 |
Idaho Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Idaho Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Idaho Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Idaho Altius Health Plan - High Self |
9K1 |
1150.85 |
1214.72 |
562.73 |
651.99 |
31.67 |
Idaho Altius Health Plan - High Self & Family |
9K2 |
2545.10 |
2686.39 |
1324.74 |
1361.65 |
60.50 |
Idaho Altius Health Plan - High Self Plus One |
9K3 |
2519.92 |
2659.82 |
1214.46 |
1445.36 |
62.14 |
Idaho Altius Health Plan - HDHP Self |
9K4 |
759.22 |
794.89 |
562.73 |
232.16 |
3.47 |
Idaho Altius Health Plan - HDHP Self & Family |
9K5 |
1586.72 |
1661.25 |
1245.94 |
415.31 |
18.63 |
Idaho Altius Health Plan - HDHP Self Plus One |
9K6 |
1555.56 |
1628.62 |
1214.46 |
414.16 |
-4.70 |
Idaho Altius Health Plan - Standard Self |
DK4 |
942.54 |
993.35 |
562.73 |
430.62 |
18.61 |
Idaho Altius Health Plan - Standard Self & Family |
DK5 |
2081.43 |
2193.69 |
1324.74 |
868.95 |
31.47 |
Idaho Altius Health Plan - Standard Self Plus One |
DK6 |
2060.80 |
2171.95 |
1214.46 |
957.49 |
33.39 |
Idaho Kaiser Permanente - Washington Core - Standard Self |
544 |
625.21 |
640.86 |
480.65 |
160.21 |
3.91 |
Idaho Kaiser Permanente - Washington Core - Standard Self & Family |
545 |
1438.00 |
1473.94 |
1105.46 |
368.48 |
8.98 |
Idaho Kaiser Permanente - Washington Core - Standard Self Plus One |
546 |
1438.00 |
1473.94 |
1105.46 |
368.48 |
8.98 |
Idaho Kaiser Permanente - Washington Core - High Self |
541 |
869.53 |
902.79 |
562.73 |
340.06 |
1.06 |
Idaho Kaiser Permanente - Washington Core - High Self & Family |
542 |
1912.93 |
1986.12 |
1324.74 |
661.38 |
-7.60 |
Idaho Kaiser Permanente - Washington Core - High Self Plus One |
543 |
1912.93 |
1986.12 |
1214.46 |
771.66 |
-4.57 |
Idaho Kaiser Permanente - Washington Core - Prosper Self |
PT4 |
390.00 |
390.00 |
292.50 |
97.50 |
0.00 |
Idaho Kaiser Permanente - Washington Core - Prosper Self & Family |
PT5 |
1091.98 |
1091.98 |
818.99 |
272.99 |
0.00 |
Idaho Kaiser Permanente - Washington Core - Prosper Self Plus One |
PT6 |
944.67 |
944.67 |
708.50 |
236.17 |
0.00 |
Illinois Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Illinois Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Illinois Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Illinois Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Illinois Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Illinois Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
826.19 |
864.93 |
562.73 |
302.20 |
6.54 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
1883.22 |
1971.52 |
1324.74 |
646.78 |
7.51 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
1864.96 |
1952.41 |
1214.46 |
737.95 |
9.69 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
833.73 |
901.16 |
562.73 |
338.43 |
35.23 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
1913.45 |
2068.11 |
1324.74 |
743.37 |
73.87 |
Illinois Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
1875.94 |
2027.59 |
1214.46 |
813.13 |
73.89 |
Illinois Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Illinois Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Illinois Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Illinois Health Alliance HMO - Standard Self |
K84 |
704.08 |
788.58 |
562.73 |
225.85 |
49.83 |
Illinois Health Alliance HMO - Standard Self & Family |
K85 |
1631.89 |
1848.97 |
1324.74 |
524.23 |
116.26 |
Illinois Health Alliance HMO - Standard Self Plus One |
K86 |
1505.44 |
1689.55 |
1214.46 |
475.09 |
98.73 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self |
GB4 |
827.91 |
836.16 |
562.73 |
273.43 |
-23.95 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self & Family |
GB5 |
1862.71 |
1881.32 |
1324.74 |
556.58 |
-62.18 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
GB6 |
1779.92 |
1797.66 |
1214.46 |
583.20 |
-60.02 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self |
GB1 |
1319.83 |
1333.02 |
562.73 |
770.29 |
-19.01 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
GB2 |
2969.55 |
2999.23 |
1324.74 |
1674.49 |
-51.11 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
GB3 |
2837.62 |
2866.00 |
1214.46 |
1651.54 |
-49.38 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self |
MW4 |
799.70 |
815.69 |
562.73 |
252.96 |
-16.21 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self & Family |
MW5 |
1799.27 |
1835.28 |
1324.74 |
510.54 |
-44.78 |
Illinois Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
MW6 |
1719.32 |
1753.74 |
1214.46 |
539.28 |
-43.34 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self |
MW1 |
1056.75 |
1097.50 |
562.73 |
534.77 |
8.55 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
MW2 |
2377.81 |
2469.55 |
1324.74 |
1144.81 |
10.95 |
Illinois Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
MW3 |
2272.08 |
2359.74 |
1214.46 |
1145.28 |
9.90 |
Illinois Humana HDHP - HDHP Self |
BB1 |
445.29 |
458.66 |
344.00 |
114.66 |
3.34 |
Illinois Humana HDHP - HDHP Self & Family |
BB2 |
1109.33 |
1142.61 |
856.96 |
285.65 |
8.32 |
Illinois Humana HDHP - HDHP Self Plus One |
BB3 |
976.52 |
1005.81 |
754.36 |
251.45 |
7.32 |
Illinois Humana HDHP - HDHP Self |
AW1 |
420.70 |
433.31 |
324.98 |
108.33 |
3.16 |
Illinois Humana HDHP - HDHP Self & Family |
AW2 |
1047.82 |
1079.26 |
809.45 |
269.81 |
7.86 |
Illinois Humana HDHP - HDHP Self Plus One |
AW3 |
922.39 |
950.08 |
712.56 |
237.52 |
6.92 |
Illinois Humana Health Plan, Inc. - Standard Self |
754 |
1055.80 |
1160.42 |
562.73 |
597.69 |
72.42 |
Illinois Humana Health Plan, Inc. - Standard Self & Family |
755 |
2375.56 |
2610.99 |
1324.74 |
1286.25 |
154.64 |
Illinois Humana Health Plan, Inc. - Standard Self Plus One |
756 |
2270.00 |
2494.94 |
1214.46 |
1280.48 |
147.18 |
Illinois Humana Health Plan, Inc. - High Self |
751 |
1403.24 |
1445.34 |
562.73 |
882.61 |
9.90 |
Illinois Humana Health Plan, Inc. - High Self & Family |
752 |
3157.29 |
3251.99 |
1324.74 |
1927.25 |
13.91 |
Illinois Humana Health Plan, Inc. - High Self Plus One |
753 |
3016.98 |
3107.46 |
1214.46 |
1893.00 |
12.72 |
Illinois Humana Health Plan, Inc. - High Self |
9F1 |
2116.64 |
2691.74 |
562.73 |
2129.01 |
542.90 |
Illinois Humana Health Plan, Inc. - High Self & Family |
9F2 |
4762.44 |
6056.40 |
1324.74 |
4731.66 |
1213.17 |
Illinois Humana Health Plan, Inc. - High Self Plus One |
9F3 |
4550.74 |
5787.17 |
1214.46 |
4572.71 |
1158.67 |
Illinois Humana Health Plan, Inc. - Standard Self |
AB4 |
1447.46 |
1514.76 |
562.73 |
952.03 |
35.10 |
Illinois Humana Health Plan, Inc. - Standard Self & Family |
AB5 |
3256.85 |
3408.28 |
1324.74 |
2083.54 |
70.64 |
Illinois Humana Health Plan, Inc. - Standard Self Plus One |
AB6 |
3112.11 |
3256.80 |
1214.46 |
2042.34 |
66.93 |
Illinois Humana Health Plan, Inc. - Basic Self |
AB1 |
845.93 |
948.50 |
562.73 |
385.77 |
70.37 |
Illinois Humana Health Plan, Inc. - Basic Self & Family |
AB2 |
1903.40 |
2134.17 |
1324.74 |
809.43 |
149.98 |
Illinois Humana Health Plan, Inc. - Basic Self Plus One |
AB3 |
1818.81 |
2039.33 |
1214.46 |
824.87 |
142.76 |
Illinois Humana Health Plan, Inc. - Basic Self |
RW1 |
839.50 |
934.79 |
562.73 |
372.06 |
63.09 |
Illinois Humana Health Plan, Inc. - Basic Self & Family |
RW2 |
1888.88 |
2103.27 |
1324.74 |
778.53 |
133.60 |
Illinois Humana Health Plan, Inc. - Basic Self Plus One |
RW3 |
1804.92 |
2009.78 |
1214.46 |
795.32 |
127.10 |
Illinois UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
650.91 |
711.79 |
533.84 |
177.95 |
15.22 |
Illinois UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
1539.46 |
1683.37 |
1262.53 |
420.84 |
35.98 |
Illinois UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
1399.49 |
1530.34 |
1147.76 |
382.58 |
32.71 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
L91 |
663.76 |
697.00 |
522.75 |
174.25 |
8.31 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
L92 |
1586.41 |
1672.80 |
1254.60 |
418.20 |
21.60 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self Plus One |
L93 |
1327.54 |
1481.16 |
1110.87 |
370.29 |
38.41 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
581.25 |
675.42 |
506.57 |
168.85 |
23.54 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
1374.69 |
1597.35 |
1198.01 |
399.34 |
55.67 |
Illinois UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
1249.71 |
1452.14 |
1089.11 |
363.03 |
50.60 |
Indiana Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Indiana Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Indiana Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Indiana Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Indiana Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Indiana Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
JS4 |
1094.51 |
1106.97 |
562.73 |
544.24 |
-19.74 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
JS5 |
2498.64 |
2527.05 |
1324.74 |
1202.31 |
-52.38 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
JS6 |
2473.94 |
2502.07 |
1214.46 |
1287.61 |
-49.63 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
JS1 |
1037.34 |
1166.40 |
562.73 |
603.67 |
96.86 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
JS2 |
2364.66 |
2658.89 |
1324.74 |
1334.15 |
213.44 |
Indiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
JS3 |
2341.24 |
2632.54 |
1214.46 |
1418.08 |
213.54 |
Indiana Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Indiana Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Indiana Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Indiana Health Alliance HMO - Standard Self |
K84 |
704.08 |
788.58 |
562.73 |
225.85 |
49.83 |
Indiana Health Alliance HMO - Standard Self & Family |
K85 |
1631.89 |
1848.97 |
1324.74 |
524.23 |
116.26 |
Indiana Health Alliance HMO - Standard Self Plus One |
K86 |
1505.44 |
1689.55 |
1214.46 |
475.09 |
98.73 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self |
MW4 |
799.70 |
815.69 |
562.73 |
252.96 |
-16.21 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self & Family |
MW5 |
1799.27 |
1835.28 |
1324.74 |
510.54 |
-44.78 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
MW6 |
1719.32 |
1753.74 |
1214.46 |
539.28 |
-43.34 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self |
MW1 |
1056.75 |
1097.50 |
562.73 |
534.77 |
8.55 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
MW2 |
2377.81 |
2469.55 |
1324.74 |
1144.81 |
10.95 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
MW3 |
2272.08 |
2359.74 |
1214.46 |
1145.28 |
9.90 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self |
TC1 |
757.06 |
806.26 |
562.73 |
243.53 |
17.00 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
TC2 |
1703.33 |
1814.02 |
1324.74 |
489.28 |
29.90 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
TC3 |
1627.64 |
1733.44 |
1214.46 |
518.98 |
28.04 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self |
TC4 |
579.74 |
626.10 |
469.58 |
156.52 |
11.59 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self & Family |
TC5 |
1304.42 |
1408.77 |
1056.58 |
352.19 |
26.09 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
TC6 |
1246.44 |
1346.15 |
1009.61 |
336.54 |
24.93 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self |
X34 |
694.33 |
732.51 |
549.38 |
183.13 |
9.55 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self & Family |
X35 |
1562.23 |
1648.16 |
1236.12 |
412.04 |
21.48 |
Indiana Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
X36 |
1492.81 |
1574.93 |
1181.20 |
393.73 |
20.53 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self |
X31 |
902.37 |
952.01 |
562.73 |
389.28 |
17.44 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
X32 |
2030.34 |
2142.01 |
1324.74 |
817.27 |
30.88 |
Indiana Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
X33 |
1940.12 |
2046.83 |
1214.46 |
832.37 |
28.95 |
Indiana Humana HDHP - HDHP Self |
BB1 |
445.29 |
458.66 |
344.00 |
114.66 |
3.34 |
Indiana Humana HDHP - HDHP Self & Family |
BB2 |
1109.33 |
1142.61 |
856.96 |
285.65 |
8.32 |
Indiana Humana HDHP - HDHP Self Plus One |
BB3 |
976.52 |
1005.81 |
754.36 |
251.45 |
7.32 |
Indiana Humana HDHP - HDHP Self |
DT1 |
495.73 |
510.60 |
382.95 |
127.65 |
3.72 |
Indiana Humana HDHP - HDHP Self & Family |
DT2 |
1235.41 |
1272.48 |
954.36 |
318.12 |
9.27 |
Indiana Humana HDHP - HDHP Self Plus One |
DT3 |
1087.47 |
1120.10 |
840.08 |
280.02 |
8.15 |
Indiana Humana HDHP - HDHP Self |
FZ1 |
New Plan |
413.68 |
310.26 |
103.42 |
New Plan |
Indiana Humana HDHP - HDHP Self & Family |
FZ2 |
New Plan |
1030.16 |
772.62 |
257.54 |
New Plan |
Indiana Humana HDHP - HDHP Self Plus One |
FZ3 |
New Plan |
906.86 |
680.15 |
226.71 |
New Plan |
Indiana Humana Health Plan of Ohio, Inc. - Standard Self |
A64 |
1243.08 |
1304.46 |
562.73 |
741.73 |
29.18 |
Indiana Humana Health Plan of Ohio, Inc. - Standard Self & Family |
A65 |
2796.95 |
2935.05 |
1324.74 |
1610.31 |
57.31 |
Indiana Humana Health Plan of Ohio, Inc. - Standard Self Plus One |
A66 |
2672.63 |
2804.62 |
1214.46 |
1590.16 |
54.23 |
Indiana Humana Health Plan, Inc. - Standard Self |
754 |
1055.80 |
1160.42 |
562.73 |
597.69 |
72.42 |
Indiana Humana Health Plan, Inc. - Standard Self & Family |
755 |
2375.56 |
2610.99 |
1324.74 |
1286.25 |
154.64 |
Indiana Humana Health Plan, Inc. - Standard Self Plus One |
756 |
2270.00 |
2494.94 |
1214.46 |
1280.48 |
147.18 |
Indiana Humana Health Plan, Inc. - High Self |
751 |
1403.24 |
1445.34 |
562.73 |
882.61 |
9.90 |
Indiana Humana Health Plan, Inc. - High Self & Family |
752 |
3157.29 |
3251.99 |
1324.74 |
1927.25 |
13.91 |
Indiana Humana Health Plan, Inc. - High Self Plus One |
753 |
3016.98 |
3107.46 |
1214.46 |
1893.00 |
12.72 |
Indiana Humana Health Plan, Inc. - Standard Self |
MH4 |
992.90 |
1098.72 |
562.73 |
535.99 |
73.62 |
Indiana Humana Health Plan, Inc. - Standard Self & Family |
MH5 |
2233.96 |
2472.10 |
1324.74 |
1147.36 |
157.35 |
Indiana Humana Health Plan, Inc. - Standard Self Plus One |
MH6 |
2134.67 |
2362.21 |
1214.46 |
1147.75 |
149.78 |
Indiana Indiana University Health Plans Select - High Self |
FS1 |
New Plan |
606.23 |
454.67 |
151.56 |
New Plan |
Indiana Indiana University Health Plans Select - High Self & Family |
FS2 |
New Plan |
1697.45 |
1273.09 |
424.36 |
New Plan |
Indiana Indiana University Health Plans Select - High Self Plus One |
FS3 |
New Plan |
1333.74 |
1000.31 |
333.43 |
New Plan |
Iowa Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Iowa Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Iowa Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Iowa Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Iowa Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Iowa Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
826.19 |
864.93 |
562.73 |
302.20 |
6.54 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
1883.22 |
1971.52 |
1324.74 |
646.78 |
7.51 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
1864.96 |
1952.41 |
1214.46 |
737.95 |
9.69 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
833.73 |
901.16 |
562.73 |
338.43 |
35.23 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
1913.45 |
2068.11 |
1324.74 |
743.37 |
73.87 |
Iowa Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
1875.94 |
2027.59 |
1214.46 |
813.13 |
73.89 |
Iowa Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Iowa Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Iowa Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Iowa Health Alliance HMO - Standard Self |
K84 |
704.08 |
788.58 |
562.73 |
225.85 |
49.83 |
Iowa Health Alliance HMO - Standard Self & Family |
K85 |
1631.89 |
1848.97 |
1324.74 |
524.23 |
116.26 |
Iowa Health Alliance HMO - Standard Self Plus One |
K86 |
1505.44 |
1689.55 |
1214.46 |
475.09 |
98.73 |
Iowa HealthPartners - Standard Self |
V34 |
553.28 |
553.28 |
414.96 |
138.32 |
0.00 |
Iowa HealthPartners - Standard Self & Family |
V35 |
1347.84 |
1347.84 |
1010.88 |
336.96 |
0.00 |
Iowa HealthPartners - Standard Self Plus One |
V36 |
1222.78 |
1222.78 |
917.09 |
305.69 |
0.00 |
Iowa HealthPartners - High Self |
V31 |
692.14 |
737.17 |
552.88 |
184.29 |
11.26 |
Iowa HealthPartners - High Self & Family |
V32 |
1686.01 |
1795.73 |
1324.74 |
470.99 |
28.93 |
Iowa HealthPartners - High Self Plus One |
V33 |
1529.58 |
1629.12 |
1214.46 |
414.66 |
21.78 |
Iowa UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
650.91 |
711.79 |
533.84 |
177.95 |
15.22 |
Iowa UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
1539.46 |
1683.37 |
1262.53 |
420.84 |
35.98 |
Iowa UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
1399.49 |
1530.34 |
1147.76 |
382.58 |
32.71 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
N71 |
744.55 |
757.84 |
562.73 |
195.11 |
-18.91 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
N72 |
1712.45 |
1743.06 |
1307.30 |
435.76 |
-32.74 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
N73 |
1600.76 |
1629.40 |
1214.46 |
414.94 |
-49.12 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
LJ1 |
873.95 |
975.46 |
562.73 |
412.73 |
69.31 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
LJ2 |
2184.93 |
2438.63 |
1324.74 |
1113.89 |
172.91 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
LJ3 |
1879.04 |
2097.20 |
1214.46 |
882.74 |
140.40 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
581.25 |
675.42 |
506.57 |
168.85 |
23.54 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
1374.69 |
1597.35 |
1198.01 |
399.34 |
55.67 |
Iowa UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
1249.71 |
1452.14 |
1089.11 |
363.03 |
50.60 |
Kansas Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Kansas Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Kansas Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Kansas Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Kansas Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Kansas Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
834.38 |
874.06 |
562.73 |
311.33 |
7.48 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
1911.07 |
2001.94 |
1324.74 |
677.20 |
10.08 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
1873.63 |
1962.70 |
1214.46 |
748.24 |
11.31 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
1135.10 |
1152.41 |
562.73 |
589.68 |
-14.89 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
2589.21 |
2628.64 |
1324.74 |
1303.90 |
-41.36 |
Kansas Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
2563.60 |
2602.64 |
1214.46 |
1388.18 |
-38.72 |
Kansas Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Kansas Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Kansas Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Kansas Aetna Open Access - Standard Self |
HA4 |
909.37 |
895.01 |
562.73 |
332.28 |
-46.56 |
Kansas Aetna Open Access - Standard Self & Family |
HA5 |
2146.47 |
2112.54 |
1324.74 |
787.80 |
-114.72 |
Kansas Aetna Open Access - Standard Self Plus One |
HA6 |
2125.26 |
2091.64 |
1214.46 |
877.18 |
-111.38 |
Kansas Aetna Open Access - High Self |
HA1 |
1188.98 |
1196.91 |
562.73 |
634.18 |
-24.27 |
Kansas Aetna Open Access - High Self & Family |
HA2 |
2808.54 |
2827.31 |
1324.74 |
1502.57 |
-62.02 |
Kansas Aetna Open Access - High Self Plus One |
HA3 |
2780.77 |
2799.33 |
1214.46 |
1584.87 |
-59.20 |
Kansas Humana CoverageFirst and Humana Value Plan - Value Self |
PH4 |
567.17 |
587.58 |
440.69 |
146.89 |
5.10 |
Kansas Humana CoverageFirst and Humana Value Plan - Value Self & Family |
PH5 |
1276.15 |
1322.10 |
991.58 |
330.52 |
11.48 |
Kansas Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
PH6 |
1219.44 |
1263.36 |
947.52 |
315.84 |
10.98 |
Kansas Humana CoverageFirst and Humana Value Plan - CDHP Self |
PH1 |
758.03 |
750.21 |
562.66 |
187.55 |
-39.95 |
Kansas Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
PH2 |
1705.60 |
1687.96 |
1265.97 |
421.99 |
-39.66 |
Kansas Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
PH3 |
1629.79 |
1612.95 |
1209.71 |
403.24 |
-89.85 |
Kansas Humana HDHP - HDHP Self |
BK1 |
403.13 |
415.22 |
311.42 |
103.80 |
3.02 |
Kansas Humana HDHP - HDHP Self & Family |
BK2 |
1003.93 |
1034.06 |
775.55 |
258.51 |
7.53 |
Kansas Humana HDHP - HDHP Self Plus One |
BK3 |
883.78 |
910.30 |
682.73 |
227.57 |
6.63 |
Kansas Humana Health Plan, Inc. - Standard Self |
MS4 |
1290.64 |
1362.75 |
562.73 |
800.02 |
39.91 |
Kansas Humana Health Plan, Inc. - Standard Self & Family |
MS5 |
2903.98 |
3066.20 |
1324.74 |
1741.46 |
81.43 |
Kansas Humana Health Plan, Inc. - Standard Self Plus One |
MS6 |
2774.94 |
2929.96 |
1214.46 |
1715.50 |
77.26 |
Kentucky Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Kentucky Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Kentucky Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Kentucky Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Kentucky Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Kentucky Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Kentucky Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
826.19 |
864.93 |
562.73 |
302.20 |
6.54 |
Kentucky Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
1883.22 |
1971.52 |
1324.74 |
646.78 |
7.51 |
Kentucky Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
1864.96 |
1952.41 |
1214.46 |
737.95 |
9.69 |
Kentucky Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
833.73 |
901.16 |
562.73 |
338.43 |
35.23 |
Kentucky Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
1913.45 |
2068.11 |
1324.74 |
743.37 |
73.87 |
Kentucky Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
1875.94 |
2027.59 |
1214.46 |
813.13 |
73.89 |
Kentucky Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Kentucky Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Kentucky Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Kentucky Humana CoverageFirst and Humana Value Plan - CDHP Self |
TC1 |
757.06 |
806.26 |
562.73 |
243.53 |
17.00 |
Kentucky Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
TC2 |
1703.33 |
1814.02 |
1324.74 |
489.28 |
29.90 |
Kentucky Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
TC3 |
1627.64 |
1733.44 |
1214.46 |
518.98 |
28.04 |
Kentucky Humana CoverageFirst and Humana Value Plan - Value Self |
TC4 |
579.74 |
626.10 |
469.58 |
156.52 |
11.59 |
Kentucky Humana CoverageFirst and Humana Value Plan - Value Self & Family |
TC5 |
1304.42 |
1408.77 |
1056.58 |
352.19 |
26.09 |
Kentucky Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
TC6 |
1246.44 |
1346.15 |
1009.61 |
336.54 |
24.93 |
Kentucky Humana CoverageFirst and Humana Value Plan - CDHP Self |
6N1 |
848.75 |
900.08 |
562.73 |
337.35 |
19.13 |
Kentucky Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
6N2 |
1909.68 |
2025.16 |
1324.74 |
700.42 |
34.69 |
Kentucky Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
6N3 |
1824.81 |
1935.14 |
1214.46 |
720.68 |
32.57 |
Kentucky Humana CoverageFirst and Humana Value Plan - Value Self |
6N4 |
633.82 |
678.19 |
508.64 |
169.55 |
11.10 |
Kentucky Humana CoverageFirst and Humana Value Plan - Value Self & Family |
6N5 |
1426.06 |
1525.90 |
1144.43 |
381.47 |
24.96 |
Kentucky Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
6N6 |
1362.70 |
1458.08 |
1093.56 |
364.52 |
23.85 |
Kentucky Humana CoverageFirst and Humana Value Plan - Value Self |
X34 |
694.33 |
732.51 |
549.38 |
183.13 |
9.55 |
Kentucky Humana CoverageFirst and Humana Value Plan - Value Self & Family |
X35 |
1562.23 |
1648.16 |
1236.12 |
412.04 |
21.48 |
Kentucky Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
X36 |
1492.81 |
1574.93 |
1181.20 |
393.73 |
20.53 |
Kentucky Humana CoverageFirst and Humana Value Plan - CDHP Self |
X31 |
902.37 |
952.01 |
562.73 |
389.28 |
17.44 |
Kentucky Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
X32 |
2030.34 |
2142.01 |
1324.74 |
817.27 |
30.88 |
Kentucky Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
X33 |
1940.12 |
2046.83 |
1214.46 |
832.37 |
28.95 |
Kentucky Humana HDHP - HDHP Self |
DT1 |
495.73 |
510.60 |
382.95 |
127.65 |
3.72 |
Kentucky Humana HDHP - HDHP Self & Family |
DT2 |
1235.41 |
1272.48 |
954.36 |
318.12 |
9.27 |
Kentucky Humana HDHP - HDHP Self Plus One |
DT3 |
1087.47 |
1120.10 |
840.08 |
280.02 |
8.15 |
Kentucky Humana HDHP - HDHP Self |
FZ1 |
New Plan |
413.68 |
310.26 |
103.42 |
New Plan |
Kentucky Humana HDHP - HDHP Self & Family |
FZ2 |
New Plan |
1030.16 |
772.62 |
257.54 |
New Plan |
Kentucky Humana HDHP - HDHP Self Plus One |
FZ3 |
New Plan |
906.86 |
680.15 |
226.71 |
New Plan |
Kentucky Humana HDHP - HDHP Self |
FW1 |
New Plan |
413.68 |
310.26 |
103.42 |
New Plan |
Kentucky Humana HDHP - HDHP Self & Family |
FW2 |
New Plan |
1030.16 |
772.62 |
257.54 |
New Plan |
Kentucky Humana HDHP - HDHP Self Plus One |
FW3 |
New Plan |
906.86 |
680.15 |
226.71 |
New Plan |
Kentucky Humana Health Plan of Ohio, Inc. - Standard Self |
A64 |
1243.08 |
1304.46 |
562.73 |
741.73 |
29.18 |
Kentucky Humana Health Plan of Ohio, Inc. - Standard Self & Family |
A65 |
2796.95 |
2935.05 |
1324.74 |
1610.31 |
57.31 |
Kentucky Humana Health Plan of Ohio, Inc. - Standard Self Plus One |
A66 |
2672.63 |
2804.62 |
1214.46 |
1590.16 |
54.23 |
Kentucky Humana Health Plan of Ohio, Inc. - Basic Self |
W61 |
671.02 |
758.25 |
562.73 |
195.52 |
27.77 |
Kentucky Humana Health Plan of Ohio, Inc. - Basic Self & Family |
W62 |
1509.82 |
1706.10 |
1279.58 |
426.52 |
49.07 |
Kentucky Humana Health Plan of Ohio, Inc. - Basic Self Plus One |
W63 |
1442.72 |
1630.24 |
1214.46 |
415.78 |
55.10 |
Kentucky Humana Health Plan, Inc. - Standard Self |
MI4 |
929.59 |
1040.63 |
562.73 |
477.90 |
78.84 |
Kentucky Humana Health Plan, Inc. - Standard Self & Family |
MI5 |
2091.55 |
2341.41 |
1324.74 |
1016.67 |
169.07 |
Kentucky Humana Health Plan, Inc. - Standard Self Plus One |
MI6 |
1998.62 |
2237.41 |
1214.46 |
1022.95 |
161.03 |
Kentucky Humana Health Plan, Inc. - Standard Self |
MH4 |
992.90 |
1098.72 |
562.73 |
535.99 |
73.62 |
Kentucky Humana Health Plan, Inc. - Standard Self & Family |
MH5 |
2233.96 |
2472.10 |
1324.74 |
1147.36 |
157.35 |
Kentucky Humana Health Plan, Inc. - Standard Self Plus One |
MH6 |
2134.67 |
2362.21 |
1214.46 |
1147.75 |
149.78 |
Kentucky UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
650.91 |
711.79 |
533.84 |
177.95 |
15.22 |
Kentucky UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
1539.46 |
1683.37 |
1262.53 |
420.84 |
35.98 |
Kentucky UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
1399.49 |
1530.34 |
1147.76 |
382.58 |
32.71 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
N71 |
744.55 |
757.84 |
562.73 |
195.11 |
-18.91 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
N72 |
1712.45 |
1743.06 |
1307.30 |
435.76 |
-32.74 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
N73 |
1600.76 |
1629.40 |
1214.46 |
414.94 |
-49.12 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
LJ1 |
873.95 |
975.46 |
562.73 |
412.73 |
69.31 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
LJ2 |
2184.93 |
2438.63 |
1324.74 |
1113.89 |
172.91 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
LJ3 |
1879.04 |
2097.20 |
1214.46 |
882.74 |
140.40 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
581.25 |
675.42 |
506.57 |
168.85 |
23.54 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
1374.69 |
1597.35 |
1198.01 |
399.34 |
55.67 |
Kentucky UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
1249.71 |
1452.14 |
1089.11 |
363.03 |
50.60 |
Louisiana Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Louisiana Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Louisiana Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Louisiana Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Louisiana Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Louisiana Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Louisiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
870.65 |
978.21 |
562.73 |
415.48 |
75.36 |
Louisiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
1985.10 |
2230.43 |
1324.74 |
905.69 |
164.54 |
Louisiana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
1965.45 |
2208.33 |
1214.46 |
993.87 |
165.12 |
Louisiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
895.53 |
1008.28 |
562.73 |
445.55 |
80.55 |
Louisiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
2050.64 |
2308.89 |
1324.74 |
984.15 |
177.46 |
Louisiana Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
2010.45 |
2263.58 |
1214.46 |
1049.12 |
175.37 |
Louisiana Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Louisiana Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Louisiana Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - Standard Self |
BC4 |
760.09 |
848.29 |
562.73 |
285.56 |
56.00 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - Standard Self & Family |
BC5 |
1710.22 |
1908.64 |
1324.74 |
583.90 |
117.63 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - Standard Self Plus One |
BC6 |
1634.19 |
1823.81 |
1214.46 |
609.35 |
111.86 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - High Self |
BC1 |
1031.12 |
1109.46 |
562.73 |
546.73 |
46.14 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - High Self & Family |
BC2 |
2320.07 |
2496.37 |
1324.74 |
1171.63 |
95.51 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - High Self Plus One |
BC3 |
2216.96 |
2385.41 |
1214.46 |
1170.95 |
90.69 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - High Self |
AE1 |
1271.25 |
1366.58 |
562.73 |
803.85 |
63.13 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - High Self & Family |
AE2 |
2860.22 |
3074.74 |
1324.74 |
1750.00 |
133.73 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - High Self Plus One |
AE3 |
2733.12 |
2938.11 |
1214.46 |
1723.65 |
127.23 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - Standard Self |
AE4 |
939.79 |
979.03 |
562.73 |
416.30 |
7.04 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - Standard Self & Family |
AE5 |
2114.58 |
2202.85 |
1324.74 |
878.11 |
7.48 |
Louisiana Humana Health Benefit Plan of Louisiana, Inc. - Standard Self Plus One |
AE6 |
2020.59 |
2104.96 |
1214.46 |
890.50 |
6.61 |
Louisiana UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
650.91 |
711.79 |
533.84 |
177.95 |
15.22 |
Louisiana UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
1539.46 |
1683.37 |
1262.53 |
420.84 |
35.98 |
Louisiana UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
1399.49 |
1530.34 |
1147.76 |
382.58 |
32.71 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LS1 |
624.67 |
658.84 |
494.13 |
164.71 |
8.54 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LS2 |
1436.76 |
1507.18 |
1130.39 |
376.79 |
17.60 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LS3 |
1343.07 |
1416.52 |
1062.39 |
354.13 |
18.36 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KK1 |
847.30 |
940.98 |
562.73 |
378.25 |
61.48 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KK2 |
2118.24 |
2352.52 |
1324.74 |
1027.78 |
153.49 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KK3 |
1821.69 |
2023.17 |
1214.46 |
808.71 |
123.72 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
581.25 |
675.42 |
506.57 |
168.85 |
23.54 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
1374.69 |
1597.35 |
1198.01 |
399.34 |
55.67 |
Louisiana UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
1249.71 |
1452.14 |
1089.11 |
363.03 |
50.60 |
Maine Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Maine Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Maine Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Maine Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Maine Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Maine Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Maine Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
927.77 |
1093.78 |
562.73 |
531.05 |
133.81 |
Maine Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
2124.50 |
2504.60 |
1324.74 |
1179.86 |
299.31 |
Maine Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
2082.84 |
2455.48 |
1214.46 |
1241.02 |
294.88 |
Maine Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
1156.37 |
1257.23 |
562.73 |
694.50 |
68.66 |
Maine Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
2637.12 |
2867.17 |
1324.74 |
1542.43 |
149.26 |
Maine Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
2611.01 |
2838.77 |
1214.46 |
1624.31 |
150.00 |
Maine Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Maine Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Maine Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Maryland Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Maryland Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Maryland Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Maryland Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Maryland Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Maryland Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Maryland Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
F51 |
870.65 |
978.21 |
562.73 |
415.48 |
75.36 |
Maryland Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
F52 |
1985.10 |
2230.43 |
1324.74 |
905.69 |
164.54 |
Maryland Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
F53 |
1965.45 |
2208.33 |
1214.46 |
993.87 |
165.12 |
Maryland Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
F54 |
895.53 |
1008.28 |
562.73 |
445.55 |
80.55 |
Maryland Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
F55 |
2050.64 |
2308.89 |
1324.74 |
984.15 |
177.46 |
Maryland Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
F56 |
2010.45 |
2263.58 |
1214.46 |
1049.12 |
175.37 |
Maryland Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Maryland Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Maryland Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Maryland Aetna Open Access - High Self |
JN1 |
1251.55 |
1328.84 |
562.73 |
766.11 |
45.09 |
Maryland Aetna Open Access - High Self & Family |
JN2 |
2813.68 |
2987.40 |
1324.74 |
1662.66 |
92.93 |
Maryland Aetna Open Access - High Self Plus One |
JN3 |
2785.79 |
2957.80 |
1214.46 |
1743.34 |
94.25 |
Maryland Aetna Open Access - Basic Self |
JN4 |
739.46 |
770.73 |
562.73 |
208.00 |
-0.93 |
Maryland Aetna Open Access - Basic Self & Family |
JN5 |
1692.23 |
1763.82 |
1322.87 |
440.95 |
-7.33 |
Maryland Aetna Open Access - Basic Self Plus One |
JN6 |
1553.93 |
1619.67 |
1214.46 |
405.21 |
-12.02 |
Maryland Aetna Saver (Open Access) - Saver Self |
QQ4 |
595.21 |
613.56 |
460.17 |
153.39 |
4.59 |
Maryland Aetna Saver (Open Access) - Saver Self & Family |
QQ5 |
1362.12 |
1404.20 |
1053.15 |
351.05 |
10.52 |
Maryland Aetna Saver (Open Access) - Saver Self Plus One |
QQ6 |
1250.82 |
1289.45 |
967.09 |
322.36 |
9.66 |
Maryland CareFirst BlueChoice - Standard Self |
2G4 |
905.58 |
1023.27 |
562.73 |
460.54 |
85.49 |
Maryland CareFirst BlueChoice - Standard Self & Family |
2G5 |
2151.59 |
2431.30 |
1324.74 |
1106.56 |
198.92 |
Maryland CareFirst BlueChoice - Standard Self Plus One |
2G6 |
1811.12 |
2046.57 |
1214.46 |
832.11 |
157.69 |
Maryland CareFirst BlueChoice - HDHP Self |
B61 |
604.31 |
691.90 |
518.93 |
172.97 |
21.89 |
Maryland CareFirst BlueChoice - HDHP Self & Family |
B62 |
1435.79 |
1643.96 |
1232.97 |
410.99 |
52.04 |
Maryland CareFirst BlueChoice - HDHP Self Plus One |
B63 |
1208.57 |
1383.85 |
1037.89 |
345.96 |
43.82 |
Maryland CareFirst BlueChoice - Blue Value Plus Self |
B64 |
723.67 |
759.83 |
562.73 |
197.10 |
3.96 |
Maryland CareFirst BlueChoice - Blue Value Plus Self & Family |
B65 |
1719.38 |
1805.35 |
1324.74 |
480.61 |
5.18 |
Maryland CareFirst BlueChoice - Blue Value Plus Self Plus One |
B66 |
1447.29 |
1519.68 |
1139.76 |
379.92 |
18.10 |
Maryland Kaiser Permanente - Mid-Atlantic States - Prosper Self |
T71 |
368.90 |
379.73 |
284.80 |
94.93 |
2.71 |
Maryland Kaiser Permanente - Mid-Atlantic States - Prosper Self & Family |
T72 |
1051.33 |
1068.34 |
801.26 |
267.08 |
4.25 |
Maryland Kaiser Permanente - Mid-Atlantic States - Prosper Self Plus One |
T73 |
866.91 |
907.18 |
680.39 |
226.79 |
10.06 |
Maryland Kaiser Permanente - Mid-Atlantic States - Standard Self |
E34 |
607.25 |
635.27 |
476.45 |
158.82 |
7.01 |
Maryland Kaiser Permanente - Mid-Atlantic States - Standard Self & Family |
E35 |
1396.63 |
1461.09 |
1095.82 |
365.27 |
16.11 |
Maryland Kaiser Permanente - Mid-Atlantic States - Standard Self Plus One |
E36 |
1396.63 |
1461.09 |
1095.82 |
365.27 |
16.11 |
Maryland Kaiser Permanente - Mid-Atlantic States - High Self |
E31 |
756.60 |
790.90 |
562.73 |
228.17 |
2.10 |
Maryland Kaiser Permanente - Mid-Atlantic States - High Self & Family |
E32 |
1740.20 |
1819.03 |
1324.74 |
494.29 |
-1.96 |
Maryland Kaiser Permanente - Mid-Atlantic States - High Self Plus One |
E33 |
1740.20 |
1819.03 |
1214.46 |
604.57 |
1.07 |
Maryland M.D. IPA - High Self |
JP1 |
1011.99 |
1065.78 |
562.73 |
503.05 |
21.59 |
Maryland M.D. IPA - High Self & Family |
JP2 |
2837.66 |
2988.44 |
1324.74 |
1663.70 |
69.99 |
Maryland M.D. IPA - High Self Plus One |
JP3 |
1976.43 |
2081.45 |
1214.46 |
866.99 |
27.26 |
Maryland UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
650.91 |
711.79 |
533.84 |
177.95 |
15.22 |
Maryland UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
1539.46 |
1683.37 |
1262.53 |
420.84 |
35.98 |
Maryland UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
1399.49 |
1530.34 |
1147.76 |
382.58 |
32.71 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
V41 |
661.81 |
665.19 |
498.89 |
166.30 |
0.85 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
V42 |
1514.20 |
1529.86 |
1147.40 |
382.46 |
3.91 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
V43 |
1422.92 |
1430.13 |
1072.60 |
357.53 |
1.80 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
LR1 |
822.16 |
908.01 |
562.73 |
345.28 |
53.65 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
LR2 |
1948.55 |
2151.93 |
1324.74 |
827.19 |
122.59 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
LR3 |
1767.68 |
1952.17 |
1214.46 |
737.71 |
106.73 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self |
L91 |
663.76 |
697.00 |
522.75 |
174.25 |
8.31 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self & Family |
L92 |
1586.41 |
1672.80 |
1254.60 |
418.20 |
21.60 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Plus Advanced - Value Self Plus One |
L93 |
1327.54 |
1481.16 |
1110.87 |
370.29 |
38.41 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
581.25 |
675.42 |
506.57 |
168.85 |
23.54 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
1374.69 |
1597.35 |
1198.01 |
399.34 |
55.67 |
Maryland UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
1249.71 |
1452.14 |
1089.11 |
363.03 |
50.60 |
Massachusetts Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Massachusetts Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Massachusetts Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Massachusetts Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Massachusetts Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Massachusetts Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
927.77 |
1093.78 |
562.73 |
531.05 |
133.81 |
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
2124.50 |
2504.60 |
1324.74 |
1179.86 |
299.31 |
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
2082.84 |
2455.48 |
1214.46 |
1241.02 |
294.88 |
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
1156.37 |
1257.23 |
562.73 |
694.50 |
68.66 |
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
2637.12 |
2867.17 |
1324.74 |
1542.43 |
149.26 |
Massachusetts Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
2611.01 |
2838.77 |
1214.46 |
1624.31 |
150.00 |
Massachusetts Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Massachusetts Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Massachusetts Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Michigan Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Michigan Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Michigan Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Michigan Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Michigan Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Michigan Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Michigan Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
834.38 |
874.06 |
562.73 |
311.33 |
7.48 |
Michigan Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
1911.07 |
2001.94 |
1324.74 |
677.20 |
10.08 |
Michigan Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
1873.63 |
1962.70 |
1214.46 |
748.24 |
11.31 |
Michigan Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
1135.10 |
1152.41 |
562.73 |
589.68 |
-14.89 |
Michigan Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
2589.21 |
2628.64 |
1324.74 |
1303.90 |
-41.36 |
Michigan Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
2563.60 |
2602.64 |
1214.46 |
1388.18 |
-38.72 |
Michigan Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Michigan Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Michigan Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Michigan Blue Care Network of Michigan - High Self |
LX1 |
790.44 |
850.05 |
562.73 |
287.32 |
27.41 |
Michigan Blue Care Network of Michigan - High Self & Family |
LX2 |
1928.70 |
2074.19 |
1324.74 |
749.45 |
64.70 |
Michigan Blue Care Network of Michigan - High Self Plus One |
LX3 |
1818.03 |
1955.20 |
1214.46 |
740.74 |
59.41 |
Michigan Blue Care Network of Michigan - High Self |
K51 |
1042.12 |
1042.28 |
562.73 |
479.55 |
-32.04 |
Michigan Blue Care Network of Michigan - High Self & Family |
K52 |
2542.76 |
2543.08 |
1324.74 |
1218.34 |
-80.47 |
Michigan Blue Care Network of Michigan - High Self Plus One |
K53 |
2396.85 |
2397.14 |
1214.46 |
1182.68 |
-77.47 |
Michigan Health Alliance Plan - High Self |
521 |
910.11 |
915.09 |
562.73 |
352.36 |
-27.22 |
Michigan Health Alliance Plan - High Self & Family |
522 |
2220.62 |
2232.86 |
1324.74 |
908.12 |
-68.55 |
Michigan Health Alliance Plan - High Self Plus One |
523 |
2093.22 |
2104.72 |
1214.46 |
890.26 |
-66.26 |
Michigan Health Alliance Plan - Standard Self |
GY4 |
530.16 |
533.15 |
399.86 |
133.29 |
0.75 |
Michigan Health Alliance Plan - Standard Self & Family |
GY5 |
1293.57 |
1300.89 |
975.67 |
325.22 |
1.83 |
Michigan Health Alliance Plan - Standard Self Plus One |
GY6 |
1219.38 |
1226.27 |
919.70 |
306.57 |
1.73 |
Michigan Priority Health - High Self |
LE1 |
1106.71 |
1110.87 |
562.73 |
548.14 |
-28.04 |
Michigan Priority Health - High Self & Family |
LE2 |
2600.74 |
2610.53 |
1324.74 |
1285.79 |
-71.00 |
Michigan Priority Health - High Self Plus One |
LE3 |
2434.73 |
2443.89 |
1214.46 |
1229.43 |
-68.60 |
Michigan Priority Health - Standard Self |
LE4 |
617.22 |
671.04 |
503.28 |
167.76 |
13.46 |
Michigan Priority Health - Standard Self & Family |
LE5 |
1450.45 |
1576.94 |
1182.71 |
394.23 |
31.62 |
Michigan Priority Health - Standard Self Plus One |
LE6 |
1357.85 |
1476.30 |
1107.23 |
369.07 |
29.61 |
Michigan Priority Health - Value Self |
Y41 |
473.24 |
473.24 |
354.93 |
118.31 |
0.00 |
Michigan Priority Health - Value Self & Family |
Y42 |
1112.13 |
1112.13 |
834.10 |
278.03 |
0.00 |
Michigan Priority Health - Value Self Plus One |
Y43 |
1041.13 |
1041.13 |
780.85 |
260.28 |
0.00 |
Minnesota Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Minnesota Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Minnesota Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Minnesota Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Minnesota Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Minnesota Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Minnesota Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
826.19 |
864.93 |
562.73 |
302.20 |
6.54 |
Minnesota Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
1883.22 |
1971.52 |
1324.74 |
646.78 |
7.51 |
Minnesota Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
1864.96 |
1952.41 |
1214.46 |
737.95 |
9.69 |
Minnesota Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
833.73 |
901.16 |
562.73 |
338.43 |
35.23 |
Minnesota Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
1913.45 |
2068.11 |
1324.74 |
743.37 |
73.87 |
Minnesota Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
1875.94 |
2027.59 |
1214.46 |
813.13 |
73.89 |
Minnesota Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Minnesota Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Minnesota Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Minnesota HealthPartners - Standard Self |
V34 |
553.28 |
553.28 |
414.96 |
138.32 |
0.00 |
Minnesota HealthPartners - Standard Self & Family |
V35 |
1347.84 |
1347.84 |
1010.88 |
336.96 |
0.00 |
Minnesota HealthPartners - Standard Self Plus One |
V36 |
1222.78 |
1222.78 |
917.09 |
305.69 |
0.00 |
Minnesota HealthPartners - High Self |
V31 |
692.14 |
737.17 |
552.88 |
184.29 |
11.26 |
Minnesota HealthPartners - High Self & Family |
V32 |
1686.01 |
1795.73 |
1324.74 |
470.99 |
28.93 |
Minnesota HealthPartners - High Self Plus One |
V33 |
1529.58 |
1629.12 |
1214.46 |
414.66 |
21.78 |
Mississippi Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Mississippi Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Mississippi Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Mississippi Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Mississippi Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Mississippi Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Mississippi Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
826.19 |
864.93 |
562.73 |
302.20 |
6.54 |
Mississippi Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
1883.22 |
1971.52 |
1324.74 |
646.78 |
7.51 |
Mississippi Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
1864.96 |
1952.41 |
1214.46 |
737.95 |
9.69 |
Mississippi Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
833.73 |
901.16 |
562.73 |
338.43 |
35.23 |
Mississippi Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
1913.45 |
2068.11 |
1324.74 |
743.37 |
73.87 |
Mississippi Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
1875.94 |
2027.59 |
1214.46 |
813.13 |
73.89 |
Mississippi Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Mississippi Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Mississippi Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Mississippi UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
650.91 |
711.79 |
533.84 |
177.95 |
15.22 |
Mississippi UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
1539.46 |
1683.37 |
1262.53 |
420.84 |
35.98 |
Mississippi UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
1399.49 |
1530.34 |
1147.76 |
382.58 |
32.71 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LS1 |
624.67 |
658.84 |
494.13 |
164.71 |
8.54 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LS2 |
1436.76 |
1507.18 |
1130.39 |
376.79 |
17.60 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LS3 |
1343.07 |
1416.52 |
1062.39 |
354.13 |
18.36 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KK1 |
847.30 |
940.98 |
562.73 |
378.25 |
61.48 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KK2 |
2118.24 |
2352.52 |
1324.74 |
1027.78 |
153.49 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KK3 |
1821.69 |
2023.17 |
1214.46 |
808.71 |
123.72 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
581.25 |
675.42 |
506.57 |
168.85 |
23.54 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
1374.69 |
1597.35 |
1198.01 |
399.34 |
55.67 |
Mississippi UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
1249.71 |
1452.14 |
1089.11 |
363.03 |
50.60 |
Missouri Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Missouri Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Missouri Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Missouri Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Missouri Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Missouri Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Missouri Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
834.38 |
874.06 |
562.73 |
311.33 |
7.48 |
Missouri Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
1911.07 |
2001.94 |
1324.74 |
677.20 |
10.08 |
Missouri Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
1873.63 |
1962.70 |
1214.46 |
748.24 |
11.31 |
Missouri Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
1135.10 |
1152.41 |
562.73 |
589.68 |
-14.89 |
Missouri Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
2589.21 |
2628.64 |
1324.74 |
1303.90 |
-41.36 |
Missouri Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
2563.60 |
2602.64 |
1214.46 |
1388.18 |
-38.72 |
Missouri Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Missouri Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Missouri Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Missouri Aetna Open Access - Standard Self |
HA4 |
909.37 |
895.01 |
562.73 |
332.28 |
-46.56 |
Missouri Aetna Open Access - Standard Self & Family |
HA5 |
2146.47 |
2112.54 |
1324.74 |
787.80 |
-114.72 |
Missouri Aetna Open Access - Standard Self Plus One |
HA6 |
2125.26 |
2091.64 |
1214.46 |
877.18 |
-111.38 |
Missouri Aetna Open Access - High Self |
HA1 |
1188.98 |
1196.91 |
562.73 |
634.18 |
-24.27 |
Missouri Aetna Open Access - High Self & Family |
HA2 |
2808.54 |
2827.31 |
1324.74 |
1502.57 |
-62.02 |
Missouri Aetna Open Access - High Self Plus One |
HA3 |
2780.77 |
2799.33 |
1214.46 |
1584.87 |
-59.20 |
Missouri Humana CoverageFirst and Humana Value Plan - Value Self |
PH4 |
567.17 |
587.58 |
440.69 |
146.89 |
5.10 |
Missouri Humana CoverageFirst and Humana Value Plan - Value Self & Family |
PH5 |
1276.15 |
1322.10 |
991.58 |
330.52 |
11.48 |
Missouri Humana CoverageFirst and Humana Value Plan - Value Self Plus One |
PH6 |
1219.44 |
1263.36 |
947.52 |
315.84 |
10.98 |
Missouri Humana CoverageFirst and Humana Value Plan - CDHP Self |
PH1 |
758.03 |
750.21 |
562.66 |
187.55 |
-39.95 |
Missouri Humana CoverageFirst and Humana Value Plan - CDHP Self & Family |
PH2 |
1705.60 |
1687.96 |
1265.97 |
421.99 |
-39.66 |
Missouri Humana CoverageFirst and Humana Value Plan - CDHP Self Plus One |
PH3 |
1629.79 |
1612.95 |
1209.71 |
403.24 |
-89.85 |
Missouri Humana HDHP - HDHP Self |
BK1 |
403.13 |
415.22 |
311.42 |
103.80 |
3.02 |
Missouri Humana HDHP - HDHP Self & Family |
BK2 |
1003.93 |
1034.06 |
775.55 |
258.51 |
7.53 |
Missouri Humana HDHP - HDHP Self Plus One |
BK3 |
883.78 |
910.30 |
682.73 |
227.57 |
6.63 |
Missouri Humana Health Plan, Inc. - Standard Self |
MS4 |
1290.64 |
1362.75 |
562.73 |
800.02 |
39.91 |
Missouri Humana Health Plan, Inc. - Standard Self & Family |
MS5 |
2903.98 |
3066.20 |
1324.74 |
1741.46 |
81.43 |
Missouri Humana Health Plan, Inc. - Standard Self Plus One |
MS6 |
2774.94 |
2929.96 |
1214.46 |
1715.50 |
77.26 |
Missouri UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
AS1 |
650.91 |
711.79 |
533.84 |
177.95 |
15.22 |
Missouri UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
AS2 |
1539.46 |
1683.37 |
1262.53 |
420.84 |
35.98 |
Missouri UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
AS3 |
1399.49 |
1530.34 |
1147.76 |
382.58 |
32.71 |
Missouri UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
Y81 |
581.25 |
675.42 |
506.57 |
168.85 |
23.54 |
Missouri UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
Y82 |
1374.69 |
1597.35 |
1198.01 |
399.34 |
55.67 |
Missouri UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
Y83 |
1249.71 |
1452.14 |
1089.11 |
363.03 |
50.60 |
Montana Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Montana Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Montana Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Montana Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Montana Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Montana Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Montana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
826.19 |
864.93 |
562.73 |
302.20 |
6.54 |
Montana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
1883.22 |
1971.52 |
1324.74 |
646.78 |
7.51 |
Montana Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
1864.96 |
1952.41 |
1214.46 |
737.95 |
9.69 |
Montana Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
833.73 |
901.16 |
562.73 |
338.43 |
35.23 |
Montana Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
1913.45 |
2068.11 |
1324.74 |
743.37 |
73.87 |
Montana Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
1875.94 |
2027.59 |
1214.46 |
813.13 |
73.89 |
Montana Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Montana Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Montana Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Nebraska Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Nebraska Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Nebraska Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Nebraska Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Nebraska Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Nebraska Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Nebraska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
H41 |
826.19 |
864.93 |
562.73 |
302.20 |
6.54 |
Nebraska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
H42 |
1883.22 |
1971.52 |
1324.74 |
646.78 |
7.51 |
Nebraska Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
H43 |
1864.96 |
1952.41 |
1214.46 |
737.95 |
9.69 |
Nebraska Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
H44 |
833.73 |
901.16 |
562.73 |
338.43 |
35.23 |
Nebraska Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
H45 |
1913.45 |
2068.11 |
1324.74 |
743.37 |
73.87 |
Nebraska Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
H46 |
1875.94 |
2027.59 |
1214.46 |
813.13 |
73.89 |
Nebraska Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Nebraska Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Nebraska Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Nevada Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
Nevada Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
Nevada Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
Nevada Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
Nevada Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
Nevada Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
Nevada Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
834.38 |
874.06 |
562.73 |
311.33 |
7.48 |
Nevada Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
1911.07 |
2001.94 |
1324.74 |
677.20 |
10.08 |
Nevada Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
1873.63 |
1962.70 |
1214.46 |
748.24 |
11.31 |
Nevada Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
1135.10 |
1152.41 |
562.73 |
589.68 |
-14.89 |
Nevada Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
2589.21 |
2628.64 |
1324.74 |
1303.90 |
-41.36 |
Nevada Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
2563.60 |
2602.64 |
1214.46 |
1388.18 |
-38.72 |
Nevada Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
Nevada Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
Nevada Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
Nevada Health Plan of Nevada, Inc. - High Self |
NM1 |
830.16 |
752.98 |
562.73 |
190.25 |
-109.38 |
Nevada Health Plan of Nevada, Inc. - High Self & Family |
NM2 |
1967.40 |
1784.47 |
1324.74 |
459.73 |
-263.72 |
Nevada Health Plan of Nevada, Inc. - High Self Plus One |
NM3 |
1577.31 |
1430.67 |
1073.00 |
357.67 |
-82.94 |
Nevada UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self |
WF1 |
668.46 |
709.71 |
532.28 |
177.43 |
10.32 |
Nevada UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self & Family |
WF2 |
1580.91 |
1678.47 |
1258.85 |
419.62 |
24.39 |
Nevada UnitedHealthcare Insurance Company, Inc. - Choice Plus Primary - High Self Plus One |
WF3 |
1437.17 |
1525.88 |
1144.41 |
381.47 |
22.18 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self |
LU1 |
672.10 |
708.63 |
531.47 |
177.16 |
9.14 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self & Family |
LU2 |
1545.85 |
1629.77 |
1222.33 |
407.44 |
20.98 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice HDHP - HDHP Self Plus One |
LU3 |
1445.04 |
1523.51 |
1142.63 |
380.88 |
19.62 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self |
KT1 |
864.87 |
963.45 |
562.73 |
400.72 |
66.38 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self & Family |
KT2 |
2162.16 |
2408.62 |
1324.74 |
1083.88 |
165.67 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Open Access HMO - High Self Plus One |
KT3 |
1859.46 |
2071.40 |
1214.46 |
856.94 |
134.18 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self |
VD1 |
657.65 |
634.34 |
475.76 |
158.58 |
-5.83 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self & Family |
VD2 |
1555.39 |
1500.18 |
1125.14 |
375.04 |
-13.81 |
Nevada UnitedHealthcare Insurance Company, Inc. Choice Primary - High Self Plus One |
VD3 |
1413.97 |
1363.81 |
1022.86 |
340.95 |
-12.54 |
New Hampshire Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
New Hampshire Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
New Hampshire Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
New Hampshire Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
New Hampshire Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
New Hampshire Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
927.77 |
1093.78 |
562.73 |
531.05 |
133.81 |
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
2124.50 |
2504.60 |
1324.74 |
1179.86 |
299.31 |
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
2082.84 |
2455.48 |
1214.46 |
1241.02 |
294.88 |
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
1156.37 |
1257.23 |
562.73 |
694.50 |
68.66 |
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
2637.12 |
2867.17 |
1324.74 |
1542.43 |
149.26 |
New Hampshire Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
2611.01 |
2838.77 |
1214.46 |
1624.31 |
150.00 |
New Hampshire Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
New Hampshire Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
New Hampshire Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
New Jersey Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
New Jersey Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
New Jersey Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
New Jersey Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
New Jersey Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
New Jersey Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
New Jersey Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
927.77 |
1093.78 |
562.73 |
531.05 |
133.81 |
New Jersey Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
2124.50 |
2504.60 |
1324.74 |
1179.86 |
299.31 |
New Jersey Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
2082.84 |
2455.48 |
1214.46 |
1241.02 |
294.88 |
New Jersey Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
1156.37 |
1257.23 |
562.73 |
694.50 |
68.66 |
New Jersey Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
2637.12 |
2867.17 |
1324.74 |
1542.43 |
149.26 |
New Jersey Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
2611.01 |
2838.77 |
1214.46 |
1624.31 |
150.00 |
New Jersey Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
New Jersey Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
New Jersey Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
New Jersey Aetna Open Access - High Self |
JR1 |
1655.18 |
1682.03 |
562.73 |
1119.30 |
-5.35 |
New Jersey Aetna Open Access - High Self & Family |
JR2 |
3823.24 |
3885.25 |
1324.74 |
2560.51 |
-18.78 |
New Jersey Aetna Open Access - High Self Plus One |
JR3 |
3785.41 |
3846.79 |
1214.46 |
2632.33 |
-16.38 |
New Jersey Aetna Open Access - Basic Self |
JR4 |
1428.27 |
1446.40 |
562.73 |
883.67 |
-14.07 |
New Jersey Aetna Open Access - Basic Self & Family |
JR5 |
3310.19 |
3352.14 |
1324.74 |
2027.40 |
-38.84 |
New Jersey Aetna Open Access - Basic Self Plus One |
JR6 |
3277.41 |
3318.94 |
1214.46 |
2104.48 |
-36.23 |
New Jersey Aetna Open Access - Basic Self |
P34 |
1721.76 |
1754.03 |
562.73 |
1191.30 |
0.07 |
New Jersey Aetna Open Access - Basic Self & Family |
P35 |
3996.29 |
4071.10 |
1324.74 |
2746.36 |
-5.98 |
New Jersey Aetna Open Access - Basic Self Plus One |
P36 |
3956.70 |
4030.74 |
1214.46 |
2816.28 |
-3.72 |
New Jersey Aetna Open Access - High Self |
P31 |
1762.54 |
1737.97 |
562.73 |
1175.24 |
-56.77 |
New Jersey Aetna Open Access - High Self & Family |
P32 |
4273.27 |
4213.71 |
1324.74 |
2888.97 |
-140.35 |
New Jersey Aetna Open Access - High Self Plus One |
P33 |
4230.98 |
4172.00 |
1214.46 |
2957.54 |
-136.74 |
New Mexico Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
New Mexico Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
New Mexico Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
New Mexico Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
New Mexico Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
New Mexico Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
New Mexico Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
G54 |
834.38 |
874.06 |
562.73 |
311.33 |
7.48 |
New Mexico Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
G55 |
1911.07 |
2001.94 |
1324.74 |
677.20 |
10.08 |
New Mexico Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
G56 |
1873.63 |
1962.70 |
1214.46 |
748.24 |
11.31 |
New Mexico Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
G51 |
1135.10 |
1152.41 |
562.73 |
589.68 |
-14.89 |
New Mexico Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
G52 |
2589.21 |
2628.64 |
1324.74 |
1303.90 |
-41.36 |
New Mexico Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
G53 |
2563.60 |
2602.64 |
1214.46 |
1388.18 |
-38.72 |
New Mexico Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
New Mexico Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
New Mexico Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
1782.63 |
1800.72 |
1214.46 |
586.26 |
-59.67 |
New Mexico Presbyterian Health Plan - High Self |
P21 |
874.47 |
1018.20 |
562.73 |
455.47 |
111.53 |
New Mexico Presbyterian Health Plan - High Self & Family |
P22 |
2055.08 |
2392.85 |
1324.74 |
1068.11 |
256.98 |
New Mexico Presbyterian Health Plan - High Self Plus One |
P23 |
1985.12 |
2311.38 |
1214.46 |
1096.92 |
248.50 |
New Mexico Presbyterian Health Plan - Standard Self |
PS4 |
725.23 |
853.75 |
562.73 |
291.02 |
96.32 |
New Mexico Presbyterian Health Plan - Standard Self & Family |
PS5 |
1704.34 |
2006.38 |
1324.74 |
681.64 |
221.25 |
New Mexico Presbyterian Health Plan - Standard Self Plus One |
PS6 |
1646.36 |
1938.06 |
1214.46 |
723.60 |
213.94 |
New Mexico Presbyterian Health Plan - Wellness Self |
PS1 |
653.81 |
756.54 |
562.73 |
193.81 |
30.36 |
New Mexico Presbyterian Health Plan - Wellness Self & Family |
PS2 |
1536.43 |
1777.88 |
1324.74 |
453.14 |
69.03 |
New Mexico Presbyterian Health Plan - Wellness Self Plus One |
PS3 |
1484.17 |
1717.34 |
1214.46 |
502.88 |
131.84 |
New York Aetna Advantage - Advantage Self |
Z24 |
500.02 |
500.02 |
375.02 |
125.00 |
0.00 |
New York Aetna Advantage - Advantage Self & Family |
Z25 |
1325.00 |
1325.00 |
993.75 |
331.25 |
0.00 |
New York Aetna Advantage - Advantage Self Plus One |
Z26 |
1100.02 |
1100.02 |
825.02 |
275.00 |
0.00 |
New York Aetna Direct - CDHP Self |
N61 |
628.27 |
641.42 |
481.07 |
160.35 |
3.28 |
New York Aetna Direct - CDHP Self & Family |
N62 |
1584.48 |
1617.57 |
1213.18 |
404.39 |
8.27 |
New York Aetna Direct - CDHP Self Plus One |
N63 |
1377.87 |
1406.67 |
1055.00 |
351.67 |
7.20 |
New York Aetna HealthFund CDHP and Aetna Value Plan - Value Self |
EP4 |
927.77 |
1093.78 |
562.73 |
531.05 |
133.81 |
New York Aetna HealthFund CDHP and Aetna Value Plan - Value Self & Family |
EP5 |
2124.50 |
2504.60 |
1324.74 |
1179.86 |
299.31 |
New York Aetna HealthFund CDHP and Aetna Value Plan - Value Self Plus One |
EP6 |
2082.84 |
2455.48 |
1214.46 |
1241.02 |
294.88 |
New York Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self |
EP1 |
1156.37 |
1257.23 |
562.73 |
694.50 |
68.66 |
New York Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self & Family |
EP2 |
2637.12 |
2867.17 |
1324.74 |
1542.43 |
149.26 |
New York Aetna HealthFund CDHP and Aetna Value Plan - CDHP Self Plus One |
EP3 |
2611.01 |
2838.77 |
1214.46 |
1624.31 |
150.00 |
New York Aetna HealthFund HDHP - HDHP Self |
224 |
824.31 |
832.65 |
562.73 |
269.92 |
-23.86 |
New York Aetna HealthFund HDHP - HDHP Self & Family |
225 |
1818.25 |
1836.66 |
1324.74 |
511.92 |
-62.38 |
New York Aetna HealthFund HDHP - HDHP Self Plus One |
226 |
178 |