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    2020 Plan Information for Arkansas 
    
        Choose a Location, Employee Type, & Payment Period  
        
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                    Nationwide 
         
        
                    Non-Postal 
                    Certain Temporary Employees 
                    Annuitant 
                    U.S. Postal Service (Category 1) 
                    Former Spouse Enrollee 
                    Federal Deposit Insurance Corporation 
                    Temporary Continuation of Coverage (TCC) 
                    U.S. Postal Service (Category 2) 
                    Tribal Employee 
         
        
                    Biweekly 
                    Every Four Weeks 
                    Semi-Monthly 
                    Monthly 
         
         
    
Location Specific Rates 
            
                
                    
                        Contract 
                        Enrollment Code 
                        Enrollment Type 
                        Option/Enrollment Type 
                        Payment Period 
                        Employee Payment 
                     
                 
                
                        
                            Aetna Direct  
                            224 
                            Non-Postal 
                            HDHP Self 
                            Monthly 
                            217.96 
                         
                        
                            Aetna Direct  
                            225 
                            Non-Postal 
                            HDHP Self & Family 
                            Monthly 
                            423.58 
                         
                        
                            Aetna Direct  
                            226 
                            Non-Postal 
                            HDHP Self Plus One 
                            Monthly 
                            483.84 
                         
                        
                            Aetna Direct  
                            N61 
                            Non-Postal 
                            CDHP Self 
                            Monthly 
                            153.16 
                         
                        
                            Aetna Direct  
                            N62 
                            Non-Postal 
                            CDHP Self & Family 
                            Monthly 
                            386.25 
                         
                        
                            Aetna Direct  
                            N63 
                            Non-Postal 
                            CDHP Self Plus One 
                            Monthly 
                            335.89 
                         
                        
                            Aetna Direct  
                            Z24 
                            Non-Postal 
                            Advantage Self 
                            Monthly 
                            115.96 
                         
                        
                            Aetna Direct  
                            Z25 
                            Non-Postal 
                            Advantage Self & Family 
                            Monthly 
                            307.29 
                         
                        
                            Aetna Direct  
                            Z26 
                            Non-Postal 
                            Advantage Self Plus One 
                            Monthly 
                            255.11 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            F51 
                            Non-Postal 
                            CDHP Self 
                            Monthly 
                            318.39 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            F52 
                            Non-Postal 
                            CDHP Self & Family 
                            Monthly 
                            706.7 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            F53 
                            Non-Postal 
                            CDHP Self Plus One 
                            Monthly 
                            779.74 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            F54 
                            Non-Postal 
                            Value Self 
                            Monthly 
                            309.14 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            F55 
                            Non-Postal 
                            Value Self & Family 
                            Monthly 
                            693.59 
                         
                        
                            Aetna HealthFund CDHP and Aetna Value Plan 
                            F56 
                            Non-Postal 
                            Value Self Plus One 
                            Monthly 
                            748.52 
                         
                        
                            QualChoice 
                            DH1 
                            Non-Postal 
                            High Self 
                            Monthly 
                            241.36 
                         
                        
                            QualChoice 
                            DH2 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            777.94 
                         
                        
                            QualChoice 
                            DH3 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            368.92 
                         
                        
                            QualChoice 
                            DH4 
                            Non-Postal 
                            Standard Self 
                            Monthly 
                            146.81 
                         
                        
                            QualChoice 
                            DH5 
                            Non-Postal 
                            Standard Self & Family 
                            Monthly 
                            382.94 
                         
                        
                            QualChoice 
                            DH6 
                            Non-Postal 
                            Standard Self Plus One 
                            Monthly 
                            285.19 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA)) 
                            LS1 
                            Non-Postal 
                            HDHP Self 
                            Monthly 
                            113.68 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA)) 
                            LS2 
                            Non-Postal 
                            HDHP Self & Family 
                            Monthly 
                            261.48 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. (A HDHP with a Health Savings Account (HSA)) 
                            LS3 
                            Non-Postal 
                            HDHP Self Plus One 
                            Monthly 
                            244.43 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. (Choice Open Access)  
                            KK1 
                            Non-Postal 
                            High Self 
                            Monthly 
                            203.03 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. (Choice Open Access)  
                            KK2 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            600.69 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. (Choice Open Access)  
                            KK3 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            442.61 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Plus Primary  
                            AS1 
                            Non-Postal 
                            High Self 
                            Monthly 
                            131.45 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Plus Primary  
                            AS2 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            310.84 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Plus Primary  
                            AS3 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            282.6 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Primary  
                            Y81 
                            Non-Postal 
                            High Self 
                            Monthly 
                            126.68 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Primary  
                            Y82 
                            Non-Postal 
                            High Self & Family 
                            Monthly 
                            299.56 
                         
                        
                            UnitedHealthcare Insurance Company, Inc. Choice Primary  
                            Y83 
                            Non-Postal 
                            High Self Plus One 
                            Monthly 
                            272.34 
                         
                 
            
         
 
				 
			 
		 
		
		
			
				
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