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Postal Premium Rates for the Federal Employees Health Benefits Program

2001 Biweekly Postal premium rates

Alliance Health PlanHigh Self 1R1 134.42 141.14 102.22 38.92 -2.44High Family 1R2 284.97 299.22 231.17 68.05 -9.18

APWU Health PlanHigh Self 471 118.55 133.37 102.22 31.15 5.66High Family 472 260.17 292.69 231.17 61.52 9.09

Blue Cross and Blue ShieldHigh Self 101 145.12 156.73 102.22 54.51 2.45High Family 102 310.32 335.14 231.17 103.97 1.39Standard Self 104 108.87 120.85 102.22 18.63 2.82Standard Family 105 242.75 276.73 231.17 45.56 10.55

GEHA Benefit PlanHigh Self 311 124.55 137.01 102.22 34.79 3.30High Family 312 268.64 298.18 231.17 67.01 6.11Standard Self 314 New Option 110.00 97.63 12.37 N/AStandard Family 315 New Option 250.00 221.88 28.12 N/A

Mail HandlersHigh Self 451 124.26 133.58 102.22 31.36 0.16High Family 452 262.10 281.76 231.17 50.59 -3.77Standard Self 454 84.33 87.70 77.83 9.87 0.38Standard Family 455 183.04 190.36 168.94 21.42 0.83

NALCHigh Self 321 125.70 135.60 102.22 33.38 0.74High Family 322 268.63 289.74 231.17 58.57 -2.32

PostmastersHigh Self 361 200.98 261.28 102.22 159.06 51.14High Family 362 433.64 563.73 231.17 332.56 106.66Standard Self 364 122.44 144.48 102.22 42.26 12.88Standard Family 365 264.86 312.53 231.17 81.36 24.24

Association Benefit PlanHigh Self 421 116.26 127.54 102.22 25.32 2.12High Family 422 267.80 293.78 231.17 62.61 2.55

Foreign ServiceHigh Self 401 111.39 121.35 102.22 19.13 0.80High Family 402 270.88 294.70 231.17 63.53 0.39

Change in Postal employee

payment

Fee-for-Service Plans (FFS)

Plan - Option -Enrollment Code

2000 Total Biweekly Premium

Total Postal Premium

USPS Pays

Postal Employee

Pays

of 27



Panama Canal AreaHigh Self 431 99.42 124.28 102.22 22.06 10.88High Family 432 215.62 269.53 231.17 38.36 14.10

Rural Carrier Benefit PlanHigh Self 381 118.85 137.40 102.22 35.18 9.39High Family 382 242.30 279.87 231.17 48.70 14.14

SAMBAHigh Self 441 124.63 143.33 102.22 41.11 9.54High Family 442 293.52 337.54 231.17 106.37 20.59

Secret ServiceHigh Self Y71 97.25 110.86 98.39 12.47 1.53High Family Y72 230.47 262.74 231.17 31.57 5.64



payment

Fee-for-Service Plans (FFS)

Plan - Option - Total Postal Premium

USPS Pays

Postal Employee

PaysEnrollment Code

of 27



AL Health Partners of AlabamaHigh Self DF1 106.50 127.39 102.22 25.17 11.73High Family DF2 272.64 326.12 231.17 94.95 30.05

AL PrimeHealth of Alabama, Inc.High Self AA1 101.87 102.63 91.08 11.55 0.09High Family AA2 249.98 262.95 231.17 31.78 -10.46

AZ Aetna U.S. HealthcareHigh Self WQ1 76.00 86.91 77.13 9.78 1.23High Family WQ2 213.86 244.61 217.09 27.52 3.46

AZ CIGNA HC of AZ-PhoenixHigh Self 161 101.30 116.81 102.22 14.59 3.19High Family 162 238.02 268.65 231.17 37.48 7.20

AZ Intergroup of Arizona, Inc.High Self A71 79.91 96.01 85.21 10.80 1.81High Family A72 215.69 259.05 229.91 29.14 4.87

AZ PacifiCare Health PlansHigh Self A31 81.59 88.93 78.93 10.00 0.82High Family A32 228.43 248.99 220.98 28.01 2.31

CA Aetna U.S. HealthcareHigh Self 2X1 80.77 85.24 75.65 9.59 0.50High Family 2X2 188.61 198.96 176.58 22.38 1.16

CA Aetna U.S. HealthcareHigh Self BU1 112.75 124.22 102.22 22.00 2.31High Family BU2 252.48 277.74 231.17 46.57 1.83

CA Blue Cross- HMOHigh Self M51 90.28 94.08 83.50 10.58 0.42High Family M52 230.35 240.02 213.02 27.00 1.09

CA Blue Shield of CA Access+High Self SJ1 81.96 90.16 80.02 10.14 0.92High Family SJ2 203.33 223.66 198.50 25.16 2.29

CA CIGNA HealthCare of CaliforniaHigh Self 9T1 90.41 97.35 86.40 10.95 0.78High Family 9T2 198.92 214.18 190.08 24.10 1.72

CA Health NetHigh Self LB1 81.70 93.01 82.55 10.46 1.27High Family LB2 193.39 220.17 195.40 24.77 3.01


payment

HMO Plan

Location - Plan - Option - Total Postal Premium

USPS Pays

Postal Employee

PaysEnrollment Code


of 27



CA Kaiser PermanenteHigh Self 591 86.67 90.30 80.14 10.16 0.41High Family 592 206.90 215.57 191.32 24.25 0.97

CA Kaiser PermanenteHigh Self 621 93.10 94.39 83.77 10.62 0.15High Family 622 215.18 218.16 193.62 24.54 0.33

CA Maxicare Southern CaliforniaHigh Self CM1 73.70 77.07 68.40 8.67 0.38High Family CM2 187.24 195.78 173.75 22.03 0.97

CA National HMO Health PlanHigh Self MN1 62.02 75.26 66.79 8.47 1.49High Family MN2 163.52 197.65 175.41 22.24 3.84

CA PacifiCare Health PlansHigh Self CY1 77.83 80.26 71.23 9.03 0.27High Family CY2 193.20 209.30 185.75 23.55 1.82

CA UHP HEALTHCAREHigh Self C41 67.80 75.22 66.76 8.46 0.83High Family C42 144.47 160.28 142.25 18.03 1.78

CA Universal CareHigh Self 6Q1 72.77 76.47 67.87 8.60 0.41High Family 6Q2 174.66 201.94 179.22 22.72 3.07

CA Western Health AdvantageHigh Self 5Z1 78.28 89.76 79.66 10.10 1.29High Family 5Z2 187.86 215.42 191.19 24.23 3.10

CO Aetna U.S. HealthcareHigh Self 6F1 78.68 103.81 92.13 11.68 2.83High Family 6F2 207.79 274.29 231.17 43.12 19.74

CO Kaiser PermanenteHigh Self 651 80.54 86.81 77.04 9.77 0.71High Family 652 205.59 221.36 196.46 24.90 1.77

CO PacifiCare of ColoradoHigh Self D61 87.53 102.41 90.89 11.52 1.67High Family D62 226.48 264.98 231.17 33.81 8.33Standard Self D64 68.43 77.29 68.59 8.70 1.00Standard Family D65 177.33 200.21 177.69 22.52 2.57

CO Rocky Mountain HMOHigh Self XJ1 101.35 136.82 102.22 34.60 23.20High Family XJ2 237.04 320.00 231.17 88.83 59.53

USPS Pays

Postal Employee

Pays


paymentEnrollment Code



HMO Plan

of 27



CT Aetna U.S. HealthcareHigh Self H11 112.63 128.28 102.22 26.06 6.49High Family H12 303.21 343.06 231.17 111.89 16.42

CT Blue Cross and Blue ShieldStandard Self 104 108.87 120.85 102.22 18.63 2.82Standard Family 105 242.75 276.73 231.17 45.56 10.55

CT ConnectiCareHigh Self TE1 95.64 98.31 87.25 11.06 0.30High Family TE2 250.45 257.45 228.49 28.96 -13.75

CT Health New EnglandHigh Self DJ1 107.07 122.27 102.22 20.05 6.04High Family DJ2 236.61 304.72 231.17 73.55 44.68

CT Physicians Health Services/CTHigh Self DP1 112.23 137.69 102.22 35.47 16.30High Family DP2 313.64 384.76 231.17 153.59 47.69

DE Aetna U.S. HealthcareHigh Self SU1 115.81 122.88 102.22 20.66 -2.09High Family SU2 295.84 315.11 231.17 83.94 -4.16Standard Self SU4 98.98 107.99 95.84 12.15 1.01Standard Family SU5 255.61 278.77 231.17 47.60 -0.27

DC Aetna U.S. HealthcareHigh Self JN1 108.20 114.25 101.40 12.85 -2.29High Family JN2 253.30 264.25 231.17 33.08 -12.48Standard Self JN4 74.69 83.16 73.80 9.36 0.96Standard Family JN5 175.20 194.60 172.71 21.89 2.18

DC CapitalCareHigh Self 2G1 103.45 119.01 102.22 16.79 5.15High Family 2G2 253.44 273.72 231.17 42.55 -3.15

DC Free State Health PlanHigh Self LD1 124.90 119.38 102.22 17.16 -14.68High Family LD2 284.79 272.14 231.17 40.97 -36.08

DC George Washington Univ HPHigh Self E51 97.46 102.44 90.92 11.52 0.56High Family E52 238.88 251.01 222.77 28.24 -2.90

DC Kaiser PermanenteHigh Self E31 94.00 105.76 93.86 11.90 1.33High Family E32 232.40 261.22 231.17 30.05 3.91

HMO Plan2000 Total Biweekly Premium


USPS Pays

Postal Employee

Pays



of 27



DC MD-IPAHigh Self JP1 104.61 108.91 96.66 12.25 0.48High Family JP2 251.12 261.41 231.17 30.24 -13.14

FL Av-Med Health PlanHigh Self EM1 89.06 115.29 102.22 13.07 3.05High Family EM2 244.92 317.13 231.17 85.96 48.78

FL Av-Med Health PlanHigh Self GP1 89.88 121.47 102.22 19.25 9.14High Family GP2 247.17 334.07 231.17 102.90 63.47

FL Av-Med Health PlanHigh Self H51 96.44 128.15 102.22 25.93 15.08High Family H52 265.18 352.40 231.17 121.23 63.79

FL Av-Med Health PlanHigh Self HW1 98.76 114.13 101.29 12.84 1.73High Family HW2 271.60 313.85 231.17 82.68 18.82

FL Av-Med Health PlanHigh Self JF1 100.05 116.81 102.22 14.59 3.33High Family JF2 275.10 321.19 231.17 90.02 22.66

FL Beacon Health PlansHigh Self 4K1 72.90 86.98 77.19 9.79 1.59High Family 4K2 205.25 245.22 217.63 27.59 4.50

FL Capital Health PlanHigh Self EA1 84.91 93.85 83.29 10.56 1.01High Family EA2 226.72 250.55 222.36 28.19 2.68

FL Foundation HealthHigh Self 5D1 88.42 93.86 83.30 10.56 0.61High Family 5D2 249.15 264.48 231.17 33.31 -8.10

FL Foundation HealthHigh Self 5E1 73.09 74.97 66.54 8.43 0.21High Family 5E2 201.01 206.19 182.99 23.20 0.59

FL HIP Health Plan of FLHigh Self 3N1 102.92 108.01 95.86 12.15 0.57High Family 3N2 284.53 298.60 231.17 67.43 -9.36

FL HIP Health Plan of FLHigh Self K71 124.96 136.73 102.22 34.51 -2.64High Family K72 345.46 378.01 231.17 146.84 2.83



USPS Pays

Postal Employee

Pays



of 27



FL Humana Medical PlanHigh Self EE1 81.06 101.46 90.05 11.41 2.29High Family EE2 202.65 253.66 225.12 28.54 5.74

FL Prudential HealthCare HMOHigh Self EC1 77.29 102.52 90.99 11.53 2.83High Family EC2 212.46 281.82 231.17 50.65 26.75

FL Prudential HealthCare HMOHigh Self EH1 90.32 95.34 84.61 10.73 0.57High Family EH2 252.81 266.80 231.17 35.63 -9.44

FL Total Health ChoiceHigh Self 4A1 78.54 90.31 80.15 10.16 1.32High Family 4A2 195.56 224.89 199.59 25.30 3.30

GA Aetna U.S. HealthcareHigh Self 2U1 94.46 96.13 85.32 10.81 0.18High Family 2U2 243.43 252.52 224.11 28.41 -7.28

GA Blue Cross and Blue ShieldStandard Self 104 108.87 120.85 102.22 18.63 2.82Standard Family 105 242.75 276.73 231.17 45.56 10.55

GA Kaiser PermanenteHigh Self F81 91.16 96.76 85.87 10.89 0.63High Family F82 231.42 245.64 218.01 27.63 1.60

GU PacifiCare Asia PacificHigh Self JK1 100.12 109.08 96.81 12.27 1.01High Family JK2 244.60 286.60 231.17 55.43 18.57Standard Self JK4 62.38 71.80 63.72 8.08 1.06Standard Family JK5 186.32 189.58 168.25 21.33 0.37

HI HMSAHigh Self 871 91.25 98.69 87.59 11.10 0.83High Family 872 203.10 219.67 194.96 24.71 1.86

HI Kaiser PermanenteHigh Self 631 119.15 119.45 102.22 17.23 -8.86High Family 632 256.17 256.81 227.92 28.89 -19.54Standard Self 634 99.82 90.85 80.63 10.22 -1.01Standard Family 635 214.61 195.34 173.36 21.98 -2.16

ID Group Health CooperativeHigh Self VR1 109.16 119.48 102.22 17.26 1.16High Family VR2 281.20 307.47 231.17 76.30 2.84



USPS Pays

Postal Employee

Pays



of 27



ID Premera HealthPlusHigh Self 8F1 99.67 118.68 102.22 16.46 5.25High Family 8F2 240.86 286.80 231.17 55.63 22.51

IL Aetna U.S. HealthcareHigh Self D41 New Area 81.23 72.09 9.14 N/AHigh Family D42 New Area 216.11 191.80 24.31 N/A

IL Aetna U.S. HealthcareHigh Self XC1 70.08 71.61 63.55 8.06 0.18High Family XC2 221.98 227.98 202.33 25.65 0.68

IL Group Health PlanHigh Self MM1 101.95 127.58 102.22 25.36 13.89High Family MM2 222.25 276.86 231.17 45.69 20.69

IL Health Alliance HMOHigh Self FX1 110.73 121.80 102.22 19.58 1.91High Family FX2 258.46 284.30 231.17 53.13 2.41

IL Health Partners of the MidwestHigh Self RN1 113.44 127.92 102.22 25.70 5.32High Family RN2 246.17 277.58 231.17 46.41 7.98

IL Humana Health Plan Inc.High Self 751 100.03 111.90 99.31 12.59 1.34High Family 752 239.90 268.36 231.17 37.19 5.03

IL John Deere Health PlanHigh Self YH1 94.86 113.76 100.96 12.80 2.13High Family YH2 256.12 307.15 231.17 75.98 27.60

IL Mercy Health Plans/PremierHigh Self 7M1 98.80 103.64 91.98 11.66 0.55High Family 7M2 229.81 241.06 213.94 27.12 1.27

IL OSF HealthPlansHigh Self 9F1 76.86 96.83 85.94 10.89 2.24High Family 9F2 202.10 254.71 226.06 28.65 5.91

IL PersonalCare's HMOHigh Self GE1 78.94 78.43 69.61 8.82 -0.06High Family GE2 203.02 201.64 178.96 22.68 -0.16

IL Prudential HealthCare HMOHigh Self VZ1 80.00 85.74 76.09 9.65 0.65High Family VZ2 202.02 216.55 192.19 24.36 1.63



USPS Pays

Postal Employee

Pays



of 27



IL UNICARE Health Plans of the Mid-WestHigh Self 171 88.90 83.03 73.69 9.34 -0.66High Family 172 230.72 215.52 191.27 24.25 -1.71

IL Union Health ServiceHigh Self 761 83.08 89.74 79.64 10.10 0.75High Family 762 206.91 222.56 197.52 25.04 1.76

IN Aetna U.S. HealthcareHigh Self 7L1 New Area 99.22 88.06 11.16 N/AHigh Family 7L2 New Area 245.12 217.54 27.58 N/A

IN Aetna U.S. HealthcareHigh Self RD1 104.29 112.56 99.90 12.66 0.93High Family RD2 258.14 284.70 231.17 53.53 3.13

IN Aetna U.S. HealthcareHigh Self XC1 70.08 71.61 63.55 8.06 0.18High Family XC2 221.98 227.98 202.33 25.65 0.68

IN Arnett HMOHigh Self G21 106.43 121.20 102.22 18.98 5.61High Family G22 276.75 315.14 231.17 83.97 14.96

IN Health Alliance HMOHigh Self FX1 110.73 121.80 102.22 19.58 1.91High Family FX2 258.46 284.30 231.17 53.13 2.41

IN Humana Health PlanHigh Self D21 107.94 115.09 102.14 12.95 -1.93High Family D22 269.83 287.73 231.17 56.56 -5.53

IN Humana Health Plan Inc.High Self 751 100.03 111.90 99.31 12.59 1.34High Family 752 239.90 268.36 231.17 37.19 5.03

IN M*PlanHigh Self IN1 103.83 120.62 102.22 18.40 6.72High Family IN2 231.16 269.25 231.17 38.08 12.07

IN Maxicare IndianaHigh Self GK1 96.34 106.60 94.61 11.99 1.15High Family GK2 226.21 250.54 222.35 28.19 2.74

IN Physicians HP of N. IndianaHigh Self DQ1 105.33 123.50 102.22 21.28 9.01High Family DQ2 237.41 278.04 231.17 46.87 17.20

Enrollment Code



HMO Plan

USPS Pays

Postal Employee

Pays


payment

of 27



IN Sagmore Advantage HMO, Inc.High Self 6Y1 New Plan 106.11 94.17 11.94 N/AHigh Family 6Y2 New Plan 249.15 221.12 28.03 N/A

IN UNICARE Health Plans of the Mid-WestHigh Self 171 88.90 83.03 73.69 9.34 -0.66High Family 172 230.72 215.52 191.27 24.25 -1.71

IN Welborn HMOHigh Self H31 93.06 117.73 102.22 15.51 5.04High Family H32 240.56 304.32 231.17 73.15 40.33

IA Coventry Health Care of IowaHigh Self SV1 83.98 83.98 74.53 9.45 0.00High Family SV2 226.79 226.79 201.28 25.51 0.00

IA Health Alliance HMOHigh Self 7X1 90.62 99.67 88.46 11.21 1.02High Family 7X2 219.78 241.76 214.56 27.20 2.47

IA John Deere Health PlanHigh Self YH1 94.86 113.76 100.96 12.80 2.13High Family YH2 256.12 307.15 231.17 75.98 27.60

IA SecureCare of IowaHigh Self 3Q1 79.70 100.53 89.22 11.31 2.34High Family 3Q2 208.79 263.35 231.17 32.18 8.69

KS Aetna U.S. HealthcareHigh Self 7K1 84.46 88.31 78.38 9.93 0.43High Family 7K2 223.74 231.68 205.62 26.06 0.89

KS Blue Cross and Blue ShieldStandard Self 104 108.87 120.85 102.22 18.63 2.82Standard Family 105 242.75 276.73 231.17 45.56 10.55

KS Coventry Health Care of KansasHigh Self 7W1 85.33 98.95 87.82 11.13 1.53High Family 7W2 217.61 252.31 223.93 28.38 3.90

KS Humana Kansas City, Inc.High Self MS1 94.16 113.43 100.67 12.76 2.17High Family MS2 225.89 272.13 231.17 40.96 15.55Standard Self MS4 88.63 87.92 78.03 9.89 -0.08Standard Family MS5 212.62 210.91 187.18 23.73 -0.19

KS Kaiser PermanenteHigh Self HA1 80.13 84.83 75.29 9.54 0.53High Family HA2 206.75 218.86 194.24 24.62 1.36

USPS Pays

Postal Employee

Pays


payment


Location - Plan - Option - Total Postal PremiumEnrollment Code

of 27



KS Preferred Plus of KansasHigh Self VA1 103.93 113.71 100.92 12.79 1.10High Family VA2 276.44 302.45 231.17 71.28 2.58

KY Advantage Care, Inc.High Self XW1 94.02 106.35 94.39 11.96 1.38High Family XW2 244.23 276.28 231.17 45.11 8.62

KY Aetna U.S. HealthcareHigh Self 7L1 New Area 99.22 88.06 11.16 N/AHigh Family 7L2 New Area 245.12 217.54 27.58 N/A

KY Aetna U.S. HealthcareHigh Self RD1 104.29 112.56 99.90 12.66 0.93High Family RD2 258.14 284.70 231.17 53.53 3.13

KY Bluegrass Family HealthHigh Self 2B1 106.95 121.43 102.22 19.21 5.32High Family 2B2 218.07 315.71 231.17 84.54 60.01

KY Bluegrass Family HealthHigh Self BD1 New Area 126.21 102.22 23.99 N/AHigh Family BD2 New Area 328.15 231.17 96.98 N/A

KY Bluegrass Family HealthHigh Self BH1 New Area 128.61 102.22 26.39 N/AHigh Family BH2 New Area 334.37 231.17 103.20 N/A

KY Humana Health PlanHigh Self D21 107.94 115.09 102.14 12.95 -1.93High Family D22 269.83 287.73 231.17 56.56 -5.53

KY United Health Care of Ohio, Inc.High Self 3U1 106.96 121.45 102.22 19.23 5.33High Family 3U2 246.01 279.33 231.17 48.16 9.89

LA Aetna U.S. HealthcareHigh Self NG1 90.93 92.30 81.92 10.38 0.15High Family NG2 236.37 261.24 231.17 30.07 1.44

LA Amcare Health PlansHigh Self ZH1 New Plan 84.06 74.60 9.46 N/AHigh Family ZH2 New Plan 218.56 193.97 24.59 N/A

LA Amcare Health PlansHigh Self ZQ1 New Plan 95.09 84.39 10.70 N/AHigh Family ZQ2 New Plan 247.22 219.41 27.81 N/A

USPS Pays

Postal Employee

Pays


payment


Location - Plan - Option - Total Postal PremiumEnrollment Code

of 27



LA Blue Cross and Blue ShieldStandard Self 104 108.87 120.85 102.22 18.63 2.82Standard Family 105 242.75 276.73 231.17 45.56 10.55

LA Maxicare LouisianaHigh Self JA1 81.53 93.88 83.32 10.56 1.39High Family JA2 189.35 218.04 193.51 24.53 3.23

MD Aetna U.S. HealthcareHigh Self JN1 108.20 114.25 101.40 12.85 -2.29High Family JN2 253.30 264.25 231.17 33.08 -12.48Standard Self JN4 74.69 83.16 73.80 9.36 0.96Standard Family JN5 175.20 194.60 172.71 21.89 2.18

MD CapitalCareHigh Self 2G1 103.45 119.01 102.22 16.79 5.15High Family 2G2 253.44 273.72 231.17 42.55 -3.15

MD Free State Health PlanHigh Self LD1 124.90 119.38 102.22 17.16 -14.68High Family LD2 284.79 272.14 231.17 40.97 -36.08

MD George Washington Univ HPHigh Self E51 97.46 102.44 90.92 11.52 0.56High Family E52 238.88 251.01 222.77 28.24 -2.90

MD Kaiser PermanenteHigh Self E31 94.00 105.76 93.86 11.90 1.33High Family E32 232.40 261.22 231.17 30.05 3.91

MD MD-IPAHigh Self JP1 104.61 108.91 96.66 12.25 0.48High Family JP2 251.12 261.41 231.17 30.24 -13.14

MA Aetna U.S. HealthcareHigh Self NE1 116.40 130.02 102.22 27.80 4.46High Family NE2 309.08 342.21 231.17 111.04 9.70

MA Blue Chip, Coord Hlth PartnersHigh Self DA1 100.26 118.77 102.22 16.55 5.27High Family DA2 256.69 304.12 231.17 72.95 24.00

MA Blue Cross and Blue ShieldStandard Self 104 108.87 120.85 102.22 18.63 2.82Standard Family 105 242.75 276.73 231.17 45.56 10.55

MA Fallon Community Health PlanHigh Self JV1 87.40 105.24 93.40 11.84 2.01High Family JV2 225.23 270.87 231.17 39.70 14.36



USPS Pays

Postal Employee

Pays



of 27



MA Health New EnglandHigh Self DJ1 107.07 122.27 102.22 20.05 6.04High Family DJ2 236.61 304.72 231.17 73.55 44.68

MI Aetna U.S. HealthcareHigh Self 8Z1 85.40 89.96 79.84 10.12 0.51High Family 8Z2 222.80 232.74 206.56 26.18 1.12

MI Blue Care Network West MIHigh Self G71 123.97 148.51 102.22 46.29 15.38High Family G72 313.02 375.34 231.17 144.17 38.89

MI Blue Care Network West MIHigh Self K51 96.08 109.56 97.23 12.33 1.52High Family K52 267.79 305.96 231.17 74.79 14.74

MI Blue Care Network West MIHigh Self KF1 81.55 116.06 102.22 13.84 4.67High Family KF2 223.79 319.20 231.17 88.03 62.85

MI Blue Care Network West MIHigh Self KN1 97.60 114.78 101.87 12.91 1.93High Family KN2 272.07 320.57 231.17 89.40 25.07

MI Blue Care Network West MIHigh Self KR1 89.51 120.73 102.22 18.51 8.44High Family KR2 257.47 348.29 231.17 117.12 67.39

MI Blue Care Network West MIHigh Self LN1 104.20 135.74 102.22 33.52 21.80High Family LN2 250.58 326.72 231.17 95.55 52.71

MI Blue Care Network West MIHigh Self LX1 65.86 78.80 69.94 8.86 1.45High Family LX2 215.81 259.01 229.87 29.14 4.86

MI Grand Valley Health PlanHigh Self RL1 92.11 104.10 92.39 11.71 1.35High Family RL2 235.45 262.39 231.17 31.22 3.51

MI Health AllianceHigh Self 521 88.28 95.62 84.86 10.76 0.83High Family 522 233.93 253.41 224.90 28.51 2.19

MI HealthPlus MIHigh Self X51 100.70 108.91 96.66 12.25 0.92High Family X52 246.88 266.98 231.17 35.81 -3.33



USPS Pays

Postal Employee

Pays



of 27



MI M-CareHigh Self EG1 87.37 95.40 84.67 10.73 0.90High Family EG2 231.60 252.80 224.36 28.44 2.39

MI OmniCareHigh Self KA1 70.77 90.78 80.57 10.21 2.25High Family KA2 176.95 227.88 202.24 25.64 5.73

MI SelectCare HMOHigh Self K61 72.80 91.30 81.03 10.27 2.08High Family K62 203.87 255.61 226.85 28.76 5.82

MI SelectCare HMOHigh Self KP1 New Area 109.54 97.22 12.32 N/AHigh Family KP2 New Area 306.74 231.17 75.57 N/A

MI The Wellness PlanHigh Self K31 78.45 93.41 82.90 10.51 1.68High Family K32 213.40 255.73 226.96 28.77 4.76

MI Total Health CareHigh Self N21 78.46 88.56 78.60 9.96 1.13High Family N22 198.99 224.13 198.92 25.21 2.82

MN APWU Health PlanHigh Self 471 118.55 133.37 102.22 31.15 5.66High Family 472 260.17 292.69 231.17 61.52 9.09

MN Blue Cross and Blue ShieldStandard Self 104 108.87 120.85 102.22 18.63 2.82Standard Family 105 242.75 276.73 231.17 45.56 10.55

MN HealthPartners ClassicHigh Self 531 110.97 130.10 102.22 27.88 9.97High Family 532 266.30 312.25 231.17 81.08 22.52Standard Self 534 94.85 109.24 96.95 12.29 1.62Standard Family 535 227.60 262.18 231.17 31.01 5.41

MN HealthPartners Health PlanHigh Self HQ1 122.30 145.23 102.22 43.01 13.77High Family HQ2 293.55 348.54 231.17 117.37 31.56

MS Prudential HealthCare HMOHigh Self UB1 77.92 76.93 68.28 8.65 -0.12High Family UB2 237.45 234.37 208.00 26.37 -3.34

MO Aetna U.S. HealthcareHigh Self 7K1 84.46 88.31 78.38 9.93 0.43High Family 7K2 223.74 231.68 205.62 26.06 0.89

MO Aetna U.S. HealthcareHigh Self D41 New Area 81.23 72.09 9.14 N/AHigh Family D42 New Area 216.11 191.80 24.31 N/A

USPS Pays

Postal Employee

Pays





of 27



MO BlueCHOICEHigh Self 9G1 111.52 111.52 98.97 12.55 -5.91High Family 9G2 241.44 241.44 214.28 27.16 -6.54

MO Group Health PlanHigh Self MM1 101.95 127.58 102.22 25.36 13.89High Family MM2 222.25 276.86 231.17 45.69 20.69

MO Health Partners of the MidwestHigh Self RN1 113.44 127.92 102.22 25.70 5.32High Family RN2 246.17 277.58 231.17 46.41 7.98

MO Humana Kansas City, Inc.High Self MS1 94.16 113.43 100.67 12.76 2.17High Family MS2 225.89 272.13 231.17 40.96 15.55Standard Self MS4 88.63 87.92 78.03 9.89 -0.08Standard Family MS5 212.62 210.91 187.18 23.73 -0.19

MO Kaiser PermanenteHigh Self HA1 80.13 84.83 75.29 9.54 0.53High Family HA2 206.75 218.86 194.24 24.62 1.36

MO Mercy Health Plans/PremierHigh Self 7M1 98.80 103.64 91.98 11.66 0.55High Family 7M2 229.81 241.06 213.94 27.12 1.27

MO Prudential HealthCare HMOHigh Self VZ1 80.00 85.74 76.09 9.65 0.65High Family VZ2 202.02 216.55 192.19 24.36 1.63

NV Aetna U.S. HealthcareHigh Self 8L1 73.42 92.52 82.11 10.41 2.15High Family 8L2 192.32 242.32 215.06 27.26 5.62

NV Health Plan of NevadaHigh Self NM1 74.60 90.60 80.41 10.19 1.80High Family NM2 190.96 231.95 205.86 26.09 4.61

NV PacifiCare Health PlansHigh Self K91 76.48 90.25 80.10 10.15 1.55High Family K92 193.78 228.66 202.94 25.72 3.92

NJ Aetna U.S. HealthcareHigh Self P31 136.79 136.48 102.22 34.26 -9.47High Family P32 355.61 352.02 231.17 120.85 -27.02Standard Self P34 101.89 120.76 102.22 18.54 7.08Standard Family P35 268.06 317.68 231.17 86.51 26.19



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Postal Employee

Pays



of 27



NJ AmeriHealth HMOHigh Self FK1 138.08 161.48 102.22 59.26 14.24High Family FK2 306.65 358.35 231.17 127.18 28.27

NJ Blue Cross and Blue ShieldStandard Self 104 108.87 120.85 102.22 18.63 2.82Standard Family 105 242.75 276.73 231.17 45.56 10.55

NJ CIGNA CoMED HealthCareHigh Self P41 132.14 161.80 102.22 59.58 20.50High Family P42 277.48 339.82 231.17 108.65 38.91

NJ GHI Health PlanHigh Self 801 104.86 117.19 102.22 14.97 3.17High Family 802 262.15 292.96 231.17 61.79 7.38

NJ Physicians Health Services of NJHigh Self 2F1 87.06 97.23 86.29 10.94 1.15High Family 2F2 208.92 233.30 207.05 26.25 2.75

NJ QualMed Plans for HealthHigh Self 271 123.29 140.20 102.22 37.98 7.75High Family 272 286.63 325.94 231.17 94.77 15.88

NM Lovelace Health PlanHigh Self Q11 95.12 109.95 97.58 12.37 1.67High Family Q12 247.30 285.86 231.17 54.69 15.13

NM Presbyterian Health PlanHigh Self P21 82.40 97.54 86.57 10.97 1.70High Family P22 214.91 254.38 225.76 28.62 4.44

NM QualMed Plans for HealthHigh Self PX1 76.91 79.77 70.80 8.97 0.32High Family PX2 203.03 210.51 186.83 23.68 0.84

NY Aetna U.S. HealthcareHigh Self JC1 98.24 106.31 94.35 11.96 0.91High Family JC2 246.92 266.07 231.17 34.90 -4.28

NY Aetna U.S. HealthcareHigh Self TG1 New Area 103.72 92.05 11.67 N/AHigh Family TG2 New Area 260.15 230.88 29.27 N/A

NY Blue ChoiceHigh Self MK1 89.59 109.35 97.05 12.30 2.22High Family MK2 224.05 273.68 231.17 42.51 17.30

NY Blue Cross and Blue ShieldStandard Self 104 108.87 120.85 102.22 18.63 2.82Standard Family 105 242.75 276.73 231.17 45.56 10.55



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of 27



NY C.D.P.H.P.High Self PW1 101.07 104.53 92.77 11.76 0.39High Family PW2 251.69 266.60 231.17 35.43 -8.52

NY C.D.P.H.P.High Self QB1 108.49 116.38 102.22 14.16 -1.27High Family QB2 273.92 298.99 231.17 67.82 1.64

NY C.D.P.H.P.High Self SG1 83.03 104.02 92.32 11.70 2.36High Family SG2 213.06 266.42 231.17 35.25 11.28

NY CIGNA HealthCare of NYHigh Self HU1 97.34 126.48 102.22 24.26 13.31High Family HU2 257.96 335.16 231.17 103.99 53.77

NY GHI Health PlanHigh Self 801 104.86 117.19 102.22 14.97 3.17High Family 802 262.15 292.96 231.17 61.79 7.38

NY GHI HMO SelectHigh Self 6V1 86.83 151.17 102.22 48.95 39.18High Family 6V2 268.13 332.22 231.17 101.05 40.66

NY GHI HMO SelectHigh Self X41 90.79 104.00 92.30 11.70 1.49High Family X42 236.83 257.21 228.27 28.94 -0.15

NY Health First New YorkHigh Self 7N1 New Plan 106.18 94.23 11.95 N/AHigh Family 7N2 New Plan 266.53 231.17 35.36 N/A

NY HealthCarePlanHigh Self Q81 74.82 81.63 72.45 9.18 0.76High Family Q82 211.96 231.30 205.28 26.02 2.17

NY HIP of Greater New YorkHigh Self 511 85.66 93.27 82.78 10.49 0.85High Family 512 256.99 279.81 231.17 48.64 -0.61

NY HMO BlueHigh Self AH1 89.93 120.98 102.22 18.76 8.64High Family AH2 228.84 307.29 231.17 76.12 50.38

NY HMO-CNYHigh Self EB1 90.50 110.83 98.36 12.47 2.29High Family EB2 240.00 293.83 231.17 62.66 30.40



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of 27



NY Independent Health AssocHigh Self QA1 69.23 76.24 67.66 8.58 0.79High Family QA2 194.41 214.03 189.95 24.08 2.21

NY MVP Health PlanHigh Self GA1 97.88 101.87 90.41 11.46 0.45High Family GA2 246.10 262.65 231.17 31.48 -6.88

NY MVP Health PlanHigh Self M91 97.56 101.42 90.01 11.41 0.43High Family M92 245.51 261.52 231.17 30.35 -7.42

NY MVP Health PlanHigh Self MX1 108.53 113.84 101.03 12.81 -2.66High Family MX2 271.32 293.55 231.17 62.38 -1.20

NY PHP/Mohawk Valley RegionHigh Self SH1 101.30 106.88 94.86 12.02 0.62High Family SH2 268.58 283.45 231.17 52.28 -8.56

NY Physicians Health Srvs of NYHigh Self PD1 100.15 121.46 102.22 19.24 7.97High Family PD2 258.90 313.98 231.17 82.81 31.65

NY Preferred CareHigh Self GV1 80.43 101.72 90.28 11.44 2.39High Family GV2 204.08 258.03 229.00 29.03 6.07

NY Prepaid Health PlanHigh Self QE1 107.13 108.51 96.30 12.21 -1.86High Family QE2 283.89 287.79 231.17 56.62 -19.53

NY Vytra Health PlansHigh Self J61 112.18 125.93 102.22 23.71 4.59High Family J62 293.48 330.00 231.17 98.83 13.09

NC Aetna U.S. HealthcareHigh Self 3G1 87.34 89.41 79.35 10.06 0.23High Family 3G2 226.69 231.51 205.47 26.04 0.54

NC Doctors Health Plan, Inc.High Self 6D1 98.43 99.04 87.90 11.14 0.07High Family 6D2 265.76 235.65 209.14 26.51 -31.51



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NC PARTNERS NHP of NCHigh Self EQ1 99.13 116.21 102.22 13.99 2.84High Family EQ2 223.04 261.49 231.17 30.32 5.23

NC QualChoice of North CarolinaHigh Self 7Q1 97.75 122.12 102.22 19.90 8.90High Family 7Q2 237.99 297.25 231.17 66.08 35.83

NC UHC of North CarolinaHigh Self XM1 112.31 127.12 102.22 24.90 5.65High Family XM2 253.47 286.03 231.17 54.86 9.13

ND Blue Cross and Blue ShieldStandard Self 104 108.87 120.85 102.22 18.63 2.82Standard Family 105 242.75 276.73 231.17 45.56 10.55

ND Heart of America HMOHigh Self RU1 94.17 105.67 93.78 11.89 1.30High Family RU2 236.34 254.36 225.74 28.62 0.02

OH Aetna U.S. HealthcareHigh Self 7D1 New Area 117.26 102.22 15.04 N/AHigh Family 7D2 New Area 289.80 231.17 58.63 N/A

OH Aetna U.S. HealthcareHigh Self 7J1 New Area 125.65 102.22 23.43 N/AHigh Family 7J2 New Area 310.55 231.17 79.38 N/A

OH Aetna U.S. HealthcareHigh Self RD1 104.29 112.56 99.90 12.66 0.93High Family RD2 258.14 284.70 231.17 53.53 3.13

OH AultCare HMOHigh Self 3A1 94.56 100.51 89.20 11.31 0.67High Family 3A2 231.94 261.32 231.17 30.15 4.06

OH CHP of OhioHigh Self MG1 87.16 99.49 88.30 11.19 1.38High Family MG2 185.47 291.19 231.17 60.02 39.15

OH Health Maintenance Plan(HMP)High Self R51 99.83 114.81 101.89 12.92 1.69High Family R52 225.61 259.45 230.26 29.19 3.81

OH Health Plan Upper OH ValleyHigh Self U41 90.80 102.24 90.74 11.50 1.29High Family U42 226.89 281.16 231.17 49.99 24.46



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OH HMO Health OhioHigh Self L41 98.97 102.21 90.71 11.50 0.37High Family L42 253.18 261.45 231.17 30.28 -15.16

OH Kaiser PermanenteHigh Self 641 93.63 100.21 88.94 11.27 0.74High Family 642 229.79 245.93 218.26 27.67 1.82

OH Paramount Health CareHigh Self U21 105.16 111.33 98.81 12.52 0.42High Family U22 278.62 295.18 231.17 64.01 -6.87

OH SummaCare Health PlanHigh Self 5W1 81.23 89.66 79.57 10.09 0.95High Family 5W2 223.40 246.55 218.81 27.74 2.61

OH SuperMed HMOHigh Self 5M1 105.10 97.49 86.52 10.97 -1.07High Family 5M2 268.84 249.36 221.31 28.05 -33.05

OH United Health Care of Ohio, Inc.High Self 3U1 106.96 121.45 102.22 19.23 5.33High Family 3U2 246.01 279.33 231.17 48.16 9.89

OH Vantage Health PlanHigh Self 6A1 93.71 104.72 92.94 11.78 1.24High Family 6A2 232.25 259.52 230.32 29.20 3.07

OK Aetna U.S. HealthcareHigh Self 8V1 71.09 88.28 78.35 9.93 1.93High Family 8V2 183.98 231.39 205.36 26.03 5.33

OK Amcare Health PlansHigh Self ZX1 New Plan 88.85 78.85 10.00 N/AHigh Family ZX2 New Plan 230.98 204.99 25.99 N/A

OK Blue Cross and Blue ShieldStandard Self 104 108.87 120.85 102.22 18.63 2.82Standard Family 105 242.75 276.73 231.17 45.56 10.55

OK Healthcare OklahomaHigh Self 6W1 76.54 78.49 69.66 8.83 0.22High Family 6W2 198.87 203.94 181.00 22.94 0.57

OK PacifiCare Health PlansHigh Self 2N1 73.48 88.87 78.87 10.00 1.73High Family 2N2 191.05 232.18 206.06 26.12 4.63



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OK Prudential HealthCare HMOHigh Self RR1 87.66 95.58 84.83 10.75 0.89High Family RR2 233.32 254.40 225.78 28.62 2.37

OK Prudential HealthCare HMOHigh Self RS1 99.01 103.95 92.26 11.69 0.55High Family RS2 219.13 230.17 204.28 25.89 1.24

OR Kaiser PermanenteHigh Self 571 108.57 122.05 102.22 19.83 4.32High Family 572 249.16 280.10 231.17 48.93 7.51Standard Self 574 88.89 107.13 95.08 12.05 2.05Standard Family 575 204.00 245.87 218.21 27.66 4.71

OR PacifiCare Health PlansHigh Self 7Z1 94.66 126.72 102.22 24.50 13.85High Family 7Z2 209.70 280.77 231.17 49.60 26.01

PN Panama Canal AreaHigh Self 431 99.42 124.28 102.22 22.06 10.88High Family 432 215.62 269.53 231.17 38.36 14.10

PA Aetna U.S. HealthcareHigh Self KL1 90.94 91.56 81.26 10.30 0.07High Family KL2 242.04 242.29 215.03 27.26 -7.04Standard Self KL4 76.41 79.51 70.57 8.94 0.34Standard Family KL5 203.80 211.53 187.73 23.80 0.87

PA Aetna U.S. HealthcareHigh Self SU1 115.81 122.88 102.22 20.66 -2.09High Family SU2 295.84 315.11 231.17 83.94 -4.16Standard Self SU4 98.98 107.99 95.84 12.15 1.01Standard Family SU5 255.61 278.77 231.17 47.60 -0.27

PA First Priority HlthHigh Self C81 96.26 140.49 102.22 38.27 27.44High Family C82 248.14 362.17 231.17 131.00 90.60

PA Free State Health PlanHigh Self LD1 124.90 119.38 102.22 17.16 -14.68High Family LD2 284.79 272.14 231.17 40.97 -36.08

PA Geisinger Health PlanHigh Self N91 65.34 91.07 80.82 10.25 2.90High Family N92 199.31 271.37 231.17 40.20 17.78



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of 27



PA HealthAmerica PennsylvaniaHigh Self 261 87.62 92.94 82.48 10.46 0.60High Family 262 227.81 241.66 214.47 27.19 1.56

PA HealthAmerica PennsylvaniaHigh Self SW1 94.55 99.27 88.10 11.17 0.53High Family SW2 245.82 258.08 229.05 29.03 -9.05

PA HealthGuardHigh Self NQ1 83.28 92.31 81.93 10.38 1.01High Family NQ2 217.01 240.73 213.65 27.08 2.67

PA Keystone Health Plan CentralHigh Self S41 108.30 115.94 102.22 13.72 -1.52High Family S42 262.29 280.60 231.17 49.43 -5.12

PA Keystone Health Plan EastHigh Self ED1 93.16 107.01 94.97 12.04 1.56High Family ED2 245.72 282.00 231.17 50.83 12.85

PA KeystoneBlueHigh Self EF1 96.38 110.84 98.37 12.47 1.63High Family EF2 285.93 328.82 231.17 97.65 19.46

PA QualMed Plans for HealthHigh Self 271 123.29 140.20 102.22 37.98 7.75High Family 272 286.63 325.94 231.17 94.77 15.88

PA QualMed Plans for HealthHigh Self 2K1 88.04 116.28 102.22 14.06 4.16High Family 2K2 213.75 282.32 231.17 51.15 27.10

PA UPMC Health PlanHigh Self 8W1 72.53 81.32 72.17 9.15 0.99High Family 8W2 214.95 207.44 184.10 23.34 -0.84

PR Triple-SHigh Self 891 85.19 91.15 80.90 10.25 0.67High Family 892 182.96 195.76 173.74 22.02 1.44

RI Aetna U.S. HealthcareHigh Self 5U1 74.52 87.07 77.27 9.80 1.42High Family 5U2 197.15 234.21 207.86 26.35 4.17

RI Blue Chip, Coord Hlth PartnersHigh Self DA1 100.26 118.77 102.22 16.55 5.27High Family DA2 256.69 304.12 231.17 72.95 24.00



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of 27



SC Doctors Health Plan, Inc.High Self 6D1 98.43 99.04 87.90 11.14 0.07High Family 6D2 265.76 235.65 209.14 26.51 -31.51

SC PARTNERS NHP of NCHigh Self EQ1 99.13 116.21 102.22 13.99 2.84High Family EQ2 223.04 261.49 231.17 30.32 5.23

TN Aetna U.S. HealthcareHigh Self 6J1 74.99 104.47 92.72 11.75 3.31High Family 6J2 208.93 291.13 231.17 59.96 36.46

TN Prudential HealthCare HMOHigh Self UA1 92.27 105.59 93.71 11.88 1.50High Family UA2 260.21 297.74 231.17 66.57 14.10

TN Prudential HealthCare HMOHigh Self UB1 77.92 76.93 68.28 8.65 -0.12High Family UB2 237.45 234.37 208.00 26.37 -3.34

TX Aetna U.S. HealthcareHigh Self 5B1 87.43 91.61 81.30 10.31 0.47High Family 5B2 245.08 266.88 231.17 35.71 -1.63

TX Aetna U.S. HealthcareHigh Self 8X1 75.33 101.97 90.50 11.47 3.00High Family 8X2 211.21 264.92 231.17 33.75 9.99

TX Amcare Health PlansHigh Self 2V1 New Plan 91.22 80.96 10.26 N/AHigh Family 2V2 New Plan 237.16 210.48 26.68 N/A

TX Amcare Health PlansHigh Self ZG1 New Plan 84.06 74.60 9.46 N/AHigh Family ZG2 New Plan 218.56 193.97 24.59 N/A

TX APWU Health PlanHigh Self 471 118.55 133.37 102.22 31.15 5.66High Family 472 260.17 292.69 231.17 61.52 9.09

TX FIRSTCAREHigh Self 6U1 92.16 117.09 102.22 14.87 4.50High Family 6U2 197.96 251.52 223.22 28.30 6.03



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TX FIRSTCAREHigh Self CK1 113.93 153.89 102.22 51.67 30.80High Family CK2 244.72 330.55 231.17 99.38 62.40

TX Humana Health Plan of TexasHigh Self UR1 81.99 94.71 84.06 10.65 1.43High Family UR2 210.74 243.44 216.05 27.39 3.68

TX Mercy Health Plans/PremierHigh Self HM1 New Area 112.96 100.25 12.71 N/AHigh Family HM2 New Area 282.42 231.17 51.25 N/A

TX HMO Blue TexasHigh Self YX1 103.45 116.78 102.22 14.56 2.92High Family YX2 226.63 283.23 231.17 52.06 26.56

TX HMO Blue TexasHigh Self YM1 New Area 100.87 89.52 11.35 N/AHigh Family YM2 New Area 246.92 219.14 27.78 N/A

TX PacifiCare Health PlansHigh Self GF1 72.57 87.79 77.91 9.88 1.72High Family GF2 188.67 229.31 203.51 25.80 4.57

TX Texas Health Choice, L. C.High Self UK1 81.20 94.90 84.22 10.68 1.55High Family UK2 207.84 242.92 215.59 27.33 3.95

UT Altius Health PlansHigh Self 9K1 116.97 132.17 102.22 29.95 6.04High Family 9K2 257.33 290.78 231.17 59.61 10.02

VT MVP Health PlanHigh Self VW1 108.09 129.15 102.22 26.93 11.90High Family VW2 272.53 333.09 231.17 101.92 37.13

VA Aetna U.S. HealthcareHigh Self JN1 108.20 114.25 101.40 12.85 -2.29High Family JN2 253.30 264.25 231.17 33.08 -12.48Standard Self JN4 74.69 83.16 73.80 9.36 0.96Standard Family JN5 175.20 194.60 172.71 21.89 2.18



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VA Aetna U.S. HealthcareHigh Self XE1 101.89 97.72 86.73 10.99 -0.47High Family XE2 255.74 253.53 225.01 28.52 -19.48Standard Self XE4 New Option 86.95 77.17 9.78 N/AStandard Family XE5 New Option 225.93 200.51 25.42 N/A

VA CapitalCareHigh Self 2G1 103.45 119.01 102.22 16.79 5.15High Family 2G2 253.44 273.72 231.17 42.55 -3.15

VA CIGNA HealthCare of VAHigh Self W21 83.82 98.59 87.50 11.09 1.66High Family W22 187.42 220.94 196.08 24.86 3.78

VA CIGNA HealthCare of VAHigh Self W31 89.78 92.13 81.77 10.36 0.26High Family W32 202.51 208.27 184.84 23.43 0.65

VA George Washington Univ HPHigh Self E51 97.46 102.44 90.92 11.52 0.56High Family E52 238.88 251.01 222.77 28.24 -2.90

VA HealthKeepersHigh Self X81 88.19 104.44 92.69 11.75 1.83High Family X82 223.96 265.21 231.17 34.04 8.84

VA Kaiser PermanenteHigh Self E31 94.00 105.76 93.86 11.90 1.33High Family E32 232.40 261.22 231.17 30.05 3.91

VA MD-IPAHigh Self JP1 104.61 108.91 96.66 12.25 0.48High Family JP2 251.12 261.41 231.17 30.24 -13.14

VA OPTIMA Health PlanHigh Self 9R1 107.17 122.18 102.22 19.96 5.85High Family 9R2 253.59 289.10 231.17 57.93 12.08

VA PARTNERS NHP of NCHigh Self EQ1 99.13 116.21 102.22 13.99 2.84High Family EQ2 223.04 261.49 231.17 30.32 5.23

VA Piedmont Community HealthcareHigh Self 2C1 89.70 111.54 98.99 12.55 2.46High Family 2C2 260.15 259.57 230.37 29.20 -23.21



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WA Aetna U.S. HealthcareHigh Self 8J1 73.17 88.62 78.65 9.97 1.74High Family 8J2 191.62 229.63 203.80 25.83 4.27

WA First Choice Health PlanHigh Self 5G1 98.89 119.06 102.22 16.84 5.71High Family 5G2 257.11 309.54 231.17 78.37 29.00

WA Group Health CooperativeHigh Self 541 107.33 115.33 102.22 13.11 -1.16High Family 542 242.16 260.22 230.95 29.27 -5.15

WA Group Health CooperativeHigh Self VR1 109.16 119.48 102.22 17.26 1.16High Family VR2 281.20 307.47 231.17 76.30 2.84

WA Kaiser PermanenteHigh Self 571 108.57 122.05 102.22 19.83 4.32High Family 572 249.16 280.10 231.17 48.93 7.51Standard Self 574 88.89 107.13 95.08 12.05 2.05Standard Family 575 204.00 245.87 218.21 27.66 4.71

WA Kitsap Physicians ServiceHigh Self VT1 150.11 165.12 102.22 62.90 5.85High Family VT2 321.08 353.18 231.17 122.01 8.67Standard Self VT4 103.43 124.11 102.22 21.89 10.25Standard Family VT5 226.01 271.21 231.17 40.04 14.61

WA PacifiCare Health PlansHigh Self 7Z1 94.66 126.72 102.22 24.50 13.85High Family 7Z2 209.70 280.77 231.17 49.60 26.01

WA PacifiCare Health PlansHigh Self WB1 79.19 94.21 83.61 10.60 1.69High Family WB2 205.07 246.01 218.33 27.68 4.61

WA Premera HealthPlusHigh Self 8F1 99.67 118.68 102.22 16.46 5.25High Family 8F2 240.86 286.80 231.17 55.63 22.51

WV Carelink Health PlansHigh Self 4C1 81.87 108.28 96.10 12.18 2.97High Family 4C2 241.19 319.07 231.17 87.90 54.45

WV Free State Health PlanHigh Self LD1 124.90 119.38 102.22 17.16 -14.68High Family LD2 284.79 272.14 231.17 40.97 -36.08



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WV Health Plan Upper OH ValleyHigh Self U41 90.80 102.24 90.74 11.50 1.29High Family U42 226.89 281.16 231.17 49.99 24.46

WI Compcare Health ServicesHigh Self 691 104.29 135.56 102.22 33.34 21.61High Family 692 269.94 350.86 231.17 119.69 57.49

WI Compcare Health ServicesHigh Self 6X1 107.91 128.66 102.22 26.44 11.59High Family 6X2 279.39 321.72 231.17 90.55 18.90

WI Dean Health PlanHigh Self WD1 96.02 110.32 97.91 12.41 1.61High Family WD2 259.26 297.89 231.17 66.72 15.20

WI Family Health PlanHigh Self WH1 113.40 122.87 102.22 20.65 0.31High Family WH2 293.86 318.38 231.17 87.21 1.09

WI Group Health CoopHigh Self WJ1 86.12 99.50 88.31 11.19 1.50High Family WJ2 229.91 265.58 231.17 34.41 8.55

WI Group Hlth Coop/Eau ClaireHigh Self WT1 114.49 135.22 102.22 33.00 11.57High Family WT2 295.46 348.94 231.17 117.77 30.05

WI HealthPartners ClassicHigh Self 531 110.97 130.10 102.22 27.88 9.97High Family 532 266.30 312.25 231.17 81.08 22.52Standard Self 534 94.85 109.24 96.95 12.29 1.62Standard Family 535 227.60 262.18 231.17 31.01 5.41

WI HealthPartners Health PlanHigh Self HQ1 122.30 145.23 102.22 43.01 13.77High Family HQ2 293.55 348.54 231.17 117.37 31.56

WI Unity Health PlansHigh Self W41 99.57 109.01 96.75 12.26 1.06High Family W42 254.04 288.88 231.17 57.71 11.41

WI Valley Health PlanHigh Self VH1 116.47 150.12 102.22 47.90 24.49High Family VH2 298.15 384.31 231.17 153.14 62.73



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