U.S. Postal Rates - opm.gov · Postal Premium Rates for the Federal Employees Health Benefits...

Alabama Aetna HealthFund CDHP and Aetna Value PlanCDHP Self F51 330.91 371.98 235.62 136.36 36.35 330.91 371.98 241.98 130.00 33.07CDHP Self & Family F52 754.52 848.15 536.07 312.08 83.84 754.52 848.15 550.56 297.59 76.36CDHP Self Plus One F53 747.04 839.75 504.64 335.11 83.69 747.04 839.75 518.28 321.47 76.65Value Self F54 258.16 269.07 207.86 61.21 5.06 258.16 269.07 213.24 55.83 2.26Value Self & Family F55 591.16 616.15 475.98 140.17 11.59 591.16 616.15 488.30 127.85 5.18Value Self Plus One F56 579.56 604.06 466.64 137.42 11.37 579.56 604.06 478.72 125.34 5.08

Alabama Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Alabama Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Alabama UnitedHealthcare Insurance Company, Inc. Choice HMOHigh Self KK1 257.80 274.77 212.26 62.51 6.44 257.80 274.77 217.76 57.01 3.52High Self & Family KK2 644.49 686.91 530.64 156.27 16.09 644.49 686.91 544.38 142.53 8.80High Self Plus One KK3 554.26 590.74 456.35 134.39 13.84 554.26 590.74 468.16 122.58 7.57

Alabama UnitedHealthcare Insurance Company, Inc. Choice Plus HDHPHDHP Self LS1 212.83 202.27 156.25 46.02 -0.27 212.83 202.27 160.30 41.97 -2.19HDHP Self & Family LS2 532.06 505.67 390.63 115.04 -0.68 532.06 505.67 400.74 104.93 -5.47HDHP Self Plus One LS3 457.58 434.88 335.94 98.94 -0.58 457.58 434.88 344.64 90.24 -4.71

Postal Premium Rates for the Federal Employees Health Benefits ProgramHealth Management Organizations (HMO) 2017 Total

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Plan - Option - Enrollment Code Total Premium

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Alaska Aetna HealthFund CDHP and Aetna Value PlanCDHP Self JS1 445.61 481.36 235.62 245.74 31.03 445.61 481.36 241.98 239.38 27.75CDHP Self & Family JS2 1,015.78 1,097.29 536.07 561.22 71.72 1,015.78 1,097.29 550.56 546.73 64.24CDHP Self Plus One JS3 1,005.73 1,086.44 504.64 581.80 71.69 1,005.73 1,086.44 518.28 568.16 64.65Value Self JS4 322.40 352.77 235.62 117.15 25.65 322.40 352.77 241.98 110.79 22.37Value Self & Family JS5 736.01 805.33 536.07 269.26 59.53 736.01 805.33 550.56 254.77 52.05Value Self Plus One JS6 728.72 797.36 504.64 292.72 59.62 728.72 797.36 518.28 279.08 52.58

Alaska Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Alaska Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Arizona Aetna HealthFund CDHP and Aetna Value PlanCDHP Self G51 322.56 346.28 235.62 110.66 19.00 322.56 346.28 241.98 104.30 15.72CDHP Self & Family G52 735.73 789.85 536.07 253.78 44.33 735.73 789.85 550.56 239.29 36.85CDHP Self Plus One G53 728.45 782.04 504.64 277.40 44.57 728.45 782.04 518.28 263.76 37.53Value Self G54 246.85 253.66 195.95 57.71 4.02 246.85 253.66 201.03 52.63 1.41Value Self & Family G55 565.39 580.95 448.78 132.17 9.20 565.39 580.95 460.40 120.55 3.23Value Self Plus One G56 554.30 569.57 439.99 129.58 9.02 554.30 569.57 451.38 118.19 3.17

Arizona Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12


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HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Arizona Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Arizona Aetna Open AccessHigh Self WQ1 432.90 522.74 235.62 287.12 85.12 432.90 522.74 241.98 280.76 81.84High Self & Family WQ2 1,051.08 1,269.17 536.07 733.10 208.30 1,051.08 1,269.17 550.56 718.61 200.82High Self Plus One WQ3 1,040.67 1,256.60 504.64 751.96 206.91 1,040.67 1,256.60 518.28 738.32 199.87

Arizona Health Net of Arizona, Inc.Standard Self A74 344.24 360.11 235.62 124.49 11.15 344.24 360.11 241.98 118.13 7.87Standard Self & Family A75 871.61 911.81 536.07 375.74 30.41 871.61 911.81 550.56 361.25 22.93Standard Self Plus One A76 871.61 911.81 504.64 407.17 31.18 871.61 911.81 518.28 393.53 24.14

Arizona Humana CoverageFirst/Value PlanCDHP Self R61 New Plan 294.43 227.45 66.98 New Plan New Plan 294.43 233.34 61.09 New PlanCDHP Self & Family R62 New Plan 662.48 511.77 150.71 New Plan New Plan 662.48 525.02 137.46 New PlanCDHP Self Plus One R63 New Plan 633.04 489.02 144.02 New Plan New Plan 633.04 501.68 131.36 New PlanValue Self R64 New Plan 239.86 185.29 54.57 New Plan New Plan 239.86 190.09 49.77 New PlanValue Self & Family R65 New Plan 539.68 416.90 122.78 New Plan New Plan 539.68 427.70 111.98 New PlanValue Self Plus One R66 New Plan 515.68 398.36 117.32 New Plan New Plan 515.68 408.68 107.00 New Plan

Arizona Humana CoverageFirst/Value PlanCDHP Self R91 New Plan 285.64 220.66 64.98 New Plan New Plan 285.64 226.37 59.27 New PlanCDHP Self & Family R92 New Plan 642.68 496.47 146.21 New Plan New Plan 642.68 509.32 133.36 New PlanCDHP Self Plus One R93 New Plan 614.12 474.41 139.71 New Plan New Plan 614.12 486.69 127.43 New PlanValue Self R94 New Plan 227.43 175.69 51.74 New Plan New Plan 227.43 180.24 47.19 New Plan


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Value Self & Family R95 New Plan 511.71 395.30 116.41 New Plan New Plan 511.71 405.53 106.18 New PlanValue Self Plus One R96 New Plan 488.97 377.73 111.24 New Plan New Plan 488.97 387.51 101.46 New Plan

Arizona Humana Health Plan, Inc.High Self BF1 417.84 522.31 235.62 286.69 99.75 417.84 522.31 241.98 280.33 96.47High Self & Family BF2 940.14 1,175.19 536.07 639.12 225.26 940.14 1,175.19 550.56 624.63 217.78High Self Plus One BF3 898.36 1,122.96 504.64 618.32 215.58 898.36 1,122.96 518.28 604.68 208.54Standard Self BF4 318.70 366.52 235.62 130.90 43.10 318.70 366.52 241.98 124.54 39.82Standard Self & Family BF5 717.08 824.67 536.07 288.60 97.80 717.08 824.67 550.56 274.11 90.32Standard Self Plus One BF6 685.20 788.01 504.64 283.37 93.79 685.20 788.01 518.28 269.73 86.75

Arizona Humana Health Plan, Inc.High Self C71 340.72 378.22 235.62 142.60 32.78 340.72 378.22 241.98 136.24 29.50High Self & Family C72 766.64 850.99 536.07 314.92 74.56 766.64 850.99 550.56 300.43 67.08High Self Plus One C73 732.56 813.17 504.64 308.53 71.59 732.56 813.17 518.28 294.89 64.55Standard Self C74 300.40 312.43 235.62 76.81 7.31 300.40 312.43 241.98 70.45 4.03Standard Self & Family C75 675.91 702.95 536.07 166.88 17.25 675.91 702.95 550.56 152.39 9.77Standard Self Plus One C76 645.87 671.70 504.64 167.06 16.81 645.87 671.70 518.28 153.42 9.77

Arizona UnitedHealthcare Insurance Company, Inc. Choice HMOHigh Self KT1 257.12 281.85 217.73 64.12 8.20 257.12 281.85 223.37 58.48 5.13High Self & Family KT2 642.80 704.63 536.07 168.56 28.75 642.80 704.63 550.56 154.07 20.69High Self Plus One KT3 552.80 605.98 468.12 137.86 17.63 552.80 605.98 480.24 125.74 11.03

Arizona UnitedHealthcare Insurance Company, Inc. Choice Plus HDHPHDHP Self LU1 227.24 222.88 172.17 50.71 1.29 227.24 222.88 176.63 46.25 -0.90HDHP Self & Family LU2 568.10 557.19 430.43 126.76 3.20 568.10 557.19 441.57 115.62 -2.26HDHP Self Plus One LU3 488.57 479.19 370.17 109.02 2.76 488.57 479.19 379.76 99.43 -1.95


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Arkansas Aetna HealthFund CDHP and Aetna Value PlanCDHP Self F51 330.91 371.98 235.62 136.36 36.35 330.91 371.98 241.98 130.00 33.07CDHP Self & Family F52 754.52 848.15 536.07 312.08 83.84 754.52 848.15 550.56 297.59 76.36CDHP Self Plus One F53 747.04 839.75 504.64 335.11 83.69 747.04 839.75 518.28 321.47 76.65Value Self F54 258.16 269.07 207.86 61.21 5.06 258.16 269.07 213.24 55.83 2.26Value Self & Family F55 591.16 616.15 475.98 140.17 11.59 591.16 616.15 488.30 127.85 5.18Value Self Plus One F56 579.56 604.06 466.64 137.42 11.37 579.56 604.06 478.72 125.34 5.08

Arkansas Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Arkansas Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Arkansas QualChoiceHigh Self DH1 329.12 338.58 235.62 102.96 4.74 329.12 338.58 241.98 96.60 1.46High Self & Family DH2 858.44 883.13 536.07 347.06 14.90 858.44 883.13 550.56 332.57 7.42High Self Plus One DH3 639.32 657.71 504.64 153.07 9.37 639.32 657.71 518.28 139.43 2.33Standard Self DH4 256.70 264.05 203.98 60.07 4.24 256.70 264.05 209.26 54.79 1.52Standard Self & Family DH5 669.54 688.71 532.03 156.68 11.06 669.54 688.71 545.80 142.91 3.98Standard Self Plus One DH6 498.64 512.92 396.23 116.69 8.24 498.64 512.92 406.49 106.43 2.96


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Arkansas UnitedHealthcare Insurance Company, Inc. Choice HMOHigh Self KK1 257.80 274.77 212.26 62.51 6.44 257.80 274.77 217.76 57.01 3.52High Self & Family KK2 644.49 686.91 530.64 156.27 16.09 644.49 686.91 544.38 142.53 8.80High Self Plus One KK3 554.26 590.74 456.35 134.39 13.84 554.26 590.74 468.16 122.58 7.57

Arkansas UnitedHealthcare Insurance Company, Inc. Choice Plus HDHPHDHP Self LS1 212.83 202.27 156.25 46.02 -0.27 212.83 202.27 160.30 41.97 -2.19HDHP Self & Family LS2 532.06 505.67 390.63 115.04 -0.68 532.06 505.67 400.74 104.93 -5.47HDHP Self Plus One LS3 457.58 434.88 335.94 98.94 -0.58 457.58 434.88 344.64 90.24 -4.71

California Aetna HealthFund CDHP and Aetna Value PlanCDHP Self JS1 445.61 481.36 235.62 245.74 31.03 445.61 481.36 241.98 239.38 27.75CDHP Self & Family JS2 1,015.78 1,097.29 536.07 561.22 71.72 1,015.78 1,097.29 550.56 546.73 64.24CDHP Self Plus One JS3 1,005.73 1,086.44 504.64 581.80 71.69 1,005.73 1,086.44 518.28 568.16 64.65Value Self JS4 322.40 352.77 235.62 117.15 25.65 322.40 352.77 241.98 110.79 22.37Value Self & Family JS5 736.01 805.33 536.07 269.26 59.53 736.01 805.33 550.56 254.77 52.05Value Self Plus One JS6 728.72 797.36 504.64 292.72 59.62 728.72 797.36 518.28 279.08 52.58

California Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

California Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

California Aetna Open AccessHigh Self 2X1 313.47 346.80 235.62 111.18 28.61 313.47 346.80 241.98 104.82 25.33


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High Self & Family 2X2 735.90 814.15 536.07 278.08 68.46 735.90 814.15 550.56 263.59 60.98High Self Plus One 2X3 721.48 798.19 504.64 293.55 67.69 721.48 798.19 518.28 279.91 60.65

California Anthem Blue Cross Select HMO of CAHigh Self B31 348.90 359.25 235.62 123.63 5.63 348.90 359.25 241.98 117.27 2.35High Self & Family B32 755.36 786.75 536.07 250.68 21.60 755.36 786.75 550.56 236.19 14.12High Self Plus One B33 708.26 736.46 504.64 231.82 19.18 708.26 736.46 518.28 218.18 12.14

California Blue Shield of CA Access+HMOHigh Self SI1 342.54 342.54 235.62 106.92 -4.72 342.54 342.54 241.98 100.56 -8.00High Self & Family SI2 787.86 787.86 536.07 251.79 -9.79 787.86 787.86 550.56 237.30 -17.27High Self Plus One SI3 753.60 753.60 504.64 248.96 -9.02 753.60 753.60 518.28 235.32 -16.06

California Health Net of CaliforniaHigh Self LB1 626.64 638.57 235.62 402.95 7.21 626.64 638.57 241.98 396.59 3.93High Self & Family LB2 1,503.92 1,532.56 536.07 996.49 18.85 1,503.92 1,532.56 550.56 982.00 11.37High Self Plus One LB3 1,378.60 1,404.86 504.64 900.22 17.24 1,378.60 1,404.86 518.28 886.58 10.20Standard Self LB4 595.12 602.96 235.62 367.34 3.12 595.12 602.96 241.98 360.98 -0.16Standard Self & Family LB5 1,428.28 1,447.11 536.07 911.04 9.04 1,428.28 1,447.11 550.56 896.55 1.56Standard Self Plus One LB6 1,309.27 1,326.52 504.64 821.88 8.23 1,309.27 1,326.52 518.28 808.24 1.19

California Health Net of CaliforniaHigh Self LP1 380.01 421.64 235.62 186.02 36.91 380.01 421.64 241.98 179.66 33.63High Self & Family LP2 912.01 1,011.92 536.07 475.85 90.12 912.01 1,011.92 550.56 461.36 82.64High Self Plus One LP3 836.00 927.60 504.64 422.96 82.58 836.00 927.60 518.28 409.32 75.54Standard Self LP4 361.71 404.10 235.62 168.48 37.67 361.71 404.10 241.98 162.12 34.39Standard Self & Family LP5 868.11 969.86 536.07 433.79 91.96 868.11 969.86 550.56 419.30 84.48Standard Self Plus One LP6 795.77 889.03 504.64 384.39 84.24 795.77 889.03 518.28 370.75 77.20

California Health Net of CaliforniaBasic Self P61 141.38 141.42 109.25 32.17 1.42 141.38 141.42 112.08 29.34 0.00


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Basic Self & Family P62 339.31 339.41 262.19 77.22 3.42 339.31 339.41 268.98 70.43 0.02Basic Self Plus One P63 311.03 311.14 240.36 70.78 3.13 311.03 311.14 246.58 64.56 0.02

California Health Net of CaliforniaBasic Self T41 New Plan 363.31 235.62 127.69 New Plan New Plan 363.31 241.98 121.33 New PlanBasic Self & Family T42 New Plan 871.95 536.07 335.88 New Plan New Plan 871.95 550.56 321.39 New PlanBasic Self Plus One T43 New Plan 799.28 504.64 294.64 New Plan New Plan 799.28 518.28 281.00 New Plan

California Kaiser Foundation Health Plan of CaliforniaHigh Self 591 396.45 424.84 235.62 189.22 23.67 396.45 424.84 241.98 182.86 20.39High Self & Family 592 946.36 1,014.15 536.07 478.08 58.00 946.36 1,014.15 550.56 463.59 50.52High Self Plus One 593 946.36 1,014.15 504.64 509.51 58.77 946.36 1,014.15 518.28 495.87 51.73Standard Self 594 331.77 350.45 235.62 114.83 13.96 331.77 350.45 241.98 108.47 10.68Standard Self & Family 595 776.36 820.06 536.07 283.99 33.91 776.36 820.06 550.56 269.50 26.43Standard Self Plus One 596 776.36 820.06 504.64 315.42 34.68 776.36 820.06 518.28 301.78 27.64

California Kaiser Foundation Health Plan of CaliforniaHigh Self 621 291.35 303.76 234.65 69.11 5.74 291.35 303.76 240.73 63.03 2.57High Self & Family 622 673.38 702.07 536.07 166.00 18.90 673.38 702.07 550.56 151.51 11.42High Self Plus One 623 673.38 702.07 504.64 197.43 19.67 673.38 702.07 518.28 183.79 12.63Standard Self 624 187.37 191.90 148.24 43.66 2.91 187.37 191.90 152.08 39.82 0.94Standard Self & Family 625 433.04 443.55 342.64 100.91 6.72 433.04 443.55 351.51 92.04 2.18Standard Self Plus One 626 433.04 443.55 342.64 100.91 6.72 433.04 443.55 351.51 92.04 2.18

California Kaiser Foundation Health Plan of CaliforniaBasic Self KC1 295.73 297.87 230.10 67.77 2.94 295.73 297.87 236.06 61.81 0.06Basic Self & Family KC2 692.01 697.02 536.07 160.95 -4.78 692.01 697.02 550.56 146.46 -12.26Basic Self Plus One KC3 692.01 697.02 504.64 192.38 -4.01 692.01 697.02 518.28 178.74 -11.05

California Kaiser Foundation Health Plan of California


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High Self NZ1 312.07 329.45 235.62 93.83 12.66 312.07 329.45 241.98 87.47 9.38High Self & Family NZ2 721.26 761.44 536.07 225.37 30.39 721.26 761.44 550.56 210.88 22.91High Self Plus One NZ3 721.26 761.44 504.64 256.80 31.16 721.26 761.44 518.28 243.16 24.12Standard Self NZ4 216.84 236.14 182.42 53.72 6.56 216.84 236.14 187.14 49.00 4.01Standard Self & Family NZ5 501.14 545.77 421.61 124.16 15.16 501.14 545.77 432.52 113.25 9.26Standard Self Plus One NZ6 501.14 545.77 421.61 124.16 15.16 501.14 545.77 432.52 113.25 9.26

California UnitedHealthcare of CaliforniaHigh Self CY1 303.72 329.60 235.62 93.98 21.16 303.72 329.60 241.98 87.62 17.88High Self & Family CY2 851.59 924.15 536.07 388.08 62.77 851.59 924.15 550.56 373.59 55.29High Self Plus One CY3 593.14 643.67 497.24 146.43 17.42 593.14 643.67 510.11 133.56 10.48Standard Self CY4 282.96 306.47 235.62 70.85 9.31 282.96 306.47 241.98 64.49 5.78Standard Self & Family CY5 793.44 859.34 536.07 323.27 56.11 793.44 859.34 550.56 308.78 48.63Standard Self Plus One CY6 552.64 598.53 462.36 136.17 15.97 552.64 598.53 474.34 124.19 9.52

Colorado Aetna HealthFund CDHP and Aetna Value PlanCDHP Self G51 322.56 346.28 235.62 110.66 19.00 322.56 346.28 241.98 104.30 15.72CDHP Self & Family G52 735.73 789.85 536.07 253.78 44.33 735.73 789.85 550.56 239.29 36.85CDHP Self Plus One G53 728.45 782.04 504.64 277.40 44.57 728.45 782.04 518.28 263.76 37.53Value Self G54 246.85 253.66 195.95 57.71 4.02 246.85 253.66 201.03 52.63 1.41Value Self & Family G55 565.39 580.95 448.78 132.17 9.20 565.39 580.95 460.40 120.55 3.23Value Self Plus One G56 554.30 569.57 439.99 129.58 9.02 554.30 569.57 451.38 118.19 3.17

Colorado Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90


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Colorado Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Colorado Humana Health Plan, Inc.High Self NR1 247.10 294.06 227.16 66.90 13.16 247.10 294.06 233.04 61.02 9.75High Self & Family NR2 555.97 661.63 511.11 150.52 29.60 555.97 661.63 524.34 137.29 21.93High Self Plus One NR3 531.26 632.22 488.39 143.83 28.28 531.26 632.22 501.03 131.19 20.95Standard Self NR4 226.92 231.21 178.61 52.60 3.24 226.92 231.21 183.23 47.98 0.89Standard Self & Family NR5 510.58 520.23 401.88 118.35 7.30 510.58 520.23 412.28 107.95 2.00Standard Self Plus One NR6 487.88 497.11 384.02 113.09 6.98 487.88 497.11 393.96 103.15 1.91

Colorado Humana Health Plan, Inc.High Self NT1 262.36 288.61 222.95 65.66 8.60 262.36 288.61 228.72 59.89 5.45High Self & Family NT2 590.32 649.37 501.64 147.73 19.34 590.32 649.37 514.63 134.74 12.25High Self Plus One NT3 564.09 620.51 479.34 141.17 18.48 564.09 620.51 491.75 128.76 11.71Standard Self NT4 238.23 243.00 187.72 55.28 3.46 238.23 243.00 192.58 50.42 0.99Standard Self & Family NT5 536.03 546.75 422.36 124.39 7.80 536.03 546.75 433.30 113.45 2.22Standard Self Plus One NT6 512.20 522.44 403.58 118.86 7.46 512.20 522.44 414.03 108.41 2.13

Colorado Humana Health Plan, Inc.Basic Self R21 New Plan 217.57 168.07 49.50 New Plan New Plan 217.57 172.42 45.15 New PlanBasic Self & Family R22 New Plan 489.53 378.16 111.37 New Plan New Plan 489.53 387.95 101.58 New Plan


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Basic Self Plus One R23 New Plan 467.77 361.35 106.42 New Plan New Plan 467.77 370.71 97.06 New PlanColorado Humana Health Plan, Inc.

Basic Self RZ1 New Plan 228.65 176.63 52.02 New Plan New Plan 228.65 181.21 47.44 New PlanBasic Self & Family RZ2 New Plan 514.48 397.44 117.04 New Plan New Plan 514.48 407.73 106.75 New PlanBasic Self Plus One RZ3 New Plan 491.61 379.77 111.84 New Plan New Plan 491.61 389.60 102.01 New Plan

Colorado Kaiser Foundation Health Plan of ColoradoHigh Self 651 317.47 325.03 235.62 89.41 2.84 317.47 325.03 241.98 83.05 -0.44High Self & Family 652 717.51 734.56 536.07 198.49 7.26 717.51 734.56 550.56 184.00 -0.22High Self Plus One 653 717.51 734.56 504.64 229.92 8.03 717.51 734.56 518.28 216.28 0.99Standard Self 654 218.31 235.89 182.23 53.66 6.18 218.31 235.89 186.94 48.95 3.65Standard Self & Family 655 493.38 533.12 411.84 121.28 13.97 493.38 533.12 422.50 110.62 8.24Standard Self Plus One 656 493.38 533.12 411.84 121.28 13.97 493.38 533.12 422.50 110.62 8.24

Colorado Kaiser Foundation Health Plan of ColoradoBasic Self N41 169.45 185.30 143.14 42.16 5.30 169.45 185.30 146.85 38.45 3.29Basic Self & Family N42 382.95 418.78 323.51 95.27 11.98 382.95 418.78 331.88 86.90 7.44Basic Self Plus One N43 382.95 418.78 323.51 95.27 11.98 382.95 418.78 331.88 86.90 7.44

Colorado UnitedHealthcare Insurance Company, Inc. Choice HMOHigh Self KT1 257.12 281.85 217.73 64.12 8.20 257.12 281.85 223.37 58.48 5.13High Self & Family KT2 642.80 704.63 536.07 168.56 28.75 642.80 704.63 550.56 154.07 20.69High Self Plus One KT3 552.80 605.98 468.12 137.86 17.63 552.80 605.98 480.24 125.74 11.03

Colorado UnitedHealthcare Insurance Company, Inc. Choice Plus HDHP


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HDHP Self LU1 227.24 222.88 172.17 50.71 1.29 227.24 222.88 176.63 46.25 -0.90HDHP Self & Family LU2 568.10 557.19 430.43 126.76 3.20 568.10 557.19 441.57 115.62 -2.26HDHP Self Plus One LU3 488.57 479.19 370.17 109.02 2.76 488.57 479.19 379.76 99.43 -1.95

Connecticut Aetna HealthFund CDHP and Aetna Value PlanCDHP Self EP1 374.41 414.74 235.62 179.12 35.61 374.41 414.74 241.98 172.76 32.33CDHP Self & Family EP2 853.86 945.84 536.07 409.77 82.19 853.86 945.84 550.56 395.28 74.71CDHP Self Plus One EP3 845.41 936.48 504.64 431.84 82.05 845.41 936.48 518.28 418.20 75.01Value Self EP4 250.29 260.95 201.58 59.37 4.93 250.29 260.95 206.80 54.15 2.21Value Self & Family EP5 573.16 597.56 461.62 135.94 11.28 573.16 597.56 473.57 123.99 5.06Value Self Plus One EP6 561.92 585.84 452.56 133.28 11.06 561.92 585.84 464.28 121.56 4.96

Connecticut Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Connecticut Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Delaware Aetna HealthFund CDHP and Aetna Value PlanCDHP Self EP1 374.41 414.74 235.62 179.12 35.61 374.41 414.74 241.98 172.76 32.33CDHP Self & Family EP2 853.86 945.84 536.07 409.77 82.19 853.86 945.84 550.56 395.28 74.71CDHP Self Plus One EP3 845.41 936.48 504.64 431.84 82.05 845.41 936.48 518.28 418.20 75.01Value Self EP4 250.29 260.95 201.58 59.37 4.93 250.29 260.95 206.80 54.15 2.21Value Self & Family EP5 573.16 597.56 461.62 135.94 11.28 573.16 597.56 473.57 123.99 5.06Value Self Plus One EP6 561.92 585.84 452.56 133.28 11.06 561.92 585.84 464.28 121.56 4.96


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Delaware Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Delaware Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Delaware Aetna Open AccessHigh Self P31 655.24 725.73 235.62 490.11 65.77 655.24 725.73 241.98 483.75 62.49High Self & Family P32 1,588.64 1,759.54 536.07 1,223.47 161.11 1,588.64 1,759.54 550.56 1,208.98 153.63High Self Plus One P33 1,572.91 1,742.11 504.64 1,237.47 160.18 1,572.91 1,742.11 518.28 1,223.83 153.14Basic Self P34 549.01 622.19 235.62 386.57 68.46 549.01 622.19 241.98 380.21 65.18Basic Self & Family P35 1,274.25 1,444.10 536.07 908.03 160.06 1,274.25 1,444.10 550.56 893.54 152.58Basic Self Plus One P36 1,261.63 1,429.80 504.64 925.16 159.15 1,261.63 1,429.80 518.28 911.52 152.11

District of Columbia Aetna HealthFund CDHP and Aetna Value PlanCDHP Self F51 330.91 371.98 235.62 136.36 36.35 330.91 371.98 241.98 130.00 33.07CDHP Self & Family F52 754.52 848.15 536.07 312.08 83.84 754.52 848.15 550.56 297.59 76.36CDHP Self Plus One F53 747.04 839.75 504.64 335.11 83.69 747.04 839.75 518.28 321.47 76.65Value Self F54 258.16 269.07 207.86 61.21 5.06 258.16 269.07 213.24 55.83 2.26Value Self & Family F55 591.16 616.15 475.98 140.17 11.59 591.16 616.15 488.30 127.85 5.18Value Self Plus One F56 579.56 604.06 466.64 137.42 11.37 579.56 604.06 478.72 125.34 5.08


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District of Columbia Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

District of Columbia Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

District of Columbia Aetna Open AccessHigh Self JN1 469.08 509.12 235.62 273.50 35.32 469.08 509.12 241.98 267.14 32.04High Self & Family JN2 1,054.58 1,144.59 536.07 608.52 80.22 1,054.58 1,144.59 550.56 594.03 72.74High Self Plus One JN3 1,044.14 1,133.25 504.64 628.61 80.09 1,044.14 1,133.25 518.28 614.97 73.05Basic Self JN4 294.16 305.93 235.62 70.31 6.33 294.16 305.93 241.98 63.95 2.91Basic Self & Family JN5 664.55 700.13 536.07 164.06 19.52 664.55 700.13 550.56 149.57 11.68Basic Self Plus One JN6 634.15 642.92 496.66 146.26 7.73 634.15 642.92 509.51 133.41 1.48

District of Columbia CareFirst BlueChoiceHigh Self 2G1 358.77 394.65 235.62 159.03 31.16 358.77 394.65 241.98 152.67 27.88High Self & Family 2G2 852.43 937.66 536.07 401.59 75.44 852.43 937.66 550.56 387.10 67.96High Self Plus One 2G3 717.54 789.29 504.64 284.65 62.73 717.54 789.29 518.28 271.01 55.69Standard Self 2G4 304.89 320.13 235.62 84.51 10.52 304.89 320.13 241.98 78.15 7.24Standard Self & Family 2G5 724.41 760.64 536.07 224.57 26.44 724.41 760.64 550.56 210.08 18.96


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Standard Self Plus One 2G6 609.78 640.27 494.61 145.66 13.03 609.78 640.27 507.41 132.86 6.33District of Columbia CareFirst BlueChoice

HDHP Self B61 281.41 281.41 217.39 64.02 2.81 281.41 281.41 223.02 58.39 0.00HDHP Self & Family B62 668.62 668.62 516.51 152.11 6.69 668.62 668.62 529.88 138.74 0.00HDHP Self Plus One B63 562.82 562.82 434.78 128.04 5.63 562.82 562.82 446.03 116.79 0.00

District of Columbia Kaiser Foundation Health Plan Mid-Atlantic StatesHigh Self E31 296.17 304.78 235.44 69.34 4.07 296.17 304.78 241.54 63.24 1.05High Self & Family E32 693.06 701.00 536.07 164.93 -1.85 693.06 701.00 550.56 150.44 -9.33High Self Plus One E33 669.36 701.00 504.64 196.36 22.62 669.36 701.00 518.28 182.72 15.58Standard Self E34 223.40 233.06 180.04 53.02 4.43 223.40 233.06 184.70 48.36 2.00Standard Self & Family E35 522.75 536.07 414.11 121.96 8.26 522.75 536.07 424.84 111.23 2.76Standard Self Plus One E36 504.87 536.07 414.11 121.96 12.15 504.87 536.07 424.84 111.23 6.47

District of Columbia Kaiser Foundation Health Plan Mid-Atlantic StatesBasic Self T71 New Plan 212.32 164.02 48.30 New Plan New Plan 212.32 168.26 44.06 New PlanBasic Self & Family T72 New Plan 509.77 393.80 115.97 New Plan New Plan 509.77 403.99 105.78 New PlanBasic Self Plus One T73 New Plan 464.41 358.76 105.65 New Plan New Plan 464.41 368.04 96.37 New Plan

District of Columbia M.D. IPAHigh Self JP1 318.80 331.28 235.62 95.66 7.76 318.80 331.28 241.98 89.30 4.48High Self & Family JP2 893.91 928.92 536.07 392.85 25.22 893.91 928.92 550.56 378.36 17.74High Self Plus One JP3 622.62 646.99 499.80 147.19 11.77 622.62 646.99 512.74 134.25 5.06

District of Columbia UnitedHealthcare Insurance Company, Inc. Choice HMOHigh Self LR1 279.74 280.61 216.77 63.84 3.00 279.74 280.61 222.38 58.23 0.18High Self & Family LR2 699.35 701.54 536.07 165.47 -7.60 699.35 701.54 550.56 150.98 -15.08High Self Plus One LR3 573.47 603.32 466.06 137.26 12.53 573.47 603.32 478.13 125.19 6.19


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District of Columbia UnitedHealthcare Insurance Company, Inc. Choice Plus AdvancedValue Self L91 199.88 213.84 165.19 48.65 5.18 199.88 213.84 169.47 44.37 2.89Value Self & Family L92 560.47 599.62 463.21 136.41 14.51 560.47 599.62 475.20 124.42 8.12Value Self Plus One L93 390.36 417.64 322.63 95.01 10.11 390.36 417.64 330.98 86.66 5.66

District of Columbia UnitedHealthcare Insurance Company, Inc. Choice Plus HDHPHDHP Self V41 New Plan 261.68 202.15 59.53 New Plan New Plan 261.68 207.38 54.30 New PlanHDHP Self & Family V42 New Plan 654.22 505.38 148.84 New Plan New Plan 654.22 518.47 135.75 New PlanHDHP Self Plus One V43 New Plan 562.62 434.62 128.00 New Plan New Plan 562.62 445.88 116.74 New Plan

Florida Aetna HealthFund CDHP and Aetna Value PlanCDHP Self F51 330.91 371.98 235.62 136.36 36.35 330.91 371.98 241.98 130.00 33.07CDHP Self & Family F52 754.52 848.15 536.07 312.08 83.84 754.52 848.15 550.56 297.59 76.36CDHP Self Plus One F53 747.04 839.75 504.64 335.11 83.69 747.04 839.75 518.28 321.47 76.65Value Self F54 258.16 269.07 207.86 61.21 5.06 258.16 269.07 213.24 55.83 2.26Value Self & Family F55 591.16 616.15 475.98 140.17 11.59 591.16 616.15 488.30 127.85 5.18Value Self Plus One F56 579.56 604.06 466.64 137.42 11.37 579.56 604.06 478.72 125.34 5.08

Florida Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Florida Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Florida Av-Med Health PlanStandard Self ML4 298.92 316.02 235.62 80.40 12.38 298.92 316.02 241.98 74.04 9.10Standard Self & Family ML5 774.28 818.60 536.07 282.53 34.53 774.28 818.60 550.56 268.04 27.05


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Standard Self Plus One ML6 597.83 632.06 488.27 143.79 13.76 597.83 632.06 500.91 131.15 7.10Florida Capital Health Plan

High Self EA1 292.18 306.94 235.62 71.32 7.77 292.18 306.94 241.98 64.96 4.33High Self & Family EA2 788.88 828.78 536.07 292.71 30.11 788.88 828.78 550.56 278.22 22.63High Self Plus One EA3 584.34 613.91 474.25 139.66 12.57 584.34 613.91 486.52 127.39 6.14

Florida Humana CoverageFirst/Value PlanCDHP Self MJ1 322.48 370.85 235.62 135.23 43.65 322.48 370.85 241.98 128.87 40.37CDHP Self & Family MJ2 725.60 834.42 536.07 298.35 99.03 725.60 834.42 550.56 283.86 91.55CDHP Self Plus One MJ3 693.35 797.34 504.64 292.70 94.97 693.35 797.34 518.28 279.06 87.93Value Self MJ4 214.76 227.64 175.85 51.79 5.08 214.76 227.64 180.40 47.24 2.68Value Self & Family MJ5 483.20 512.18 395.66 116.52 11.42 483.20 512.18 405.90 106.28 6.02Value Self Plus One MJ6 461.73 489.41 378.07 111.34 10.91 461.73 489.41 387.86 101.55 5.74

Florida Humana CoverageFirst/Value PlanCDHP Self QP1 258.39 314.82 235.62 79.20 23.00 258.39 314.82 241.98 72.84 19.22CDHP Self & Family QP2 582.31 709.28 536.07 173.21 46.56 582.31 709.28 550.56 158.72 37.89CDHP Self Plus One QP3 556.43 677.76 504.64 173.12 52.10 556.43 677.76 518.28 159.48 44.02Value Self QP4 214.76 225.49 174.19 51.30 4.59 214.76 225.49 178.70 46.79 2.23Value Self & Family QP5 483.20 507.35 391.93 115.42 10.32 483.20 507.35 402.07 105.28 5.02Value Self Plus One QP6 461.73 484.81 374.52 110.29 9.86 461.73 484.81 384.21 100.60 4.79

Florida Humana Medical Plan, Inc.High Self E21 337.82 405.19 235.62 169.57 62.65 337.82 405.19 241.98 163.21 59.37High Self & Family E22 760.12 911.68 536.07 375.61 141.77 760.12 911.68 550.56 361.12 134.29


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High Self Plus One E23 726.33 871.18 504.64 366.54 135.83 726.33 871.18 518.28 352.90 128.79Standard Self E24 262.23 267.47 206.62 60.85 3.81 262.23 267.47 211.97 55.50 1.09Standard Self & Family E25 590.01 601.81 464.90 136.91 8.58 590.01 601.81 476.93 124.88 2.45Standard Self Plus One E26 563.78 575.06 444.23 130.83 8.21 563.78 575.06 455.74 119.32 2.34

Florida Humana Medical Plan, Inc.High Self EE1 400.61 404.63 235.62 169.01 -0.70 400.61 404.63 241.98 162.65 -3.98High Self & Family EE2 901.38 910.43 536.07 374.36 -0.74 901.38 910.43 550.56 359.87 -8.22High Self Plus One EE3 861.32 869.96 504.64 365.32 -0.38 861.32 869.96 518.28 351.68 -7.42Standard Self EE4 344.58 351.45 235.62 115.83 2.15 344.58 351.45 241.98 109.47 -1.13Standard Self & Family EE5 775.31 790.75 536.07 254.68 5.65 775.31 790.75 550.56 240.19 -1.83Standard Self Plus One EE6 740.85 755.61 504.64 250.97 5.74 740.85 755.61 518.28 237.33 -1.30

Florida Humana Medical Plan, Inc.High Self EX1 311.14 317.37 235.62 81.75 1.51 311.14 317.37 241.98 75.39 -1.77High Self & Family EX2 700.04 714.06 536.07 177.99 4.23 700.04 714.06 550.56 163.50 -3.25High Self Plus One EX3 668.93 682.32 504.64 177.68 4.37 668.93 682.32 518.28 164.04 -2.67Standard Self EX4 273.06 278.52 215.16 63.36 3.97 273.06 278.52 220.73 57.79 1.13Standard Self & Family EX5 614.39 626.68 484.11 142.57 8.94 614.39 626.68 496.64 130.04 2.55Standard Self Plus One EX6 587.09 598.83 462.60 136.23 8.54 587.09 598.83 474.57 124.26 2.44

Florida Humana Medical Plan, Inc.High Self LL1 622.23 628.47 235.62 392.85 1.52 622.23 628.47 241.98 386.49 -1.76


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High Self & Family LL2 1,400.03 1,414.06 536.07 877.99 4.24 1,400.03 1,414.06 550.56 863.50 -3.24High Self Plus One LL3 1,337.79 1,351.21 504.64 846.57 4.40 1,337.79 1,351.21 518.28 832.93 -2.64Standard Self LL4 362.32 365.93 235.62 130.31 -1.11 362.32 365.93 241.98 123.95 -4.39Standard Self & Family LL5 815.19 823.34 536.07 287.27 -1.64 815.19 823.34 550.56 272.78 -9.12Standard Self Plus One LL6 778.96 786.75 504.64 282.11 -1.23 778.96 786.75 518.28 268.47 -8.27

Florida UnitedHealthcare Insurance Company, Inc. Choice HMOHigh Self KK1 New Plan 274.77 212.26 62.51 New Plan New Plan 274.77 217.76 57.01 New PlanHigh Self & Family KK2 New Plan 686.91 530.64 156.27 New Plan New Plan 686.91 544.38 142.53 New PlanHigh Self Plus One KK3 New Plan 590.74 456.35 134.39 New Plan New Plan 590.74 468.16 122.58 New Plan

Florida UnitedHealthcare Insurance Company, Inc. Choice Plus AdvancedValue Self LV1 266.26 290.79 224.64 66.15 8.24 266.26 290.79 230.45 60.34 5.09Value Self & Family LV2 746.62 815.41 536.07 279.34 59.00 746.62 815.41 550.56 264.85 51.52Value Self Plus One LV3 520.02 567.93 438.73 129.20 16.10 520.02 567.93 450.08 117.85 9.95

Florida UnitedHealthcare Insurance Company, Inc. Choice Plus HDHPHDHP Self LS1 New Plan 202.27 156.25 46.02 New Plan New Plan 202.27 160.30 41.97 New PlanHDHP Self & Family LS2 New Plan 505.67 390.63 115.04 New Plan New Plan 505.67 400.74 104.93 New PlanHDHP Self Plus One LS3 New Plan 434.88 335.94 98.94 New Plan New Plan 434.88 344.64 90.24 New Plan

Georgia Aetna HealthFund CDHP and Aetna Value PlanCDHP Self F51 330.91 371.98 235.62 136.36 36.35 330.91 371.98 241.98 130.00 33.07CDHP Self & Family F52 754.52 848.15 536.07 312.08 83.84 754.52 848.15 550.56 297.59 76.36CDHP Self Plus One F53 747.04 839.75 504.64 335.11 83.69 747.04 839.75 518.28 321.47 76.65Value Self F54 258.16 269.07 207.86 61.21 5.06 258.16 269.07 213.24 55.83 2.26Value Self & Family F55 591.16 616.15 475.98 140.17 11.59 591.16 616.15 488.30 127.85 5.18Value Self Plus One F56 579.56 604.06 466.64 137.42 11.37 579.56 604.06 478.72 125.34 5.08

Georgia Aetna HealthFund HDHP


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HDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Georgia Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Georgia Aetna Open AccessHigh Self 2U1 525.94 559.12 235.62 323.50 28.46 525.94 559.12 241.98 317.14 25.18High Self & Family 2U2 1,211.46 1,287.92 536.07 751.85 66.67 1,211.46 1,287.92 550.56 737.36 59.19High Self Plus One 2U3 1,199.47 1,275.16 504.64 770.52 66.67 1,199.47 1,275.16 518.28 756.88 59.63

Georgia Blue Open Access POSHigh Self QM1 New Plan 264.23 204.12 60.11 New Plan New Plan 264.23 209.40 54.83 New PlanHigh Self & Family QM2 New Plan 706.82 536.07 170.75 New Plan New Plan 706.82 550.56 156.26 New PlanHigh Self Plus One QM3 New Plan 587.91 454.16 133.75 New Plan New Plan 587.91 465.92 121.99 New Plan

Georgia Humana CoverageFirst/Value PlanCDHP Self AD1 282.74 330.81 235.62 95.19 33.69 282.74 330.81 241.98 88.83 30.16CDHP Self & Family AD2 636.17 744.33 536.07 208.26 69.89 636.17 744.33 550.56 193.77 61.76CDHP Self Plus One AD3 607.91 711.26 504.64 206.62 74.40 607.91 711.26 518.28 192.98 66.84Value Self AD4 240.53 252.56 195.10 57.46 5.14 240.53 252.56 200.15 52.41 2.50Value Self & Family AD5 541.20 568.26 438.98 129.28 11.57 541.20 568.26 450.35 117.91 5.61Value Self Plus One AD6 517.14 543.00 419.47 123.53 11.05 517.14 543.00 430.33 112.67 5.36


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Georgia Humana CoverageFirst/Value PlanCDHP Self LM1 271.49 276.91 213.91 63.00 3.95 271.49 276.91 219.45 57.46 1.13CDHP Self & Family LM2 610.85 623.04 481.30 141.74 8.88 610.85 623.04 493.76 129.28 2.53CDHP Self Plus One LM3 583.71 595.36 459.92 135.44 8.48 583.71 595.36 471.82 123.54 2.42Value Self LM4 214.76 219.06 169.22 49.84 3.13 214.76 219.06 173.61 45.45 0.89Value Self & Family LM5 483.20 492.88 380.75 112.13 7.03 483.20 492.88 390.61 102.27 2.01Value Self Plus One LM6 461.73 470.97 363.82 107.15 6.72 461.73 470.97 373.24 97.73 1.92

Georgia Humana CoverageFirst/Value PlanCDHP Self S91 New Plan 292.20 225.72 66.48 New Plan New Plan 292.20 231.57 60.63 New PlanCDHP Self & Family S92 New Plan 657.45 507.88 149.57 New Plan New Plan 657.45 521.03 136.42 New PlanCDHP Self Plus One S93 New Plan 628.22 485.30 142.92 New Plan New Plan 628.22 497.86 130.36 New PlanValue Self S94 New Plan 232.65 179.72 52.93 New Plan New Plan 232.65 184.38 48.27 New PlanValue Self & Family S95 New Plan 523.46 404.37 119.09 New Plan New Plan 523.46 414.84 108.62 New PlanValue Self Plus One S96 New Plan 500.20 386.40 113.80 New Plan New Plan 500.20 396.41 103.79 New Plan

Georgia Humana Employers Health Plan of Georgia, IncHigh Self CB1 351.16 417.87 235.62 182.25 61.99 351.16 417.87 241.98 175.89 58.71High Self & Family CB2 790.10 940.22 536.07 404.15 140.33 790.10 940.22 550.56 389.66 132.85High Self Plus One CB3 754.97 898.44 504.64 393.80 134.45 754.97 898.44 518.28 380.16 127.41Standard Self CB4 312.80 385.14 235.62 149.52 67.62 312.80 385.14 241.98 143.16 64.34Standard Self & Family CB5 703.79 866.57 536.07 330.50 152.99 703.79 866.57 550.56 316.01 145.51


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Standard Self Plus One CB6 672.52 828.06 504.64 323.42 146.52 672.52 828.06 518.28 309.78 139.48Georgia Humana Employers Health Plan of Georgia, Inc

High Self DG1 488.98 557.43 235.62 321.81 63.73 488.98 557.43 241.98 315.45 60.45High Self & Family DG2 1,100.20 1,254.21 536.07 718.14 144.22 1,100.20 1,254.21 550.56 703.65 136.74High Self Plus One DG3 1,051.30 1,198.48 504.64 693.84 138.16 1,051.30 1,198.48 518.28 680.20 131.12Standard Self DG4 353.19 385.02 235.62 149.40 27.11 353.19 385.02 241.98 143.04 23.83Standard Self & Family DG5 794.67 866.27 536.07 330.20 61.81 794.67 866.27 550.56 315.71 54.33Standard Self Plus One DG6 759.36 827.77 504.64 323.13 59.39 759.36 827.77 518.28 309.49 52.35

Georgia Humana Employers Health Plan of Georgia, IncHigh Self DN1 322.70 329.16 235.62 93.54 1.74 322.70 329.16 241.98 87.18 -1.54High Self & Family DN2 726.08 740.60 536.07 204.53 4.73 726.08 740.60 550.56 190.04 -2.75High Self Plus One DN3 693.80 707.69 504.64 203.05 4.87 693.80 707.69 518.28 189.41 -2.17Standard Self DN4 308.96 315.14 235.62 79.52 1.46 308.96 315.14 241.98 73.16 -1.82Standard Self & Family DN5 695.17 709.07 536.07 173.00 4.11 695.17 709.07 550.56 158.51 -3.37Standard Self Plus One DN6 664.28 677.55 504.64 172.91 4.25 664.28 677.55 518.28 159.27 -2.79

Georgia Humana Employers Health Plan of Georgia, IncBasic Self Q71 New Plan 271.76 209.93 61.83 New Plan New Plan 271.76 215.37 56.39 New PlanBasic Self & Family Q72 New Plan 611.47 472.36 139.11 New Plan New Plan 611.47 484.59 126.88 New PlanBasic Self Plus One Q73 New Plan 584.29 451.36 132.93 New Plan New Plan 584.29 463.05 121.24 New Plan

Georgia Humana Employers Health Plan of Georgia, IncBasic Self RJ1 New Plan 252.05 194.71 57.34 New Plan New Plan 252.05 199.75 52.30 New PlanBasic Self & Family RJ2 New Plan 567.12 438.10 129.02 New Plan New Plan 567.12 449.44 117.68 New PlanBasic Self Plus One RJ3 New Plan 541.91 418.63 123.28 New Plan New Plan 541.91 429.46 112.45 New Plan

Georgia Humana Employers Health Plan of Georgia, Inc


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Basic Self RM1 New Plan 263.24 203.35 59.89 New Plan New Plan 263.24 208.62 54.62 New PlanBasic Self & Family RM2 New Plan 592.30 457.55 134.75 New Plan New Plan 592.30 469.40 122.90 New PlanBasic Self Plus One RM3 New Plan 565.98 437.22 128.76 New Plan New Plan 565.98 448.54 117.44 New Plan

Georgia Kaiser Foundation Health Plan of GeorgiaHigh Self F81 299.74 314.82 235.62 79.20 10.36 299.74 314.82 241.98 72.84 7.08High Self & Family F82 684.89 711.51 536.07 175.44 16.83 684.89 711.51 550.56 160.95 9.35High Self Plus One F83 665.41 711.51 504.64 206.87 37.08 665.41 711.51 518.28 193.23 30.04Standard Self F84 224.36 236.76 182.90 53.86 5.06 224.36 236.76 187.63 49.13 2.58Standard Self & Family F85 516.02 535.07 413.34 121.73 9.50 516.02 535.07 424.04 111.03 3.96Standard Self Plus One F86 500.31 535.07 413.34 121.73 12.91 500.31 535.07 424.04 111.03 7.22

Georgia UnitedHealthcare Insurance Company, Inc. Choice Plus AdvancedValue Self LV1 266.26 290.79 224.64 66.15 8.24 266.26 290.79 230.45 60.34 5.09Value Self & Family LV2 746.62 815.41 536.07 279.34 59.00 746.62 815.41 550.56 264.85 51.52Value Self Plus One LV3 520.02 567.93 438.73 129.20 16.10 520.02 567.93 450.08 117.85 9.95

Guam Calvo's SelectcareHigh Self B41 196.66 216.33 167.11 49.22 6.45 196.66 216.33 171.44 44.89 4.08High Self & Family B42 525.80 578.39 446.81 131.58 17.22 525.80 578.39 458.37 120.02 10.92High Self Plus One B43 383.78 422.16 326.12 96.04 12.57 383.78 422.16 334.56 87.60 7.97Standard Self B44 180.98 190.03 146.80 43.23 3.87 180.98 190.03 150.60 39.43 1.88Standard Self & Family B45 483.88 508.07 392.48 115.59 10.35 483.88 508.07 402.65 105.42 5.01Standard Self Plus One B46 353.17 370.83 286.47 84.36 7.55 353.17 370.83 293.88 76.95 3.67

Guam TakeCareHigh Self JK1 275.43 269.83 208.44 61.39 1.48 275.43 269.83 213.84 55.99 -1.16High Self & Family JK2 656.99 643.61 497.19 146.42 3.52 656.99 643.61 510.06 133.55 -2.78High Self Plus One JK3 544.17 533.09 411.81 121.28 2.92 544.17 533.09 422.47 110.62 -2.30


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Standard Self JK4 174.69 187.00 144.46 42.54 4.54 174.69 187.00 148.20 38.80 2.55Standard Self & Family JK5 494.70 529.57 409.09 120.48 12.88 494.70 529.57 419.68 109.89 7.24Standard Self Plus One JK6 344.28 368.56 284.71 83.85 8.97 344.28 368.56 292.08 76.48 5.04

Guam TakeCareHDHP Self KX1 59.61 59.04 45.61 13.43 0.46 59.61 59.04 46.79 12.25 -0.12HDHP Self & Family KX2 176.04 158.29 122.28 36.01 -2.28 176.04 158.29 125.44 32.85 -3.68HDHP Self Plus One KX3 140.96 142.50 110.08 32.42 1.76 140.96 142.50 112.93 29.57 0.32

Hawaii Aetna HealthFund CDHP and Aetna Value PlanCDHP Self JS1 445.61 481.36 235.62 245.74 31.03 445.61 481.36 241.98 239.38 27.75CDHP Self & Family JS2 1,015.78 1,097.29 536.07 561.22 71.72 1,015.78 1,097.29 550.56 546.73 64.24CDHP Self Plus One JS3 1,005.73 1,086.44 504.64 581.80 71.69 1,005.73 1,086.44 518.28 568.16 64.65Value Self JS4 322.40 352.77 235.62 117.15 25.65 322.40 352.77 241.98 110.79 22.37Value Self & Family JS5 736.01 805.33 536.07 269.26 59.53 736.01 805.33 550.56 254.77 52.05Value Self Plus One JS6 728.72 797.36 504.64 292.72 59.62 728.72 797.36 518.28 279.08 52.58

Hawaii Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Hawaii Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Hawaii HMSAHigh Self 871 280.13 280.13 216.40 63.73 2.80 280.13 280.13 222.00 58.13 0.00High Self & Family 872 629.74 629.74 486.47 143.27 6.30 629.74 629.74 499.07 130.67 0.00


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High Self Plus One 873 613.79 613.79 474.15 139.64 6.14 613.79 613.79 486.43 127.36 0.00Hawaii Kaiser Foundation Health Plan of Hawaii

High Self 631 296.64 303.96 234.81 69.15 3.41 296.64 303.96 240.89 63.07 0.41High Self & Family 632 661.51 677.83 523.62 154.21 10.33 661.51 677.83 537.18 140.65 3.39High Self Plus One 633 661.51 677.83 504.64 173.19 7.30 661.51 677.83 518.28 159.55 0.26Standard Self 634 203.37 205.24 158.55 46.69 2.46 203.37 205.24 162.65 42.59 0.39Standard Self & Family 635 453.51 457.68 353.56 104.12 5.48 453.51 457.68 362.71 94.97 0.87Standard Self Plus One 636 453.51 457.68 353.56 104.12 5.48 453.51 457.68 362.71 94.97 0.87

Idaho Aetna HealthFund CDHP and Aetna Value PlanCDHP Self H41 347.17 379.77 235.62 144.15 27.88 347.17 379.77 241.98 137.79 24.60CDHP Self & Family H42 791.39 865.68 536.07 329.61 64.50 791.39 865.68 550.56 315.12 57.02CDHP Self Plus One H43 783.56 857.11 504.64 352.47 64.53 783.56 857.11 518.28 338.83 57.49Value Self H44 257.63 265.72 205.27 60.45 4.42 257.63 265.72 210.58 55.14 1.68Value Self & Family H45 591.28 609.86 471.12 138.74 10.14 591.28 609.86 483.31 126.55 3.86Value Self Plus One H46 579.69 597.90 461.88 136.02 9.94 579.69 597.90 473.84 124.06 3.77

Idaho Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Idaho Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Idaho Altius Health PlansHigh Self 9K1 344.47 391.42 235.62 155.80 42.23 344.47 391.42 241.98 149.44 38.95


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High Self & Family 9K2 761.77 865.60 536.07 329.53 94.04 761.77 865.60 550.56 315.04 86.56High Self Plus One 9K3 754.23 857.03 504.64 352.39 93.78 754.23 857.03 518.28 338.75 86.74HDHP Self 9K4 173.69 194.17 150.00 44.17 6.39 173.69 194.17 153.88 40.29 4.25HDHP Self & Family 9K5 363.00 405.80 313.48 92.32 13.37 363.00 405.80 321.60 84.20 8.88HDHP Self Plus One 9K6 355.89 397.84 307.33 90.51 13.10 355.89 397.84 315.29 82.55 8.70

Idaho Altius Health PlansStandard Self DK4 242.10 273.97 211.64 62.33 9.67 242.10 273.97 217.12 56.85 6.61Standard Self & Family DK5 534.63 604.99 467.35 137.64 21.36 534.63 604.99 479.45 125.54 14.60Standard Self Plus One DK6 529.33 599.00 462.73 136.27 21.14 529.33 599.00 474.71 124.29 14.45

Idaho Kaiser Foundation Health Plan of WashingtonHigh Self 541 349.46 381.04 235.62 145.42 26.86 349.46 381.04 241.98 139.06 23.58High Self & Family 542 908.59 838.30 536.07 302.23 -80.08 908.59 838.30 550.56 287.74 -87.56High Self Plus One 543 716.38 838.30 504.64 333.66 112.90 716.38 838.30 518.28 320.02 105.86Standard Self 544 262.54 281.07 217.13 63.94 6.84 262.54 281.07 222.75 58.32 3.84Standard Self & Family 545 682.59 646.46 499.39 147.07 -9.24 682.59 646.46 512.32 134.14 -15.16Standard Self Plus One 546 538.20 646.46 499.39 147.07 30.01 538.20 646.46 512.32 134.14 22.46

Idaho Kaiser Foundation Health Plan of WashingtonHDHP Self PT1 233.54 234.17 180.90 53.27 2.48 233.54 234.17 185.58 48.59 0.13HDHP Self & Family PT2 607.22 538.58 416.05 122.53 -9.54 607.22 538.58 426.82 111.76 -14.24HDHP Self Plus One PT3 478.77 538.58 416.05 122.53 18.40 478.77 538.58 426.82 111.76 12.42

Idaho SelectHealth


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High Self SF1 342.83 449.39 235.62 213.77 101.84 342.83 449.39 241.98 207.41 98.56High Self & Family SF2 764.71 1,024.25 536.07 488.18 249.75 764.71 1,024.25 550.56 473.69 242.27High Self Plus One SF3 764.71 1,024.25 504.64 519.61 250.52 764.71 1,024.25 518.28 505.97 243.48Standard Self SF4 248.28 274.81 212.29 62.52 8.52 248.28 274.81 217.79 57.02 5.50Standard Self & Family SF5 551.32 626.33 483.84 142.49 22.58 551.32 626.33 496.37 129.96 15.56Standard Self Plus One SF6 551.32 626.33 483.84 142.49 22.58 551.32 626.33 496.37 129.96 15.56

Illinois Aetna HealthFund CDHP and Aetna Value PlanCDHP Self H41 347.17 379.77 235.62 144.15 27.88 347.17 379.77 241.98 137.79 24.60CDHP Self & Family H42 791.39 865.68 536.07 329.61 64.50 791.39 865.68 550.56 315.12 57.02CDHP Self Plus One H43 783.56 857.11 504.64 352.47 64.53 783.56 857.11 518.28 338.83 57.49Value Self H44 257.63 265.72 205.27 60.45 4.42 257.63 265.72 210.58 55.14 1.68Value Self & Family H45 591.28 609.86 471.12 138.74 10.14 591.28 609.86 483.31 126.55 3.86Value Self Plus One H46 579.69 597.90 461.88 136.02 9.94 579.69 597.90 473.84 124.06 3.77

Illinois Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Illinois Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96


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Illinois Blue PreferredHigh Self 9G1 322.38 338.73 235.62 103.11 11.63 322.38 338.73 241.98 96.75 8.35High Self & Family 9G2 697.96 733.35 536.07 197.28 25.60 697.96 733.35 550.56 182.79 18.12High Self Plus One 9G3 651.22 694.40 504.64 189.76 34.16 651.22 694.40 518.28 176.12 27.12Standard Self 9G4 239.60 245.59 189.72 55.87 3.76 239.60 245.59 194.63 50.96 1.24Standard Self & Family 9G5 678.07 706.05 536.07 169.98 18.19 678.07 706.05 550.56 155.49 10.71Standard Self Plus One 9G6 622.96 638.52 493.26 145.26 9.77 622.96 638.52 506.03 132.49 3.23

Illinois Health Alliance HMOStandard Self K84 279.77 289.29 223.48 65.81 4.96 279.77 289.29 229.26 60.03 1.98Standard Self & Family K85 776.35 885.51 536.07 349.44 99.37 776.35 885.51 550.56 334.95 91.89Standard Self Plus One K86 587.52 670.12 504.64 165.48 37.69 587.52 670.12 518.28 151.84 29.93

Illinois Humana CoverageFirst/Value PlanCDHP Self GB1 332.04 403.00 235.62 167.38 66.24 332.04 403.00 241.98 161.02 62.96CDHP Self & Family GB2 747.09 906.74 536.07 370.67 149.86 747.09 906.74 550.56 356.18 142.38CDHP Self Plus One GB3 713.89 866.44 504.64 361.80 143.53 713.89 866.44 518.28 348.16 136.49Value Self GB4 214.76 238.39 184.16 54.23 7.52 214.76 238.39 188.92 49.47 4.91Value Self & Family GB5 483.20 536.37 414.35 122.02 16.92 483.20 536.37 425.07 111.30 11.04Value Self Plus One GB6 461.73 512.55 395.94 116.61 16.18 461.73 512.55 406.20 106.35 10.54

Illinois Humana CoverageFirst/Value PlanCDHP Self MW1 322.26 328.71 235.62 93.09 1.73 322.26 328.71 241.98 86.73 -1.55CDHP Self & Family MW2 725.09 739.62 536.07 203.55 4.74 725.09 739.62 550.56 189.06 -2.74CDHP Self Plus One MW3 692.86 706.74 504.64 202.10 4.86 692.86 706.74 518.28 188.46 -2.18Value Self MW4 225.49 257.07 198.59 58.48 9.44 225.49 257.07 203.73 53.34 6.55Value Self & Family MW5 507.36 578.39 446.81 131.58 21.23 507.36 578.39 458.37 120.02 14.74Value Self Plus One MW6 484.82 552.69 426.95 125.74 20.29 484.82 552.69 438.01 114.68 14.08


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Illinois Humana Health Plan, Inc.High Self 751 580.53 582.31 235.62 346.69 -2.94 580.53 582.31 241.98 340.33 -6.22High Self & Family 752 1,306.18 1,310.18 536.07 774.11 -5.79 1,306.18 1,310.18 550.56 759.62 -13.27High Self Plus One 753 1,248.12 1,251.95 504.64 747.31 -5.19 1,248.12 1,251.95 518.28 733.67 -12.23Standard Self 754 406.01 406.84 235.62 171.22 -3.89 406.01 406.84 241.98 164.86 -7.17Standard Self & Family 755 913.52 915.39 536.07 379.32 -7.92 913.52 915.39 550.56 364.83 -15.40Standard Self Plus One 756 872.91 874.69 504.64 370.05 -7.24 872.91 874.69 518.28 356.41 -14.28

Illinois Humana Health Plan, Inc.High Self 9F1 710.58 724.79 235.62 489.17 9.49 710.58 724.79 241.98 482.81 6.21High Self & Family 9F2 1,598.81 1,630.79 536.07 1,094.72 22.19 1,598.81 1,630.79 550.56 1,080.23 14.71High Self Plus One 9F3 1,527.75 1,558.30 504.64 1,053.66 21.53 1,527.75 1,558.30 518.28 1,040.02 14.49

Illinois Humana Health Plan, Inc.Basic Self AB1 New Plan 269.57 208.24 61.33 New Plan New Plan 269.57 213.63 55.94 New PlanBasic Self & Family AB2 New Plan 606.53 468.54 137.99 New Plan New Plan 606.53 480.68 125.85 New PlanBasic Self Plus One AB3 New Plan 579.57 447.72 131.85 New Plan New Plan 579.57 459.31 120.26 New PlanStandard Self AB4 436.19 471.05 235.62 235.43 30.14 436.19 471.05 241.98 229.07 26.86Standard Self & Family AB5 981.40 1,059.87 536.07 523.80 68.68 981.40 1,059.87 550.56 509.31 61.20Standard Self Plus One AB6 937.79 1,012.76 504.64 508.12 65.95 937.79 1,012.76 518.28 494.48 58.91

Illinois Humana Health Plan, Inc.Basic Self RW1 New Plan 273.24 211.08 62.16 New Plan New Plan 273.24 216.54 56.70 New PlanBasic Self & Family RW2 New Plan 614.79 474.93 139.86 New Plan New Plan 614.79 487.22 127.57 New PlanBasic Self Plus One RW3 New Plan 587.46 453.81 133.65 New Plan New Plan 587.46 465.56 121.90 New Plan

Illinois MercyCare HMOHigh Self EY1 335.85 353.76 235.62 118.14 13.19 335.85 353.76 241.98 111.78 9.91High Self & Family EY2 873.23 923.20 536.07 387.13 40.18 873.23 923.20 550.56 372.64 32.70


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High Self Plus One EY3 722.08 760.59 504.64 255.95 29.49 722.08 760.59 518.28 242.31 22.45

Illinois Union Health ServiceHigh Self 761 288.86 309.74 235.62 74.12 11.29 288.86 309.74 241.98 67.76 7.82High Self & Family 762 717.84 775.83 536.07 239.76 48.20 717.84 775.83 550.56 225.27 40.72High Self Plus One 763 631.70 680.38 504.64 175.74 38.35 631.70 680.38 518.28 162.10 31.02

Illinois UnitedHealthcare Insurance Company, Inc. Choice Plus AdvancedValue Self L91 199.88 213.84 165.19 48.65 5.18 199.88 213.84 169.47 44.37 2.89Value Self & Family L92 560.47 599.62 463.21 136.41 14.51 560.47 599.62 475.20 124.42 8.12Value Self Plus One L93 390.36 417.64 322.63 95.01 10.11 390.36 417.64 330.98 86.66 5.66

Illinois UnitedHealthcare Plan of the River Valley Inc.High Self YH1 296.58 325.90 235.62 90.28 24.60 296.58 325.90 241.98 83.92 21.32High Self & Family YH2 831.59 913.84 536.07 377.77 72.46 831.59 913.84 550.56 363.28 64.98High Self Plus One YH3 579.22 636.50 491.70 144.80 18.82 579.22 636.50 504.43 132.07 11.88

Indiana Aetna HealthFund CDHP and Aetna Value PlanCDHP Self JS1 445.61 481.36 235.62 245.74 31.03 445.61 481.36 241.98 239.38 27.75CDHP Self & Family JS2 1,015.78 1,097.29 536.07 561.22 71.72 1,015.78 1,097.29 550.56 546.73 64.24CDHP Self Plus One JS3 1,005.73 1,086.44 504.64 581.80 71.69 1,005.73 1,086.44 518.28 568.16 64.65Value Self JS4 322.40 352.77 235.62 117.15 25.65 322.40 352.77 241.98 110.79 22.37Value Self & Family JS5 736.01 805.33 536.07 269.26 59.53 736.01 805.33 550.56 254.77 52.05Value Self Plus One JS6 728.72 797.36 504.64 292.72 59.62 728.72 797.36 518.28 279.08 52.58

Indiana Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Indiana Aetna Direct


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CDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Indiana Health Alliance HMOStandard Self K84 279.77 289.29 223.48 65.81 4.96 279.77 289.29 229.26 60.03 1.98Standard Self & Family K85 776.35 885.51 536.07 349.44 99.37 776.35 885.51 550.56 334.95 91.89Standard Self Plus One K86 587.52 670.12 504.64 165.48 37.69 587.52 670.12 518.28 151.84 29.93

Indiana Humana CoverageFirst/Value PlanCDHP Self MW1 322.26 328.71 235.62 93.09 1.73 322.26 328.71 241.98 86.73 -1.55CDHP Self & Family MW2 725.09 739.62 536.07 203.55 4.74 725.09 739.62 550.56 189.06 -2.74CDHP Self Plus One MW3 692.86 706.74 504.64 202.10 4.86 692.86 706.74 518.28 188.46 -2.18Value Self MW4 225.49 257.07 198.59 58.48 9.44 225.49 257.07 203.73 53.34 6.55Value Self & Family MW5 507.36 578.39 446.81 131.58 21.23 507.36 578.39 458.37 120.02 14.74Value Self Plus One MW6 484.82 552.69 426.95 125.74 20.29 484.82 552.69 438.01 114.68 14.08

Indiana Humana CoverageFirst/Value PlanCDHP Self TC1 New Plan 277.99 214.75 63.24 New Plan New Plan 277.99 220.31 57.68 New PlanCDHP Self & Family TC2 New Plan 625.49 483.19 142.30 New Plan New Plan 625.49 495.70 129.79 New PlanCDHP Self Plus One TC3 New Plan 597.69 461.72 135.97 New Plan New Plan 597.69 473.67 124.02 New Plan

Indiana Humana Health Plan of Ohio, Inc.High Self A61 454.72 482.03 235.62 246.41 22.59 454.72 482.03 241.98 240.05 19.31High Self & Family A62 1,023.12 1,084.57 536.07 548.50 51.66 1,023.12 1,084.57 550.56 534.01 44.18High Self Plus One A63 977.65 1,036.37 504.64 531.73 49.70 977.65 1,036.37 518.28 518.09 42.66Standard Self A64 358.48 385.79 235.62 150.17 22.59 358.48 385.79 241.98 143.81 19.31Standard Self & Family A65 806.56 868.03 536.07 331.96 51.68 806.56 868.03 550.56 317.47 44.20Standard Self Plus One A66 770.71 829.45 504.64 324.81 49.72 770.71 829.45 518.28 311.17 42.68


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Indiana Humana Health Plan, Inc.High Self 751 580.53 582.31 235.62 346.69 -2.94 580.53 582.31 241.98 340.33 -6.22High Self & Family 752 1,306.18 1,310.18 536.07 774.11 -5.79 1,306.18 1,310.18 550.56 759.62 -13.27High Self Plus One 753 1,248.12 1,251.95 504.64 747.31 -5.19 1,248.12 1,251.95 518.28 733.67 -12.23Standard Self 754 406.01 406.84 235.62 171.22 -3.89 406.01 406.84 241.98 164.86 -7.17Standard Self & Family 755 913.52 915.39 536.07 379.32 -7.92 913.52 915.39 550.56 364.83 -15.40Standard Self Plus One 756 872.91 874.69 504.64 370.05 -7.24 872.91 874.69 518.28 356.41 -14.28

Indiana Humana Health Plan, Inc.High Self MH1 330.34 369.98 235.62 134.36 34.92 330.34 369.98 241.98 128.00 31.64High Self & Family MH2 743.27 832.45 536.07 296.38 79.39 743.27 832.45 550.56 281.89 71.91High Self Plus One MH3 710.24 795.44 504.64 290.80 76.18 710.24 795.44 518.28 277.16 69.14Standard Self MH4 301.59 310.64 235.62 75.02 4.33 301.59 310.64 241.98 68.66 1.05Standard Self & Family MH5 678.58 698.93 536.07 162.86 10.56 678.58 698.93 550.56 148.37 3.08Standard Self Plus One MH6 648.42 667.87 504.64 163.23 10.43 648.42 667.87 518.28 149.59 3.39

Iowa Aetna HealthFund CDHP and Aetna Value PlanCDHP Self H41 347.17 379.77 235.62 144.15 27.88 347.17 379.77 241.98 137.79 24.60CDHP Self & Family H42 791.39 865.68 536.07 329.61 64.50 791.39 865.68 550.56 315.12 57.02CDHP Self Plus One H43 783.56 857.11 504.64 352.47 64.53 783.56 857.11 518.28 338.83 57.49Value Self H44 257.63 265.72 205.27 60.45 4.42 257.63 265.72 210.58 55.14 1.68Value Self & Family H45 591.28 609.86 471.12 138.74 10.14 591.28 609.86 483.31 126.55 3.86Value Self Plus One H46 579.69 597.90 461.88 136.02 9.94 579.69 597.90 473.84 124.06 3.77

Iowa Aetna HealthFund HDHP


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Iowa Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Iowa Health Alliance HMOStandard Self K84 279.77 289.29 223.48 65.81 4.96 279.77 289.29 229.26 60.03 1.98Standard Self & Family K85 776.35 885.51 536.07 349.44 99.37 776.35 885.51 550.56 334.95 91.89Standard Self Plus One K86 587.52 670.12 504.64 165.48 37.69 587.52 670.12 518.28 151.84 29.93

Iowa HealthPartnersHigh Self V31 329.41 356.92 235.62 121.30 22.79 329.41 356.92 241.98 114.94 19.51High Self & Family V32 802.44 869.46 536.07 333.39 57.23 802.44 869.46 550.56 318.90 49.75High Self Plus One V33 727.99 788.79 504.64 284.15 51.78 727.99 788.79 518.28 270.51 44.74Standard Self V34 196.66 211.15 163.11 48.04 5.27 196.66 211.15 167.34 43.81 3.00Standard Self & Family V35 479.08 514.37 397.35 117.02 12.82 479.08 514.37 407.64 106.73 7.32Standard Self Plus One V36 434.64 466.65 360.49 106.16 11.63 434.64 466.65 369.82 96.83 6.64

Iowa UnitedHealthcare Insurance Company, Inc. Choice HMOHigh Self LJ1 256.93 281.86 217.74 64.12 8.24 256.93 281.86 223.37 58.49 5.18High Self & Family LJ2 642.34 704.66 536.07 168.59 28.88 642.34 704.66 550.56 154.10 20.81High Self Plus One LJ3 552.41 606.01 468.14 137.87 17.72 552.41 606.01 480.26 125.75 11.12

Iowa UnitedHealthcare Insurance Company, Inc. Choice Plus HDHPHDHP Self N71 244.51 231.60 178.91 52.69 -0.49 244.51 231.60 183.54 48.06 -2.68


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HDHP Self & Family N72 611.29 579.00 447.28 131.72 -1.24 611.29 579.00 458.86 120.14 -6.70HDHP Self Plus One N73 525.71 497.94 384.66 113.28 -1.06 525.71 497.94 394.62 103.32 -5.76

Iowa UnitedHealthcare Plan of the River Valley Inc.High Self YH1 296.58 325.90 235.62 90.28 24.60 296.58 325.90 241.98 83.92 21.32High Self & Family YH2 831.59 913.84 536.07 377.77 72.46 831.59 913.84 550.56 363.28 64.98High Self Plus One YH3 579.22 636.50 491.70 144.80 18.82 579.22 636.50 504.43 132.07 11.88

Kansas Aetna HealthFund CDHP and Aetna Value PlanCDHP Self G51 322.56 346.28 235.62 110.66 19.00 322.56 346.28 241.98 104.30 15.72CDHP Self & Family G52 735.73 789.85 536.07 253.78 44.33 735.73 789.85 550.56 239.29 36.85CDHP Self Plus One G53 728.45 782.04 504.64 277.40 44.57 728.45 782.04 518.28 263.76 37.53Value Self G54 246.85 253.66 195.95 57.71 4.02 246.85 253.66 201.03 52.63 1.41Value Self & Family G55 565.39 580.95 448.78 132.17 9.20 565.39 580.95 460.40 120.55 3.23Value Self Plus One G56 554.30 569.57 439.99 129.58 9.02 554.30 569.57 451.38 118.19 3.17

Kansas Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Kansas Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Kansas Aetna Open AccessHigh Self HA1 324.69 336.16 235.62 100.54 6.75 324.69 336.16 241.98 94.18 3.47High Self & Family HA2 766.98 794.06 536.07 257.99 17.29 766.98 794.06 550.56 243.50 9.81High Self Plus One HA3 759.40 786.22 504.64 281.58 17.80 759.40 786.22 518.28 267.94 10.76Standard Self HA4 279.33 282.10 217.92 64.18 3.43 279.33 282.10 223.56 58.54 0.58


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Standard Self & Family HA5 659.35 665.86 514.38 151.48 8.07 659.35 665.86 527.69 138.17 1.35Standard Self Plus One HA6 652.83 659.27 504.64 154.63 -2.58 652.83 659.27 518.28 140.99 -9.62

Kansas Humana CoverageFirst/Value PlanCDHP Self PH1 279.85 265.95 205.45 60.50 -0.37 279.85 265.95 210.77 55.18 -2.89CDHP Self & Family PH2 629.68 598.38 462.25 136.13 -0.83 629.68 598.38 474.22 124.16 -6.50CDHP Self Plus One PH3 601.69 571.79 441.71 130.08 -0.79 601.69 571.79 453.14 118.65 -6.20Value Self PH4 214.76 193.28 149.31 43.97 -2.74 214.76 193.28 153.17 40.11 -4.45Value Self & Family PH5 483.20 434.90 335.96 98.94 -6.16 483.20 434.90 344.66 90.24 -10.02Value Self Plus One PH6 461.73 415.56 321.02 94.54 -5.89 461.73 415.56 329.33 86.23 -9.58

Kansas Humana Health Plan, Inc.High Self MS1 741.03 748.42 235.62 512.80 2.67 741.03 748.42 241.98 506.44 -0.61High Self & Family MS2 1,667.32 1,683.94 536.07 1,147.87 6.83 1,667.32 1,683.94 550.56 1,133.38 -0.65High Self Plus One MS3 1,593.21 1,609.10 504.64 1,104.46 6.87 1,593.21 1,609.10 518.28 1,090.82 -0.17Standard Self MS4 383.06 402.19 235.62 166.57 14.41 383.06 402.19 241.98 160.21 11.13Standard Self & Family MS5 861.90 904.94 536.07 368.87 33.25 861.90 904.94 550.56 354.38 25.77Standard Self Plus One MS6 823.60 864.72 504.64 360.08 32.10 823.60 864.72 518.28 346.44 25.06

Kentucky Aetna HealthFund CDHP and Aetna Value PlanCDHP Self H41 347.17 379.77 235.62 144.15 27.88 347.17 379.77 241.98 137.79 24.60CDHP Self & Family H42 791.39 865.68 536.07 329.61 64.50 791.39 865.68 550.56 315.12 57.02CDHP Self Plus One H43 783.56 857.11 504.64 352.47 64.53 783.56 857.11 518.28 338.83 57.49Value Self H44 257.63 265.72 205.27 60.45 4.42 257.63 265.72 210.58 55.14 1.68


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Value Self & Family H45 591.28 609.86 471.12 138.74 10.14 591.28 609.86 483.31 126.55 3.86Value Self Plus One H46 579.69 597.90 461.88 136.02 9.94 579.69 597.90 473.84 124.06 3.77

Kentucky Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Kentucky Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Kentucky Humana CoverageFirst/Value PlanCDHP Self 6N1 259.64 270.03 208.60 61.43 4.96 259.64 270.03 214.00 56.03 2.15CDHP Self & Family 6N2 584.17 607.56 469.34 138.22 11.16 584.17 607.56 481.49 126.07 4.85CDHP Self Plus One 6N3 558.20 580.56 448.48 132.08 10.67 558.20 580.56 460.09 120.47 4.64

Kentucky Humana CoverageFirst/Value PlanCDHP Self TC1 New Plan 277.99 214.75 63.24 New Plan New Plan 277.99 220.31 57.68 New PlanCDHP Self & Family TC2 New Plan 625.49 483.19 142.30 New Plan New Plan 625.49 495.70 129.79 New PlanCDHP Self Plus One TC3 New Plan 597.69 461.72 135.97 New Plan New Plan 597.69 473.67 124.02 New Plan

Kentucky Humana Health Plan of Ohio, Inc.High Self A61 454.72 482.03 235.62 246.41 22.59 454.72 482.03 241.98 240.05 19.31High Self & Family A62 1,023.12 1,084.57 536.07 548.50 51.66 1,023.12 1,084.57 550.56 534.01 44.18High Self Plus One A63 977.65 1,036.37 504.64 531.73 49.70 977.65 1,036.37 518.28 518.09 42.66Standard Self A64 358.48 385.79 235.62 150.17 22.59 358.48 385.79 241.98 143.81 19.31Standard Self & Family A65 806.56 868.03 536.07 331.96 51.68 806.56 868.03 550.56 317.47 44.20


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Standard Self Plus One A66 770.71 829.45 504.64 324.81 49.72 770.71 829.45 518.28 311.17 42.68Kentucky Humana Health Plan, Inc.

High Self MH1 330.34 369.98 235.62 134.36 34.92 330.34 369.98 241.98 128.00 31.64High Self & Family MH2 743.27 832.45 536.07 296.38 79.39 743.27 832.45 550.56 281.89 71.91High Self Plus One MH3 710.24 795.44 504.64 290.80 76.18 710.24 795.44 518.28 277.16 69.14Standard Self MH4 301.59 310.64 235.62 75.02 4.33 301.59 310.64 241.98 68.66 1.05Standard Self & Family MH5 678.58 698.93 536.07 162.86 10.56 678.58 698.93 550.56 148.37 3.08Standard Self Plus One MH6 648.42 667.87 504.64 163.23 10.43 648.42 667.87 518.28 149.59 3.39

Kentucky Humana Health Plan, Inc.High Self MI1 376.40 461.68 235.62 226.06 80.56 376.40 461.68 241.98 219.70 77.28High Self & Family MI2 846.88 1,038.76 536.07 502.69 182.09 846.88 1,038.76 550.56 488.20 174.61High Self Plus One MI3 809.24 992.60 504.64 487.96 174.34 809.24 992.60 518.28 474.32 167.30Standard Self MI4 338.89 352.42 235.62 116.80 8.81 338.89 352.42 241.98 110.44 5.53Standard Self & Family MI5 762.50 792.96 536.07 256.89 20.67 762.50 792.96 550.56 242.40 13.19Standard Self Plus One MI6 728.61 757.71 504.64 253.07 20.08 728.61 757.71 518.28 239.43 13.04

Kentucky UnitedHealthcare Insurance Company, Inc. Choice HMOHigh Self LJ1 256.93 281.86 217.74 64.12 8.24 256.93 281.86 223.37 58.49 5.18High Self & Family LJ2 642.34 704.66 536.07 168.59 28.88 642.34 704.66 550.56 154.10 20.81High Self Plus One LJ3 552.41 606.01 468.14 137.87 17.72 552.41 606.01 480.26 125.75 11.12

Kentucky UnitedHealthcare Insurance Company, Inc. Choice Plus HDHPHDHP Self N71 244.51 231.60 178.91 52.69 -0.49 244.51 231.60 183.54 48.06 -2.68HDHP Self & Family N72 611.29 579.00 447.28 131.72 -1.24 611.29 579.00 458.86 120.14 -6.70HDHP Self Plus One N73 525.71 497.94 384.66 113.28 -1.06 525.71 497.94 394.62 103.32 -5.76

Louisiana Aetna HealthFund CDHP and Aetna Value PlanCDHP Self F51 330.91 371.98 235.62 136.36 36.35 330.91 371.98 241.98 130.00 33.07


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CDHP Self & Family F52 754.52 848.15 536.07 312.08 83.84 754.52 848.15 550.56 297.59 76.36CDHP Self Plus One F53 747.04 839.75 504.64 335.11 83.69 747.04 839.75 518.28 321.47 76.65Value Self F54 258.16 269.07 207.86 61.21 5.06 258.16 269.07 213.24 55.83 2.26Value Self & Family F55 591.16 616.15 475.98 140.17 11.59 591.16 616.15 488.30 127.85 5.18Value Self Plus One F56 579.56 604.06 466.64 137.42 11.37 579.56 604.06 478.72 125.34 5.08

Louisiana Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Louisiana Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Louisiana Humana Health Benefit Plan of Louisiana, Inc.High Self AE1 350.92 364.95 235.62 129.33 9.31 350.92 364.95 241.98 122.97 6.03High Self & Family AE2 789.56 821.12 536.07 285.05 21.77 789.56 821.12 550.56 270.56 14.29High Self Plus One AE3 754.46 784.63 504.64 279.99 21.15 754.46 784.63 518.28 266.35 14.11Standard Self AE4 309.46 315.65 235.62 80.03 1.47 309.46 315.65 241.98 73.67 -1.81Standard Self & Family AE5 696.29 710.22 536.07 174.15 4.14 696.29 710.22 550.56 159.66 -3.34Standard Self Plus One AE6 665.35 678.65 504.64 174.01 4.28 665.35 678.65 518.28 160.37 -2.76

Louisiana Humana Health Benefit Plan of Louisiana, Inc.High Self BC1 307.86 320.18 235.62 84.56 7.60 307.86 320.18 241.98 78.20 4.32High Self & Family BC2 692.68 720.43 536.07 184.36 17.96 692.68 720.43 550.56 169.87 10.48High Self Plus One BC3 661.90 688.41 504.64 183.77 17.49 661.90 688.41 518.28 170.13 10.45Standard Self BC4 263.93 263.93 203.89 60.04 2.64 263.93 263.93 209.16 54.77 0.00


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Standard Self & Family BC5 593.85 593.85 458.75 135.10 5.94 593.85 593.85 470.63 123.22 0.00Standard Self Plus One BC6 567.46 567.46 438.36 129.10 5.68 567.46 567.46 449.71 117.75 0.00

Louisiana UnitedHealthcare Insurance Company, Inc. Choice HMOHigh Self KK1 257.80 274.77 212.26 62.51 6.44 257.80 274.77 217.76 57.01 3.52High Self & Family KK2 644.49 686.91 530.64 156.27 16.09 644.49 686.91 544.38 142.53 8.80High Self Plus One KK3 554.26 590.74 456.35 134.39 13.84 554.26 590.74 468.16 122.58 7.57

Louisiana UnitedHealthcare Insurance Company, Inc. Choice Plus HDHPHDHP Self LS1 212.83 202.27 156.25 46.02 -0.27 212.83 202.27 160.30 41.97 -2.19HDHP Self & Family LS2 532.06 505.67 390.63 115.04 -0.68 532.06 505.67 400.74 104.93 -5.47HDHP Self Plus One LS3 457.58 434.88 335.94 98.94 -0.58 457.58 434.88 344.64 90.24 -4.71

Maine Aetna HealthFund CDHP and Aetna Value PlanCDHP Self EP1 374.41 414.74 235.62 179.12 35.61 374.41 414.74 241.98 172.76 32.33CDHP Self & Family EP2 853.86 945.84 536.07 409.77 82.19 853.86 945.84 550.56 395.28 74.71CDHP Self Plus One EP3 845.41 936.48 504.64 431.84 82.05 845.41 936.48 518.28 418.20 75.01Value Self EP4 250.29 260.95 201.58 59.37 4.93 250.29 260.95 206.80 54.15 2.21Value Self & Family EP5 573.16 597.56 461.62 135.94 11.28 573.16 597.56 473.57 123.99 5.06Value Self Plus One EP6 561.92 585.84 452.56 133.28 11.06 561.92 585.84 464.28 121.56 4.96

Maine Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Maine Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96


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Maryland Aetna HealthFund CDHP and Aetna Value PlanCDHP Self F51 330.91 371.98 235.62 136.36 36.35 330.91 371.98 241.98 130.00 33.07CDHP Self & Family F52 754.52 848.15 536.07 312.08 83.84 754.52 848.15 550.56 297.59 76.36CDHP Self Plus One F53 747.04 839.75 504.64 335.11 83.69 747.04 839.75 518.28 321.47 76.65Value Self F54 258.16 269.07 207.86 61.21 5.06 258.16 269.07 213.24 55.83 2.26Value Self & Family F55 591.16 616.15 475.98 140.17 11.59 591.16 616.15 488.30 127.85 5.18Value Self Plus One F56 579.56 604.06 466.64 137.42 11.37 579.56 604.06 478.72 125.34 5.08

Maryland Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Maryland Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Maryland Aetna Open AccessHigh Self JN1 469.08 509.12 235.62 273.50 35.32 469.08 509.12 241.98 267.14 32.04High Self & Family JN2 1,054.58 1,144.59 536.07 608.52 80.22 1,054.58 1,144.59 550.56 594.03 72.74High Self Plus One JN3 1,044.14 1,133.25 504.64 628.61 80.09 1,044.14 1,133.25 518.28 614.97 73.05Basic Self JN4 294.16 305.93 235.62 70.31 6.33 294.16 305.93 241.98 63.95 2.91Basic Self & Family JN5 664.55 700.13 536.07 164.06 19.52 664.55 700.13 550.56 149.57 11.68Basic Self Plus One JN6 634.15 642.92 496.66 146.26 7.73 634.15 642.92 509.51 133.41 1.48

Maryland CareFirst BlueChoiceHigh Self 2G1 358.77 394.65 235.62 159.03 31.16 358.77 394.65 241.98 152.67 27.88High Self & Family 2G2 852.43 937.66 536.07 401.59 75.44 852.43 937.66 550.56 387.10 67.96


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High Self Plus One 2G3 717.54 789.29 504.64 284.65 62.73 717.54 789.29 518.28 271.01 55.69Standard Self 2G4 304.89 320.13 235.62 84.51 10.52 304.89 320.13 241.98 78.15 7.24Standard Self & Family 2G5 724.41 760.64 536.07 224.57 26.44 724.41 760.64 550.56 210.08 18.96Standard Self Plus One 2G6 609.78 640.27 494.61 145.66 13.03 609.78 640.27 507.41 132.86 6.33

Maryland CareFirst BlueChoiceHDHP Self B61 281.41 281.41 217.39 64.02 2.81 281.41 281.41 223.02 58.39 0.00HDHP Self & Family B62 668.62 668.62 516.51 152.11 6.69 668.62 668.62 529.88 138.74 0.00HDHP Self Plus One B63 562.82 562.82 434.78 128.04 5.63 562.82 562.82 446.03 116.79 0.00

Maryland Kaiser Foundation Health Plan Mid-Atlantic StatesHigh Self E31 296.17 304.78 235.44 69.34 4.07 296.17 304.78 241.54 63.24 1.05High Self & Family E32 693.06 701.00 536.07 164.93 -1.85 693.06 701.00 550.56 150.44 -9.33High Self Plus One E33 669.36 701.00 504.64 196.36 22.62 669.36 701.00 518.28 182.72 15.58Standard Self E34 223.40 233.06 180.04 53.02 4.43 223.40 233.06 184.70 48.36 2.00Standard Self & Family E35 522.75 536.07 414.11 121.96 8.26 522.75 536.07 424.84 111.23 2.76Standard Self Plus One E36 504.87 536.07 414.11 121.96 12.15 504.87 536.07 424.84 111.23 6.47

Maryland Kaiser Foundation Health Plan Mid-Atlantic StatesBasic Self T71 New Plan 212.32 164.02 48.30 New Plan New Plan 212.32 168.26 44.06 New PlanBasic Self & Family T72 New Plan 509.77 393.80 115.97 New Plan New Plan 509.77 403.99 105.78 New PlanBasic Self Plus One T73 New Plan 464.41 358.76 105.65 New Plan New Plan 464.41 368.04 96.37 New Plan

Maryland M.D. IPAHigh Self JP1 318.80 331.28 235.62 95.66 7.76 318.80 331.28 241.98 89.30 4.48


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High Self & Family JP2 893.91 928.92 536.07 392.85 25.22 893.91 928.92 550.56 378.36 17.74High Self Plus One JP3 622.62 646.99 499.80 147.19 11.77 622.62 646.99 512.74 134.25 5.06

Maryland UnitedHealthcare Insurance Company, Inc. Choice HMOHigh Self LR1 279.74 280.61 216.77 63.84 3.00 279.74 280.61 222.38 58.23 0.18High Self & Family LR2 699.35 701.54 536.07 165.47 -7.60 699.35 701.54 550.56 150.98 -15.08High Self Plus One LR3 573.47 603.32 466.06 137.26 12.53 573.47 603.32 478.13 125.19 6.19

Maryland UnitedHealthcare Insurance Company, Inc. Choice Plus AdvancedValue Self L91 199.88 213.84 165.19 48.65 5.18 199.88 213.84 169.47 44.37 2.89Value Self & Family L92 560.47 599.62 463.21 136.41 14.51 560.47 599.62 475.20 124.42 8.12Value Self Plus One L93 390.36 417.64 322.63 95.01 10.11 390.36 417.64 330.98 86.66 5.66

Maryland UnitedHealthcare Insurance Company, Inc. Choice Plus HDHPHDHP Self V41 New Plan 261.68 202.15 59.53 New Plan New Plan 261.68 207.38 54.30 New PlanHDHP Self & Family V42 New Plan 654.22 505.38 148.84 New Plan New Plan 654.22 518.47 135.75 New PlanHDHP Self Plus One V43 New Plan 562.62 434.62 128.00 New Plan New Plan 562.62 445.88 116.74 New Plan

Massachusetts Aetna HealthFund CDHP and Aetna Value PlanCDHP Self EP1 374.41 414.74 235.62 179.12 35.61 374.41 414.74 241.98 172.76 32.33CDHP Self & Family EP2 853.86 945.84 536.07 409.77 82.19 853.86 945.84 550.56 395.28 74.71CDHP Self Plus One EP3 845.41 936.48 504.64 431.84 82.05 845.41 936.48 518.28 418.20 75.01Value Self EP4 250.29 260.95 201.58 59.37 4.93 250.29 260.95 206.80 54.15 2.21Value Self & Family EP5 573.16 597.56 461.62 135.94 11.28 573.16 597.56 473.57 123.99 5.06Value Self Plus One EP6 561.92 585.84 452.56 133.28 11.06 561.92 585.84 464.28 121.56 4.96

Massachusetts Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Massachusetts Aetna Direct


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Michigan Aetna HealthFund CDHP and Aetna Value PlanCDHP Self G51 322.56 346.28 235.62 110.66 19.00 322.56 346.28 241.98 104.30 15.72CDHP Self & Family G52 735.73 789.85 536.07 253.78 44.33 735.73 789.85 550.56 239.29 36.85CDHP Self Plus One G53 728.45 782.04 504.64 277.40 44.57 728.45 782.04 518.28 263.76 37.53Value Self G54 246.85 253.66 195.95 57.71 4.02 246.85 253.66 201.03 52.63 1.41Value Self & Family G55 565.39 580.95 448.78 132.17 9.20 565.39 580.95 460.40 120.55 3.23Value Self Plus One G56 554.30 569.57 439.99 129.58 9.02 554.30 569.57 451.38 118.19 3.17

Michigan Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Michigan Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Michigan Bluecare Network of MIHigh Self K51 390.42 428.22 235.62 192.60 33.08 390.42 428.22 241.98 186.24 29.80High Self & Family K52 952.59 1,044.84 536.07 508.77 82.46 952.59 1,044.84 550.56 494.28 74.98High Self Plus One K53 897.96 984.91 504.64 480.27 77.93 897.96 984.91 518.28 466.63 70.89

Michigan Bluecare Network of MIHigh Self LX1 308.30 308.30 235.62 72.68 -4.72 308.30 308.30 241.98 66.32 -8.00High Self & Family LX2 752.26 752.23 536.07 216.16 -9.82 752.26 752.23 550.56 201.67 -17.30


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High Self Plus One LX3 709.09 709.09 504.64 204.45 -9.02 709.09 709.09 518.28 190.81 -16.06Michigan Health Alliance Plan

High Self 521 331.75 326.87 235.62 91.25 -9.60 331.75 326.87 241.98 84.89 -12.88High Self & Family 522 809.46 797.56 536.07 261.49 -21.69 809.46 797.56 550.56 247.00 -29.17High Self Plus One 523 763.03 751.80 504.64 247.16 -20.25 763.03 751.80 518.28 233.52 -27.29

Michigan Health Alliance PlanStandard Self GY4 279.80 260.27 201.06 59.21 -1.65 279.80 260.27 206.26 54.01 -4.05Standard Self & Family GY5 682.72 635.06 490.58 144.48 -11.96 682.72 635.06 503.29 131.77 -17.66Standard Self Plus One GY6 643.54 598.62 462.43 136.19 -11.73 643.54 598.62 474.41 124.21 -17.11

Michigan Priority HealthHigh Self LE1 314.98 375.60 235.62 139.98 55.90 314.98 375.60 241.98 133.62 52.62High Self & Family LE2 740.21 882.65 536.07 346.58 132.65 740.21 882.65 550.56 332.09 125.17High Self Plus One LE3 692.96 826.31 504.64 321.67 124.33 692.96 826.31 518.28 308.03 117.29Standard Self LE4 252.32 273.84 211.54 62.30 7.42 252.32 273.84 217.02 56.82 4.46Standard Self & Family LE5 592.97 643.53 497.13 146.40 17.43 592.97 643.53 510.00 133.53 10.49Standard Self Plus One LE6 555.11 602.45 465.39 137.06 16.32 555.11 602.45 477.44 125.01 9.82

Minnesota Aetna HealthFund CDHP and Aetna Value PlanCDHP Self H41 347.17 379.77 235.62 144.15 27.88 347.17 379.77 241.98 137.79 24.60CDHP Self & Family H42 791.39 865.68 536.07 329.61 64.50 791.39 865.68 550.56 315.12 57.02CDHP Self Plus One H43 783.56 857.11 504.64 352.47 64.53 783.56 857.11 518.28 338.83 57.49Value Self H44 257.63 265.72 205.27 60.45 4.42 257.63 265.72 210.58 55.14 1.68Value Self & Family H45 591.28 609.86 471.12 138.74 10.14 591.28 609.86 483.31 126.55 3.86Value Self Plus One H46 579.69 597.90 461.88 136.02 9.94 579.69 597.90 473.84 124.06 3.77

Minnesota Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12


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HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90Minnesota Aetna Direct


Minnesota HealthPartnersHigh Self V31 329.41 356.92 235.62 121.30 22.79 329.41 356.92 241.98 114.94 19.51High Self & Family V32 802.44 869.46 536.07 333.39 57.23 802.44 869.46 550.56 318.90 49.75High Self Plus One V33 727.99 788.79 504.64 284.15 51.78 727.99 788.79 518.28 270.51 44.74Standard Self V34 196.66 211.15 163.11 48.04 5.27 196.66 211.15 167.34 43.81 3.00Standard Self & Family V35 479.08 514.37 397.35 117.02 12.82 479.08 514.37 407.64 106.73 7.32Standard Self Plus One V36 434.64 466.65 360.49 106.16 11.63 434.64 466.65 369.82 96.83 6.64

Mississippi Aetna HealthFund CDHP and Aetna Value PlanCDHP Self H41 347.17 379.77 235.62 144.15 27.88 347.17 379.77 241.98 137.79 24.60CDHP Self & Family H42 791.39 865.68 536.07 329.61 64.50 791.39 865.68 550.56 315.12 57.02CDHP Self Plus One H43 783.56 857.11 504.64 352.47 64.53 783.56 857.11 518.28 338.83 57.49Value Self H44 257.63 265.72 205.27 60.45 4.42 257.63 265.72 210.58 55.14 1.68Value Self & Family H45 591.28 609.86 471.12 138.74 10.14 591.28 609.86 483.31 126.55 3.86Value Self Plus One H46 579.69 597.90 461.88 136.02 9.94 579.69 597.90 473.84 124.06 3.77

Mississippi Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04


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HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Mississippi Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Mississippi UnitedHealthcare Insurance Company, Inc. Choice HMOHigh Self KK1 257.80 274.77 212.26 62.51 6.44 257.80 274.77 217.76 57.01 3.52High Self & Family KK2 644.49 686.91 530.64 156.27 16.09 644.49 686.91 544.38 142.53 8.80High Self Plus One KK3 554.26 590.74 456.35 134.39 13.84 554.26 590.74 468.16 122.58 7.57

Mississippi UnitedHealthcare Insurance Company, Inc. Choice Plus HDHPHDHP Self LS1 212.83 202.27 156.25 46.02 -0.27 212.83 202.27 160.30 41.97 -2.19HDHP Self & Family LS2 532.06 505.67 390.63 115.04 -0.68 532.06 505.67 400.74 104.93 -5.47HDHP Self Plus One LS3 457.58 434.88 335.94 98.94 -0.58 457.58 434.88 344.64 90.24 -4.71

Missouri Aetna HealthFund CDHP and Aetna Value PlanCDHP Self G51 322.56 346.28 235.62 110.66 19.00 322.56 346.28 241.98 104.30 15.72CDHP Self & Family G52 735.73 789.85 536.07 253.78 44.33 735.73 789.85 550.56 239.29 36.85CDHP Self Plus One G53 728.45 782.04 504.64 277.40 44.57 728.45 782.04 518.28 263.76 37.53Value Self G54 246.85 253.66 195.95 57.71 4.02 246.85 253.66 201.03 52.63 1.41Value Self & Family G55 565.39 580.95 448.78 132.17 9.20 565.39 580.95 460.40 120.55 3.23Value Self Plus One G56 554.30 569.57 439.99 129.58 9.02 554.30 569.57 451.38 118.19 3.17

Missouri Aetna HealthFund HDHP


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Missouri Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Missouri Aetna Open AccessHigh Self HA1 324.69 336.16 235.62 100.54 6.75 324.69 336.16 241.98 94.18 3.47High Self & Family HA2 766.98 794.06 536.07 257.99 17.29 766.98 794.06 550.56 243.50 9.81High Self Plus One HA3 759.40 786.22 504.64 281.58 17.80 759.40 786.22 518.28 267.94 10.76Standard Self HA4 279.33 282.10 217.92 64.18 3.43 279.33 282.10 223.56 58.54 0.58Standard Self & Family HA5 659.35 665.86 514.38 151.48 8.07 659.35 665.86 527.69 138.17 1.35Standard Self Plus One HA6 652.83 659.27 504.64 154.63 -2.58 652.83 659.27 518.28 140.99 -9.62

Missouri Blue PreferredHigh Self 9G1 322.38 338.73 235.62 103.11 11.63 322.38 338.73 241.98 96.75 8.35High Self & Family 9G2 697.96 733.35 536.07 197.28 25.60 697.96 733.35 550.56 182.79 18.12High Self Plus One 9G3 651.22 694.40 504.64 189.76 34.16 651.22 694.40 518.28 176.12 27.12Standard Self 9G4 239.60 245.59 189.72 55.87 3.76 239.60 245.59 194.63 50.96 1.24Standard Self & Family 9G5 678.07 706.05 536.07 169.98 18.19 678.07 706.05 550.56 155.49 10.71Standard Self Plus One 9G6 622.96 638.52 493.26 145.26 9.77 622.96 638.52 506.03 132.49 3.23


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Missouri Humana CoverageFirst/Value PlanCDHP Self PH1 279.85 265.95 205.45 60.50 -0.37 279.85 265.95 210.77 55.18 -2.89CDHP Self & Family PH2 629.68 598.38 462.25 136.13 -0.83 629.68 598.38 474.22 124.16 -6.50CDHP Self Plus One PH3 601.69 571.79 441.71 130.08 -0.79 601.69 571.79 453.14 118.65 -6.20Value Self PH4 214.76 193.28 149.31 43.97 -2.74 214.76 193.28 153.17 40.11 -4.45Value Self & Family PH5 483.20 434.90 335.96 98.94 -6.16 483.20 434.90 344.66 90.24 -10.02Value Self Plus One PH6 461.73 415.56 321.02 94.54 -5.89 461.73 415.56 329.33 86.23 -9.58

Missouri Humana Health Plan, Inc.High Self MS1 741.03 748.42 235.62 512.80 2.67 741.03 748.42 241.98 506.44 -0.61High Self & Family MS2 1,667.32 1,683.94 536.07 1,147.87 6.83 1,667.32 1,683.94 550.56 1,133.38 -0.65High Self Plus One MS3 1,593.21 1,609.10 504.64 1,104.46 6.87 1,593.21 1,609.10 518.28 1,090.82 -0.17Standard Self MS4 383.06 402.19 235.62 166.57 14.41 383.06 402.19 241.98 160.21 11.13Standard Self & Family MS5 861.90 904.94 536.07 368.87 33.25 861.90 904.94 550.56 354.38 25.77Standard Self Plus One MS6 823.60 864.72 504.64 360.08 32.10 823.60 864.72 518.28 346.44 25.06

Montana Aetna HealthFund CDHP and Aetna Value PlanCDHP Self H41 347.17 379.77 235.62 144.15 27.88 347.17 379.77 241.98 137.79 24.60CDHP Self & Family H42 791.39 865.68 536.07 329.61 64.50 791.39 865.68 550.56 315.12 57.02CDHP Self Plus One H43 783.56 857.11 504.64 352.47 64.53 783.56 857.11 518.28 338.83 57.49Value Self H44 257.63 265.72 205.27 60.45 4.42 257.63 265.72 210.58 55.14 1.68Value Self & Family H45 591.28 609.86 471.12 138.74 10.14 591.28 609.86 483.31 126.55 3.86


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Value Self Plus One H46 579.69 597.90 461.88 136.02 9.94 579.69 597.90 473.84 124.06 3.77Montana Aetna HealthFund HDHP


Montana Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Nebraska Aetna HealthFund CDHP and Aetna Value PlanCDHP Self H41 347.17 379.77 235.62 144.15 27.88 347.17 379.77 241.98 137.79 24.60CDHP Self & Family H42 791.39 865.68 536.07 329.61 64.50 791.39 865.68 550.56 315.12 57.02CDHP Self Plus One H43 783.56 857.11 504.64 352.47 64.53 783.56 857.11 518.28 338.83 57.49Value Self H44 257.63 265.72 205.27 60.45 4.42 257.63 265.72 210.58 55.14 1.68Value Self & Family H45 591.28 609.86 471.12 138.74 10.14 591.28 609.86 483.31 126.55 3.86Value Self Plus One H46 579.69 597.90 461.88 136.02 9.94 579.69 597.90 473.84 124.06 3.77

Nebraska Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Nebraska Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Nevada Aetna HealthFund CDHP and Aetna Value Plan


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CDHP Self G51 322.56 346.28 235.62 110.66 19.00 322.56 346.28 241.98 104.30 15.72CDHP Self & Family G52 735.73 789.85 536.07 253.78 44.33 735.73 789.85 550.56 239.29 36.85CDHP Self Plus One G53 728.45 782.04 504.64 277.40 44.57 728.45 782.04 518.28 263.76 37.53Value Self G54 246.85 253.66 195.95 57.71 4.02 246.85 253.66 201.03 52.63 1.41Value Self & Family G55 565.39 580.95 448.78 132.17 9.20 565.39 580.95 460.40 120.55 3.23Value Self Plus One G56 554.30 569.57 439.99 129.58 9.02 554.30 569.57 451.38 118.19 3.17

Nevada Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Nevada Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Nevada Health Plan of NevadaHigh Self NM1 246.70 280.40 216.61 63.79 10.13 246.70 280.40 222.22 58.18 6.99High Self & Family NM2 584.66 664.52 513.34 151.18 24.02 584.66 664.52 526.63 137.89 16.57High Self Plus One NM3 468.71 532.76 411.56 121.20 19.26 468.71 532.76 422.21 110.55 13.29

Nevada UnitedHealthcare Insurance Company, Inc. Choice HMOHigh Self KT1 New Plan 281.85 217.73 64.12 New Plan New Plan 281.85 223.37 58.48 New PlanHigh Self & Family KT2 New Plan 704.63 536.07 168.56 New Plan New Plan 704.63 550.56 154.07 New PlanHigh Self Plus One KT3 New Plan 605.98 468.12 137.86 New Plan New Plan 605.98 480.24 125.74 New Plan

Nevada UnitedHealthcare Insurance Company, Inc. Choice Plus HDHPHDHP Self LU1 New Plan 222.88 172.17 50.71 New Plan New Plan 222.88 176.63 46.25 New PlanHDHP Self & Family LU2 New Plan 557.19 430.43 126.76 New Plan New Plan 557.19 441.57 115.62 New PlanHDHP Self Plus One LU3 New Plan 479.19 370.17 109.02 New Plan New Plan 479.19 379.76 99.43 New Plan


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New Hampshire Aetna HealthFund CDHP and Aetna Value PlanCDHP Self EP1 374.41 414.74 235.62 179.12 35.61 374.41 414.74 241.98 172.76 32.33CDHP Self & Family EP2 853.86 945.84 536.07 409.77 82.19 853.86 945.84 550.56 395.28 74.71CDHP Self Plus One EP3 845.41 936.48 504.64 431.84 82.05 845.41 936.48 518.28 418.20 75.01Value Self EP4 250.29 260.95 201.58 59.37 4.93 250.29 260.95 206.80 54.15 2.21Value Self & Family EP5 573.16 597.56 461.62 135.94 11.28 573.16 597.56 473.57 123.99 5.06Value Self Plus One EP6 561.92 585.84 452.56 133.28 11.06 561.92 585.84 464.28 121.56 4.96

New Hampshire Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

New Hampshire Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

New Jersey Aetna HealthFund CDHP and Aetna Value PlanCDHP Self EP1 374.41 414.74 235.62 179.12 35.61 374.41 414.74 241.98 172.76 32.33CDHP Self & Family EP2 853.86 945.84 536.07 409.77 82.19 853.86 945.84 550.56 395.28 74.71CDHP Self Plus One EP3 845.41 936.48 504.64 431.84 82.05 845.41 936.48 518.28 418.20 75.01Value Self EP4 250.29 260.95 201.58 59.37 4.93 250.29 260.95 206.80 54.15 2.21Value Self & Family EP5 573.16 597.56 461.62 135.94 11.28 573.16 597.56 473.57 123.99 5.06Value Self Plus One EP6 561.92 585.84 452.56 133.28 11.06 561.92 585.84 464.28 121.56 4.96

New Jersey Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12


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HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90New Jersey Aetna Direct


New Jersey Aetna Open AccessHigh Self JR1 636.14 666.58 235.62 430.96 25.72 636.14 666.58 241.98 424.60 22.44High Self & Family JR2 1,469.44 1,539.74 536.07 1,003.67 60.51 1,469.44 1,539.74 550.56 989.18 53.03High Self Plus One JR3 1,454.89 1,524.49 504.64 1,019.85 60.58 1,454.89 1,524.49 518.28 1,006.21 53.54Basic Self JR4 489.08 537.15 235.62 301.53 43.35 489.08 537.15 241.98 295.17 40.07Basic Self & Family JR5 1,133.48 1,244.88 536.07 708.81 101.61 1,133.48 1,244.88 550.56 694.32 94.13Basic Self Plus One JR6 1,122.25 1,232.56 504.64 727.92 101.29 1,122.25 1,232.56 518.28 714.28 94.25

New Jersey Aetna Open AccessHigh Self P31 655.24 725.73 235.62 490.11 65.77 655.24 725.73 241.98 483.75 62.49High Self & Family P32 1,588.64 1,759.54 536.07 1,223.47 161.11 1,588.64 1,759.54 550.56 1,208.98 153.63High Self Plus One P33 1,572.91 1,742.11 504.64 1,237.47 160.18 1,572.91 1,742.11 518.28 1,223.83 153.14Basic Self P34 549.01 622.19 235.62 386.57 68.46 549.01 622.19 241.98 380.21 65.18Basic Self & Family P35 1,274.25 1,444.10 536.07 908.03 160.06 1,274.25 1,444.10 550.56 893.54 152.58Basic Self Plus One P36 1,261.63 1,429.80 504.64 925.16 159.15 1,261.63 1,429.80 518.28 911.52 152.11

New Jersey GHI Health Plan -High Self 801 441.06 474.15 235.62 238.53 28.37 441.06 474.15 241.98 232.17 25.09


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High Self & Family 802 1,196.52 1,286.26 536.07 750.19 79.95 1,196.52 1,286.26 550.56 735.70 72.47High Self Plus One 803 1,074.06 1,154.62 504.64 649.98 71.54 1,074.06 1,154.62 518.28 636.34 64.50Standard Self 804 328.15 328.15 235.62 92.53 -4.72 328.15 328.15 241.98 86.17 -8.00Standard Self & Family 805 782.70 972.59 536.07 436.52 180.10 782.70 972.59 550.56 422.03 172.62Standard Self Plus One 806 750.09 772.60 504.64 267.96 13.49 750.09 772.60 518.28 254.32 6.45

New Mexico Aetna HealthFund CDHP and Aetna Value PlanCDHP Self G51 322.56 346.28 235.62 110.66 19.00 322.56 346.28 241.98 104.30 15.72CDHP Self & Family G52 735.73 789.85 536.07 253.78 44.33 735.73 789.85 550.56 239.29 36.85CDHP Self Plus One G53 728.45 782.04 504.64 277.40 44.57 728.45 782.04 518.28 263.76 37.53Value Self G54 246.85 253.66 195.95 57.71 4.02 246.85 253.66 201.03 52.63 1.41Value Self & Family G55 565.39 580.95 448.78 132.17 9.20 565.39 580.95 460.40 120.55 3.23Value Self Plus One G56 554.30 569.57 439.99 129.58 9.02 554.30 569.57 451.38 118.19 3.17

New Mexico Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

New Mexico Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

New Mexico Presbyterian Health PlanHigh Self P21 312.72 355.93 235.62 120.31 38.49 312.72 355.93 241.98 113.95 35.21High Self & Family P22 734.91 836.44 536.07 300.37 91.74 734.91 836.44 550.56 285.88 84.26High Self Plus One P23 709.89 807.98 504.64 303.34 89.07 709.89 807.98 518.28 289.70 82.03

New Mexico Presbyterian Health Plan


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Standard Self PS4 261.73 299.96 231.72 68.24 11.31 261.73 299.96 237.72 62.24 7.93Standard Self & Family PS5 615.08 704.93 536.07 168.86 35.08 615.08 704.93 550.56 154.37 26.74Standard Self Plus One PS6 594.14 680.93 504.64 176.29 47.06 594.14 680.93 518.28 162.65 39.37

New York Aetna HealthFund CDHP and Aetna Value PlanCDHP Self EP1 374.41 414.74 235.62 179.12 35.61 374.41 414.74 241.98 172.76 32.33CDHP Self & Family EP2 853.86 945.84 536.07 409.77 82.19 853.86 945.84 550.56 395.28 74.71CDHP Self Plus One EP3 845.41 936.48 504.64 431.84 82.05 845.41 936.48 518.28 418.20 75.01Value Self EP4 250.29 260.95 201.58 59.37 4.93 250.29 260.95 206.80 54.15 2.21Value Self & Family EP5 573.16 597.56 461.62 135.94 11.28 573.16 597.56 473.57 123.99 5.06Value Self Plus One EP6 561.92 585.84 452.56 133.28 11.06 561.92 585.84 464.28 121.56 4.96

New York Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

New York Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

New York Aetna Open AccessHigh Self JC1 483.32 537.70 235.62 302.08 49.66 483.32 537.70 241.98 295.72 46.38High Self & Family JC2 1,194.29 1,328.64 536.07 792.57 124.56 1,194.29 1,328.64 550.56 778.08 117.08High Self Plus One JC3 1,182.48 1,315.51 504.64 810.87 124.01 1,182.48 1,315.51 518.28 797.23 116.97Basic Self JC4 371.30 408.23 235.62 172.61 32.21 371.30 408.23 241.98 166.25 28.93Basic Self & Family JC5 905.66 995.75 536.07 459.68 80.30 905.66 995.75 550.56 445.19 72.82Basic Self Plus One JC6 896.71 985.90 504.64 481.26 80.17 896.71 985.90 518.28 467.62 73.13


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New York CDPHP Universal Benefits, Inc.High Self SG1 345.92 371.90 235.62 136.28 21.26 345.92 371.90 241.98 129.92 17.98High Self & Family SG2 1,037.75 1,115.66 536.07 579.59 68.12 1,037.75 1,115.66 550.56 565.10 60.64High Self Plus One SG3 691.85 743.82 504.64 239.18 42.95 691.85 743.82 518.28 225.54 35.91Standard Self SG4 244.54 266.57 205.93 60.64 7.45 244.54 266.57 211.26 55.31 4.57Standard Self & Family SG5 733.57 799.69 536.07 263.62 56.33 733.57 799.69 550.56 249.13 48.85Standard Self Plus One SG6 489.06 533.14 411.85 121.29 14.92 489.06 533.14 422.51 110.63 9.15

New York GHI Health Plan -High Self 801 441.06 474.15 235.62 238.53 28.37 441.06 474.15 241.98 232.17 25.09High Self & Family 802 1,196.52 1,286.26 536.07 750.19 79.95 1,196.52 1,286.26 550.56 735.70 72.47High Self Plus One 803 1,074.06 1,154.62 504.64 649.98 71.54 1,074.06 1,154.62 518.28 636.34 64.50Standard Self 804 328.15 328.15 235.62 92.53 -4.72 328.15 328.15 241.98 86.17 -8.00Standard Self & Family 805 782.70 972.59 536.07 436.52 180.10 782.70 972.59 550.56 422.03 172.62Standard Self Plus One 806 750.09 772.60 504.64 267.96 13.49 750.09 772.60 518.28 254.32 6.45

New York HIP of Greater New YorkHigh Self 511 333.14 352.04 235.62 116.42 14.18 333.14 352.04 241.98 110.06 10.90High Self & Family 512 972.45 991.50 536.07 455.43 9.26 972.45 991.50 550.56 440.94 1.78High Self Plus One 513 656.91 627.36 484.64 142.72 -18.57 656.91 627.36 497.18 130.18 -24.51

New York Independent Health AssocStandard Self C54 302.28 312.04 235.62 76.42 5.04 302.28 312.04 241.98 70.06 1.76Standard Self & Family C55 816.15 842.50 536.07 306.43 16.56 816.15 842.50 550.56 291.94 9.08Standard Self Plus One C56 770.81 795.69 504.64 291.05 15.86 770.81 795.69 518.28 277.41 8.82


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New York Independent Health AssocHigh Self QA1 318.10 327.65 235.62 92.03 4.83 318.10 327.65 241.98 85.67 1.55High Self & Family QA2 858.88 884.67 536.07 348.60 16.00 858.88 884.67 550.56 334.11 8.52High Self Plus One QA3 811.17 835.52 504.64 330.88 15.33 811.17 835.52 518.28 317.24 8.29HDHP Self QA4 207.56 241.80 186.79 55.01 9.87 207.56 241.80 191.63 50.17 7.10HDHP Self & Family QA5 550.14 620.62 479.43 141.19 21.53 550.14 620.62 491.84 128.78 14.63HDHP Self Plus One QA6 508.45 577.43 446.06 131.37 20.78 508.45 577.43 457.61 119.82 14.32

New York MVP Health CareHigh Self GA1 349.54 413.09 235.62 177.47 58.83 349.54 413.09 241.98 171.11 55.55High Self & Family GA2 856.39 1,012.08 536.07 476.01 145.90 856.39 1,012.08 550.56 461.52 138.42High Self Plus One GA3 803.95 950.11 504.64 445.47 137.14 803.95 950.11 518.28 431.83 130.10Standard Self GA4 321.11 346.54 235.62 110.92 20.71 321.11 346.54 241.98 104.56 17.43Standard Self & Family GA5 786.71 849.00 536.07 312.93 52.50 786.71 849.00 550.56 298.44 45.02Standard Self Plus One GA6 738.55 797.02 504.64 292.38 49.45 738.55 797.02 518.28 278.74 42.41

New York MVP Health CareHigh Self GV1 315.64 365.78 235.62 130.16 45.42 315.64 365.78 241.98 123.80 42.14High Self & Family GV2 773.30 896.15 536.07 360.08 113.06 773.30 896.15 550.56 345.59 105.58High Self Plus One GV3 725.96 841.29 504.64 336.65 106.31 725.96 841.29 518.28 323.01 99.27Standard Self GV4 281.73 324.76 235.62 89.14 27.86 281.73 324.76 241.98 82.78 24.32Standard Self & Family GV5 690.24 795.64 536.07 259.57 95.61 690.24 795.64 550.56 245.08 88.13Standard Self Plus One GV6 647.98 746.93 504.64 242.29 89.93 647.98 746.93 518.28 228.65 82.89


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New York MVP Health CareHigh Self M91 323.89 393.95 235.62 158.33 65.34 323.89 393.95 241.98 151.97 62.06High Self & Family M92 793.50 965.18 536.07 429.11 161.89 793.50 965.18 550.56 414.62 154.41High Self Plus One M93 744.93 906.09 504.64 401.45 152.14 744.93 906.09 518.28 387.81 145.10Standard Self M94 316.74 324.64 235.62 89.02 3.18 316.74 324.64 241.98 82.66 -0.10Standard Self & Family M95 776.03 795.37 536.07 259.30 9.55 776.03 795.37 550.56 244.81 2.07Standard Self Plus One M96 728.51 746.67 504.64 242.03 9.14 728.51 746.67 518.28 228.39 2.10

New York MVP Health CareHigh Self MF1 433.33 488.29 235.62 252.67 50.24 433.33 488.29 241.98 246.31 46.96High Self & Family MF2 1,061.63 1,196.31 536.07 660.24 124.89 1,061.63 1,196.31 550.56 645.75 117.41High Self Plus One MF3 996.63 1,123.06 504.64 618.42 117.41 996.63 1,123.06 518.28 604.78 110.37Standard Self MF4 404.20 446.23 235.62 210.61 37.31 404.20 446.23 241.98 204.25 34.03Standard Self & Family MF5 990.28 1,093.26 536.07 557.19 93.19 990.28 1,093.26 550.56 542.70 85.71Standard Self Plus One MF6 929.65 1,026.32 504.64 521.68 87.65 929.65 1,026.32 518.28 508.04 80.61

New York MVP Health CareHigh Self MX1 381.51 501.32 235.62 265.70 115.09 381.51 501.32 241.98 259.34 111.81High Self & Family MX2 934.73 1,228.24 536.07 692.17 283.72 934.73 1,228.24 550.56 677.68 276.24High Self Plus One MX3 877.49 1,153.05 504.64 648.41 266.54 877.49 1,153.05 518.28 634.77 259.50Standard Self MX4 370.80 391.83 235.62 156.21 16.31 370.80 391.83 241.98 149.85 13.03Standard Self & Family MX5 908.46 959.99 536.07 423.92 41.74 908.46 959.99 550.56 409.43 34.26Standard Self Plus One MX6 852.84 901.22 504.64 396.58 39.36 852.84 901.22 518.28 382.94 32.32


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North Carolina Aetna HealthFund CDHP and Aetna Value PlanCDHP Self F51 330.91 371.98 235.62 136.36 36.35 330.91 371.98 241.98 130.00 33.07CDHP Self & Family F52 754.52 848.15 536.07 312.08 83.84 754.52 848.15 550.56 297.59 76.36CDHP Self Plus One F53 747.04 839.75 504.64 335.11 83.69 747.04 839.75 518.28 321.47 76.65Value Self F54 258.16 269.07 207.86 61.21 5.06 258.16 269.07 213.24 55.83 2.26Value Self & Family F55 591.16 616.15 475.98 140.17 11.59 591.16 616.15 488.30 127.85 5.18Value Self Plus One F56 579.56 604.06 466.64 137.42 11.37 579.56 604.06 478.72 125.34 5.08

North Carolina Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

North Carolina Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

North Carolina UnitedHealthcare Insurance Company, Inc. Choice HMOHigh Self KK1 New Plan 274.77 212.26 62.51 New Plan New Plan 274.77 217.76 57.01 New PlanHigh Self & Family KK2 New Plan 686.91 530.64 156.27 New Plan New Plan 686.91 544.38 142.53 New PlanHigh Self Plus One KK3 New Plan 590.74 456.35 134.39 New Plan New Plan 590.74 468.16 122.58 New Plan

North Carolina UnitedHealthcare Insurance Company, Inc. Choice Plus HDHPHDHP Self LS1 New Plan 202.27 156.25 46.02 New Plan New Plan 202.27 160.30 41.97 New PlanHDHP Self & Family LS2 New Plan 505.67 390.63 115.04 New Plan New Plan 505.67 400.74 104.93 New PlanHDHP Self Plus One LS3 New Plan 434.88 335.94 98.94 New Plan New Plan 434.88 344.64 90.24 New Plan


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North Dakota Aetna HealthFund CDHP and Aetna Value PlanCDHP Self H41 347.17 379.77 235.62 144.15 27.88 347.17 379.77 241.98 137.79 24.60CDHP Self & Family H42 791.39 865.68 536.07 329.61 64.50 791.39 865.68 550.56 315.12 57.02CDHP Self Plus One H43 783.56 857.11 504.64 352.47 64.53 783.56 857.11 518.28 338.83 57.49Value Self H44 257.63 265.72 205.27 60.45 4.42 257.63 265.72 210.58 55.14 1.68Value Self & Family H45 591.28 609.86 471.12 138.74 10.14 591.28 609.86 483.31 126.55 3.86Value Self Plus One H46 579.69 597.90 461.88 136.02 9.94 579.69 597.90 473.84 124.06 3.77

North Dakota Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

North Dakota Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

North Dakota HealthPartnersHigh Self V31 329.41 356.92 235.62 121.30 22.79 329.41 356.92 241.98 114.94 19.51High Self & Family V32 802.44 869.46 536.07 333.39 57.23 802.44 869.46 550.56 318.90 49.75High Self Plus One V33 727.99 788.79 504.64 284.15 51.78 727.99 788.79 518.28 270.51 44.74Standard Self V34 196.66 211.15 163.11 48.04 5.27 196.66 211.15 167.34 43.81 3.00Standard Self & Family V35 479.08 514.37 397.35 117.02 12.82 479.08 514.37 407.64 106.73 7.32Standard Self Plus One V36 434.64 466.65 360.49 106.16 11.63 434.64 466.65 369.82 96.83 6.64


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Ohio Aetna HealthFund CDHP and Aetna Value PlanCDHP Self JS1 445.61 481.36 235.62 245.74 31.03 445.61 481.36 241.98 239.38 27.75CDHP Self & Family JS2 1,015.78 1,097.29 536.07 561.22 71.72 1,015.78 1,097.29 550.56 546.73 64.24CDHP Self Plus One JS3 1,005.73 1,086.44 504.64 581.80 71.69 1,005.73 1,086.44 518.28 568.16 64.65Value Self JS4 322.40 352.77 235.62 117.15 25.65 322.40 352.77 241.98 110.79 22.37Value Self & Family JS5 736.01 805.33 536.07 269.26 59.53 736.01 805.33 550.56 254.77 52.05Value Self Plus One JS6 728.72 797.36 504.64 292.72 59.62 728.72 797.36 518.28 279.08 52.58

Ohio Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Ohio Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Ohio AultCare HMOHigh Self 3A1 329.85 345.84 235.62 110.22 11.27 329.85 345.84 241.98 103.86 7.99High Self & Family 3A2 814.70 854.24 536.07 318.17 29.75 814.70 854.24 550.56 303.68 22.27High Self Plus One 3A3 692.68 726.26 504.64 221.62 24.56 692.68 726.26 518.28 207.98 17.52HDHP Self 3A4 161.62 166.00 128.24 37.76 2.61 161.62 166.00 131.56 34.44 0.90HDHP Self & Family 3A5 517.15 533.86 412.41 121.45 8.97 517.15 533.86 423.08 110.78 3.47


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HDHP Self Plus One 3A6 307.06 314.64 243.06 71.58 4.79 307.06 314.64 249.35 65.29 1.58

Ohio Humana Health Plan of Ohio, Inc.High Self A61 454.72 482.03 235.62 246.41 22.59 454.72 482.03 241.98 240.05 19.31High Self & Family A62 1,023.12 1,084.57 536.07 548.50 51.66 1,023.12 1,084.57 550.56 534.01 44.18High Self Plus One A63 977.65 1,036.37 504.64 531.73 49.70 977.65 1,036.37 518.28 518.09 42.66Standard Self A64 358.48 385.79 235.62 150.17 22.59 358.48 385.79 241.98 143.81 19.31Standard Self & Family A65 806.56 868.03 536.07 331.96 51.68 806.56 868.03 550.56 317.47 44.20Standard Self Plus One A66 770.71 829.45 504.64 324.81 49.72 770.71 829.45 518.28 311.17 42.68

Ohio Medical MutualHigh Self 641 402.58 421.73 235.62 186.11 14.43 402.58 421.73 241.98 179.75 11.15High Self & Family 642 966.20 1,012.13 536.07 476.06 36.14 966.20 1,012.13 550.56 461.57 28.66High Self Plus One 643 885.68 927.78 504.64 423.14 33.08 885.68 927.78 518.28 409.50 26.04Standard Self 644 337.46 351.44 235.62 115.82 9.26 337.46 351.44 241.98 109.46 5.98Standard Self & Family 645 809.91 843.46 536.07 307.39 23.76 809.91 843.46 550.56 292.90 16.28Standard Self Plus One 646 742.42 773.19 504.64 268.55 21.75 742.42 773.19 518.28 254.91 14.71

Ohio Medical MutualBasic Self UX1 New Plan 273.96 211.63 62.33 New Plan New Plan 273.96 217.11 56.85 New PlanBasic Self & Family UX2 New Plan 657.52 507.93 149.59 New Plan New Plan 657.52 521.08 136.44 New PlanBasic Self Plus One UX3 New Plan 602.73 465.61 137.12 New Plan New Plan 602.73 477.66 125.07 New Plan

Oklahoma Aetna HealthFund CDHP and Aetna Value PlanCDHP Self JS1 445.61 481.36 235.62 245.74 31.03 445.61 481.36 241.98 239.38 27.75


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CDHP Self & Family JS2 1,015.78 1,097.29 536.07 561.22 71.72 1,015.78 1,097.29 550.56 546.73 64.24CDHP Self Plus One JS3 1,005.73 1,086.44 504.64 581.80 71.69 1,005.73 1,086.44 518.28 568.16 64.65Value Self JS4 322.40 352.77 235.62 117.15 25.65 322.40 352.77 241.98 110.79 22.37Value Self & Family JS5 736.01 805.33 536.07 269.26 59.53 736.01 805.33 550.56 254.77 52.05Value Self Plus One JS6 728.72 797.36 504.64 292.72 59.62 728.72 797.36 518.28 279.08 52.58

Oklahoma Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Oklahoma Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Oklahoma GlobalHealth, Inc.High Self IM1 261.85 262.11 202.48 59.63 2.68 261.85 262.11 207.72 54.39 0.06High Self & Family IM2 654.64 655.26 506.19 149.07 6.69 654.64 655.26 519.29 135.97 0.13High Self Plus One IM3 523.71 524.21 404.95 119.26 5.35 523.71 524.21 415.44 108.77 0.10Standard Self IM4 242.42 242.44 187.28 55.16 2.43 242.42 242.44 192.13 50.31 0.01Standard Self & Family IM5 606.07 606.10 468.21 137.89 6.07 606.07 606.10 480.33 125.77 0.01Standard Self Plus One IM6 484.86 484.88 374.57 110.31 4.85 484.86 484.88 384.27 100.61 0.00

Oregon Aetna HealthFund CDHP and Aetna Value PlanCDHP Self H41 347.17 379.77 235.62 144.15 27.88 347.17 379.77 241.98 137.79 24.60CDHP Self & Family H42 791.39 865.68 536.07 329.61 64.50 791.39 865.68 550.56 315.12 57.02CDHP Self Plus One H43 783.56 857.11 504.64 352.47 64.53 783.56 857.11 518.28 338.83 57.49


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Value Self H44 257.63 265.72 205.27 60.45 4.42 257.63 265.72 210.58 55.14 1.68Value Self & Family H45 591.28 609.86 471.12 138.74 10.14 591.28 609.86 483.31 126.55 3.86Value Self Plus One H46 579.69 597.90 461.88 136.02 9.94 579.69 597.90 473.84 124.06 3.77

Oregon Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Oregon Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Oregon Kaiser Foundation Health Plan of NorthwestHigh Self 571 317.04 319.42 235.62 83.80 -2.34 317.04 319.42 241.98 77.44 -5.62High Self & Family 572 716.12 721.45 536.07 185.38 -4.46 716.12 721.45 550.56 170.89 -11.94High Self Plus One 573 716.12 721.45 504.64 216.81 -3.69 716.12 721.45 518.28 203.17 -10.73Standard Self 574 274.08 277.04 214.01 63.03 3.42 274.08 277.04 219.55 57.49 0.62Standard Self & Family 575 629.64 636.45 491.66 144.79 7.84 629.64 636.45 504.39 132.06 1.41Standard Self Plus One 576 629.64 636.45 491.66 144.79 7.84 629.64 636.45 504.39 132.06 1.41

Oregon UnitedHealthcare Insurance Company, Inc. Choice HMOHigh Self KT1 New Plan 281.85 217.73 64.12 New Plan New Plan 281.85 223.37 58.48 New PlanHigh Self & Family KT2 New Plan 704.63 536.07 168.56 New Plan New Plan 704.63 550.56 154.07 New PlanHigh Self Plus One KT3 New Plan 605.98 468.12 137.86 New Plan New Plan 605.98 480.24 125.74 New Plan

Oregon UnitedHealthcare Insurance Company, Inc. Choice Plus HDHPHDHP Self LU1 New Plan 222.88 172.17 50.71 New Plan New Plan 222.88 176.63 46.25 New PlanHDHP Self & Family LU2 New Plan 557.19 430.43 126.76 New Plan New Plan 557.19 441.57 115.62 New Plan


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HDHP Self Plus One LU3 New Plan 479.19 370.17 109.02 New Plan New Plan 479.19 379.76 99.43 New PlanPennsylvania Aetna HealthFund CDHP and Aetna Value Plan

CDHP Self H41 347.17 379.77 235.62 144.15 27.88 347.17 379.77 241.98 137.79 24.60CDHP Self & Family H42 791.39 865.68 536.07 329.61 64.50 791.39 865.68 550.56 315.12 57.02CDHP Self Plus One H43 783.56 857.11 504.64 352.47 64.53 783.56 857.11 518.28 338.83 57.49Value Self H44 257.63 265.72 205.27 60.45 4.42 257.63 265.72 210.58 55.14 1.68Value Self & Family H45 591.28 609.86 471.12 138.74 10.14 591.28 609.86 483.31 126.55 3.86Value Self Plus One H46 579.69 597.90 461.88 136.02 9.94 579.69 597.90 473.84 124.06 3.77

Pennsylvania Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Pennsylvania Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Pennsylvania Aetna Open AccessHigh Self P31 655.24 725.73 235.62 490.11 65.77 655.24 725.73 241.98 483.75 62.49High Self & Family P32 1,588.64 1,759.54 536.07 1,223.47 161.11 1,588.64 1,759.54 550.56 1,208.98 153.63High Self Plus One P33 1,572.91 1,742.11 504.64 1,237.47 160.18 1,572.91 1,742.11 518.28 1,223.83 153.14Basic Self P34 549.01 622.19 235.62 386.57 68.46 549.01 622.19 241.98 380.21 65.18Basic Self & Family P35 1,274.25 1,444.10 536.07 908.03 160.06 1,274.25 1,444.10 550.56 893.54 152.58Basic Self Plus One P36 1,261.63 1,429.80 504.64 925.16 159.15 1,261.63 1,429.80 518.28 911.52 152.11

Pennsylvania Aetna Open AccessHigh Self YE1 373.97 424.66 235.62 189.04 45.97 373.97 424.66 241.98 182.68 42.69


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High Self & Family YE2 939.06 1,066.33 536.07 530.26 117.48 939.06 1,066.33 550.56 515.77 110.00High Self Plus One YE3 929.75 1,055.77 504.64 551.13 117.00 929.75 1,055.77 518.28 537.49 109.96

Pennsylvania Geisinger Health PlanStandard Self GG4 306.72 315.73 235.62 80.11 4.29 306.72 315.73 241.98 73.75 1.01Standard Self & Family GG5 702.24 722.86 536.07 186.79 10.83 702.24 722.86 550.56 172.30 3.35Standard Self Plus One GG6 662.73 682.20 504.64 177.56 10.45 662.73 682.20 518.28 163.92 3.41

Pennsylvania Highmark Choice CompanyHigh Self NP1 285.79 318.35 235.62 82.73 20.57 285.79 318.35 241.98 76.37 17.07High Self & Family NP2 648.17 723.78 536.07 187.71 46.73 648.17 723.78 550.56 173.22 38.72High Self Plus One NP3 537.86 641.16 495.30 145.86 28.88 537.86 641.16 508.12 133.04 21.43

Pennsylvania UnitedHealthcare Insurance Company, Inc. Choice HMOHigh Self LR1 New Plan 280.61 216.77 63.84 New Plan New Plan 280.61 222.38 58.23 New PlanHigh Self & Family LR2 New Plan 701.54 536.07 165.47 New Plan New Plan 701.54 550.56 150.98 New PlanHigh Self Plus One LR3 New Plan 603.32 466.06 137.26 New Plan New Plan 603.32 478.13 125.19 New Plan

Pennsylvania UnitedHealthcare Insurance Company, Inc. Choice Plus HDHPHDHP Self V41 New Plan 261.68 202.15 59.53 New Plan New Plan 261.68 207.38 54.30 New PlanHDHP Self & Family V42 New Plan 654.22 505.38 148.84 New Plan New Plan 654.22 518.47 135.75 New PlanHDHP Self Plus One V43 New Plan 562.62 434.62 128.00 New Plan New Plan 562.62 445.88 116.74 New Plan

Pennsylvania UPMC Health PlanHigh Self 8W1 355.26 398.95 235.62 163.33 38.97 355.26 398.95 241.98 156.97 35.69High Self & Family 8W2 834.83 937.53 536.07 401.46 92.91 834.83 937.53 550.56 386.97 85.43High Self Plus One 8W3 799.33 897.67 504.64 393.03 89.32 799.33 897.67 518.28 379.39 82.28HDHP Self 8W4 236.29 249.05 192.39 56.66 5.27 236.29 249.05 197.37 51.68 2.65HDHP Self & Family 8W5 541.25 571.19 441.24 129.95 12.23 541.25 571.19 452.67 118.52 6.21HDHP Self Plus One 8W6 521.24 549.90 424.80 125.10 11.73 521.24 549.90 435.80 114.10 5.94

Pennsylvania UPMC Health Plan


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Standard Self UW4 276.84 288.23 222.66 65.57 5.36 276.84 288.23 228.42 59.81 2.37Standard Self & Family UW5 650.55 677.31 523.22 154.09 12.60 650.55 677.31 536.77 140.54 5.55Standard Self Plus One UW6 622.90 648.51 500.97 147.54 12.06 622.90 648.51 513.94 134.57 5.32

Puerto Rico Humana Health Plans of Puerto Rico, Inc.High Self ZJ1 168.31 169.71 131.10 38.61 2.00 168.31 169.71 134.50 35.21 0.29High Self & Family ZJ2 378.70 381.83 294.96 86.87 4.50 378.70 381.83 302.60 79.23 0.65High Self Plus One ZJ3 361.88 364.86 281.85 83.01 4.30 361.88 364.86 289.15 75.71 0.62

Puerto Rico Triple-S Salud, Inc.High Self 891 188.02 188.02 145.25 42.77 1.88 188.02 188.02 149.01 39.01 0.00High Self & Family 892 430.56 430.56 332.61 97.95 4.30 430.56 430.56 341.22 89.34 0.00High Self Plus One 893 422.17 422.17 326.13 96.04 4.22 422.17 422.17 334.57 87.60 0.00

Rhode Island Aetna HealthFund CDHP and Aetna Value PlanCDHP Self EP1 374.41 414.74 235.62 179.12 35.61 374.41 414.74 241.98 172.76 32.33CDHP Self & Family EP2 853.86 945.84 536.07 409.77 82.19 853.86 945.84 550.56 395.28 74.71CDHP Self Plus One EP3 845.41 936.48 504.64 431.84 82.05 845.41 936.48 518.28 418.20 75.01Value Self EP4 250.29 260.95 201.58 59.37 4.93 250.29 260.95 206.80 54.15 2.21Value Self & Family EP5 573.16 597.56 461.62 135.94 11.28 573.16 597.56 473.57 123.99 5.06Value Self Plus One EP6 561.92 585.84 452.56 133.28 11.06 561.92 585.84 464.28 121.56 4.96

Rhode Island Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Rhode Island Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96


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South Carolina Aetna HealthFund CDHP and Aetna Value PlanCDHP Self JS1 445.61 481.36 235.62 245.74 31.03 445.61 481.36 241.98 239.38 27.75CDHP Self & Family JS2 1,015.78 1,097.29 536.07 561.22 71.72 1,015.78 1,097.29 550.56 546.73 64.24CDHP Self Plus One JS3 1,005.73 1,086.44 504.64 581.80 71.69 1,005.73 1,086.44 518.28 568.16 64.65Value Self JS4 322.40 352.77 235.62 117.15 25.65 322.40 352.77 241.98 110.79 22.37Value Self & Family JS5 736.01 805.33 536.07 269.26 59.53 736.01 805.33 550.56 254.77 52.05Value Self Plus One JS6 728.72 797.36 504.64 292.72 59.62 728.72 797.36 518.28 279.08 52.58

South Carolina Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

South Carolina Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

South Dakota Aetna HealthFund CDHP and Aetna Value PlanCDHP Self G51 322.56 346.28 235.62 110.66 19.00 322.56 346.28 241.98 104.30 15.72CDHP Self & Family G52 735.73 789.85 536.07 253.78 44.33 735.73 789.85 550.56 239.29 36.85CDHP Self Plus One G53 728.45 782.04 504.64 277.40 44.57 728.45 782.04 518.28 263.76 37.53Value Self G54 246.85 253.66 195.95 57.71 4.02 246.85 253.66 201.03 52.63 1.41Value Self & Family G55 565.39 580.95 448.78 132.17 9.20 565.39 580.95 460.40 120.55 3.23Value Self Plus One G56 554.30 569.57 439.99 129.58 9.02 554.30 569.57 451.38 118.19 3.17

South Dakota Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12


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HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90South Dakota Aetna Direct


South Dakota HealthPartnersHigh Self V31 329.41 356.92 235.62 121.30 22.79 329.41 356.92 241.98 114.94 19.51High Self & Family V32 802.44 869.46 536.07 333.39 57.23 802.44 869.46 550.56 318.90 49.75High Self Plus One V33 727.99 788.79 504.64 284.15 51.78 727.99 788.79 518.28 270.51 44.74Standard Self V34 196.66 211.15 163.11 48.04 5.27 196.66 211.15 167.34 43.81 3.00Standard Self & Family V35 479.08 514.37 397.35 117.02 12.82 479.08 514.37 407.64 106.73 7.32Standard Self Plus One V36 434.64 466.65 360.49 106.16 11.63 434.64 466.65 369.82 96.83 6.64

Tennessee Aetna HealthFund CDHP and Aetna Value PlanCDHP Self F51 330.91 371.98 235.62 136.36 36.35 330.91 371.98 241.98 130.00 33.07CDHP Self & Family F52 754.52 848.15 536.07 312.08 83.84 754.52 848.15 550.56 297.59 76.36CDHP Self Plus One F53 747.04 839.75 504.64 335.11 83.69 747.04 839.75 518.28 321.47 76.65Value Self F54 258.16 269.07 207.86 61.21 5.06 258.16 269.07 213.24 55.83 2.26Value Self & Family F55 591.16 616.15 475.98 140.17 11.59 591.16 616.15 488.30 127.85 5.18Value Self Plus One F56 579.56 604.06 466.64 137.42 11.37 579.56 604.06 478.72 125.34 5.08

Tennessee Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Tennessee Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54


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CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Tennessee Aetna Open AccessHigh Self UB1 398.06 486.01 235.62 250.39 83.23 398.06 486.01 241.98 244.03 79.95High Self & Family UB2 1,020.04 1,245.42 536.07 709.35 215.59 1,020.04 1,245.42 550.56 694.86 208.11High Self Plus One UB3 1,009.94 1,233.10 504.64 728.46 214.14 1,009.94 1,233.10 518.28 714.82 207.10

Tennessee Humana CoverageFirst/Value PlanCDHP Self TT1 New Plan 294.50 227.50 67.00 New Plan New Plan 294.50 233.39 61.11 New PlanCDHP Self & Family TT2 New Plan 662.62 511.87 150.75 New Plan New Plan 662.62 525.13 137.49 New PlanCDHP Self Plus One TT3 New Plan 633.17 489.12 144.05 New Plan New Plan 633.17 501.79 131.38 New PlanValue Self TT4 New Plan 237.98 183.84 54.14 New Plan New Plan 237.98 188.60 49.38 New PlanValue Self & Family TT5 New Plan 535.46 413.64 121.82 New Plan New Plan 535.46 424.35 111.11 New PlanValue Self Plus One TT6 New Plan 511.66 395.26 116.40 New Plan New Plan 511.66 405.49 106.17 New Plan

Tennessee Humana Health Plan, Inc.High Self GJ1 334.13 396.16 235.62 160.54 57.31 334.13 396.16 241.98 154.18 54.03High Self & Family GJ2 751.82 891.34 536.07 355.27 129.73 751.82 891.34 550.56 340.78 122.25High Self Plus One GJ3 718.40 851.72 504.64 347.08 124.30 718.40 851.72 518.28 333.44 117.26Standard Self GJ4 331.09 360.88 235.62 125.26 25.07 331.09 360.88 241.98 118.90 21.79Standard Self & Family GJ5 744.95 811.98 536.07 275.91 57.24 744.95 811.98 550.56 261.42 49.76Standard Self Plus One GJ6 711.85 775.89 504.64 271.25 55.02 711.85 775.89 518.28 257.61 47.98

Tennessee UnitedHealthcare Insurance Company, Inc. Choice HMOHigh Self KK1 257.80 274.77 212.26 62.51 6.44 257.80 274.77 217.76 57.01 3.52High Self & Family KK2 644.49 686.91 530.64 156.27 16.09 644.49 686.91 544.38 142.53 8.80High Self Plus One KK3 554.26 590.74 456.35 134.39 13.84 554.26 590.74 468.16 122.58 7.57

Tennessee UnitedHealthcare Insurance Company, Inc. Choice Plus HDHP


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HDHP Self LS1 212.83 202.27 156.25 46.02 -0.27 212.83 202.27 160.30 41.97 -2.19HDHP Self & Family LS2 532.06 505.67 390.63 115.04 -0.68 532.06 505.67 400.74 104.93 -5.47HDHP Self Plus One LS3 457.58 434.88 335.94 98.94 -0.58 457.58 434.88 344.64 90.24 -4.71

Texas Aetna HealthFund CDHP and Aetna Value PlanCDHP Self JS1 445.61 481.36 235.62 245.74 31.03 445.61 481.36 241.98 239.38 27.75CDHP Self & Family JS2 1,015.78 1,097.29 536.07 561.22 71.72 1,015.78 1,097.29 550.56 546.73 64.24CDHP Self Plus One JS3 1,005.73 1,086.44 504.64 581.80 71.69 1,005.73 1,086.44 518.28 568.16 64.65Value Self JS4 322.40 352.77 235.62 117.15 25.65 322.40 352.77 241.98 110.79 22.37Value Self & Family JS5 736.01 805.33 536.07 269.26 59.53 736.01 805.33 550.56 254.77 52.05Value Self Plus One JS6 728.72 797.36 504.64 292.72 59.62 728.72 797.36 518.28 279.08 52.58

Texas Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Texas Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Texas Humana CoverageFirst/Value PlanCDHP Self T31 New Plan 292.28 225.79 66.49 New Plan New Plan 292.28 231.63 60.65 New PlanCDHP Self & Family T32 New Plan 657.63 508.02 149.61 New Plan New Plan 657.63 521.17 136.46 New PlanCDHP Self Plus One T33 New Plan 628.41 485.45 142.96 New Plan New Plan 628.41 498.01 130.40 New PlanValue Self T34 New Plan 222.64 171.99 50.65 New Plan New Plan 222.64 176.44 46.20 New PlanValue Self & Family T35 New Plan 500.95 386.98 113.97 New Plan New Plan 500.95 397.00 103.95 New PlanValue Self Plus One T36 New Plan 478.68 369.78 108.90 New Plan New Plan 478.68 379.35 99.33 New Plan


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Texas Humana CoverageFirst/Value PlanCDHP Self TP1 302.46 272.23 210.30 61.93 -9.63 302.46 272.23 215.74 56.49 -11.99CDHP Self & Family TP2 680.54 612.52 473.17 139.35 -14.91 680.54 612.52 485.42 127.10 -20.15CDHP Self Plus One TP3 650.29 585.30 452.14 133.16 -21.51 650.29 585.30 463.85 121.45 -26.62Value Self TP4 214.76 193.27 149.30 43.97 -2.74 214.76 193.27 153.17 40.10 -4.46Value Self & Family TP5 483.20 434.87 335.94 98.93 -6.17 483.20 434.87 344.63 90.24 -10.02Value Self Plus One TP6 461.73 415.54 321.00 94.54 -5.89 461.73 415.54 329.32 86.22 -9.59

Texas Humana CoverageFirst/Value PlanCDHP Self TU1 294.28 294.28 227.33 66.95 2.94 294.28 294.28 233.22 61.06 0.00CDHP Self & Family TU2 662.14 662.14 511.50 150.64 6.62 662.14 662.14 524.75 137.39 0.00CDHP Self Plus One TU3 632.70 632.70 488.76 143.94 6.33 632.70 632.70 501.41 131.29 0.00Value Self TU4 214.76 234.09 180.83 53.26 6.55 214.76 234.09 185.52 48.57 4.01Value Self & Family TU5 483.20 526.71 406.88 119.83 14.73 483.20 526.71 417.42 109.29 9.03Value Self Plus One TU6 461.73 503.31 388.81 114.50 14.07 461.73 503.31 398.87 104.44 8.63

Texas Humana CoverageFirst/Value PlanCDHP Self TV1 301.20 307.24 235.62 71.62 1.32 301.20 307.24 241.98 65.26 -1.96CDHP Self & Family TV2 677.71 691.29 534.02 157.27 5.84 677.71 691.29 547.85 143.44 -0.98CDHP Self Plus One TV3 647.59 660.57 504.64 155.93 3.96 647.59 660.57 518.28 142.29 -3.08Value Self TV4 214.76 249.11 192.44 56.67 9.96 214.76 249.11 197.42 51.69 7.13Value Self & Family TV5 483.20 560.50 432.99 127.51 22.41 483.20 560.50 444.20 116.30 16.04Value Self Plus One TV6 461.73 535.59 413.74 121.85 21.42 461.73 535.59 424.46 111.13 15.32

Texas Humana Health Plan of TexasHigh Self EW1 358.77 426.82 235.62 191.20 63.33 358.77 426.82 241.98 184.84 60.05High Self & Family EW2 807.23 960.35 536.07 424.28 143.33 807.23 960.35 550.56 409.79 135.85


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High Self Plus One EW3 771.35 917.66 504.64 413.02 137.29 771.35 917.66 518.28 399.38 130.25Standard Self EW4 308.50 342.43 235.62 106.81 29.21 308.50 342.43 241.98 100.45 25.93Standard Self & Family EW5 694.12 770.46 536.07 234.39 66.55 694.12 770.46 550.56 219.90 59.07Standard Self Plus One EW6 663.26 736.22 504.64 231.58 63.94 663.26 736.22 518.28 217.94 56.90

Texas Humana Health Plan of TexasBasic Self Q21 New Plan 261.82 202.26 59.56 New Plan New Plan 261.82 207.49 54.33 New PlanBasic Self & Family Q22 New Plan 589.10 455.08 134.02 New Plan New Plan 589.10 466.86 122.24 New PlanBasic Self Plus One Q23 New Plan 562.91 434.85 128.06 New Plan New Plan 562.91 446.11 116.80 New Plan

Texas Humana Health Plan of TexasBasic Self Q61 New Plan 260.55 201.27 59.28 New Plan New Plan 260.55 206.49 54.06 New PlanBasic Self & Family Q62 New Plan 586.24 452.87 133.37 New Plan New Plan 586.24 464.60 121.64 New PlanBasic Self Plus One Q63 New Plan 560.19 432.75 127.44 New Plan New Plan 560.19 443.95 116.24 New Plan

Texas Humana Health Plan of TexasBasic Self QX1 New Plan 271.34 209.61 61.73 New Plan New Plan 271.34 215.04 56.30 New PlanBasic Self & Family QX2 New Plan 610.51 471.62 138.89 New Plan New Plan 610.51 483.83 126.68 New PlanBasic Self Plus One QX3 New Plan 583.38 450.66 132.72 New Plan New Plan 583.38 462.33 121.05 New Plan

Texas Humana Health Plan of TexasBasic Self QY1 New Plan 268.91 207.73 61.18 New Plan New Plan 268.91 213.11 55.80 New PlanBasic Self & Family QY2 New Plan 605.05 467.40 137.65 New Plan New Plan 605.05 479.50 125.55 New PlanBasic Self Plus One QY3 New Plan 578.17 446.64 131.53 New Plan New Plan 578.17 458.20 119.97 New Plan

Texas Humana Health Plan of TexasHigh Self UC1 366.49 428.79 235.62 193.17 57.58 366.49 428.79 241.98 186.81 54.30High Self & Family UC2 824.60 964.78 536.07 428.71 130.39 824.60 964.78 550.56 414.22 122.91High Self Plus One UC3 787.95 921.90 504.64 417.26 124.93 787.95 921.90 518.28 403.62 117.89Standard Self UC4 296.50 343.95 235.62 108.33 42.73 296.50 343.95 241.98 101.97 39.45


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Standard Self & Family UC5 667.16 773.88 536.07 237.81 92.70 667.16 773.88 550.56 223.32 84.88Standard Self Plus One UC6 637.50 739.49 504.64 234.85 92.97 637.50 739.49 518.28 221.21 85.93

Texas Humana Health Plan of TexasHigh Self UR1 614.26 632.72 235.62 397.10 13.74 614.26 632.72 241.98 390.74 10.46High Self & Family UR2 1,382.09 1,423.61 536.07 887.54 31.73 1,382.09 1,423.61 550.56 873.05 24.25High Self Plus One UR3 1,320.65 1,360.35 504.64 855.71 30.68 1,320.65 1,360.35 518.28 842.07 23.64Standard Self UR4 344.46 409.92 235.62 174.30 60.74 344.46 409.92 241.98 167.94 57.46Standard Self & Family UR5 775.04 922.31 536.07 386.24 137.48 775.04 922.31 550.56 371.75 130.00Standard Self Plus One UR6 740.58 881.32 504.64 376.68 131.72 740.58 881.32 518.28 363.04 124.68

Texas Humana Health Plan of TexasHigh Self UU1 540.81 670.60 235.62 434.98 125.07 540.81 670.60 241.98 428.62 121.79High Self & Family UU2 1,216.82 1,508.86 536.07 972.79 282.25 1,216.82 1,508.86 550.56 958.30 274.77High Self Plus One UU3 1,162.74 1,441.80 504.64 937.16 270.04 1,162.74 1,441.80 518.28 923.52 263.00Standard Self UU4 448.93 547.68 235.62 312.06 94.03 448.93 547.68 241.98 305.70 90.75Standard Self & Family UU5 1,010.08 1,232.31 536.07 696.24 212.44 1,010.08 1,232.31 550.56 681.75 204.96Standard Self Plus One UU6 965.18 1,177.54 504.64 672.90 203.34 965.18 1,177.54 518.28 659.26 196.30

Texas Scott and White Health PlanBasic Self A81 New Plan 304.52 235.24 69.28 New Plan New Plan 304.52 241.33 63.19 New PlanBasic Self & Family A82 New Plan 713.56 536.07 177.49 New Plan New Plan 713.56 550.56 163.00 New PlanBasic Self Plus One A83 New Plan 596.89 461.10 135.79 New Plan New Plan 596.89 473.04 123.85 New PlanStandard Self A84 313.14 360.53 235.62 124.91 42.67 313.14 360.53 241.98 118.55 39.39Standard Self & Family A85 733.80 844.98 536.07 308.91 101.39 733.80 844.98 550.56 294.42 93.91Standard Self Plus One A86 655.90 706.79 504.64 202.15 41.87 655.90 706.79 518.28 188.51 34.83

Texas Scott and White Health Plan


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Basic Self P81 New Plan 340.97 235.62 105.35 New Plan New Plan 340.97 241.98 98.99 New PlanBasic Self & Family P82 New Plan 799.09 536.07 263.02 New Plan New Plan 799.09 550.56 248.53 New PlanBasic Self Plus One P83 New Plan 668.42 504.64 163.78 New Plan New Plan 668.42 518.28 150.14 New PlanStandard Self P84 350.54 403.70 235.62 168.08 48.44 350.54 403.70 241.98 161.72 45.16Standard Self & Family P85 821.67 946.29 536.07 410.22 114.83 821.67 946.29 550.56 395.73 107.35Standard Self Plus One P86 734.43 791.51 504.64 286.87 48.06 734.43 791.51 518.28 273.23 41.02

Texas UnitedHealthcare Insurance Company, Inc. Choice Plus AdvancedValue Self L91 199.88 213.84 165.19 48.65 5.18 199.88 213.84 169.47 44.37 2.89Value Self & Family L92 560.47 599.62 463.21 136.41 14.51 560.47 599.62 475.20 124.42 8.12Value Self Plus One L93 390.36 417.64 322.63 95.01 10.11 390.36 417.64 330.98 86.66 5.66

Utah Aetna HealthFund CDHP and Aetna Value PlanCDHP Self G51 322.56 346.28 235.62 110.66 19.00 322.56 346.28 241.98 104.30 15.72CDHP Self & Family G52 735.73 789.85 536.07 253.78 44.33 735.73 789.85 550.56 239.29 36.85CDHP Self Plus One G53 728.45 782.04 504.64 277.40 44.57 728.45 782.04 518.28 263.76 37.53Value Self G54 246.85 253.66 195.95 57.71 4.02 246.85 253.66 201.03 52.63 1.41Value Self & Family G55 565.39 580.95 448.78 132.17 9.20 565.39 580.95 460.40 120.55 3.23Value Self Plus One G56 554.30 569.57 439.99 129.58 9.02 554.30 569.57 451.38 118.19 3.17

Utah Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Utah Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45


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CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96Utah Altius Health Plans

High Self 9K1 344.47 391.42 235.62 155.80 42.23 344.47 391.42 241.98 149.44 38.95High Self & Family 9K2 761.77 865.60 536.07 329.53 94.04 761.77 865.60 550.56 315.04 86.56High Self Plus One 9K3 754.23 857.03 504.64 352.39 93.78 754.23 857.03 518.28 338.75 86.74HDHP Self 9K4 173.69 194.17 150.00 44.17 6.39 173.69 194.17 153.88 40.29 4.25HDHP Self & Family 9K5 363.00 405.80 313.48 92.32 13.37 363.00 405.80 321.60 84.20 8.88HDHP Self Plus One 9K6 355.89 397.84 307.33 90.51 13.10 355.89 397.84 315.29 82.55 8.70

Utah Altius Health PlansStandard Self DK4 242.10 273.97 211.64 62.33 9.67 242.10 273.97 217.12 56.85 6.61Standard Self & Family DK5 534.63 604.99 467.35 137.64 21.36 534.63 604.99 479.45 125.54 14.60Standard Self Plus One DK6 529.33 599.00 462.73 136.27 21.14 529.33 599.00 474.71 124.29 14.45

Utah SelectHealthHigh Self SF1 342.83 449.39 235.62 213.77 101.84 342.83 449.39 241.98 207.41 98.56High Self & Family SF2 764.71 1,024.25 536.07 488.18 249.75 764.71 1,024.25 550.56 473.69 242.27High Self Plus One SF3 764.71 1,024.25 504.64 519.61 250.52 764.71 1,024.25 518.28 505.97 243.48Standard Self SF4 248.28 274.81 212.29 62.52 8.52 248.28 274.81 217.79 57.02 5.50Standard Self & Family SF5 551.32 626.33 483.84 142.49 22.58 551.32 626.33 496.37 129.96 15.56Standard Self Plus One SF6 551.32 626.33 483.84 142.49 22.58 551.32 626.33 496.37 129.96 15.56

Vermont Aetna HealthFund CDHP and Aetna Value PlanCDHP Self EP1 374.41 414.74 235.62 179.12 35.61 374.41 414.74 241.98 172.76 32.33CDHP Self & Family EP2 853.86 945.84 536.07 409.77 82.19 853.86 945.84 550.56 395.28 74.71CDHP Self Plus One EP3 845.41 936.48 504.64 431.84 82.05 845.41 936.48 518.28 418.20 75.01Value Self EP4 250.29 260.95 201.58 59.37 4.93 250.29 260.95 206.80 54.15 2.21Value Self & Family EP5 573.16 597.56 461.62 135.94 11.28 573.16 597.56 473.57 123.99 5.06


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Value Self Plus One EP6 561.92 585.84 452.56 133.28 11.06 561.92 585.84 464.28 121.56 4.96Vermont Aetna HealthFund HDHP


Vermont Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Virgin Islands Triple-S Salud, Inc.High Self 851 275.98 289.79 223.86 65.93 5.90 275.98 289.79 229.66 60.13 2.86High Self & Family 852 632.00 663.61 512.64 150.97 13.51 632.00 663.61 525.91 137.70 6.56High Self Plus One 853 619.67 650.67 502.64 148.03 13.25 619.67 650.67 515.66 135.01 6.43

Virginia Aetna HealthFund CDHP and Aetna Value PlanCDHP Self F51 330.91 371.98 235.62 136.36 36.35 330.91 371.98 241.98 130.00 33.07CDHP Self & Family F52 754.52 848.15 536.07 312.08 83.84 754.52 848.15 550.56 297.59 76.36CDHP Self Plus One F53 747.04 839.75 504.64 335.11 83.69 747.04 839.75 518.28 321.47 76.65Value Self F54 258.16 269.07 207.86 61.21 5.06 258.16 269.07 213.24 55.83 2.26Value Self & Family F55 591.16 616.15 475.98 140.17 11.59 591.16 616.15 488.30 127.85 5.18Value Self Plus One F56 579.56 604.06 466.64 137.42 11.37 579.56 604.06 478.72 125.34 5.08

Virginia Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Virginia Aetna Direct


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Virginia Aetna Open AccessHigh Self JN1 469.08 509.12 235.62 273.50 35.32 469.08 509.12 241.98 267.14 32.04High Self & Family JN2 1,054.58 1,144.59 536.07 608.52 80.22 1,054.58 1,144.59 550.56 594.03 72.74High Self Plus One JN3 1,044.14 1,133.25 504.64 628.61 80.09 1,044.14 1,133.25 518.28 614.97 73.05Basic Self JN4 294.16 305.93 235.62 70.31 6.33 294.16 305.93 241.98 63.95 2.91Basic Self & Family JN5 664.55 700.13 536.07 164.06 19.52 664.55 700.13 550.56 149.57 11.68Basic Self Plus One JN6 634.15 642.92 496.66 146.26 7.73 634.15 642.92 509.51 133.41 1.48

Virginia CareFirst BlueChoiceHigh Self 2G1 358.77 394.65 235.62 159.03 31.16 358.77 394.65 241.98 152.67 27.88High Self & Family 2G2 852.43 937.66 536.07 401.59 75.44 852.43 937.66 550.56 387.10 67.96High Self Plus One 2G3 717.54 789.29 504.64 284.65 62.73 717.54 789.29 518.28 271.01 55.69Standard Self 2G4 304.89 320.13 235.62 84.51 10.52 304.89 320.13 241.98 78.15 7.24Standard Self & Family 2G5 724.41 760.64 536.07 224.57 26.44 724.41 760.64 550.56 210.08 18.96Standard Self Plus One 2G6 609.78 640.27 494.61 145.66 13.03 609.78 640.27 507.41 132.86 6.33

Virginia CareFirst BlueChoiceHDHP Self B61 281.41 281.41 217.39 64.02 2.81 281.41 281.41 223.02 58.39 0.00HDHP Self & Family B62 668.62 668.62 516.51 152.11 6.69 668.62 668.62 529.88 138.74 0.00HDHP Self Plus One B63 562.82 562.82 434.78 128.04 5.63 562.82 562.82 446.03 116.79 0.00

Virginia Kaiser Foundation Health Plan Mid-Atlantic StatesHigh Self E31 296.17 304.78 235.44 69.34 4.07 296.17 304.78 241.54 63.24 1.05High Self & Family E32 693.06 701.00 536.07 164.93 -1.85 693.06 701.00 550.56 150.44 -9.33High Self Plus One E33 669.36 701.00 504.64 196.36 22.62 669.36 701.00 518.28 182.72 15.58


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Standard Self E34 223.40 233.06 180.04 53.02 4.43 223.40 233.06 184.70 48.36 2.00Standard Self & Family E35 522.75 536.07 414.11 121.96 8.26 522.75 536.07 424.84 111.23 2.76Standard Self Plus One E36 504.87 536.07 414.11 121.96 12.15 504.87 536.07 424.84 111.23 6.47

Virginia Kaiser Foundation Health Plan Mid-Atlantic StatesBasic Self T71 New Plan 212.32 164.02 48.30 New Plan New Plan 212.32 168.26 44.06 New PlanBasic Self & Family T72 New Plan 509.77 393.80 115.97 New Plan New Plan 509.77 403.99 105.78 New PlanBasic Self Plus One T73 New Plan 464.41 358.76 105.65 New Plan New Plan 464.41 368.04 96.37 New Plan

Virginia M.D. IPAHigh Self JP1 318.80 331.28 235.62 95.66 7.76 318.80 331.28 241.98 89.30 4.48High Self & Family JP2 893.91 928.92 536.07 392.85 25.22 893.91 928.92 550.56 378.36 17.74High Self Plus One JP3 622.62 646.99 499.80 147.19 11.77 622.62 646.99 512.74 134.25 5.06

Virginia Optima HealthHigh Self PG1 262.87 300.59 232.21 68.38 11.21 262.87 300.59 238.22 62.37 7.82High Self & Family PG2 647.91 726.37 536.07 190.30 49.38 647.91 726.37 550.56 175.81 41.37High Self Plus One PG3 641.43 726.32 504.64 221.68 75.87 641.43 726.32 518.28 208.04 68.83

Virginia UnitedHealthcare Insurance Company, Inc. Choice HMOHigh Self LR1 279.74 280.61 216.77 63.84 3.00 279.74 280.61 222.38 58.23 0.18High Self & Family LR2 699.35 701.54 536.07 165.47 -7.60 699.35 701.54 550.56 150.98 -15.08High Self Plus One LR3 573.47 603.32 466.06 137.26 12.53 573.47 603.32 478.13 125.19 6.19

Virginia UnitedHealthcare Insurance Company, Inc. Choice Plus AdvancedValue Self L91 199.88 213.84 165.19 48.65 5.18 199.88 213.84 169.47 44.37 2.89Value Self & Family L92 560.47 599.62 463.21 136.41 14.51 560.47 599.62 475.20 124.42 8.12Value Self Plus One L93 390.36 417.64 322.63 95.01 10.11 390.36 417.64 330.98 86.66 5.66

Virginia UnitedHealthcare Insurance Company, Inc. Choice Plus HDHPHDHP Self V41 New Plan 261.68 202.15 59.53 New Plan New Plan 261.68 207.38 54.30 New PlanHDHP Self & Family V42 New Plan 654.22 505.38 148.84 New Plan New Plan 654.22 518.47 135.75 New Plan


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HDHP Self Plus One V43 New Plan 562.62 434.62 128.00 New Plan New Plan 562.62 445.88 116.74 New PlanWashington Aetna HealthFund CDHP and Aetna Value Plan

CDHP Self G51 322.56 346.28 235.62 110.66 19.00 322.56 346.28 241.98 104.30 15.72CDHP Self & Family G52 735.73 789.85 536.07 253.78 44.33 735.73 789.85 550.56 239.29 36.85CDHP Self Plus One G53 728.45 782.04 504.64 277.40 44.57 728.45 782.04 518.28 263.76 37.53Value Self G54 246.85 253.66 195.95 57.71 4.02 246.85 253.66 201.03 52.63 1.41Value Self & Family G55 565.39 580.95 448.78 132.17 9.20 565.39 580.95 460.40 120.55 3.23Value Self Plus One G56 554.30 569.57 439.99 129.58 9.02 554.30 569.57 451.38 118.19 3.17

Washington Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Washington Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Washington Kaiser Foundation Health Plan of NorthwestHigh Self 571 317.04 319.42 235.62 83.80 -2.34 317.04 319.42 241.98 77.44 -5.62High Self & Family 572 716.12 721.45 536.07 185.38 -4.46 716.12 721.45 550.56 170.89 -11.94High Self Plus One 573 716.12 721.45 504.64 216.81 -3.69 716.12 721.45 518.28 203.17 -10.73Standard Self 574 274.08 277.04 214.01 63.03 3.42 274.08 277.04 219.55 57.49 0.62Standard Self & Family 575 629.64 636.45 491.66 144.79 7.84 629.64 636.45 504.39 132.06 1.41Standard Self Plus One 576 629.64 636.45 491.66 144.79 7.84 629.64 636.45 504.39 132.06 1.41

Washington Kaiser Foundation Health Plan of WashingtonHigh Self 541 349.46 381.04 235.62 145.42 26.86 349.46 381.04 241.98 139.06 23.58


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High Self & Family 542 908.59 838.30 536.07 302.23 -80.08 908.59 838.30 550.56 287.74 -87.56High Self Plus One 543 716.38 838.30 504.64 333.66 112.90 716.38 838.30 518.28 320.02 105.86Standard Self 544 262.54 281.07 217.13 63.94 6.84 262.54 281.07 222.75 58.32 3.84Standard Self & Family 545 682.59 646.46 499.39 147.07 -9.24 682.59 646.46 512.32 134.14 -15.16Standard Self Plus One 546 538.20 646.46 499.39 147.07 30.01 538.20 646.46 512.32 134.14 22.46

Washington Kaiser Foundation Health Plan of WashingtonHDHP Self PT1 233.54 234.17 180.90 53.27 2.48 233.54 234.17 185.58 48.59 0.13HDHP Self & Family PT2 607.22 538.58 416.05 122.53 -9.54 607.22 538.58 426.82 111.76 -14.24HDHP Self Plus One PT3 478.77 538.58 416.05 122.53 18.40 478.77 538.58 426.82 111.76 12.42

Washington Kaiser Permanente Washington Options FederalStandard Self L11 294.57 306.72 235.62 71.10 7.03 294.57 306.72 241.98 64.74 3.62Standard Self & Family L12 706.98 680.91 526.00 154.91 -25.79 706.98 680.91 539.62 141.29 -32.40Standard Self Plus One L13 618.62 680.91 504.64 176.27 41.72 618.62 680.91 518.28 162.63 34.27HDHP Self L14 236.65 242.67 187.46 55.21 3.74 236.65 242.67 192.32 50.35 1.25HDHP Self & Family L15 554.55 538.73 416.17 122.56 1.95 554.55 538.73 426.94 111.79 -3.28HDHP Self Plus One L16 493.63 538.73 416.17 122.56 15.20 493.63 538.73 426.94 111.79 9.36

Washington UnitedHealthcare Insurance Company, Inc. Choice HMOHigh Self KT1 New Plan 281.85 217.73 64.12 New Plan New Plan 281.85 223.37 58.48 New PlanHigh Self & Family KT2 New Plan 704.63 536.07 168.56 New Plan New Plan 704.63 550.56 154.07 New PlanHigh Self Plus One KT3 New Plan 605.98 468.12 137.86 New Plan New Plan 605.98 480.24 125.74 New Plan

Washington UnitedHealthcare Insurance Company, Inc. Choice Plus HDHPHDHP Self LU1 New Plan 222.88 172.17 50.71 New Plan New Plan 222.88 176.63 46.25 New PlanHDHP Self & Family LU2 New Plan 557.19 430.43 126.76 New Plan New Plan 557.19 441.57 115.62 New PlanHDHP Self Plus One LU3 New Plan 479.19 370.17 109.02 New Plan New Plan 479.19 379.76 99.43 New Plan

West Virginia Aetna HealthFund CDHP and Aetna Value Plan


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CDHP Self F51 330.91 371.98 235.62 136.36 36.35 330.91 371.98 241.98 130.00 33.07CDHP Self & Family F52 754.52 848.15 536.07 312.08 83.84 754.52 848.15 550.56 297.59 76.36CDHP Self Plus One F53 747.04 839.75 504.64 335.11 83.69 747.04 839.75 518.28 321.47 76.65Value Self F54 258.16 269.07 207.86 61.21 5.06 258.16 269.07 213.24 55.83 2.26Value Self & Family F55 591.16 616.15 475.98 140.17 11.59 591.16 616.15 488.30 127.85 5.18Value Self Plus One F56 579.56 604.06 466.64 137.42 11.37 579.56 604.06 478.72 125.34 5.08

West Virginia Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

West Virginia Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Wisconsin Aetna HealthFund CDHP and Aetna Value PlanCDHP Self JS1 445.61 481.36 235.62 245.74 31.03 445.61 481.36 241.98 239.38 27.75CDHP Self & Family JS2 1,015.78 1,097.29 536.07 561.22 71.72 1,015.78 1,097.29 550.56 546.73 64.24CDHP Self Plus One JS3 1,005.73 1,086.44 504.64 581.80 71.69 1,005.73 1,086.44 518.28 568.16 64.65Value Self JS4 322.40 352.77 235.62 117.15 25.65 322.40 352.77 241.98 110.79 22.37Value Self & Family JS5 736.01 805.33 536.07 269.26 59.53 736.01 805.33 550.56 254.77 52.05Value Self Plus One JS6 728.72 797.36 504.64 292.72 59.62 728.72 797.36 518.28 279.08 52.58

Wisconsin Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90


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Wisconsin Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96

Wisconsin Dean Health PlanHigh Self WD1 418.74 492.66 235.62 257.04 69.20 418.74 492.66 241.98 250.68 65.92High Self & Family WD2 963.09 1,133.10 536.07 597.03 160.22 963.09 1,133.10 550.56 582.54 152.74High Self Plus One WD3 879.34 1,034.57 504.64 529.93 146.21 879.34 1,034.57 518.28 516.29 139.17Standard Self WD4 277.05 296.77 229.25 67.52 7.26 277.05 296.77 235.19 61.58 4.09Standard Self & Family WD5 664.92 712.25 536.07 176.18 31.56 664.92 712.25 550.56 161.69 23.72Standard Self Plus One WD6 609.51 652.90 504.37 148.53 15.96 609.51 652.90 517.42 135.48 9.01

Wisconsin Group Health CooperativeHigh Self WJ1 310.90 321.77 235.62 86.15 6.15 310.90 321.77 241.98 79.79 2.87High Self & Family WJ2 926.49 958.87 536.07 422.80 22.59 926.49 958.87 550.56 408.31 15.11High Self Plus One WJ3 615.60 637.10 492.16 144.94 11.05 615.60 637.10 504.90 132.20 4.46

Wisconsin HealthPartnersHigh Self V31 329.41 356.92 235.62 121.30 22.79 329.41 356.92 241.98 114.94 19.51High Self & Family V32 802.44 869.46 536.07 333.39 57.23 802.44 869.46 550.56 318.90 49.75High Self Plus One V33 727.99 788.79 504.64 284.15 51.78 727.99 788.79 518.28 270.51 44.74Standard Self V34 196.66 211.15 163.11 48.04 5.27 196.66 211.15 167.34 43.81 3.00Standard Self & Family V35 479.08 514.37 397.35 117.02 12.82 479.08 514.37 407.64 106.73 7.32Standard Self Plus One V36 434.64 466.65 360.49 106.16 11.63 434.64 466.65 369.82 96.83 6.64

Wisconsin MercyCare HMOHigh Self EY1 335.85 353.76 235.62 118.14 13.19 335.85 353.76 241.98 111.78 9.91High Self & Family EY2 873.23 923.20 536.07 387.13 40.18 873.23 923.20 550.56 372.64 32.70High Self Plus One EY3 722.08 760.59 504.64 255.95 29.49 722.08 760.59 518.28 242.31 22.45


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Wisconsin Physicians PlusHigh Self LW1 301.27 323.69 235.62 88.07 17.70 301.27 323.69 241.98 81.71 14.42High Self & Family LW2 801.36 978.42 536.07 442.35 167.27 801.36 978.42 550.56 427.86 159.79High Self Plus One LW3 753.16 757.72 504.64 253.08 -4.46 753.16 757.72 518.28 239.44 -11.50Standard Self LW4 270.62 316.73 235.62 81.11 22.25 270.62 316.73 241.98 74.75 18.60Standard Self & Family LW5 719.85 760.16 536.07 224.09 30.52 719.85 760.16 550.56 209.60 23.04Standard Self Plus One LW6 676.55 696.81 504.64 192.17 11.24 676.55 696.81 518.28 178.53 4.20

Wyoming Aetna HealthFund CDHP and Aetna Value PlanCDHP Self H41 347.17 379.77 235.62 144.15 27.88 347.17 379.77 241.98 137.79 24.60CDHP Self & Family H42 791.39 865.68 536.07 329.61 64.50 791.39 865.68 550.56 315.12 57.02CDHP Self Plus One H43 783.56 857.11 504.64 352.47 64.53 783.56 857.11 518.28 338.83 57.49Value Self H44 257.63 265.72 205.27 60.45 4.42 257.63 265.72 210.58 55.14 1.68Value Self & Family H45 591.28 609.86 471.12 138.74 10.14 591.28 609.86 483.31 126.55 3.86Value Self Plus One H46 579.69 597.90 461.88 136.02 9.94 579.69 597.90 473.84 124.06 3.77

Wyoming Aetna HealthFund HDHPHDHP Self 224 256.06 280.35 216.57 63.78 8.09 256.06 280.35 222.18 58.17 5.04HDHP Self & Family 225 564.83 618.42 477.73 140.69 17.84 564.83 618.42 490.10 128.32 11.12HDHP Self Plus One 226 553.76 606.29 468.36 137.93 17.49 553.76 606.29 480.48 125.81 10.90

Wyoming Aetna DirectCDHP Self N61 221.64 243.54 188.13 55.41 7.20 221.64 243.54 193.01 50.53 4.54CDHP Self & Family N62 558.97 614.17 474.45 139.72 18.14 558.97 614.17 486.73 127.44 11.45CDHP Self Plus One N63 486.08 534.08 412.58 121.50 15.78 486.08 534.08 423.26 110.82 9.96


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Wyoming Altius Health PlansHigh Self 9K1 344.47 391.42 235.62 155.80 42.23 344.47 391.42 241.98 149.44 38.95High Self & Family 9K2 761.77 865.60 536.07 329.53 94.04 761.77 865.60 550.56 315.04 86.56High Self Plus One 9K3 754.23 857.03 504.64 352.39 93.78 754.23 857.03 518.28 338.75 86.74HDHP Self 9K4 173.69 194.17 150.00 44.17 6.39 173.69 194.17 153.88 40.29 4.25HDHP Self & Family 9K5 363.00 405.80 313.48 92.32 13.37 363.00 405.80 321.60 84.20 8.88HDHP Self Plus One 9K6 355.89 397.84 307.33 90.51 13.10 355.89 397.84 315.29 82.55 8.70

Wyoming Altius Health PlansStandard Self DK4 242.10 273.97 211.64 62.33 9.67 242.10 273.97 217.12 56.85 6.61Standard Self & Family DK5 534.63 604.99 467.35 137.64 21.36 534.63 604.99 479.45 125.54 14.60Standard Self Plus One DK6 529.33 599.00 462.73 136.27 21.14 529.33 599.00 474.71 124.29 14.45

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