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U.S. Office of Personnel Management - Recruiting, Retaining and Honoring a World-Class Workforce to Serve the American People

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Federal Employees Health Benefits Program

2005 FEHB Non-Postal Premium Rates for Illinois

HMO Plans

2004 Total Biweekly Premium

2005 Biweekly premium rates

2004 Total Monthly Premium

2005 Monthly premium rates

Plan

Option

Enrollment Code

Total Premium

Gov't Pays

Empl. Pays

Change in employee payment

Total Premium

Gov't Pays

Empl. Pays

Change in employee payment

IL Aetna

High Self

IK1

New Plan

152.11

114.08

38.03

N/A

New Plan

329.57

247.18

82.39

N/A

High Family

IK2

New Plan

375.42

281.57

93.85

N/A

New Plan

813.41

610.06

203.35

N/A

IL Aetna HealthFund (CDHP/HDHP)

CDHP Self

221

129.44

136.8

102.6

34.2

1.84

280.45

296.4

222.3

74.1

3.99

CDHP Family

222

297.73

314.65

235.99

78.66

4.23

645.08

681.74

511.31

170.43

9.16

HDHP Self

224

New Plan

153.73

115.3

38.43

N/A

New Plan

333.08

249.81

83.27

N/A

HDHP Family

225

New Plan

353.59

265.19

88.4

N/A

New Plan

766.11

574.58

191.53

N/A

IL BlueCHOICE

High Self

9G1

153.68

177.5

131.08

46.42

8

332.97

384.58

284.01

100.57

17.33

High Family

9G2

332.73

384.3

288.23

96.07

12.89

720.92

832.65

624.49

208.16

27.93

IL Group Health Plan

High Self

MM1

197.52

205.81

131.08

74.73

-1.39

427.96

445.92

284.01

161.91

-3.02

High Family

MM2

426.63

444.53

298.23

146.3

-3.24

924.37

963.15

646.17

316.98

-7.03

HDHP Self

MM4

New Plan

170.3

127.73

42.57

N/A

New Plan

368.98

276.74

92.24

N/A

HDHP Family

MM5

New Plan

364.62

273.47

91.15

N/A

New Plan

790.01

592.51

197.5

N/A

IL Health Alliance HMO

High Self

FX1

169.4

181.36

131.08

50.28

2.28

367.03

392.95

284.01

108.94

4.94

High Family

FX2

395.37

423.25

298.23

125.02

6.74

856.64

917.04

646.17

270.87

14.59

IL Humana CoverageFirst (Consumer Driven Plan)

CDHP Self

MW1

76.86

78.54

58.91

19.63

0.42

166.53

170.17

127.63

42.54

0.91

CDHP Family

MW2

176.77

180.64

135.48

45.16

0.97

383

391.39

293.54

97.85

2.1

IL Humana Health Plan Inc.

High Self

751

155.99

171.78

128.84

42.94

3.94

337.98

372.19

279.14

93.05

8.56

High Family

752

358.77

395.11

296.33

98.78

9.09

777.34

856.07

642.05

214.02

19.69

Standard Self

754

119.6

121.84

91.38

30.46

0.56

259.13

263.99

197.99

66

1.22

Standard Family

755

275.06

280.22

210.17

70.05

1.29

595.96

607.14

455.36

151.78

2.79

IL John Deere Health Plan

High Self

YH1

142.23

151.51

113.63

37.88

2.32

308.17

328.27

246.2

82.07

5.03

High Family

YH2

348.46

371.19

278.39

92.8

5.69

755

804.25

603.19

201.06

12.31

IL Mercy Health Plans/Premier Health Plans

High Self

7M1

193.54

216.77

131.08

85.69

13.55

419.34

469.67

284.01

185.66

29.35

High Family

7M2

418.06

468.23

298.23

170

29.03

905.8

1014.5

646.17

368.33

62.89

IL OSF HealthPlans

High Self

9F1

130.78

164.47

123.35

41.12

8.43

283.36

356.35

267.26

89.09

18.25

High Family

9F2

343.94

432.52

298.23

134.29

48.31

745.2

937.13

646.17

290.96

104.66

HDHP Self

9F4

New Plan

148.24

111.18

37.06

N/A

New Plan

321.19

240.89

80.3

N/A

HDHP Family

9F5

New Plan

368.61

276.46

92.15

N/A

New Plan

798.66

599

199.66

N/A

IL PersonalCare's HMO

High Self

GE1

137.72

132.38

99.29

33.09

-1.34

298.39

286.82

215.12

71.7

-2.9

High Family

GE2

354.1

340.23

255.17

85.06

-3.46

767.22

737.17

552.88

184.29

-7.51

IL Unicare HMO

High Self

171

146.3

167.51

125.63

41.88

5.31

316.98

362.94

272.21

90.73

11.49

High Family

172

398.16

430.02

298.23

131.79

10.72

862.68

931.71

646.17

285.54

23.22

IL Union Health Service

High Self

761

123.7

131.19

98.39

32.8

1.88

268.02

284.25

213.19

71.06

4.06

High Family

762

306.74

325.36

244.02

81.34

4.66

664.6

704.95

528.71

176.24

10.09


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