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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 New York

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

NY Aetna

High Self

JC1

161.5

177.65

131.08

46.57

6.2

349.92

384.91

284.01

100.9

13.42

High Family

JC2

397.55

437.3

298.23

139.07

18.61

861.36

947.48

646.17

301.31

40.31

NY 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

NY Blue Choice

High Self

MK1

120.09

130.07

97.55

32.52

2.5

260.2

281.82

211.37

70.45

5.4

High Family

MK2

301.02

325.87

244.4

81.47

6.22

652.21

706.05

529.54

176.51

13.46

NY CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN

High Self

SG1

147.61

155.33

116.5

38.83

1.93

319.82

336.55

252.41

84.14

4.19

High Family

SG2

378.03

391.44

293.58

97.86

-3.08

819.07

848.12

636.09

212.03

-6.68

NY GHI Health Plan

High Self

801

185.17

200.91

131.08

69.83

6.06

401.2

435.31

284.01

151.3

13.13

High Family

802

462.92

502.28

298.23

204.05

18.22

1002.99

1088.27

646.17

442.1

39.47

Standard Self

804

158.87

170.15

127.61

42.54

2.82

344.22

368.66

276.5

92.16

6.11

Standard Family

805

397.2

397.2

297.9

99.3

-20.81

860.6

860.6

645.45

215.15

-45.09

NY GHI HMO Select

High Self

6V1

176.3

183.75

131.08

52.67

-2.23

381.98

398.13

284.01

114.12

-4.83

High Family

6V2

438.01

467.78

298.23

169.55

8.63

949.02

1013.52

646.17

367.35

18.69

Standard Self

6V4

New Plan

157.7

118.28

39.42

N/A

New Plan

341.68

256.26

85.42

N/A

Standard Family

6V5

New Plan

401.46

298.23

103.23

N/A

New Plan

869.83

646.17

223.66

N/A

NY GHI HMO Select

High Self

X41

164.94

169.75

127.31

42.44

-1.1

357.37

367.79

275.84

91.95

-2.39

High Family

X42

423.59

437.49

298.23

139.26

-7.24

917.78

947.9

646.17

301.73

-15.69

Standard Self

X44

New Plan

154.35

115.76

38.59

N/A

New Plan

334.43

250.82

83.61

N/A

Standard Family

X45

New Plan

390.3

292.73

97.57

N/A

New Plan

845.65

634.24

211.41

N/A

NY HIP of Greater New York

High Self

511

146.09

159.41

119.56

39.85

3.33

316.53

345.39

259.04

86.35

7.22

High Family

512

409.03

446.35

298.23

148.12

16.18

886.23

967.09

646.17

320.92

35.05

Standard Self

514

116.96

131.51

98.63

32.88

3.64

253.41

284.94

213.71

71.23

7.88

Standard Family

515

327.48

368.23

276.17

92.06

10.19

709.54

797.83

598.37

199.46

22.08

NY HMO Blue

High Self

AH1

211.03

173.97

130.48

43.49

-46.14

457.23

376.94

282.71

94.23

-99.97

High Family

AH2

538.88

442.45

298.23

144.22

-117.57

1167.57

958.64

646.17

312.47

-254.74

NY HMOBlue-CNY

High Self

EB1

183.47

172.49

129.37

43.12

-18.95

397.52

373.73

280.3

93.43

-41.06

High Family

EB2

424.46

441.23

298.23

143

-4.37

919.66

956

646.17

309.83

-9.47

NY Independent Health Assoc

High Self

QA1

105.08

129.64

97.23

32.41

6.14

227.67

280.89

210.67

70.22

13.3

High Family

QA2

294.17

355.56

266.67

88.89

15.35

637.37

770.38

577.79

192.59

33.25

NY MVP Health Care

High Self

GA1

123.7

148.03

111.02

37.01

6.09

268.02

320.73

240.55

80.18

13.18

High Family

GA2

319.47

382.28

286.71

95.57

15.7

692.19

828.27

621.2

207.07

34.02

NY MVP Health Care

High Self

M91

140.28

161.06

120.8

40.26

5.19

303.94

348.96

261.72

87.24

11.26

High Family

M92

362.22

415.92

298.23

117.69

27.14

784.81

901.16

646.17

254.99

58.79

NY MVP Health Care

High Self

MX1

144.06

166.04

124.53

41.51

5.5

312.13

359.75

269.81

89.94

11.91

High Family

MX2

372.09

428.8

298.23

130.57

35.57

806.2

929.07

646.17

282.9

77.06

NY Preferred Care

High Self

GV1

119.56

127.06

95.3

31.76

1.87

259.05

275.3

206.48

68.82

4.06

High Family

GV2

319.21

339.21

254.41

84.8

5

691.62

734.96

551.22

183.74

10.84

NY Univera Healthcare

High Self

KQ1

144.68

146.79

110.09

36.7

0.53

313.47

318.05

238.54

79.51

1.14

High Family

KQ2

383.27

388.88

291.66

97.22

-8.96

830.42

842.57

631.93

210.64

-19.42

NY Univera Healthcare

High Self

Q81

114.15

117.88

88.41

29.47

0.93

247.33

255.41

191.56

63.85

2.02

High Family

Q82

323.66

334.24

250.68

83.56

2.65

701.26

724.19

543.14

181.05

5.74

NY Vytra Health Plans

High Self

J61

175.53

190.63

131.08

59.55

5.42

380.32

413.03

284.01

129.02

11.73

High Family

J62

460.32

500.08

298.23

201.85

18.62

997.36

1083.51

646.17

437.34

40.34


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