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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 Ohio

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

OH Aetna

High Self

7D1

141.1

148.35

111.26

37.09

1.82

305.72

321.43

241.07

80.36

3.93

High Family

7D2

339.83

353.07

264.8

88.27

3.31

736.3

764.99

573.74

191.25

7.18

OH Aetna

High Self

ND1

New Plan

164.58

123.44

41.14

N/A

New Plan

356.59

267.44

89.15

N/A

High Family

ND2

New Plan

430.12

298.23

131.89

N/A

New Plan

931.93

646.17

285.76

N/A

OH Aetna

High Self

RD1

151

162.03

121.52

40.51

2.76

327.17

351.07

263.3

87.77

5.98

High Family

RD2

371.08

393.74

295.31

98.43

4.44

804.01

853.1

639.83

213.27

9.62

OH 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

OH AultCare HMO

High Self

3A1

145.88

161.47

121.1

40.37

3.9

316.07

349.85

262.39

87.46

8.44

High Family

3A2

358.16

396.39

297.29

99.1

9.56

776.01

858.85

644.14

214.71

20.71

HDHP Self

3A4

New Plan

168.53

126.4

42.13

N/A

New Plan

365.15

273.86

91.29

N/A

HDHP Family

3A5

New Plan

337.69

253.27

84.42

N/A

New Plan

731.66

548.75

182.91

N/A

OH Blue HMO

High Self

R51

173.71

194.55

131.08

63.47

11.16

376.37

421.53

284.01

137.52

24.18

High Family

R52

431.43

453

298.23

154.77

0.43

934.77

981.5

646.17

335.33

0.92

OH HMO Health Ohio

High Self

L41

151.14

165.9

124.43

41.47

3.69

327.47

359.45

269.59

89.86

7.99

High Family

L42

386.65

424.39

298.23

126.16

16.6

837.74

919.51

646.17

273.34

35.96

OH Hometown Health Plan

High Self

MZ1

129.67

135.28

101.46

33.82

1.4

280.95

293.11

219.83

73.28

3.04

High Family

MZ2

324.19

338.22

253.67

84.55

3.5

702.41

732.81

549.61

183.2

7.6

OH Humana CoverageFirst (Consumer Driven Plan)

CDHP Self

L81

96.08

98.18

73.64

24.54

0.52

208.17

212.72

159.54

53.18

1.14

CDHP Family

L82

220.97

225.8

169.35

56.45

1.21

478.77

489.23

366.92

122.31

2.62

OH Kaiser Permanente

High Self

641

151.78

171.87

128.9

42.97

5.03

328.86

372.39

279.29

93.1

10.89

High Family

642

372.47

421.77

298.23

123.54

28.16

807.02

913.84

646.17

267.67

61.01

OH Paramount Health Care

High Self

U21

154.56

166.24

124.68

41.56

2.92

334.88

360.19

270.14

90.05

6.33

High Family

U22

409.23

440.16

298.23

141.93

9.79

886.67

953.68

646.17

307.51

21.2

OH SummaCare Health Plan

High Self

5W1

145.43

182.53

131.08

51.45

15.09

315.1

395.48

284.01

111.47

32.7

High Family

5W2

399.92

419.84

298.23

121.61

-1.22

866.49

909.65

646.17

263.48

-2.65

OH SuperMed HMO

High Self

5M1

168.06

224.03

131.08

92.95

46.29

364.13

485.4

284.01

201.39

100.29

High Family

5M2

429.89

573.06

298.23

274.83

122.03

931.43

1241.63

646.17

595.46

264.39

OH The Health Plan of the Upper Ohio Valley

High Self

U41

154.45

145.32

108.99

36.33

-2.28

334.64

314.86

236.15

78.71

-4.95

High Family

U42

355.2

334.22

250.67

83.55

-5.25

769.6

724.14

543.11

181.03

-11.37

OH United Healthcare of Ohio, Inc.

High Self

3U1

197.49

251.27

131.08

120.19

44.1

427.9

544.42

284.01

260.41

95.54

High Family

3U2

454.23

554.9

298.23

256.67

79.53

984.17

1202.28

646.17

556.11

172.3

Standard Self

3U4

New Plan

202.19

131.08

71.11

N/A

New Plan

438.08

284.01

154.07

N/A

Standard Family

3U5

New Plan

440.78

298.23

142.55

N/A

New Plan

955.02

646.17

308.85

N/A


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