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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 Pennsylvania

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

PA Aetna

High Self

P31

158.9

185.14

131.08

54.06

14.34

344.28

401.14

284.01

117.13

31.06

High Family

P32

383.43

446.74

298.23

148.51

42.17

830.77

967.94

646.17

321.77

91.36

PA Aetna

High Self

YE1

123.99

134.23

100.67

33.56

2.56

268.65

290.83

218.12

72.71

5.55

High Family

YE2

341.92

370.14

277.61

92.53

7.05

740.83

801.97

601.48

200.49

15.28

PA 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

PA Coventry Health Care of Delaware

High Self

2J1

New Plan

193.32

131.08

62.24

N/A

New Plan

418.86

284.01

134.85

N/A

High Family

2J2

New Plan

488.13

298.23

189.9

N/A

New Plan

1057.62

646.17

411.45

N/A

HDHP Self

2J4

New Plan

159.4

119.55

39.85

N/A

New Plan

345.37

259.03

86.34

N/A

HDHP Family

2J5

New Plan

391.87

293.9

97.97

N/A

New Plan

849.05

636.79

212.26

N/A

PA HealthAmerica Pennsylvania

High Self

261

164.23

170.32

127.74

42.58

-0.25

355.83

369.03

276.77

92.26

-0.54

High Family

262

418.79

434.34

298.23

136.11

-5.59

907.38

941.07

646.17

294.9

-12.12

Standard Self

264

147.93

158.98

119.24

39.74

2.76

320.52

344.46

258.35

86.11

5.98

Standard Family

265

377.22

405.41

298.23

107.18

7.05

817.31

878.39

646.17

232.22

15.27

PA HealthAmerica Pennsylvania

High Self

4N1

179.14

238.06

131.08

106.98

49.24

388.14

515.8

284.01

231.79

106.68

High Family

4N2

444.26

547.54

298.23

249.31

82.14

962.56

1186.34

646.17

540.17

177.97

Standard Self

4N4

161.5

211.05

131.08

79.97

39.6

349.92

457.28

284.01

173.27

85.79

Standard Family

4N5

400.52

485.42

298.23

187.19

63.76

867.79

1051.74

646.17

405.57

138.14

PA HealthAmerica Pennsylvania - HDHP

HDHP Self

9N1

New Plan

183.76

131.08

52.68

N/A

New Plan

398.15

284.01

114.14

N/A

HDHP Family

9N2

New Plan

414.45

298.23

116.22

N/A

New Plan

897.98

646.17

251.81

N/A

PA HealthAmerica Pennsylvania

High Self

PN1

New Plan

233.6

131.08

102.52

N/A

New Plan

506.13

284.01

222.12

N/A

High Family

PN2

New Plan

536.37

298.23

238.14

N/A

New Plan

1162.14

646.17

515.97

N/A

Standard Self

PN4

New Plan

209.4

131.08

78.32

N/A

New Plan

453.7

284.01

169.69

N/A

Standard Family

PN5

New Plan

480.7

298.23

182.47

N/A

New Plan

1041.52

646.17

395.35

N/A

PA HealthAmerica Pennsylvania

High Self

SW1

177.2

202.73

131.08

71.65

15.85

383.93

439.25

284.01

155.24

34.34

High Family

SW2

429.17

466.28

298.23

168.05

15.97

929.87

1010.27

646.17

364.1

34.59

Standard Self

SW4

159.17

186.46

131.08

55.38

15.59

344.87

404

284.01

119.99

33.77

Standard Family

SW5

385.51

428.86

298.23

130.63

22.21

835.27

929.2

646.17

283.03

48.12

PA HealthAmerica Pennsylvania - HDHP

HDHP Self

Y61

New Plan

151.89

113.92

37.97

N/A

New Plan

329.1

246.83

82.27

N/A

HDHP Family

Y62

New Plan

373.42

280.07

93.35

N/A

New Plan

809.08

606.81

202.27

N/A

PA HealthAmerica Pennsylvania - HDHP

HDHP Self

YN1

New Plan

190.76

131.08

59.68

N/A

New Plan

413.31

284.01

129.3

N/A

HDHP Family

YN2

New Plan

431.16

298.23

132.93

N/A

New Plan

934.18

646.17

288.01

N/A

PA HealthAmerica Pennsylvania - HDHP

HDHP Self

YW1

New Plan

171.59

128.69

42.9

N/A

New Plan

371.78

278.84

92.94

N/A

HDHP Family

YW2

New Plan

387.1

290.33

96.77

N/A

New Plan

838.72

629.04

209.68

N/A

PA Keystone Health Plan Central

High Self

S41

174.21

208.21

131.08

77.13

24.32

377.46

451.12

284.01

167.11

52.68

High Family

S42

418.17

496.79

298.23

198.56

57.48

906.04

1076.38

646.17

430.21

124.53

PA Keystone Health Plan East

High Self

ED1

160.74

164.6

123.45

41.15

0.97

348.27

356.63

267.47

89.16

2.09

High Family

ED2

423.86

434.06

298.23

135.83

-10.94

918.36

940.46

646.17

294.29

-23.71

PA UPMC Health Plan

High Self

8W1

156.11

170.97

128.23

42.74

3.71

338.24

370.44

277.83

92.61

8.05

High Family

8W2

398.21

436.07

298.23

137.84

16.72

862.79

944.82

646.17

298.65

36.22


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