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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 South Dakota

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

SD Avera Health Plans

High Self

AV1

144.77

194.74

131.08

63.66

27.47

313.67

421.94

284.01

137.93

59.51

High Family

AV2

338.08

454.78

298.23

156.55

72.03

732.51

985.36

646.17

339.19

156.06

SD Sioux Valley Health Plan

High Self

AU1

213.66

222.21

131.08

91.13

-1.13

462.93

481.46

284.01

197.45

-2.45

High Family

AU2

491.25

511.33

298.23

213.1

-1.06

1064.38

1107.88

646.17

461.71

-2.31

Standard Self

AU4

181.32

199.46

131.08

68.38

8.46

392.86

432.16

284.01

148.15

18.32

Standard Family

AU5

416.83

458.52

298.23

160.29

20.55

903.13

993.46

646.17

347.29

44.52


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