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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 Postal Premium Rates for Indiana

HMO Plans

2004 Total Biweekly Premium

2005 Total Biweekly Premium

2005 Biweekly Postal Premium Rates

Plan

Option

Enrollment Code

USPS Pays

Employee Pays

Change in employee payment

IN Advantage Health Solutions, Inc.

High Self

6Y1

169.02

183.68

154.74

28.94

3.24

High Family

6Y2

396.85

431.28

352.08

79.2

9.47

HDHP Self

6Y4

New Plan

174.45

154.74

19.71

N/A

HDHP Family

6Y5

New Plan

396.49

351.88

44.61

N/A

IN Aetna

High Self

IK1

New Plan

152.11

135

17.11

N/A

High Family

IK2

New Plan

375.42

333.19

42.23

N/A

IN Aetna

High Self

RD1

151

162.03

143.8

18.23

1.24

High Family

RD2

371.08

393.74

349.44

44.3

0.34

IN Aetna HealthFund (CDHP/HDHP)

CDHP Self

221

129.44

136.8

121.41

15.39

0.83

CDHP Family

222

297.73

314.65

279.25

35.4

1.91

HDHP Self

224

New Plan

153.73

136.44

17.29

N/A

HDHP Family

225

New Plan

353.59

313.81

39.78

N/A

IN Arnett HMO

High Self

G21

127.96

144.38

128.14

16.24

1.84

High Family

G22

332.72

375.4

333.17

42.23

4.8

IN Health Alliance HMO

High Self

FX1

169.4

181.36

154.74

26.62

0.54

High Family

FX2

395.37

423.25

352.08

71.17

2.92

IN Humana CoverageFirst (Consumer Driven Plan)

CDHP Self

BM1

115.28

117.81

104.56

13.25

0.28

CDHP Family

BM2

265.16

270.96

240.48

30.48

0.65

IN Humana CoverageFirst (Consumer Driven Plan)

CDHP Self

L81

96.08

98.18

87.13

11.05

0.24

CDHP Family

L82

220.97

225.8

200.4

25.4

0.54

IN Humana CoverageFirst (Consumer Driven Plan)

CDHP Self

MW1

76.86

78.54

69.7

8.84

0.19

CDHP Family

MW2

176.77

180.64

160.32

20.32

0.43

IN Humana Health Plan

High Self

D21

178.07

198.88

154.74

44.14

9.39

High Family

D22

409.53

457.42

352.08

105.34

22.93

IN Humana Health Plan Inc.

High Self

751

155.99

171.78

152.45

19.33

1.78

High Family

752

358.77

395.11

350.66

44.45

4.09

Standard Self

754

119.6

121.84

108.13

13.71

0.26

Standard Family

755

275.06

280.22

248.7

31.52

0.58

IN M*Plan

High Self

IN1

188.25

204.85

154.74

50.11

5.18

High Family

IN2

432.04

470.12

352.08

118.04

13.12

IN Physicians Health Plan of Northern Indiana

High Self

DQ1

154.74

216.09

154.74

61.35

43.94

High Family

DQ2

347.45

485.23

352.08

133.15

94.06

IN Unicare HMO

High Self

171

146.3

167.51

148.67

18.84

2.38

High Family

172

398.16

430.02

352.08

77.94

6.9