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STANDARD SELF 41.64124.91 MV5LOUISIANA VANTAGE HEALTH PLAN, INC. STANDARD FAMILY 95.76287.29 MW1INDIANA HUMANA COVERAGEFIRST CDHP SELF 29.76 89.36 MW2INDIANA HUMANA COVERAGEFIRST CDHP FAMILY 68.50205.52 MX1NEW YORK MVP HEALTH CARE HIGH SELF 58.16145.04 MX2NEW YORK MVP HEALTH CARE HIGH FAMILY 194.94329.30 MX4NEW YORK MVP HEALTH CARE STANDARD SELF 47.56142.70 MX5NEW YORK MVP HEALTH CARE STANDARD FAMILY 161.64329.30 M21MINNESOTA MEDICA HEALTH PLAN HIGH SELF 53.69145.04 M22MINNESOTA MEDICA HEALTH PLAN HIGH FAMILY 125.78329.30 M51CALIFORNIA BLUE CROSS- HMO HIGH SELF 72.39145.04 M52CALIFORNIA BLUE CROSS- HMO HIGH FAMILY 228.42329.30 M56BLUE CROSS CALIFORNIACARE - HIGH SELF 217.43 M91NEW YORK MVP HEALTH CARE HIGH SELF 48.29144.89 M92NEW YORK MVP HEALTH CARE HIGH FAMILY 169.61329.30 M94NEW YORK MVP HEALTH CARE STANDARD SELF 45.38136.13 M95NEW YORK MVP HEALTH CARE STANDARD FAMILY 139.46329.30 ND1OHIO AETNA OPEN ACCESS HIGH SELF 45.36136.09 ND2OHIO AETNA OPEN ACCESS HIGH FAMILY 109.50328.52 NM1NEVADA HEALTH PLAN OF NEVADA HIGH SELF 28.00 84.02 NM2NEVADA HEALTH PLAN OF NEVADA HIGH FAMILY 71.71215.13 NV1MONTANA NEW WEST HEALTH SERVICES HIGH SELF 66.30145.04 NV2MONTANA NEW WEST HEALTH SERVICES HIGH FAMILY 122.12329.30 PH1MISSOURI HUMANA COVERAGEFIRST CDHP SELF 28.03 84.11 PH2MISSOURI HUMANA COVERAGEFIRST CDHP FAMILY 64.48193.44 PN1PENNSYLVANIA HEALTHAMERICA PENNSYLVANIA HIGH SELF 128.73145.04 PN2PENNSYLVANIA HEALTHAMERICA PENNSYLVANIA HIGH FAMILY 299.28329.30 PN4PENNSYLVANIA HEALTHAMERICA PENNSYLVANIA STANDARD SELF_ 46.47139.41 PN5PENNSYLVANIA HEALTHAMERICA PENNSYLVANIA STANDARD FAMILY 106.69320.07 PU1TEXAS AETNA OPEN ACCESS HIGH SELF 103.59145.04 PU2TEXAS AETNA OPEN ACCESS HIGH FAMILY 280.70329.30 PU4TEXAS AETNA OPEN ACCESS BASIC SELF 58.16145.04 PU5TEXAS AETNA OPEN ACCESS BASIC FAMILY 242.01329.30 P11TEXAS AETNA OPEN ACCESS HIGH SELF 51.95145.04 P12TEXAS AETNA OPEN ACCESS HIGH FAMILY 166.94329.30 P21NEW MEXICO PRESBYTERIAN HEALTH PLAN HIGH SELF 76.68145.04 P22NEW MEXICO PRESBYTERIAN HEALTH PLAN HIGH FAMILY 174.22329.30 P24NEW MEXICO PRESBYTERIAN HEALTH PLAN STANDARD SELF 65.51145.04 P25NEW MEXICO PRESBYTERIAN HEALTH PLAN STANDARD FAMILY 148.86329.30 P31PENNSYLVANIA AETNA OPEN ACCESS HIGH SELF 96.43145.04 P32PENNSYLVANIA AETNA OPEN ACCESS HIGH FAMILY 253.33329.30 P34PENNSYLVANIA AETNA OPEN ACCESS BASIC SELF 46.05138.15 P35PENNSYLVANIA AETNA OPEN ACCESS BASIC FAMILY 111.52329.30 QA1NEW YORK INDEPENDENT HEALTH ASSOC HIGH SELF 46.44139.34 QA2NEW YORK INDEPENDENT HEALTH ASSOC HIGH FAMILY 161.01329.30 QA4NEW YORK INDEPENDENT HEALTH ASSOC HDHP SELF 33.32 99.98 QA5NEW YORK INDEPENDENT HEALTH ASSOC HDHP FAMILY 83.86251.58 QP1FLORIDA HUMANA COVERAGEFIRST CDHP SELF 31.53 94.61 QP2FLORIDA HUMANA COVERAGEFIRST CDHP FAMILY 72.53217.61 Q11NEW MEXICO LOVELACE HEALTH PLAN HIGH SELF 47.61142.83 Q12NEW MEXICO LOVELACE HEALTH PLAN HIGH FAMILY 137.29329.30 Q81NEW YORK UNIVERA HEALTHCARE HIGH SELF 45.00135.00 Q82NEW YORK UNIVERA HEALTHCARE HIGH FAMILY 181.09329.30 RD1OHIO AETNA OPEN ACCESS HIGH SELF 79.82145.04 RD2OHIO AETNA OPEN ACCESS HIGH FAMILY 226.67329.30 RL1MICHIGAN GRAND VALLEY HEALTH PLAN HIGH SELF 49.47145.04 RL2MICHIGAN GRAND VALLEY HEALTH PLAN HIGH FAMILY 179.53329.30 RL4MICHIGAN GRAND VALLEY HEALTH PLAN STANDARD SELF 42.84128.51 RL5MICHIGAN GRAND VALLEY HEALTH PLAN STANDARD FAMILY 116.23329.30 RU1NORTH DAKOTA HEART OF AMERICA HEALTH PLAN HIGH SELF 39.63118.89 RU2NORTH DAKOTA HEART OF AMERICA HEALTH PLAN HIGH FAMILY 101.85305.54 R31FLORIDA UNITED HEALTHCARE OF FLORIDA HIGH SELF 51.25145.04 R32FLORIDA UNITED HEALTHCARE OF FLORIDA HIGH FAMILY 116.26329.30 SA1WASHINGTON PACIFICARE OF WASHINGTON HIGH SELF 53.00145.04 SA2WASHINGTON PACIFICARE OF WASHINGTON HIGH FAMILY 126.21329.30 SG1NEW YORK CDPHP UNIVERSAL BENEFITS HIGH SELF 57.56145.04 SG2NEW YORK CDPHP UNIVERSAL BENEFITS HIGH FAMILY 183.79329.30 SG4NEW YORK CDPHP UNIVERSAL BENEFITS STANDARD SELF 42.20126.59 SG5NEW YORK CDPHP UNIVERSAL BENEFITS STANDARD FAMILY 108.87326.60 SJ1CALIFORNIA BLUE SHIELD OF CA ACCESS+HMO HIGH SELF 45.78137.36 SJ2CALIFORNIA BLUE SHIELD OF CA ACCESS+HMO HIGH FAMILY 125.01329.30 SJ6BLUE SHIELD OF CA ACCESS HMO - 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NOT ELIGIBLE FOR FEDERAL EMPLOYEE HEALTH BENEFITS. 104BLUE CROSS AND BLUE SHIELD SERVICE BENEFIT PLAN STANDARD SELF 62.15145.04 105BLUE CROSS AND BLUE SHIELD SERVICE BENEFIT PLAN STANDARD FAMILY 145.14329.30 106BLUE CROSS AND BLUE SHIELD - HIGH SELF 23.02184.17 111BLUE CROSS AND BLUE SHIELD SERVICE BENEFIT PLAN BASIC SELF 39.13117.41 112BLUE CROSS AND BLUE SHIELD SERVICE BENEFIT PLAN BASIC FAMILY 91.66275.00 114TENNESSEE BLUE CROSS AND BLUE SHIELD SERVICE BENEF HDHP SELF 39.13117.41 115TENNESSEE BLUE CROSS AND BLUE SHIELD SERVICE BENEF HDHP FAMILY 91.66275.00 116LUE CROSS AND BLUE SHIELD SERVICE BENEFIT PLAN BASIC SELF 156.54 171INDIANA UNICARE HMO HIGH SELF 68.65145.04 172INDIANA UNICARE HMO HIGH FAMILY_ 144.62329.30 174INDIANA UNICARE HMO STANDARD SELF 37.19111.56 175INDIANA UNICARE HMO STANDARD FAMILY 82.47247.42 2C1VIRGINIA PIEDMONT COMMUNITY HEALTHCARE HIGH SELF 63.96145.04 2C2VIRGINIA PIEDMONT COMMUNITY HEALTHCARE HIGH FAMILY 149.30329.30 2C4VIRGINIA PIEDMONT COMMUNITY HEALTHCARE HDHP SELF 97.07145.04 2C5VIRGINIA PIEDMONT COMMUNITY HEALTHCARE HDHP FAMILY 200.78329.30 2G1VIRGINIA CAREFIRST BLUECHOICE HIGH SELF 61.63145.04 2G2VIRGINIA CAREFIRST BLUECHOICE HIGH FAMILY 135.64329.30 2J1NEW JERSEY COVENTRY HEALTH CARE HIGH SELF 70.40145.04 2J2NEW JERSEY COVENTRY HEALTH CARE HIGH FAMILY 209.28329.30 2J4NEW JERSEY COVENTRY HEALTH CARE STANDARD SELF 43.20129.59 2J5NEW JERSEY COVENTRY HEALTH CARE STANDARD FAMILY 107.99323.98 2L1NEVADA HEALTH PLAN OF NEVADA HIGH SELF 39.75119.25 2L2NEVADA HEALTH PLAN OF NEVADA HIGH FAMILY 101.77305.30 2N1OKLAHOMA PACIFICARE OF OKLAHOMA HIGH SELF 84.61145.04 2N2OKLAHOMA PACIFICARE OF OKLAHOMA HIGH FAMILY 208.06329.30 2U1GEORGIA AETNA OPEN ACCESS HIGH SELF 48.22144.66 2U2GEORGIA AETNA OPEN ACCESS HIGH FAMILY 113.27329.30 2X1CALIFORNIA AETNA OPEN ACCESS HIGH SELF 35.31105.95 2X2CALIFORNIA AETNA OPEN ACCESS HIGH FAMILY 87.00261.00 221WISCONSIN AETNA HEALTHFUND CDHP SELF 37.87113.63 222WISCONSIN AETNA HEALTHFUND CDHP FAMILY 87.11261.35 224WISCONSIN AETNA HEALTHFUND HDHP SELF 30.92 92.77 225WISCONSIN AETNA HEALTHFUND HDHP FAMILY 67.72203.15 226AETNA HEALTH FUND - 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HIGH SELF 123.38190.60 458MAIL HANDLERS - STANDARD SELF 197.27 471APWU HEALTH PLAN HIGH SELF 48.03144.08 472APWU HEALTH PLAN HIGH FAMILY 108.59325.78 474APWU HEALTH PLAN CDHP SELF 38.85116.55 475APWU HEALTH PLAN CDHP FAMILY 87.40262.20 476APWU - HIGH SELF 9.18182.93 478APWU HEALTH PLAN CONSUMER-DRIVEN SELF 155.40 481MAIL HANDLERS BENEFIT PLAN CONSUMER OPTION HDHP SELF 33.80101.42 482MAIL HANDLERS BENEFIT PLAN CONSUMER OPTION HDHP FAMILY 76.60229.82 486MAIL HANDLERS BENEFIT PLAN CONSUMER OPTION HDHP SELF 135.22 5E1FLORIDA VISTA HEALTHPLAN OF SOUTH FLORIDA HIGH SELF 34.25102.75 5E2FLORIDA VISTA HEALTHPLAN OF SOUTH FLORIDA HIGH FAMILY 94.20282.60 5M1OHIO SUPERMED HMO HIGH SELF 156.59145.04 5M2OHIO SUPERMED HMO HIGH FAMILY 442.26329.30 5W1OHIO SUMMACARE HEALTH PLAN HIGH SELF 73.77145.04 5W2OHIO SUMMACARE HEALTH PLAN HIGH FAMILY 173.97329.30 511NEW YORK HIP OF GREATER NEW YORK HIGH SELF 46.46139.40 512NEW YORK HIP OF GREATER NEW YORK HIGH FAMILY 191.67329.30 514NEW YORK HIP OF GREATER NEW YORK STANDARD SELF 45.36136.09 515NEW YORK HIP OF GREATER NEW YORK STANDARD FAMILY 178.76329.30 521MICHIGAN HEALTH ALLIANCE PLAN HIGH SELF 39.59118.76 522MICHIGAN HEALTH ALLIANCE PLAN HIGH FAMILY 104.91314.73 524MICHIGAN HEALTH ALLIANCE PLAN HDHP SELF 43.19129.56 525MICHIGAN HEALTH ALLIANCE PLAN HDHP FAMILY 109.57328.72 531WISCONSIN HEALTHPARTNERS CLASSIC/OPEN ACCESS DEDUC CLASSIC SELF 103.45145.04 532WISCONSIN HEALTHPARTNERS CLASSIC/OPEN ACCESS DEDUC CLASSIC FAMILY 242.71329.30 534HEALTHPARTNERS CLASSIC/OPEN ACCESS DEDUCTIBLE OPEN ACCESS DEDUCTIBLE S 82.57145.04 535HEALTHPARTNERS CLASSIC/OPEN ACCESS DEDUCTIBLE OPEN ACCESS DEDUCTIBLE F 194.24329.30 541WASHINGTON GROUP HEALTH COOPERATIVE HIGH SELF 77.14145.04 542WASHINGTON GROUP HEALTH COOPERATIVE HIGH FAMILY 148.38329.30 544WASHINGTON GROUP HEALTH COOPERATIVE STANDARD SELF 35.40106.22 545WASHINGTON GROUP HEALTH COOPERATIVE STANDARD FAMILY 79.93239.80 571WASHINGTON KAISER FOUNDATION HEALTH PLAN OF NORTHW HIGH SELF 72.84145.04 572WASHINGTON KAISER FOUNDATION HEALTH PLAN OF NORTHW HIGH FAMILY 171.22329.30 574WASHINGTON KAISER FOUNDATION HEALTH PLAN OF NORTHW STANDARD SELF 44.23132.71 575WASHINGTON KAISER FOUNDATION HEALTH PLAN OF NORTHW STANDARD FAMILY 101.61304.85 591CALIFORNIA KAISER FOUNDATION HEALTH PLAN OF CALIFO HIGH SELF 78.47145.04 592CALIFORNIA KAISER FOUNDATION HEALTH PLAN OF CALIFO HIGH FAMILY 204.24329.30 594CALIFORNIA KAISER FOUNDATION HEALTH PLAN OF CALIFO STANDARD SELF 38.93116.81 595ALIFORNIA KAISER FOUNDATION HEALTH PLAN OF CALIFO STANDARD FAMILY 92.94278.82 596CALIFORNIA HEALTH NET OF CALIFORNIA STANDARD FAMILY 39.54183.97 598KAISER FOUNDATION HEALTH PLAN, INC. STANDARD SELF 155.74 6J1TENNESSEE AETNA OPEN ACCESS HIGH SELF 114.10145.04 6J2TENNESSEE AETNA OPEN ACCESS HIGH FAMILY 261.50329.30 6N1KENTUCKY HUMANA COVERAGEFIRST CDHP SELF 38.56115.67 6N2KENTUCKY HUMANA COVERAGEFIRST CDHP FAMILY 88.68266.05 6U1TEXAS FIRSTCARE HIGH SELF 44.60133.81 6U2TEXAS FIRSTCARE HIGH FAMILY 95.89287.68 6V1NEW YORK GHI HMO SELECT HIGH SELF 52.99145.04 6V2NEW YORK GHI HMO SELECT HIGH FAMILY 173.17329.30 6Y1INDIANA ADVANTAGE HEALTH SOLUTIONS, INC. HIGH SELF 71.80145.04 6Y2INDIANA ADVANTAGE HEALTH SOLUTIONS, INC. HIGH FAMILY 179.84329.30 6Y4INDIANA ADVANTAGE HEALTH SOLUTIONS, INC. HDHP SELF 38.45115.36 6Y5INDIANA ADVANTAGE HEALTH SOLUTIONS, INC. HDHP FAMILY 86.38259.15 621CALIFORNIA KAISER FOUNDATION HEALTH PLAN OF CALIFO HIGH SELF 47.55142.66 622CALIFORNIA KAISER FOUNDATION HEALTH PLAN OF CALIFO HIGH FAMILY 110.31329.30 624CALIFORNIA KAISER FOUNDATION HEALTH PLAN OF CALIFO STANDARD SELF 29.84 89.52 625CALIFORNIA KAISER FOUNDATION HEALTH PLAN OF CALIFO STANDARD FAMILY 68.97206.91 631HAWAII KAISER FOUNDATION HEALTH PLAN OF HAWAII HIGH SELF 44.48133.45 632HAWAII KAISER FOUNDATION HEALTH PLAN OF HAWAII HIGH FAMILY 95.64286.92 634HAWAII KAISER FOUNDATION HEALTH PLAN OF HAWAII STANDARD SELF 23.08 69.24 635HAWAII KAISER FOUNDATION HEALTH PLAN OF HAWAII STANDARD FAMILY 49.62148.86 641OHIO KAISER FOUNDATION HEALTH PLAN OF OHIO HIGH SELF 69.52145.04 642OHIO KAISER FOUNDATION HEALTH PLAN OF OHIO HIGH FAMILY 197.24329.30 644OHIO KAISER FOUNDATION HEALTH PLAN OF OHIO STANDARD SELF 35.53106.58 645OHIO KAISER FOUNDATION HEALTH PLAN OF OHIO STANDARD FAMILY 87.18261.53 651COLORADO KAISER FOUNDATION HEALTH PLAN OF COLORADO HIGH SELF 62.88145.04 652COLORADO KAISER FOUNDATION HEALTH PLAN OF COLORADO HIGH FAMILY 146.83329.30 654COLORADO KAISER FOUNDATION HEALTH PLAN OF COLORADO STANDARD SELF 34.66103.99 655COLORADO KAISER FOUNDATION HEALTH PLAN OF COLORADO STANDARD FAMILY 79.38238.13 7D1OHIO AETNA OPEN ACCESS HIGH SELF 49.42145.04 7D2HIO AETNA OPEN ACCESS HIGH FAMILY 133.54329.30 7T1COLORADO HUMANA COVERAGEFIRST CDHP SELF 33.30 99.90 7T2COLORADO HUMANA COVERAGEFIRST CDHP FAMILY 76.59229.77 721INDIANA UNICARE HMO HDHP SELF 33.62100.86 722INDIANA UNICARE HMO HDHP FAMILY 73.51220.55 751INDIANA HUMANA HEALTH PLAN INC. HIGH SELF 62.46145.04 752INDIANA HUMANA HEALTH PLAN INC. HIGH FAMILY 147.98329.30 754INDIANA HUMANA HEALTH PLAN INC. STANDARD SELF 34.60103.80 755INDIANA HUMANA HEALTH PLAN INC. STANDARD FAMILY 79.58238.73 761ILLINOIS UNION HEALTH SERVICE HIGH SELF 37.59112.77 762LLINOIS UNION HEALTH SERVICE HIGH FAMILY 93.23279.68 8G1TEXAS AETNA OPEN ACCESS HIGH SELF 56.29145.04 8G2TEXAS AETNA OPEN ACCESS HIGH FAMILY 173.36329.30 8J1WASHINGTON AETNA OPEN ACCESS HIGH SELF 63.95145.04 8J2WASHINGTON AETNA OPEN ACCESS HIGH FAMILY 202.17329.30 8W1PENNSYLVANIA UPMC HEALTH PLAN HIGH SELF 74.40145.04 8W2PENNSYLVANIA UPMC HEALTH PLAN HIGH FAMILY 230.45329.30 8W4PENNSYLVANIA UPMC HEALTH PLAN HDHP SELF 72.80145.04 8W5PENNSYLVANIA UPMC HEALTH PLAN HDHP FAMILY 195.98329.30 801NEW YORK GHI HEALTH PLAN HIGH SELF 95.28145.04 802NEW YORK GHI HEALTH PLAN HIGH FAMILY 271.53329.30 804NEW YORK GHI HEALTH PLAN STANDARD SELF 44.56133.68 805NEW YORK GHI HEALTH PLAN STANDARD FAMILY 104.02312.05 851VIRGIN ISLANDS TRIPLE-S HIGH SELF 47.56142.68 852VIRGIN ISLANDS TRIPLE-S HIGH FAMILY 108.01324.03 871HAWAII HMSA HIGH SELF 39.95119.85 872HAWAII HMSA HIGH FAMILY 88.92266.78 891PUERTO RICO TRIPLE-S HIGH SELF 30.21 90.65 892PUERTO RICO TRIPLE-S HIGH FAMILY 69.49208.48 9E1COLORADO AETNA OPEN ACCESS HIGH SELF 103.38145.04 9E2COLORADO AETNA OPEN ACCESS HIGH FAMILY 253.72329.30 9E4COLORADO AETNA OPEN ACCESS BASIC SELF 49.93145.04 9E5COLORADO AETNA OPEN ACCESS BASIC FAMILY 156.79329.30 9F1ILLINOIS OSF HEALTH PLANS, INC. HIGH SELF 68.43145.04 9F2LLINOIS OSF HEALTH PLANS, INC. HIGH FAMILY 232.05329.30 9F4ILLINOIS OSF HEALTH PLANS, INC. HDHP SELF 46.85140.57 9F5ILLINOIS OSF HEALTH PLANS, INC. HDHP FAMILY 137.38329.30 9G1MISSOURI BLUE PREFERRED HMO HIGH SELF 68.80145.04 9G2MISSOURI BLUE PREFERRED HMO HIGH FAMILY 133.70329.30 9H1MISSOURI COVENTRY HEALTH CARE OF KANSAS (KANSAS CI HDHP SELF 41.24123.72 9H2MISSOURI COVENTRY HEALTH CARE OF KANSAS (KANSAS CI HDHP FAMILY 106.40319.21 9J1LOUISIANA HUMANA COVERAGEFIRST CDHP SELF 33.30 99.90 9J2LOUISIANA HUMANA COVERAGEFIRST CDHP FAMILY 76.59229.77 9K1UTAH ALTIUS HEALTH PLANS HIGH SELF 67.57145.04 9K2UTAH ALTIUS HEALTH PLANS HIGH FAMILY 138.47329.30 9K4UTAH ALTIUS HEALTH PLANS HDHP SELF 46.02138.06 9K5UTAH ALTIUS HEALTH PLANS HDHP FAMILY 95.34286.02 9L1LOUISIANA HUMANA COVERAGEFIRST CDHP SELF 36.80110.41 9L2LOUISIANA HUMANA COVERAGEFIRST CDHP FAMILY 84.65253.94 9N1PENNSYLVANIA HEALTH AMERICA PENNSYLVANIA-HDHP HDHP SELF 44.42133.26 9N2PENNSYLVANIA HEALTH AMERICA PENNSYLVANIA-HDHP HDHP FAMILY 100.22300.66 9R1VIRGINIA OPTIMA HEALTH PLAN HIGH SELF 74.16145.04 9R2VIRGINIA OPTIMA HEALTH PLAN HIGH FAMILY 189.36329.30 9U1MICHIGAN PHYSICIANS HEALTH PLAN OF MID-MICHIGAN HIGH SELF 60.21145.04 9U2MICHIGAN PHYSICIANS HEALTH PLAN OF MID-MICHIGAN HIGH FAMILY 165.36329.30 9U4MICHIGAN PHYSICIANS HEALTH PLAN OF MID-MICHIGAN STANDARD SELF 45.50136.51 9U5MICHIGAN PHYSICIANS HEALTH PLAN OF MID-MICHIGAN STANDARD FAMILY 109.66328.98