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Federal Employees Health Benefits Program

2004 Premiums

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2004 FEHB Postal Premium Rates for Indiana

HMO Plans		2003 Total Biweekly Premium	2004 Total Biweekly Premium	2004 Biweekly Postal Premium Rates
Plan - Option - Enrollment Code		2003 Total Biweekly Premium	2004 Total Biweekly Premium	USPS Pays	Postal Empl. Pays	Change in employee payment
Advantage Health Plan, Inc.
High Self	6Y1	146.02	169.02	143.32	25.70	8.71
High Family	6Y2	342.85	396.85	327.12	69.73	21.58
Aetna Health Inc.
High Self	RD1	139.97	151.00	134.01	16.99	1.24
High Family	RD2	343.99	371.08	327.12	43.96	-5.33
Aetna HealthFund (Consumer Driven Plan)
High Self	221	New Plan	129.44	114.88	14.56	N/A
High Family	222	New Plan	297.73	264.24	33.49	N/A
Arnett HMO
High Self	G21	139.82	127.96	113.56	14.40	-1.33
High Family	G22	363.57	332.72	295.29	37.43	-31.44
Health Alliance HMO
High Self	FX1	151.25	169.40	143.32	26.08	3.86
High Family	FX2	353.01	395.37	327.12	68.25	9.94
Humana CoverageFirst (Consumer Driven Plan)
High Self	BM1	New Plan	115.28	102.31	12.97	N/A
High Family	BM2	New Plan	265.16	235.33	29.83	N/A
Humana CoverageFirst (Consumer Driven Plan)
High Self	MW1	New Plan	76.86	68.21	8.65	N/A
High Family	MW2	New Plan	176.77	156.88	19.89	N/A
Humana Health Plan
High Self	D21	146.69	178.07	143.32	34.75	17.09
High Family	D22	366.78	409.53	327.12	82.41	10.33
Humana Health Plan Inc.
High Self	751	134.52	155.99	138.44	17.55	2.42
High Family	752	322.63	358.77	318.41	40.36	4.06
Standard Self	754	102.11	119.60	106.15	13.45	1.96
Standard Family	755	244.89	275.06	244.12	30.94	3.39
M*Plan
High Self	IN1	169.54	188.25	143.32	44.93	4.42
High Family	IN2	389.11	432.04	327.12	104.92	10.51
Physicians Health Plan of Northern Indiana
High Self	DQ1	129.52	154.74	137.33	17.41	2.84
High Family	DQ2	291.09	347.45	308.36	39.09	6.34
Unicare HMO
High Self	171	122.22	146.30	129.84	16.46	2.71
High Family	172	350.19	398.16	327.12	71.04	15.55

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