1

ATTACHMENT 2 – FEHB PROGRAM

TABLE 1

PLANS LEAVING THE FEHB PROGRAM 

Enrollees in the terminating plans who do not change their health plan by enrolling in 

another FEHB plan during Open Season will not have health benefits for 2014. 

 

State Plan Name 3 Digit Plan 

Code

General 

Location

Michigan Physicians Health Plan 9U4, 9U5 Mid-Michigan

New York Blue Choice MK1, MK2

MK4, MK5

Rochester, NY

area

TABLE 2 

PLANS REDUCING THEIR SERVICE AREAS 

AND TERMINATING ENROLLMENT CODES 

Enrollees in these terminating enrollment codes must make a positive election into another 

FEHB plan during Open Season or they will not have health benefits coverage for 2014. 

State Plan Name 3 Digit Plan

Code

Area Dropped

Michigan Bluecare Network of 

Michigan

H61, H62 Traverse City

J31, J32 Grand Rapids

Texas Aetna Open Access P11, P12 Austin and San Antonio areas

TABLE 3 

PLAN REDUCING ITS SERVICE AREA 

WITHOUT TERMINATING ENROLLMENT CODES 

Enrollees in the areas being dropped who do not change health plans during Open Season 

will have to travel to their plan’s remaining service area to obtain medical care in order to 

receive full benefits from the plan in 2014. 

State Plan Name 3 Digit Plan 

Code

Area Dropped

California Health Net of California

(Southern Region) 

LP1, LP2 

LP4, LP5

Counties of Kings and Santa Barbara

The following zip codes in Riverside 

County: 92248 and 92599 

The following zip codes in San 

Bernardino County: 92309 and 92310
 

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TABLE 4 

ENROLLMENT CODE MERGERS

The payroll office must automatically move enrollees into their plan’s surviving code unless 

the enrollees select another health plan during Open Season. 

State Plan Name Plan Codes (2013) 2014 Surviving 

Codes

Oregon Kaiser Foundation Health Plan 

of the Northwest

B51, B52 574, 575 

Washington Kaiser Foundation Health Plan 

of the Northwest

B51, B52 574, 575

TABLE 5

TERMINATING ENROLLMENT CODES DUE TO CONTRACT MERGER

RESULTING IN NEW ENROLLMENT CODES 

The payroll office must automatically move enrollees into their plan’s new 2014 codes 

unless the enrollees select another health plan during Open Season. 

State Plan Name Terminating 

Plan Codes 

(2013)

New Codes

(2014) 

Alaska Aetna HealthFund Consumer 

Driven Health Plan (CDHP)

221, 222 JS1, JS2

California Aetna HealthFund CDHP 221, 222 JS1, JS2

Hawaii Aetna HealthFund CDHP 221, 222 JS1, JS2

Indiana Aetna HealthFund CDHP 221, 222 JS1, JS2

Ohio Aetna HealthFund CDHP 221, 222 JS1, JS2

Oklahoma Aetna HealthFund CDHP 221, 222 JS1, JS2

South Carolina Aetna HealthFund CDHP 221, 222 JS1, JS2

Texas Aetna HealthFund CDHP 221, 222 JS1, JS2

Wisconsin Aetna HealthFund CDHP 221, 222 JS1, JS2

TABLE 6 

PLAN NAME CHANGE 

State 2013 Plan Name (Old) 3 Digit Plan 

Codes

2014 Plan Name (New)

North Dakota Heart of America Health 

Plan

RU1, RU2 Sanford Heart of America 

Health Plan

Ohio Kaiser Foundation Health 

Plan of Ohio 

641, 642

 644, 645 

HealthSpan Integrated Care
 

3

TABLE 7 

NEW PLANS ENTERING THE FEHB PROGRAM (continued on next page)

State Plan Name Plan Type 3 Digit 

Plan 

Code

Location of Areas

Louisiana Humana Health 

Benefit Plan of 

Louisiana, Inc. 

HMO BC1, BC2

BC4, BC5 

Parishes of Jefferson, Lafourche, 

Orleans, Plaquemines, St. Bernard, 

St. Charles, St. Tammany, 

Tangipahoa, Terrebonne, and 

Washington

AE1, AE2

AE4, AE5 

Parishes of East Feliciana, Iberville, 

Livingston, Point Coupee, 

St. James, St. John the Baptist,

St. Martin, and West Baton Rouge

Michigan Total Health Care 

USA, Inc.

HMO A51, A52 Counties of Genesee, Macomb, 

Oakland, and Wayne

Texas Scott & White 

Health Plan

HMO A84, A85 Counties of Austin, Bastrop, Bell, 

Blanco, Bosque, Brazos, Burleson, 

Burnet, Caldwell, Coke, Coleman, 

Concho, Coryell, Crockett, Falls, 

Freestone, Grimes, Hamilton, Hays, 

Hill, Hood, Irion, Johnson, Kimble, 

Lampasas, Lee, Limestone, Llano, 

Madison, Mason, McCulloch, 

McLennan, Menard, Milam, Mills, 

Reagan, Robertson, Runnels, San 

Saba, Schleicher, Somervell, 

Sterling, Sutton, Tom Green, Travis, 

Walk , Waller, Washington , and 

Williamson. 

The following zip codes in Erath 

county: 76433, 76446, 76401, 

76436, 76457, 76690 

The following zip codes in Leon 

county: 75833, 77855, 75850, 

77865, 77871

Virginia HealthKeepers, Inc. HMO A91, A92 Counties of Accomack, Albemarle, 

Amelia, Brunswick, Buckingham, 

Caroline, Charles City, Chesapeake, 

Chesterfield, Clarke, Culpeper, 

Cumberland, Dinwiddie, Essex, 

Fairfax, Fauquier, Fluvanna, 

Frederick, Gloucester, Goochland, 

Greene, Greensville, Hanover, 

Henrico, Isle of Wight, James City, 

King and Queen, King George, King 

William, Lancaster, Loudoun, 
 

4

Louisa, Lunenburg, Madison, 

Mathews, Mecklenburg, Middlesex, 

New Kent, Northampton, 

Northumberland, Nottoway, Orange, 

Page, Powhatan, Prince Edward, 

Prince George, Prince William, 

Rappahannock, Richmond, 

Southampton, Spotsylvania, 

Stafford, Suffolk, Surry, Sussex, 

Virginia Beach, Warren, 

Westmoreland, and York.
 

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TABLE 8 

PLANS ADDING NEW OPTIONS AND ENROLLMENT CODES 

State Plan Name New 

Option 

New 3 Digit Plan

Code

General Location 

Nationwide NALC CDHP 324, 325 Nationwide

Nationwide NALC Value KM1, KM2 Nationwide

California Kaiser Foundation Health 

Plan - Northern 

California Region Basic

KC1, KC2 Northern California

Florida Humana Value Plan

Value 

MJ4, MJ5 Tampa area

QP4, QP5 Portions of South Florida

Georgia Humana Value Plan

Value 

AD4, AD5 Atlanta area

LM4, LM5 Macon area

Illinois Humana Value Plan

Value 

GB4, GB5 Portions of Central and 

Northwestern Illinois

MW4, MW5 Chicago area

Illinois Health Alliance HMO

Standard K84, K85 Central, East Central, 

North Central, Southern and 

Western Illinois

Indiana Health Alliance HMO Standard K84, K85 Western Indiana

Indiana Humana Value Plan Value MW4, MW5 Portions of Indiana

Iowa Health Alliance HMO Standard K84, K85 Central and Eastern Iowa

Kansas Humana Value Plan Value PH4, PH5 Portions of Kansas

Missouri Humana Value Plan Value PH4, PH5 Kansas City, MO area

Texas Humana Value Plan Value TV4, TV5 Austin area

TP4, TP5 Corpus Christi area

TU4, TU5 San Antonio area
 

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TABLE 9 

SERVICE AREA EXPANSIONS WITH NEW ENROLLMENT CODES

(continued on next page) 

State Plan Name Plan Type New 3 

Digit Plan 

Codes

Location of Areas

Alaska Aetna Value Plan HMO

(Value Plan) 

JS4, JS5 Most of Alaska – Boroughs of Aleutians 

East, Aleutians West, Anchorage, Bethel, 

Bristol Bay, Denali, Dillingham, 

Fairbanks North Star, Juneau, Kenai 

Peninsula, Ketchikan Gateway, Kodiak 

Island, Lake and Peninsula, Matanuska 

Susitna, Nome, North Slope, Prince of 

Wales Outer Ketchikan, Sitka, Skagway 

Hoonah Angoon, Southeast Fairbanks, 

Valdez Cordova and Yukon Koyukuk

Arizona Humana Health Plan, Inc HMO BF1, BF2

BF4, BF5

Counties of Maricopa and Pinal

C71, C72

C74, C75

County of Pima

California Aetna Value Plan HMO

(Value Plan)

 

JS4, JS5 Most of California – Counties of 

Alameda, Amador, Butte, Colusa, Contra 

Costa, El Dorado, Fresno, Humboldt, 

Imperial, Kern, Kings, Lake, Los 

Angeles, Madera, Marin, Merced, 

Monterey, Napa, Nevada, Orange, Placer, 

Riverside, Sacramento, San Benito, San 

Bernardino, San Diego, San Francisco, 

San Joaquin, San Luis Obispo, San 

Mateo, Santa Barbara, Santa Clara, Santa 

Cruz, Shasta, Solano, Sonoma, Stanislaus, 

Sutter, Tehama, Tulare, Tuolumne, 

Ventura, Yolo and Yuba

Florida Humana Medical Plan, 

Inc.

HMO EX1, EX2

EX4, EX5

Counties of Flagler and Volusia

E21, E22

E24, E25

Counties of Lake, Orange, Osceola, and 

Seminole

Hawaii Aetna Value Plan HMO

(Value Plan) 

JS4, JS5 All of the state

Indiana Aetna Value Plan HMO

(Value Plan) 

JS4, JS5 All of the state

Ohio Aetna Value Plan HMO

(Value Plan) 

JS4, JS5 All of the state

Oklahoma Aetna Value Plan HMO

(Value Plan) 

JS4, JS5 All of the state
 

7

State Plan Name Plan Type New 3 

Digit Plan 

Codes

Location of Areas

South 

Carolina 

Aetna Value Plan HMO

(Value Plan)

JS4, JS5 All of the state

Texas Aetna Value Plan HMO

(Value Plan) 

JS4, JS5 All of the state

Texas Humana Health Plan of 

Texas, Inc.

HMO EW1, 

EW2, 

EW4, 

EW5

Counties of Austin, Brazoria, Chambers, 

Colorado, Fayette, Fort Bend, Galveston, 

Harris, Liberty, Montgomery, Waller, and 

Wharton 

Virginia Aetna Whole Health HMO J91, J92 Counties of Essex, Gloucester, Isle of 

Wight, James City, King and Queen, 

Lancaster, Mathews, Middlesex, 

Northumberland, Richmond, and York 

Cities of Hampton, Newport News, 

Poquoson, and Williamsburg

Wisconsin Aetna Value Plan HMO

(Value Plan)

JS4, JS5 All of the state
 

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TABLE 10 

SERVICE AREA EXPANSIONS WITHOUT NEW ENROLLMENT CODES 

State Plan Name Plan Type 3 Digit 

Plan 

Code

Location of Areas

Idaho SelectHealth HMO SF1, SF2

SF4, SF5 

Counties of Bingham, Bonneville, Kootenai, Madison 

and Power 

Illinois Aetna 

HealthFund High 

Deductible 

Health Plan 

(HDHP)

HDHP 224, 225 Counties of Cass, Cumberland, Henderson, Mercer, 

Moultrie, and Richland

Illinois Aetna Value Plan HMO

(Value Plan)

H44, 

H45

Counties of Cass, Cumberland, Henderson, Mercer, 

Moultrie, and Richland

Texas FirstCare 

Health Plan

HMO ET1, 

ET2

Counties of Burleson, Houston, Lee, Leon, and Milam

Utah SelectHealth HMO SF1, SF2

SF4, SF5

Counties of Carbon, Daggett, Emery, Grand, San Juan

The following zip codes in Tooele county: 84034 & 

84083 

The following zip codes in Box Elder county: 84313 

& 84329

Virginia Aetna 

HealthFund 

HDHP

HDHP 224, 225 County of Orange

Virginia Aetna Value Plan HMO

(Value Plan)

F54, F55 County of Orange

West Virginia The Health Plan 

of the Upper 

Ohio Valley, Inc.

HMO U41, 

U42

Counties of Grant, Hardy, McDowell, Mineral, Mingo, 

Pendleton and Summers

Wisconsin Physicians Plus HMO LW1, 

LW2

Counties of Adams, Columbia, Grant, Green, 

Jefferson, Lake, Iowa, Lafayette, Marquette, Richland, 

Rock, Saul, and Waushara