1

ATTACHMENT 2 – FEHB PROGRAM

TABLE 1

PLANS LEAVING THE FEHB PROGRAM 

Enrollees in these terminating plans who do not change health plans by enrolling in another 

FEHB plan during Open Season will not have health benefits for 2012. 

State Plan Name 3 Digit Plan Code

California Anthem Blue Cross M51, M52

Indiana Welborn Health Plan W11, W12

Indiana Bluegrass Family Health High 

Deductible Health Plan (HDHP)*

KV1, KV2

Kentucky Bluegrass Family Health HDHP* KV1, KV2

Minnesota Medica Health Plan M21, M22

Montana New West Health Services NV1, NV2

NV4, NV5 

New York Univera Healthcare Q81, Q82

*Enrollees who want to continue enrollment in 2012 in an HDHP and receive or make 

additional contributions to the Health Savings Account (HSA) must change to another 

HDHP in the FEHB Program during Open Season. They need to contact their current 2011

HDHP HSA Fiduciary and the Internal Revenue Service (IRS) for any guidance and 

questions about their HSA, including tax considerations and penalties. If enrollees are 

interested in consolidating their HSA accounts, they also need to contact their upcoming 

2012 HDHP HSA Fiduciary. 

If enrollees do not want to continue in an HDHP, they must change to another health plan 

option during Open Season or they will not have health benefits for 2012. However, the 

enrollees must contact the HDHP HSA Fiduciary and IRS for any guidance and questions 

about the HSA concerning tax considerations and penalties. 
2

TABLE 2

PLAN REDUCING ITS SERVICE AREA 

WITHOUT TERMINATING ENROLLMENT CODES

Enrollees in the service area 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 2012.

State Plan Name 3 Digit Plan 

Code

Area Dropped

Illinois Humana Benefits Plan of 

Illinois

9F1, 9F2

AB4, AB5

Counties of Kane and McHenry
3

TABLE 3

PLANS TERMINATING OPTIONS AND ENROLLMENT CODES 

Enrollees in these plans’ options will be automatically deemed and enrolled into their plans’

option that is identified in the table below unless they enroll in another plan option or plan 

during Open Season. 

State Plan Name Terminating 

Options (end of 

2011)

Terminating 

Codes 

(end of 2011)

Deemed Options

and Codes for 2012

Georgia Kaiser Foundation Health 

Plan of Georgia, Inc. 

High Deductible Health 

Plan (HDHP)

HDHP* GW1, GW2 Standard 

F84, F85

Michigan Health Alliance Plan

HDHP

HDHP* 524, 525 High 

521, 522

*Enrollees in the terminating HDHP options who want to continue enrollment in 2012 in an

HDHP must change to another HDHP in the FEHB Program during Open Season if they 

want to continue to receive or make additional contributions to the Health Savings Account 

(HSA). They need to contact their current 2011 HDHP HSA Fiduciary and the Internal 

Revenue Service (IRS) for any guidance and questions about their HSA, including tax 

considerations and penalties. If enrollees are interested in consolidating their HSA 

accounts, they also need to contact their upcoming 2012 HDHP HSA Fiduciary.

If these enrollees do not enroll in another HDHP plan or another FEHB plan during Open 

Season, these enrollees will be automatically switched into their plan’s 2012 deemed option. 

These enrollees should also contact the HSA Fiduciary and the IRS for any guidance and 

questions about the HSA, including tax considerations and penalties.
4

TABLE 4

PLANS ADDING NEW OPTIONS AND ENROLLMENT CODES

State Plan Name New Option New 3-Digit

Codes

District of 

Columbia

CareFirst BlueChoice Healthy Blue 

(Standard)

2G4, 2G5

Florida Coventry Health Plan 

of Florida

High Deductible 

Health Plan 

(HDHP)

J41, J42

Maryland CareFirst BlueChoice Healthy Blue 

(Standard)

2G4, 2G5

Michigan Health Alliance Plan Standard GY4, GY5

Virginia CareFirst BlueChoice Healthy Blue 

(Standard)

2G4, 2G5

TABLE 5

PLAN NAME CHANGES 

State 2011 Plan Name (Old) Plan Codes 2012 Plan Name (New)

California PacifiCare of California CY1, CY2 UnitedHealthcare of 

California

Iowa HealthPartners Open 

Access Copay / Three for 

Free

V31, V32

V34, V35

HealthPartners High and 

Standard Option

Michigan Physicians Health Plan of 

Mid-Michigan

9U4, 9U5 Physicians Health Plan

Minnesota HealthPartners Open 

Access Copay / Three for

Free

V31, V32

V34, V35

HealthPartners High and 

Standard Option

North Dakota HealthPartners Open 

Access Copay / Three for 

Free

V31, V32

V34, V35

HealthPartners High and 

Standard Option

South Dakota HealthPartners Open 

Access Copay / Three for 

Free

V31, V32

V34, V35

HealthPartners High and 

Standard Option

Texas PacifiCare of Texas GF1, GF2 UnitedHealthcare Benefits 

of Texas, Inc.

Wisconsin HealthPartners Open 

Access Copay / Three for 

Free

V31, V32

V34, V35

HealthPartners High and 

Standard Option
5

TABLE 6

SERVICE AREA EXPANSIONS WITH NEW ENROLLMENT CODES

State Plan Name New 3 Digit 

Plan Code

General Location

Illinois Humana CoverageFirst GB1, GB2 Counties of Boone, Bureau, 

DeKalb, Dewitt, Fulton 

Henderson, Henry, Knox, 

LaSalle, Lee, Livingston, 

Marshall, McDonough, McLean, 

Mercer, Ogle, Peoria, Putnam, 

Stark, Stephenson, Tazewell, 

Warren, Whiteside, Winnebago,

and Woodford

Kansas Aetna Open Access HY1, HY2 Counties of Atchison, Douglas, 

Franklin, Johnson, Leavenworth, 

Miami, and Wyandotte

Missouri Aetna Open Access HY1, HY2 Counties of Buchanan, Cass, 

Clay, Jackson, Lafayette, Platte,

and Ray

Nevada Aetna Open Access HF1, HF2 County of Clark;

Partial county of Nye in the 

following zip codes: 89041, 

89048, 89060, and 89061

Tennessee Humana Health Plan, Inc GJ1, GJ2

GJ4, GJ5

Counties of Anderson, Blout, 

Campbell, Carter, Claiborne, 

Cocke, Grainger, Greene, 

Hamblen, Hancock, Hawkins, 

Jefferson, Johnson, Knox, 

Loundon, Morgan, Roane, Scott, 

Sevier, Sullivan, Unicoi, Union, 

and Washington
6

TABLE 7

SERVICE AREA EXPANSIONS WITHOUT NEW ENROLLMENT CODES (continued

on next page)

State Plan Name 3 Digit 

Plan Code

General Location of New Area

Arkansas Aetna HealthFund

Consumer Driven Health 

Plan (CDHP)

High Deductible Health 

Plan (HDHP)

221, 222

224, 225

Counties of Clay, Fulton, and Randolph

California Aetna HealthFund

CDHP and HDHP

221, 222

224, 225

Counties of Humboldt and Tehama

California Kaiser Foundation 

Health Plan of California

621, 622

624, 625

The following seven zip codes in the 

Northern San Diego area: 92003, 92028, 

92059, 92060, 92061, 92086, and 92088

Georgia Aetna Open Access 2U1, 2U2 Counties of Dawson, Floyd, Gordon, Greene, 

Jasper, Lamar, Morgan, Pike, and Polk

Illinois Aetna HealthFund

CDHP and HDHP

221, 222

224, 225

Counties of Edwards and Lawrence

Illinois Health Alliance HMO FX1, FX2 Counties of Bond, Calhoun, Clinton, Fulton, 

Kane, Kankakee, Monroe, and Will

Iowa Coventry Health Care of 

Iowa

SV1, SV2

SY4, SY5

SV4, SV5

Counties of Cass, Crawford, Fremont, 

Harrison, Mills, Monona, Montgomery, Page, 

Pottawattamie, and Shelby

Kansas Aetna HealthFund

CDHP and HDHP

221, 222

224, 225

County of Doniphan

Louisiana Aetna HealthFund

CDHP and HDHP

221, 222

224, 225

Counties of Avoyelles, La Salle, Morehouse, 

and Tensas;

Partial county of Concordia in the following 

zip codes: 71326, 71334, and 71377

Michigan HealthPlus of Michigan X51, X52 City of Bad Axe; 

Counties of Huron and Washtenaw; 

Townships of Bingham, Caseville, Chandler, 

Colfax, Dwight, Fairhaven, Hume, Lake, 

Lincoln, McKinley, Meade, Oliver, Port 

Austin, Sheridan, Verona, Village-Port 

Austin, and Windsor

Michigan Physicians Health Plan 9U4, 9U5 Counties of Hillsdale and Jackson;

Partial County of Lenawee in the following 

Townships/zip codes: Cambridge – 49265, 

Hudson – 49247, Rollin – 49220, and

Woodstock – 49233; Partial County of 

Washtenaw in the following Townships/zip 

codes: Bridgewater – 48115, Lima – 48118, 

Manchester – 48158, Saline – 49236, Scio –

48130, Sharon – 49240, Sylvan – 48118, and 

Webster – 48189
7

TABLE 7

SERVICE AREA EXPANSIONS WITHOUT NEW ENROLLMENT CODES (continued 

from prior page)

State Plan Name 3 Digit Plan 

Code

General Location of New Area

Mississippi Aetna HealthFund

CDHP and HDHP

221, 222

224, 225

Counties of Clay, Issaquena, Leake, Smith, 

Wayne, Yalobusha, and Yazoo

Missouri Aetna HealthFund

CDHP and HDHP

221, 222

224, 225

Counties of Atchison, Gentry, Harrison, 

Nodaway, Saint Clair, and Worth

New York Aetna HealthFund

CDHP and HDHP

221, 222

224, 225

Counties of Franklin, Lewis, Otsego, and 

Schoharie; 

Partial county of Saint Lawrence in the 

following zip codes: 12922, 12927, 12965, 

12967, 13613, 13614, 13617, 13621, 13623, 

13625, 13630, 13633, 13635, 13639, 13642, 

13643, 13646, 13647, 13649, 13652, 13654,

13658, 13660, 13662, 13664, 13666, 13667, 

13668, 13669, 13670, 13672, 13676, 13677, 

13678, 13680, 13681, 13683, 13684, 13687, 

13690, 13694, 13695, 13696, 13697, and 

13699

Oklahoma Globalhealth, Inc. IM1, IM2 Counties of Adair, Alfalfa, Atoka, Beaver, 

Beckham, Bryan, Choctaw, Cimarron, Coal, 

Cotton, Craig, Delaware, Dewey, Ellis, Grant, 

Greer, Harper, Haskell, Jefferson, Kay, 

Latimer, LeFlore, Marshall, McCurtain, 

Ottawa, Pittsburg, Pushmataha, Roger Mills, 

Texas, Tillman, Washita, Woods, and 

Woodward

Pennsylvania Geisinger Health 

Plan

GG4, GG5 County of Fulton

Tennessee Aetna HealthFund

CDHP and HDHP

221, 222

224, 225

Counties of Bledsoe and Hardin

Washington Aetna HealthFund

CDHP and HDHP

221, 222

224, 225

County of Wahkiakum

Washington Kaiser Foundation 

Health Plan of 

Northwest

571, 572

574, 575

Partial county of Skamania in the following zip 

code: 98605

West Virginia Aetna HealthFund

CDHP and HDHP

221, 222

224, 225

Counties of Hampshire and Mineral

West Virginia The Health Plan of 

the Upper Ohio 

Valley, Inc.

U41, U42 Berkeley, Boone, Braxton, Cabell, Clay, 

Fayette, Greenbrier, Hampshire, Jackson, 

Jefferson, Kanawha, Lincoln, Logan, Mason, 

Mercer, Monroe, Morgan, Nicholas, 

Pocahontas, Putnam, Raleigh, Roane, Wayne,

and Wyoming