1

ATTACHMENT 1 – FEHB PROGRAM

TABLE 1

PLANS LEAVING THE FEHB PROGRAM 

Enrollees in these terminating plans must make a positive election into another FEHB plan 

during Open Season or they will be enrolled in the Standard Option of the GEHA Benefit

Plan (the lowest-cost nationwide plan option for 2017 as determined by OPM). 

State Plan Name 2016 Enrollment 

Code

General Location

Iowa Sanford Health 

Plan

AU1, AU3, 

AU2, AU4, 

AU6, AU5

Northwestern Iowa

Michigan Grand Valley 

Health Plan

RL1, RL3, 

RL2, RL4, 

RL6, RL5

Grand Rapids Michigan Area

 

North 

Dakota

Sanford Health 

Plan

 C91, C93, 

C92, C94, 

C96, C95

North Dakota

South 

Dakota

Sanford Health 

Plan

AU1, AU3, 

AU2, AU4, 

AU6, AU5

South Dakota’s Central and Eastern 

regions and Rapid City Area 

Texas FirstCare Health 

Plan

CK1, CK3, 

CK2

West and Central Texas

TABLE 2 

PLAN REDUCING 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 be enrolled in the Standard Option of the

GEHA Benefit Plan (the lowest-cost nationwide plan option for 2017 as determined by 

OPM). 

State Plan Name 2016 Enrollment 

Code

Area Dropped

Virginia Aetna Whole Health D91, D93,D92 Roanoke area:

Cities of Bedford, 

Lexington, Martinsville, 

Radford, Roanoke and 

Salem

Counties of Bedford, 

Bland, Botetourt, 

Carroll, Craig, Floyd, 
 

2

Franklin, Giles, Henry, 

Montgomery, Pulaski, 

Roanoke, Tazewell, and 

Wythe

TABLE 3

PLANS REDUCING SERVICE AREAS 

WITHOUT TERMINATING ENROLLMENT CODES

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

will only have emergency services where they live and they 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 2017. 

State Plan Name 2016 

Enrollment

Code

Area Dropped

California Kaiser Northern CaliforniaFresno RegionNZ1, NZ3, NZ2, 

NZ4, NZ6, NZ5

County of Tulare – Zip Codes 93238, 

93261 

Ohio HealthSpan Integrated Care 641, 643, 642,

644, 646, 645 

Counties of Adams, Allen, Ashland, 

Ashtabula, Auglaize, Brown, Butler, 

Carroll, Champaign, Clark, Clermont, 

Clinton, Columbiana, Darke, Defiance, 

Erie, Fayette, Fulton, Greene, Hamilton, 

Hancock, Hardin, Henry, Highland, 

Holmes, Huron, Logan, Lucas, Madison, 

Mercer, Miami, Montgomery, Ottawa, 

Paulding, Pike, Preble, Putnam, Ross, 

Sandusky, Scioto, Seneca, Shelby, 

Tuscarawas, Union, VanWert, Warren, 

Williams, Wood
 

3

TABLE 4

PLANS TERMINATING OPTION AND ENROLLMENT CODES 

Enrollees in the plan’s terminating option will be automatically enrolled into their plan’s 

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

during Open Season. 

State Plan Name Terminating 

Options (end of 

2016)

Terminating 

Codes 

(end of 2016)

Remaining Option and 

Codes for 2017 

Arizona Health Net of 

Arizona 

High A71, A73, A72 A74, A76, A75

Standard 

Illinois Health Alliance 

HMO

High FX1, FX3,

FX2 

K84, K86, K85

Standard 

Indiana Health Alliance 

HMO

High FX1, FX3,

FX2 

K84, K86, K85

Standard 

Iowa Health Alliance 

HMO

High FX1, FX3,

FX2 

K84, K86, K85

Standard 

TABLE 5 

PLAN CONTRACT AND ENROLLMENT CODE MERGER WITH TERMINATING 

ENROLLMENT CODES 

The payroll office must automatically move enrollees into their plan’s surviving 2017 codes 

unless the enrollees select another health plan during Open Season. 

State 2016 Plan 

Name 

Terminating 

Plan Codes 

(2016)

2017 Surviving Plan 2017 Surviving Codes

Michigan Health

Plus

X51, X53, 

X52

Health Alliance Plan 

(HAP)

521, 523, 522

 

TABLE 6 

PLANS ADDING NEW OPTIONS AND ENROLLMENT CODES 

State Plan Name New 

Option 

2017 Enrollment

Codes

General Location 

Illinois Blue Preferred Plus POS Standard 9G4, 9G5

9G6

St. Clair and Madison, IL

Missouri Blue Preferred Plus POS Standard 9G4, 9G5

9G6

St. Louis, Central and 

Southwest Missouri 

New Mexico New Mexico 

BlueHMO Preferred

Standard Q14, Q16, 

Q15

All of New Mexico
 

4

Oklahoma GlobalHealth, Inc. Standard IM4, IM6, 

IM5

All of Oklahoma

TABLE 7 

SERVICE AREA EXPANSIONS WITHOUT NEW ENROLLMENT CODES

State Plan Name Plan Option 2017 

Enrollment 

Codes

Location of Areas

California Kaiser Northern California High, 

Standard, 

Basic

591,593,592,

594,596,595, 

KC1, KC3, 

KC2

County of Santa Cruz - 95001, 95003, 

95005, 95006, 95007, 95010, 95017, 

95018, 95019, 95033, 95041, 95060, 

95061, 95062, 95063, 95064, 95066, 

95067, 95073, 95076, 95077

California Kaiser Southern California High, 

Standard 

621, 623,

622, 624, 

626, 625

County of Tulare – 93238, 93261

Colorado Kaiser Foundation Health 

Plan Colorado 

High, 

Standard, 

Basic,

651, 653, 

652, 

654, 656, 

655, 

N41, N43, 

N42

County of Summit - All

County of Eagle - 80423, 80426 80463, 

81620, 81631, 81632, 81637, 81645, 

81649, 81655,81657, 81658

County of Garfield - 81637 

County of Grand - 80498 

County of Routt - 80463 

Idaho Aetna HealthFund 

CDHP/Aetna Value Plan

CDHP

Value

H41, H43, 

H42, 

H44, H46, 

H45,

Counties of Camas and Clark

Idaho Aetna HealthFund 

HDHP/Aetna Direct Plan

HDHP

Direct 

224, 226, 

225, 

N61, N63, 

N62

Counties of Camas and Clark

Illinois Aetna HealthFund 

CDHP/Aetna Value Plan

CDHP

Value

H41, H43, 

H42, 

H44, H46, 

H45

Counties of Adams, Carroll, Dewitt, 

Hancock, Pike, Shelby 

Illinois Aetna HealthFund 

HDHP/Aetna Direct Plan

HDHP

Direct

224, 226, 

225, 

N61, N63, 

N62

Counties of Adams, Carroll, Dewitt, 

Hancock, Pike, Shelby 

Illinois MercyCare High EY1, EY3, 

EY2

Counties of Boone and Winnebago 

Kentucky Aetna HealthFund 

CDHP/Aetna Value Plan

CDHP

Value

H41, H43, 

H42, 

H44, H46, 

Counties of Bath, Fleming, Menifee, 

Nicholas, Powell, Rowan, Wolfe 
 

5

H45

Kentucky Aetna HealthFund 

HDHP/Aetna Direct Plan

HDHP

Direct

224, 226, 

225, 

N61, N63, 

N62

Counties of Bath, Fleming, Menifee, 

Nicholas, Powell, Rowan, Wolfe 

Louisiana Aetna HealthFund 

CDHP/Aetna Value Plan

CDHP

Value

F51, F53, 

F52, 

F54, F56, F55

County of Vernon

Louisiana Aetna HealthFund 

HDHP/Aetna Direct Plan

HDHP

Direct

224, 226, 

225, 

N61, N63, 

N62

County of Vernon

Michigan Blue Care Network High LX1, LX3, 

LX2

County of Lenawee

Michigan Health Alliance Plan 

(HAP)

High 

Standard 

521, 523, 

522, GY4, 

GY6, GY5

Counties of Arenac, Bay, 

Huron, Iosco, Jackson, 

Saginaw, Tuscola

Montana Aetna HealthFund 

CDHP/Aetna Value Plan

CDHP

Value

H41, H43, 

H42, 

H44, H46, 

H45

Counties of Carter, Garfield, Madison, 

McCone, 

Roosevelt, Wibaux 

Montana Aetna HealthFund 

HDHP/Aetna Direct Plan

HDHP

Direct

224, 226, 

225, 

N61, N63, 

N62

Counties of Carter, Garfield, Madison, 

McCone, 

Roosevelt, Wibaux 

West 

Virginia

Aetna HealthFund 

CDHP/Aetna Value Plan

CDHP

Value

F51, F53, 

F52, 

F54, F56, F55

Counties of Grant, Hardy, Pendleton, 

Pocahontas, 

Randolph, Tucker

West 

Virginia

Aetna HealthFund 

HDHP/Aetna Direct Plan

HDHP

Direct

224, 226, 

225, 

N61, N63, 

N62

Counties of Grant, Hardy, Pendleton, 

Pocahontas, 

Randolph, Tucker

TABLE 8 

SERVICE AREA EXPANSIONS WITH NEW OPTIONS AND ENROLLMENT CODES 

Blue Preferred Plus POS has added a new Standard option with a new enrollment code 

(See Table 6) and is expanding its service area in Missouri. 

State Plan Name Plan Type Plan Code Location of Areas

Missouri Blue Preferred 

Plus POS

HMO 9G1, 9G3, 9G2, 

9G4, 9G5, 9G6 

Adair, Bollinger, Butler, Cape Girardeau, Carter, 

Clark, Dent, Dunklin, Howell, Iron, Knox, Lewis, 

Linn, Marion, Mississippi, New Madrid, Oregon, 
 

6

Pemiscot, Perry, Putnam, Ralls, Reynolds, Ripley, 

Schuyler, Scotland, Scott, Shannon, Shelby, Stoddard, 

Sullivan, and Wayne counties. 

TABLE 9

SERVICE AREA EXPANSIONS ADDING NEW

ENROLLMENT CODES

State FEHB Plan

Name

Plan Option 2017 New

Enrollment Codes

Location of Areas

Texas Scott and White Standard P84, P86, P85 Counties of Collin, Dallas, Denton, 

Ellis, Erath, Head, 

Johnson, Rockwall, 

Somervell, Tarrant