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ATTACHMENT 1 – 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 2015. 

State Plan Name 3 Digit Plan 

Code

General Location

Illinois United Healthcare of 

the Midwest, Inc.

B91, B92 Southwest Illinois

Maryland Coventry Health Care IG1, IG2

IG4, IG5 

GZ1, GZ2

State of Maryland

Michigan Total Health Care 

USA

A51, A52 Southeastern Michigan Area ( Wayne, 

Oakland, Macomb and Genesee counties)

Missouri United Healthcare of 

the Midwest, Inc.

B91, B92 St. Louis area

Virginia Optima Health Plan 9R1, 9R2

9R4, 9R5

Hampton Roads, Charlottesville, 

Fredericksburg, Lynchburg, Richmond & 

the Roanoke Areas

Virginia Anthem 

HealthKeepers, Inc.

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, 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 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 not have health benefits coverage for 2015. 

State Plan Name 3 Digit Plan

Code

Area Dropped

Kansas Aetna Open Access HY1, HY2 State of Kansas

Missouri Aetna Open Access HY1, HY2 State of Missouri

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 2015. 

State Plan Name 3 Digit Plan 

Code

Area Dropped

California UnitedHealthcare of 

California*

CY1,CY2

High Option*

only

Fresno County

Michigan HealthPlus of Michigan X51, X52 Counties of Clare, Gladwin, Isabella, 

Midland, Gratiot and Montcalm

*UnitedHealthCare of California is reducing its service area by dropping Fresno County 

for only its High Option, CY1 and CY2. Therefore, enrollees in UnitedHealthCare of 

California’s High Option in Fresno County who do not change to another FEHB plan or to 

UnitedHealthCare of California’s Standard Option during Open Season will only have 

emergency services where they live and they will have to travel to UnitedHealthCare of 

California’s remaining Southern California High Option service area to obtain medical care 

in order to receive full benefits from the plan in 2015. 
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TABLE 4 

PLAN TERMINATING OPTION AND ENROLLMENT CODES 

Enrollees in the plan’s terminating option will be automatically deemed and 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 

2014)

Terminating 

Codes 

(end of 2014)

Deemed Option and 

Codes for 2015

New York HIP of NY Standard Option 514, 515 511, 512 High Option

Unless the enrollees switch to another plan during open season, current HIP of NY 

Standard option enrollees will be automatically enrolled in HIP of New York High option, 

codes 511 and 512. 

Please refer to Table 5 for details on the HIP of NY’s remaining High option for 2015. 

TABLE 5 

PLAN CONTRACT AND ENROLLMENT CODE MERGER WITH TERMINATING 

ENROLLMENT CODES 

The payroll office must automatically move enrollees into their plan’s surviving 2015 codes 

unless the enrollees select another health plan during Open Season. 

State 2014 Plan 

Name 

Terminating 

Plan Codes 

(2014)

2015 Surviving Plan 2015 Surviving Codes

New York GHI HMO 6V1, 6V2

X41, X42

HIP of NY 511, 512

GHI HMO is merging with HIP of New York for contract year 2015. HIP of New York will 

be the surviving plan and it will have one option. HIP of New York will terminate its 

Standard option leaving the High option as the only option under HIP of NY for 2015. 

Contract CS 2655 (GHI HMO NY) will terminate for contract year 2015; therefore, these 

plan codes are being merged into contract CS 1040 (HIP of New York). Unless the enrollees 

switch to another plan during open season, current GHI HMO enrollees will be 

automatically enrolled in HIP of New York High option, codes 511 and 512. 

Please see Table 4 for details on HIP of NY’s termination of the Standard option (514, 515). 

Please see Table 11 for the service area expansion for HIP of NY High option (codes 511 

and 512). 
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TABLE 6 

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 2014 Plan Codes 2015 Surviving 

Codes

Texas FirstCare Health Plan B71, B72

CK1, CK2

CN1, CN2

CZ1, CZ2

ET1, ET2

CK1, CK2

TABLE 7 

PLAN SPLITTING A SERVICE AREA AND CREATING A NEW ENROLLMENT 

CODE (IN ADDITION TO THE EXISTING ENROLLMENT CODE) 

Enrollees in the Fresno County service area of the Northern California service area who do 

not change their enrollment code from 59 or KC to NZ during Open Season will remain 

enrolled in the Northern California 59 or KC enrollment code. 

State Plan Name 2014 General 

Location

2014

Codes

2015 Codes and Service Areas

California Kaiser Foundation 

Health Plan-Northern 

California

Northern 

California 

including Fresno 

County

591, 592, 

594, 595

KC1, 

KC2

591, 592, 594, 595, KC1, KC2 

Northern California Region

NZ1, NZ2, NZ4, NZ5

Fresno County Region

Kaiser Foundation Health Plan-Northern California will split its Northern California service area, 

codes 591, 592, 594, and 595 (High Option and Standard Option) and KC1 and KC2 (Basic 

Option) into two service areas under separate FEHB brochures (one brochure for Northern 

California and one brochure for Fresno County). The Plan’s Northern California region will 

retain the current codes 591, 592, 594, and 595 (High Option & Standard Option) and KC1 and 

KC2 (Basic Option) under the existing FEHB brochure, RI 73-003, contract number CS 1044-A. 

The Plan’s Fresno County Region will receive the new enrollment codes of NZ1, NZ2, NZ4, and 

NZ5 (High Option & Standard Option) under a separate FEHB brochure, RI 73-889, contract 

number CS 1044-D. Current plan enrollees that work or live in Fresno County should make a 

positive enrollment election into enrollment codes NZ1, NZ2, NZ4, or NZ5 during Open Season. 

If enrollees in the Plan’s Fresno County region (enrollment codes 59 or KC) do not make a 

positive enrollment election, they will remain enrolled in their original Northern California 

High Option or Standard Option 59 enrollment code or Basic Option KC enrollment code. 

Also, the 2015 premiums for the NZ codes for the new Fresno County region will be lower 

than the premiums for the 59 and KC codes for the Northern California region. 

 

 
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TABLE 8

NEW PLANS ENTERING THE FEHB PROGRAM 

State Plan Name Plan 

Type

3 Digit 

Plan 

Code

Location of Areas

District of 

Columbia

UnitedHealthcare 

Insurance Company

HMO L91, L92 Entire District of Columbia

Florida UnitedHealthcare 

Insurance Company

HMO LV1, LV2 Miami, Orlando, and Tampa areas

Georgia UnitedHealthcare 

Insurance Company

HMO LV1, LV2 Atlanta area

Illinois UnitedHealthcare 

Insurance Company

HMO L91, L92 Chicago area

Maryland UnitedHealthcare 

Insurance Company

HMO L91, L92 Entire State of Maryland

Michigan Priority Health HMO LE1, LE2

LE4, LE5

Lower Peninsula in Michigan

Pennsylvania Keystone Health 

Plan West

HMO NP1, NP2 Western Pennsylvania

Texas UnitedHealthcare 

Insurance Company

HMO L91, L92 San Antonio area

Virginia UnitedHealthcare 

Insurance Company

HMO L91, L92 Northern Virginia

Virginia Innovation Health 

Plan 

HMO LQ1, LQ2 Northern Virginia
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TABLE 9 

PLANS ADDING NEW OPTIONS AND ENROLLMENT CODES 

State Plan Name New Option New 3 Digit

Plan

Code

General Location 

Nationwide Aetna HealthFund HDHP

 

CDHP Option

(Aetna Direct)

N61, N62 Portions of all 50 States and DC

Colorado Kaiser Foundation Health

Plan of Colorado

Basic Option N41, N42 Denver, Boulder, Northern 

and Southern Colorado areas

Guam Calvos Selectcare Standard 

Option

B44, B45 Guam

Indiana Physicians Health Plan of 

Northern Indiana HDHP Option

DQ4, DQ5 Northeast Indiana

Wisconsin Dean Health Plan Standard 

Option

WD4, WD5 South Central Wisconsin

TABLE 10 

SERVICE AREA EXPANSIONS WITH NEW ENROLLMENT CODES 

State Plan Name Plan Type New 3 

Digit Plan 

Codes

Location of Areas

Colorado Humana Health Plan, 

Inc.

HMO NT1, NT2 

NT4, NT5

Counties of Adams, Arapahoe,

Broomfield, Denver, Douglas, and 

Jefferson

Colorado Humana Health Plan, 

Inc.

HMO NR1, NR2 

NR4, NR5

Counties of El Paso and Teller
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TABLE 11 

SERVICE AREA EXPANSIONS WITHOUT NEW ENROLLMENT CODES 

(continued on next page) 

State Plan Name Plan Type 3 Digit 

Plan Code

Location of Areas

Alabama Aetna HealthFund

HDHP

HDHP 224, 225 Counties of Greene, Hale, Marengo and Randolph

Alabama Aetna HealthFund

CDHP/Value Plan

CDHP/HMO F51, F52

F54,F55

Counties of Green, Hale, Marengo, and Randolph

Alaska Aetna HealthFund

HDHP

HDHP 224, 225 Counties of Haines, Wade Hampton, and Yakutat

Alaska Aetna HealthFund 

CDHP/Value Plan

CDHP/HMO JS1, JS2

JS4, JS5

Counties of Haines, Wade Hampton, and Yakutat

Arizona Aetna Open 

Access

HMO WQ1,WQ2 County of Gile

Arkansas Aetna HealthFund

HDHP

HDHP 224, 225 Counties of Bradley, Dallas and Drew

Arkansas Aetna HealthFund 

CDHP/Value Plan

CDHP/HMO F51, F52

F54,F55

Counties of Bradley, Dallas and Drew

California Aetna HealthFund

HDHP

HDHP 224, 225 County of Calaveras

California Aetna HealthFund 

CDHP/Value Plan

CDHP/HMO JS1, JS2

JS4, JS5

County of Calaveras

Florida Aetna HealthFund

HDHP

HDHP 224, 225 Counties of Dixie, Franklin, Glades, Gulf, Hamilton,

Jackson, and Taylor

Florida Aetna HealthFund

CDHP/Value Plan

CDHP/HMO F51, F52

F54,F55

Counties of Dixie, Franklin, Glades, Gulf, Hamilton, 

Jackson, and Taylor

Georgia Aetna Open 

Access

HMO 2U1, 2U2 Counties of Carroll and Heard

Idaho Aetna HealthFund

HDHP

HDHP 224, 225 Counties of Caribou, Lincoln, and Teton

Idaho Aetna HealthFund

CDHP/Value Plan

CDHP/HMO H41, H42

H44, H45

Counties of Caribou, Lincoln, and Teton

Illinois Aetna HealthFund

HDHP

HDHP 224, 225 Counties of Putnam and Warren

Illinois Aetna HealthFund 

CDHP/Value Plan

CDHP/HMO H41, H42

H44, H45

Counties of Putnam and Warren

Indiana Physicians Health 

Plan of Northern 

Indiana

HMO DQ1, DQ2 Counties of Fulton, LaPorte, Marshall, Miami,

Pulaski and Starke
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State Plan Name Plan Type 3 Digit 

Plan Code

Location of Areas

Iowa Coventry Health 

Care of Iowa

HMO SV1, SV2 

SY4, SY5

Counties of Adams, Allamakee, Audubon, Clay, 

Clayton, Clinton, Des Moines, Dubuque, Henry, 

Jackson, Jefferson, Lee, Louisa, Taylor, Van Buren 

and Wapello

HDHP SV4, SV5

Mississippi Aetna HealthFund

HDHP

HDHP 224, 225 County of Franklin

Mississippi Aetna HealthFund 

CDHP/Value Plan

CDHP/HMO H41, H42

H44, H45

County of Franklin

Montana Aetna HealthFund

HDHP

HDHP 224, 225 County of Dawson

Montana Aetna HealthFund 

CDHP/Value Plan

CDHP/HMO H41, H42

H44, H45

County of Dawson

New York HIP of NY HMO 511, 512 Counties of Albany, Broome, Columbia, Delaware,

Dutchess, Fulton, Greene, Montgomery, Orange,

Otsego, Putnam, Rensselaer, Rockland, Saratoga, 

Schenectady, Schoharie, Sullivan, Ulster, Warren 

and Washington

Ohio HealthSpan 

Integrated Care

HMO 641, 642

644, 645

Counties of Adams, Allen, Auglaize, Brown, Butler, 

Champaign, Clark, Clermont, Clinton, Fulton, 

Hamilton, Highland, Henry, Lucas, Mahoning, 

Mercer, Ottawa, Preble, Putnam, Shelby, Trumbell, 

Van Wert and Wood

Pennsylvania Aetna Open 

Access

HMO YE1, YE2 Counties of Bedford, Indiana, and Venango

Tennessee Aetna HealthFund

HDHP

HDHP 224, 225 Counties of Clay, Cumberland, Fentress, Hickman, 

Overton, Perry, Pickett, Putnam, Wayne and White

Tennessee Aetna HealthFund

CDHP/Value Plan

CDHP/HMO F51, F52

F54,F55

Counties of Clay, Cumberland, Fentress, Hickman, 

Overton, Perry, Pickett, Putnam, Wayne and White

Texas FirstCare Health 

Plan 

HMO CK1, CK2 Counties of Kent, Stonewall, Jones and Comanche

Virginia Aetna HealthFund

CDHP/Value Plan

CDHP/HMO F51, F52

F54,F55

Cities of Harrisonburg and Lexington

County of Halifax

Virginia Aetna HealthFund 

HDHP

HDHP 224, 225 Cities of Harrisonburg and Lexington;

County of Halifax

Wisconsin Physicians Plus 

Insurance 

Corporation

HMO LW1,LW2 Counties of Dodge, Green, Juneau, Portage, Vernon, 

Walworth, Waukesha, and Wood