ATTACHMENT 2 – FEHB PROGRAM 

TABLE 1 

PLANS LEAVING THE FEHB PROGRAM 

Enrollees in these terminating plans who do not change health plans during Open Season 

will not have health benefits for 2009. 

 

State Plan Name 3 Digit Codes 

Georgia UnitedHealthcare of Georgia GN1, GN2 

Indiana Advantage Health Solutions, Inc. 6Y1, 6Y2, 

6Y4*, 6Y5* 

(*see Table 3 

for 6Y4 & 6Y5)

Nebraska Coventry Health Care of Nebraska IE1, IE2 

Ohio SuperMed HMO 5M1, 5M2 

Ohio SummaCare Health Plan 5W1, 5W2 

Washington PacificareCare of Washington SA1, SA2 

1
TABLE 2 

PLANS REDUCING THEIR SERVICE AREAS 

BY TERMINATING AN ENROLLMENT CODE 

Enrollees in these enrollment codes who do not change health plans during Open Season 

will not have health benefits for 2009. 

State Plan Name 3 Digit Codes Area Dropped 

Colorado Aetna Open Access 9E1, 9E2, 

9E4, 9E5 

Denver area 

Indiana Humana CoverageFirst 

(CDHP) 

HZ1, HZ2 Indianapolis area 

Kansas Aetna Open Access KS1, KS2 Kansas City area 

Louisiana Coventry Health Care of 

Louisiana 

JA1, JA2, 

JA4, JA5, 

LT1*, LT2* 

(*see Table 4 

for LT1,LT2)

Baton Rouge area 

Michigan Bluecare Network of 

Michigan 

LN1, LN2 Mid Michigan area 

Michigan Humana CoverageFirst 

(CDHP) 

BW1, BW2, 

FT1, FT2, 

GT1, GT2 

Detroit and Grand Rapids areas and most 

of Michigan 

Missouri Aetna Open Access KS1, KS2 Kansas City and St. Louis areas including 

Southwest Illinois 

Nevada Health Plan of Nevada 2L1, 2L2 Entire counties of Lyon and Mineral 

counties and portions of Washoe county 

North 

Carolina 

Aetna Open Access MP1, MP2 Charlotte and Raleigh/Durham areas 

Pennsylvania HealthAmerica 

Pennsylvania 

4N1, 4N2, 

4N4, 4N5, 

YN1*, YN2* 

(*see Table 4 

for 

YN1,YN2) 

Northeastern area 

Texas Aetna Open Access PU1, PU2, 

PU4, PU5 

Dallas/Fort Worth and 

Corpus Christi/El Paso areas 

Vermont MVP Health Care VW1, VW2, 

VW4, VW5 

Entire State 

Washington Aetna Open Access 8J1, 8J2 Seattle and Puget Sound areas 

Wisconsin Humana CoverageFirst 

(CDHP) 

FB1, FB2 Milwaukee area 

2
TABLE 3 

EXISTING PLANS TERMINATING THEIR HIGH DEDUCTIBLE HEALTH PLANS 

(HDHP) AND TERMINATING THEIR HDHP ENROLLMENT CODES 

Enrollees in these enrollment codes who do not change health plans during Open Season 

will not have health benefits for 2009. 

Enrollees who are active employees and want to continue enrollment in 2009 in a 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 2008 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 2009 HDHP HSA Fiduciary. 

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

option during Open Season or they will not have health benefits for 2009. However, the 

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

about the HSA concerning tax considerations and penalties. 

State Plan Name 3 Digit 

Codes 

Illinois OSF Health Plans, Inc. 9F4, 9F5 

Indiana Advantage Health Solutions, Inc. 

(See Table 1 also) 

6Y4, 6Y5 

Massachusetts Fallon Community Health Plan DV1, DV2 

Virginia Piedmont Community Healthcare 2C4, 2C5 

3
TABLE 4 

HIGH DEDUCTIBLE HEALTH PLANS (HDHP) REDUCING THEIR SERVICE AREAS 

BY TERMINATING AN ENROLLMENT CODE 

Enrollees in these enrollment codes who do not change health plans during Open Season 

will not have health benefits for 2009. 

Enrollees who are active employees and want to continue enrollment in 2009 in a 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 2008 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 2009 HDHP HSA Fiduciary. 

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

option during Open Season or they will not have health benefits for 2009. However, the 

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

about the HSA concerning tax considerations and penalties. 

State Plan Name 3 Digit Codes Area Dropped 

Louisiana Coventry Health Care of 

Louisiana 

LT1, LT2 Baton Rouge area 

Pennsylvania HealthAmerica 

Pennsylvania 

YN1, YN2 Northeastern PA area 

4
TABLE 5 

PLAN SPLITTING A SERVICE AREA AND CREATING A NEW ENROLLMENT 

CODE (IN ADDITION TO THE EXISTING ENROLLMENT CODE) 

Enrollees in the southern California service area who do not change their enrollment code 

from SJ to SI during Open Season will automatically remain enrolled in the northern 

California SJ enrollment code and they will have to travel to the plan’s northern California 

service area to obtain medical care in order to receive full benefits from the plan in 2009. 

 

State Plan Name General Location 2008 Codes 2009 Codes 

SJ1, SJ2 

Northern 

California Region

California Blue Shield of California 

Access+HMO 

Most of California SJ1, SJ2 

SI1, SI2 

Southern 

California Region

Blue Shield of California Access+HMO will split its California service area, code SJ, into two 

service areas (northern California and southern California) resulting in two enrollment codes, SJ 

and SI. The plan’s northern California region will retain the current SJ enrollment code; 

however, the plan’s southern California region will receive the new SI enrollment code. Current 

plan enrollees in the southern California region should make a positive enrollment election into 

enrollment code SI during Open Season. 

If enrollees in the plan’s southern California region do nothing and do not make a positive 

enrollment election, they will automatically remain enrolled in the original High Option SJ 

enrollment code and they will have to travel to the plan’s northern California service area 

to obtain medical care in order to receive full benefits from the plan in 2009. Also, the 2009 

premiums for the SJ codes for the northern California region will be higher than the 

premiums for the SI codes for the southern California region. 

In the plan’s 2009 brochure, please check Section 1 (under Service Area) for the plan’s covered 

counties and zip codes in the northern and southern California regions. 

5
TABLE 6 

PLAN MERGER WITH CODE CHANGES 

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

the enrollees select another health plan during Open Season. 

State 2008 Plans 2008 Codes 

(terminating 

end of 2008) 

2009 Surviving Plans 2009 

Surviving 

Codes 

Iowa HealthPartners Open Access 

Deductible (Standard) 

534, 535 HealthPartners Open 

Access Copay (High) 

V31, V32 

Minnesota HealthPartners Classic 

(High) 

HealthPartners Primary 

Clinic 

HealthPartners Open Access 

Deductible (Standard) 

531, 532 

HQ1, HQ2 

534, 535 

HealthPartners Open 

Access Copay (High) 

HealthPartners Open 

Access Copay (High) 

HealthPartners Open 

Access Copay (High) 

 

V31, V32 

V31, V32 

V31, V32 

North 

Dakota 

HealthPartners Open Access 

Deductible (Standard) 

534, 535 HealthPartners Open 

Access Copay (High) 

V31, V32 

South 

Dakota 

HealthPartners Open Access 

Deductible (Standard) 

534, 535 HealthPartners Open 

Access Copay (High) 

V31, V32 

Wisconsin HealthPartners Classic 

(High) 

HealthPartners Primary 

Clinic 

HealthPartners Open Access 

Deductible (Standard) 

 

531, 532 

HQ1, HQ2 

534, 535 

HealthPartners Open 

Access Copay (High) 

HealthPartners Open 

Access Copay (High) 

HealthPartners Open 

Access Copay (High) 

V31, V32 

V31, V32 

V31, V32 

 

6
 TABLE 7 

PLAN OPTION NAME CHANGE WITH CODE CHANGE 

The payroll office must automatically move enrollees into their plan’s changed option and 

code unless the enrollees select another health plan during Open Season. The changed plan 

option name and code for 2009 (Basic Option, code JG1 and JG2) will have a reduction in 

the provider network. 

State Plan Name 2008 Plan 

Option 

Name 

2008 Plan 

Codes 

2009 

Plan 

Option 

2009 Plan 

Codes 

Massachusetts Fallon Community Health 

Plan 

High JV1, JV2 Basic JG1, JG2 

TABLE 8 

PLAN NAME CHANGE 

State 2008 Plan Name (Old) Plan Codes 2009 Plan Name 

(New) 

Florida Humana Medical Plan, 

Inc. 

EE1, EE2, EE4, EE5, 

LL1, LL2, LL4, LL5 

Humana, Inc. 

TABLE 9 

PLAN OPTION NAME CHANGE 

State Plan Name 2008 Plan 

Option 

Name (Old) 

Plan Codes 2009 Plan 

Option 

Name (New) 

Connecticut ConnectiCare Standard TE4, TE5 Basic 

7
TABLE 10 

PLAN ADDING A STANDARD OPTION WITH NEW CODES (The previous 2008 

Standard Option merged into the plan’s High Option for 2009 – See Table 6) 

State Plan Name Plan Type 2009 Standard 

Option Codes 

Iowa HealthPartners Open Access Three 

for Free (Standard Option)

HMO V34, V35 

Minnesota HealthPartners Open Access Three 

for Free (Standard Option)

HMO V34, V35 

North Dakota HealthPartners Open Access Three 

for Free (Standard Option)

HMO V34, V35 

South Dakota HealthPartners Open Access Three 

for Free (Standard Option)

HMO V34, V35 

Wisconsin HealthPartners Open Access Three 

for Free (Standard Option)

HMO V34, V35 

8
TABLE 11 

NEW PLANS ENTERING THE FEHB PROGRAM 

State Plan Name Plan Type 3 Digit Codes General Location 

BX1, BX2 Western New York counties 

of: Allegany, Cattaraugus, 

Chautauqua, Erie, Genesee, 

Niagara, Orleans, Wyoming 

BZ1, BZ2 Northeastern New York 

Capital Region counties of 

Albany, Columbia, Fulton, 

Greene, Montgomery, 

Rensselaer, Saratoga, 

Schenectady, Warren, 

Washington 

New York Community Blue HMO 

BS1, BS2 Northeastern New York 

counties of Clinton, Essex 

Indiana Welborn Health 

Plan of Indiana 

HMO W11, W12 City of Evansville and 

entire counties of Daviess, 

Dubois, Gibson, Knox, 

Perry, Pike, Posey, Spencer, 

Vanderburgh, and Warrick 

TABLE 12 

PLANS ADDING A NEW STANDARD OPTION 

Enrollees who do not enroll in their plan’s Standard Option will automatically remain 

enrolled in their current High Option. 

State Plan Name Plan Type New Codes for New Options 

Florida Vista Health Plan of South Florida HMO 5E4, 5E5 

Standard Option 

Illinois OSF Healthplans HMO AB4, AB5 

Standard Option 

Iowa Coventry Health Care of Iowa HMO SY4, SY5 

Standard Option 

New York Blue Choice HMO MK4, MK5 

Standard Option 

Virginia Optima Health Plan HMO 9R4, 9R5 

Standard Option 

9
TABLE 13 

EXISTING PLAN OFFERING A HIGH DEDUCTIBLE HEALTH PLAN (HDHP) WITH 

NEW ENROLLMENT CODES 

 State Plan Name 3 Digit 

Codes 

 

Ohio Paramount Health Care Plan U24, U25 

TABLE 14 

EXISTING PLAN OFFERING A CONSUMER DRIVEN HEALTH PLAN (CDHP) WITH 

NEW ENROLLMENT CODES 

State Plan Name 3 Digit 

Codes 

Arizona UnitedHealthcare Insurance Company, Inc. E94, E95 

Arkansas UnitedHealthcare Insurance Company, Inc. E94, E95 

California UnitedHealthcare Insurance Company, Inc. E94, E95 

Colorado UnitedHealthcare Insurance Company, Inc. E94, E95 

District of Columbia UnitedHealthcare Insurance Company, Inc. E94, E95 

Florida UnitedHealthcare Insurance Company, Inc. E94, E95 

Georgia UnitedHealthcare Insurance Company, Inc. E94, E95 

Maryland UnitedHealthcare Insurance Company, Inc. E94, E95 

Illinois UnitedHealthcare Insurance Company, Inc. E94, E95 

Iowa UnitedHealthcare Insurance Company, Inc. E94, E95 

Kansas UnitedHealthcare Insurance Company, Inc. E94, E95 

Louisiana UnitedHealthcare Insurance Company, Inc. E94, E95 

Mississippi UnitedHealthcare Insurance Company, Inc. E94, E95 

Missouri UnitedHealthcare Insurance Company, Inc. E94, E95 

New Mexico UnitedHealthcare Insurance Company, Inc. E94, E95 

North Carolina UnitedHealthcare Insurance Company, Inc. E94, E95 

Nevada UnitedHealthcare Insurance Company, Inc. E94, E95 

Ohio UnitedHealthcare Insurance Company, Inc. E94, E95 

Oklahoma UnitedHealthcare Insurance Company, Inc. E94, E95 

Oregon UnitedHealthcare Insurance Company, Inc. E94, E95 

Rhode Island UnitedHealthcare Insurance Company, Inc. E94, E95 

Tennessee UnitedHealthcare Insurance Company, Inc. E94, E95 

Texas UnitedHealthcare Insurance Company, Inc. E94, E95 

Virginia UnitedHealthcare Insurance Company, Inc. E94, E95 

Washington UnitedHealthcare Insurance Company, Inc. E94, E95 

Wisconsin UnitedHealthcare Insurance Company, Inc E94, E95 

10
TABLE 15 

PLAN CHANGING FROM A CLOSED NATIONWIDE FEE-FOR-SERVICE (FFS) 

PLAN FOR SPECIFIC GROUPS TO AN OPEN NATIONWIDE FFS PLAN OPEN TO 

ALL AGENCIES, EMPLOYEES, AND RETIREES 

State Plan Name Plan 

Codes 

New Agencies 

Nationwide FFS Plan SAMBA 441, 442, 

444, 445 

Employees or retirees of all Federal 

Agencies 

TABLE 16 

CLOSED NATIONWIDE FFS PLAN FOR SPECIFIC GROUPS AVAILABLE TO NEW 

AGENCIES, EMPLOYEES, AND RETIREES 

State Plan Name Plan 

Codes 

New Agency 

Nationwide FFS Open 

Only to Specific Groups 

Association Benefit 

Plan 

421, 422 Department of Defense Employees and 

Annuitants 

 

 

11
TABLE 17 

SERVICE AREA EXPANSIONS WITH NEW ENROLLMENT CODES 

State Plan Name New Codes General Location 

Georgia Humana, Inc. DG1, DG2, 

DG4, DG5 

City of Atlanta and entire 

counties of Banks, Barrow, 

Bartow, Butts, Cherokee, Clark, 

Clayton, Cobb, Coweta, DeKalb, 

Douglas, Fayette, Floyd, Forsyth, 

Fulton, Gwinnett, Hall, Paulding, 

Polk, Rockdale, Spalding and 

Walton 

New York MVP Health Care MF1, MF2, 

MF4, MF5 

Entire counties of Clinton, Essex, 

Franklin, and St. Lawrence 

Texas Humana Health Plan of 

Texas 

UU1, UU2, 

UU4, UU5 

City of Austin and entire 

counties of Bastrop, Bell, 

Bosque, Coryell, Falls, Hays, 

Limestone, McLennan, Travis 

and Williamson 

Utah Humana CoverageFirst IA1, IA2 City of Salt Lake City and entire 

counties of Beaver, Box Elder, 

Cache, Carbon, Daggett Davis, 

Duchesne, Emery, Garfield, 

Grand, Iron, Juab, Kane, Millard, 

Morgan, Piute, Rich, Salt Lake, 

San Juan, Sanpete, Sevier, 

Summit, Tooele, Uintah, Utah, 

Wasatch, Washington, Wayne, 

Weber 

12
TABLE 18 

SERVICE AREA EXPANSIONS WITHOUT NEW ENROLLMENT CODES 

State Plan Name 3 Digit Code General Location of New Area 

Arkansas Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

224, 225 

Entire county of Miller 

California Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

224, 225 

Entire counties of Colusa, Imperial, Lake, 

Nevada, San Benito and Shasta 

Colorado UnitedHealthcare 

Insurance Company, 

Inc. (HDHP) 

E91, E92 Entire counties of Adams, Arapahoe, Boulder, 

Broomfield, Clear Creek, Crowley, Denver, 

Douglas, El Paso, Jefferson, Lincoln, Otero, 

Park, and Teller 

Florida Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

 224, 225 

Entire county of Monroe 

Florida Vista Healthplan of 

South Florida 

5E1, 5E2 Entire counties of Martin and St. Lucie 

Georgia Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

224, 225 

Entire counties of Atkinson, Bacon, Baker, Ben 

Hill, Berrien, Bleckley, Brantley, Brooks, 

Calhoun, Camden, Charlton, Chattahoochee, 

Clay, Clinch, Coffee, Colquitt, Cook, Crisp, 

Decatur, Dodge, Dooly, Dougherty, Early, 

Echols, Emanuel, Glynn, Grady, Greene, 

Hancock, Harris, Heard, Irwin, Jeff Davis, 

Jenkins, Johnson, Lanier, Lee, Lowndes, 

Macon, Marion, McIntosh, Meriwether, Miller, 

Mitchell, Montgomery, Morgan, Muscogee, 

Pierce, Putnam, Quitman, Randolph, Schley, 

Screven, Seminole, Stewart, Sumter, Taylor, 

Telfair, Terrell, Thomas, Tift, Toombs, 

Treutlen, Troup, Turner, Upson, Ware, Wayne, 

Webster, Wheeler, Wilcox, and Worth 

Georgia Kaiser Foundation 

Health Plan of 

Georgia, Inc. 

F81, F82, 

F84, F85, 

GW1, GW2 

City of Atlanta and entire counties of Carroll, 

Dawson, Haralson, Heard, Lamar, 

Merriweather, Pickens and Pike; 

City of Athens and entire counties of Clarke, 

Madison, Oconee, and Oglethorpe; 

City of Columbus and entire counties of 

Chattahoochee, Harris, Marion, and Muscogee; 

City of Macon and entire counties of Bibb, 

Bleckley, Crawford, Houston, Jones, Laurens, 

Monroe, Peach, Pulaski, and Twiggs; City of 

Savannah and entire counties of Bryan, 

Bullock, Chatham, Effingham, Evans, and 

Liberty 

Hawaii Kaiser Foundation 

Health Plan of 

Hawaii 

631, 632, 

634, 635 

The islands of Lanai and Molokai 

13
State Plan Name 3 Digit Code General Location of New Area 

Idaho Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

224, 225 

Entire counties of: Ada, Adams, Bannock, Bear 

Lake, Benewah, Bingham, Blaine, Boise, 

Bonner, Bonneville, Boundary, Butte, Canyon, 

Cassia, Elmore, Franklin, Fremont, Gem, 

Gooding, Jefferson, Jerome, Latah, Madison, 

Minidoka, Nez Perce, Oneida, Owyhee, 

Payette, Shoshone, Twin Falls, Valley, and 

Washington 

Idaho Altius Health Plans 9K1, 9K2, 

9K4, 9K5, 

DK4, DK5 

Entire counties of Bannock, Bear Lake, 

Bingham, Bonneville, Canyon, Caribou, 

Elmore, Franklin, Gem, Oneida, Payette, and 

Power 

Illinois PersonalCare 

Insurance of Illinois 

GE1, GE2 Entire counties of Adams, Brown, Bureau, 

Dekalb, Jo Davies, Pike, Putnam and Scott 

Illinois Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

224, 225 

Entire counties of Brown, Bureau, Christian, 

Clay, Coles, Crawford, Douglas, Effingham, 

Franklin, Gallatin, Hamilton, Hardin, Henry, 

Jackson, Jasper, Jefferson, Jo Daviess, 

Livingston, Logan, Macon, Marion, Mason, 

Massac, McDonough, McLean, Menard, 

Montgomery, Morgan, Perry, Piatt, Pope, Rock 

Island, Saline, Sangamon, Schuyler, 

Stephenson, Union, Wabash, Washington, 

Wayne, White, Whiteside, and Williamson 

Indiana Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

224, 225 

Entire counties of Bartholomew, Crawford, 

Daviess, Dubois, Elkhart, Fayette, Fulton, 

Jackson, Jasper, Jennings, La Porte, Marshall, 

Martin, Newton, Orange, Perry, Pulaski, 

Spencer, Starke, St. Joseph, Union, and Wayne 

(With the addition of these counties to the 

other 70 counties already in the service area in 

Indiana, the service area now will cover the 

entire state of Indiana.) 

Iowa Coventry Health 

Care of Iowa 

SV1, SV2, 

SY4, SY5, 

SV4, SV5 

Entire counties of Cherokee, Dickinson, 

Emmett, Fayette, Hardin, Lyon, Monroe, 

O’Brien, and Winneshiek 

Iowa Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

224, 225 

Entire state of Iowa 

14
State Plan Name 3 Digit Code General Location of New Area 

Kansas Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

224, 225 

Entire counties of Barton, Bourbon, Brown, 

Butler, Chase, Cheyenne, Clark, Clay, Cloud, 

Coffey, Comanche, Cowley, Crawford, 

Dickinson, Elk, Ellis, Ellsworth, Finney, Ford, 

Geary, Graham, Grant, Gray, Greeley, 

Greenwood, Hamilton, Harper, Harvey, 

Haskell, Hodgeman, Jefferson, Jewell, 

Kearney, Kingman, Labette, Lincoln, Linn, 

Logan, Lyon, Marion, Marshall, McPherson, 

Meade, Morris, Morton, Neosho, Ness, 

Osage, Osborne, Ottawa, Pawnee, Phillips, 

Pottawatomie, Pratt, Reno, Republic, Rice, 

Riley, Rooks, Russell, Saline, Scott, Sedgwick, 

Seward, Shawnee, Smith, Stafford, Stanton, 

Stevens, Sumner, Thomas, Trego, Washington, 

Wichita, Wilson, and Woodson 

Kentucky Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

224, 225 

Entire counties of Adair, Allen, Ballard, 

Barren, Boyle, Butler, Caldwell, Calloway, 

Carlisle, Casey, Christian, Clinton, Crittenden, 

Cumberland, Daviess, Edmonson, Garrard, 

Graves, Grayson, Green, Hancock, Hart, 

Hopkins, Lincoln, Livingston, Logan, Lyon, 

Marshall, McCracken, McCreary, McLean, 

Mercer, Metcalfe, Monroe, Muhlenberg, Ohio, 

Pulaski, Russell, Simpson, Taylor, Todd, 

Trigg, Warren, Wayne, Webster, and Whitley 

Louisiana Vantage Health Plan, 

Inc. 

MV1, MV2, 

MV4, MV5 

City of Baton Rouge and entire 9 parishes of 

Ascension, Assumption, East Baton Rouge, 

East Feliciana, Livingston, Pointe Coupee, St. 

James, West Baton Rouge and West Feliciana 

Massachusetts Fallon Community 

Health Plan 

JV4, JV5 Entire county of Berkshire 

Michigan HealthPlus of 

Michigan 

X51, X52 Entire county of Macomb 

15
State Plan Name 3 Digit Code General Location of New Area 

Minnesota Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

224, 225 

Entire counties of Aitkin, Anoka, Becker, 

Beltrami, Benton, Big Stone, Blue Earth, 

Brown, Carlton, Carver, Cass, Chippewa, 

Chisago, Clay, Clearwater, Cottonwood, Crow 

Wing, Dakota, Dodge, Douglas, Faribault, 

Fillmore, Freeborn, Goodhue, Grant, 

Hennepin, Houston, Hubbard, Isanti, Itasca, 

Jackson, Kanabec, Kandiyohi, Kittson, 

Koochiching, Lac Qui Parle, Lake, Lake Of 

The Woods, Le Sueur, Lincoln, Lyon, 

Mahnomen, Martin, McLeod, Meeker, Mille 

Lacs, Morrison, Mower, Murray, Nicollet,

Nobles, Norman, Olmsted, Otter Tail, 

Pennington, Pine, Pipestone, Polk, Pope, 

Ramsey, Redwood, Renville, Rice, Rock, 

Roseau, St. Louis, Scott, Sherburne, Sibley, 

Stearns, Steele, Stevens, Swift, Todd, Traverse, 

Wabasha, Wadena, Waseca, Washington, 

Watonwan, Wilkin, Winona, Wright, and 

Yellow Medicine 

Missouri Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

224, 225 

Entire counties of Cape Girardeau and 

Washington 

Montana Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

224, 225 

Entire counties of Beaverhead, Big Horn, 

Carbon, Cascade, Custer, Deer Lodge, Fergus, 

Flathead, Granite, Hill, Jefferson, Lake, Lewis 

And Clark, Mineral, Missoula, Park, Pondera, 

Powder River, Powell, Ravalli, Rosebud, 

Sanders, Silver Bow, Stillwater, Sweet Grass, 

Teton, Toole, Wheatland, and Yellowstone 

Nebraska Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

224, 225 

City of Omaha and Western Nebraska 

and entire counties of Adams, Antelope, 

Boone, Box Butte, Brown, Buffalo, Burt, 

Butler, Cass, Cedar, Chase, Cherry, Cheyenne, 

Clay, Colfax, Cuming, Custer, Dakota, Dawes, 

Dawson, Deuel, Dixon, Dodge, Douglas, 

Dundy, Fillmore, Franklin, Frontier, Furnas, 

Gage, Garden, Gosper, Hall, Hamilton, Harlan, 

Holt, Howard, Jefferson, Johnson, Kearney, 

Keith, Kimball, Knox, Lancaster, Lincoln, 

Madison, Merrick, Morrill, Nance, Nemaha, 

Nuckolls, Otoe, Pawnee, Perkins, Phelps, 

Pierce, Platte, Polk, Red Willow, Richardson, 

Saline, Sarpy, Saunders, Scotts Bluff, Seward, 

Sheridan, Sherman, Stanton, Thayer, Thurston, 

Valley, Washington, Wayne, Webster, and 

York 

16
State Plan Name 3 Digit Code General Location of New Area 

New Mexico Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

224, 225 

Cities of Albuquerque, Dona Ana and 

Hobbs and entire counties of Bernalillo, 

Chaves, Cibola, Dona Ana, Lea, Los Alamos, 

Luna, Otero, San Juan, Sandoval, Santa Fe, 

Torrance, and Valencia 

New York Preferred Care GV1, GV2, 

GV4, GV5 

Entire county of Steuben 

New York Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

224, 225 

Cayuga and Western New York areas and 

entire counties of Allegany, Cattaraugus, 

Chautauqua, Erie, Jefferson, Niagara, and 

Wyoming 

North 

Carolina 

Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

224, 225 

Cities of Greenville, Hickory, and 

Wilmington and Eastern and Southeastern 

North Carolina and entire counties of 

Alexander, Alleghany, Ashe, Avery, Beaufort, 

Bertie, Brunswick, Buncombe, Caldwell, 

Camden, Carteret, Catawba, Chowan, Craven, 

Currituck, Dare, Duplin, Edgecombe, Gates, 

Halifax, Henderson, Hertford, Hyde, Madison, 

Martin, McDowell, Mitchell, New Hanover, 

Northampton, Onslow, Pamlico, Pasquotank, 

Pender, Perquimans, Pitt, Polk, Transylvania, 

Tyrrell, Washington, Watauga, and Yancey 

(With the addition of these counties to the 

other 59 counties already in the service area in 

North Carolina, the service area will now cover 

the entire state of North Carolina.) 

North 

Carolina 

Aetna Open Access JN1, JN2, 

JN4, JN5 

Cities of Charlotte, Raleigh/Durham and entire 

counties of Anson, Cabarrus, Cleveland, 

Durham, Gaston, Iredell, Lincoln, 

Mecklenburg, Orange, Rowan, Union and 

Wake 

North Dakota Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

224, 225 

Entire counties of Barnes, Benson, Billings, 

Bottineau, Burleigh, Cass, Cavalier, Dickey, 

Eddy, Emmons, Foster, Grand Forks, Griggs, 

Kidder, Lamoure, Logan, McHenry, McIntosh, 

McLean, Mercer, Morton, Nelson, Oliver, 

Pembina, Pierce, Ramsey, Ransom, Richland, 

Rolette, Sargent, Sheridan, Sioux, Slope, Stark, 

Steele, Stutsman, Towner, Traill, Walsh, Ward, 

and Wells 

17
State Plan Name 3 Digit Code General Location of New Area 

Oklahoma Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

224, 225 

Entire counties of McIntosh and Texas 

Oklahoma Aetna Open Access SL1, SL2, 

SL4, SL5 

Entire county of Logan 

Oregon Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

224, 225 

Entire counties of Benton, Clackamas, Clatsop, 

Columbia, Coos, Crook, Deschutes, Douglas, 

Gilliam, Harney, Hood River, Jackson, 

Jefferson, Josephine, Lane, Lincoln, Linn, 

Malheur, Marion, Multnomah, Polk, 

Tillamook, Umatilla, Wasco, Washington, and 

Yamhill 

Pennsylvania HealthAmerica 

Pennsylvania 

SW1, SW2, 

SW4, SW5 

YW1, YW2 

 

Entire counties of Bradford, Potter, Sullivan, 

and Tioga 

Pennsylvania Geisinger Health 

Plan 

GG1,GG2 

GG4, GG5 

The following counties by zip codes: 

Perry - 17006, 17047, 17071 

Cumberland -17240, 17241, 17257, 17266 

Pennsylvania Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

224, 225 

City of Devon and entire counties of 

Bedford, Cameron, Centre, Clearfield, 

Crawford, Elk, Forest, Huntingdon, Juniata, 

McKean, Mifflin, Montour, Potter, Tioga, 

Union, Venango, and Warren (With the 

addition of these counties to the other 50 

counties already in the service area in 

Pennsylvania, the service area now will cover 

the entire state of Pennsylvania.) 

Rhode Island Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

224, 225 

Entire state of Rhode Island 

South 

Carolina 

Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

224, 225 

City of Charleston and entire counties of 

Berkeley, Charleston, Clarendon, Colleton, 

Dorchester, and Horry 

South Dakota Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

224, 225 

Cities of Rapid City and Sioux Falls and entire 

counties of Bon Homme, Clay, Custer, Fall 

River, Lawrence, Lincoln, Meade, Minnehaha, 

Pennington, Turner, Union, and Yankton 

Tennessee Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

224, 225 

City of Jackson and entire counties of 

Henry and McNairy 

18
State Plan Name 3 Digit Code General Location of New Area 

Tennessee Bluegrass Family 

Health - HDHP 

KV1, KV2 Cities of Knoxville and Nashville and entire 

counties of Anderson, Blount, Cannon, 

Cheatham, Davidson, Dickson, Grainger, 

Jefferson, Knox, Loudon, Macon, NashvilleAnderson, Roane, Robertson, Rutherford, 

Sevier, Smith, Sumner, Union, Williamson, 

and Wilson 

Texas Aetna HealthFund 

(CDHP/HDHP) 

221, 222, 

224, 225 

City of Texarkana and East Texas and 

entire counties of Anderson, Angelina, 

Armstrong, Bowie, Briscoe, Callahan, Cass, 

Castro, Childress, Collingsworth, 

Coke, Concho, Dallam, Donley, Eastland, 

Falls, Gray, Hall, Hansford, Hartley, Hemphill, 

Houston, Hutchinson, Irion, Leon, Limestone, 

Lipscomb, McCulloch, McLennan, Menard, 

Moore, Nacogdoches, Ochiltree, Oldham, 

Panola, Parmer, Polk, Roberts, Runnels, Rusk, 

Sabine, San Augustine, Schleicher, Shelby, 

Sherman, Sterling, Swisher, Trinity, and 

Wheeler 

Texas 

(continued on 

next page) 

UnitedHealthcare 

Insurance Company, 

Inc 

(HDHP) 

E91, E92 Entire counties of Anderson, Andrews, 

Angelina, Aransas, Archer, Armstrong, 

Atascosa, Austin, Bailey, Bandera, Bastrop, 

Baylor, Bee, Bell, Bexar, Blanco, Borden, 

Bosque, Bowie, Brazoria Brazos, Brewster, 

Briscoe, Brooks, Brown, Burleson, Burnet, 

Caldwell, Calhoun, Callahan, Cameron, Camp, 

Carson, Cass, Castro, Chambers, Cherokee, 

Childress, Clay, Cochran, Coke, Coleman, 

Collin, Collingsworth, Colorado, Comal, 

Comanche, Concho, Cooke, Coryell, Cottle, 

Crane, Crockett, Crosby, Culberson, Dallam, 

Dallas, Dawson, Deaf Smith, Delta, Denton, 

Dewitt, Dickens, Dimmit, Donley, Duval, 

Eastland, Ector, Edwards, El Paso, Ellis, Erath, 

Falls, Fannin, Fayette, Fisher, Floyd, Foard, 

Fort Bend, Franklin, Freestone, Frio, Gaines, 

Galveston, Garza, Gillespie, Glasscock, 

Goliad, Gonzales, Gray, Grayson, Gregg, 

Grimes, Guadalupe, Hale, Hall, Hamilton, 

Hansford, Hardeman, Hardin, Harris, Harrison, 

Hartley, Haskell, Hayes, Hemphill, Henderson, 

Hidalgo, Hill, Hockley, Hood, Hopkins, 

Houston, Howard, Hudspeth, Hunt, 

Hutchinson, Irion, Jack, Jackson, Jasper, Jeff 

Davis, Jefferson, Jim Hogg, Jim Wells, 

Johnson, Jones, Karnes, Kaufman, Kendall, 

Kenedy, Kent, Kerr, Kimble, King, Kinney, 

Kleberg, Knox, La Salle, Lamar, Lamb, 

Lampasas, Lavaca, Lee, Leon, Liberty, 

19
State Plan Name 3 Digit Code General Location of New Area 

Texas 

(continued) 

UnitedHealthcare 

Insurance Company, 

Inc 

(HDHP) 

E91, E92 Limestone, Lipscomb, Live Oak, Llano, 

Loving, Lubbock, Lynn, Madison, Marion, 

Martin, Mason, Matagorda, Maverick, 

McCulloch, McLennan, Medina, Menard, 

Midland, Milam, Mills, Mitchell, Montague, 

Montgomery, Moore, Morris, Motley, 

Nacogdoches, Navarro, Newton, Nolan, 

Nueces, Ochiltree, Oldham, Orange, Palo 

Pinto, Panola, Parker, Parmer, Pecos, Polk, 

Potter, Presidio, Rains, Randall, Reagan, Real, 

Red River, Reeves, Refugio, Roberts, 

Robertson, Rockwall, Runnels, Rusk, Sabine, 

San Augustine, San Jacinto, San Patricio, San 

Saba, Schleicher, Scurry, Shackelford, Shelby, 

Sherman, Smith, Somervell, Starr, Stephens, 

Sterling, Stonewall, Sutton, Swisher, Tarrant, 

Taylor, Terrell, Terry Throckmorton, Titus, 

Tom Greer, Travis, Trinity, Tyler, Upshur, 

Upton, Uvalde, Val Verde, Van Zandt, 

Victoria, Walker, Waller, Ward, Washington, 

Webb, Wharton, Wheeler, Wichita, Wilbarger, 

Willacy, Williamson, Wilson, Winkler, Wise, 

Wood, Yoakum, Young, Zapata, Zavala 

Utah Aetna HealthFund 

 (CDHP/HDHP) 

221, 222, 

224, 225 

Entire counties of Beaver, Box Elder, Cache, 

Carbon, Davis, Duchesne, Garfield, Iron, Juab, 

Kane, Millard, Morgan, Piute, Rich, Salt Lake, 

San Juan, Sanpete, Sevier, Summit, Tooele, 

Uintah, Utah, Wasatch, Washington, Wayne, 

and Weber 

Vermont Aetna HealthFund 

 (CDHP/HDHP) 

221, 222, 

224, 225 

Entire counties of Addison, Caledonia, 

Chittenden, Essex, Franklin, Grand Isle, 

Lamoille, Orange, Orleans, Rutland, 

Washington, and Windsor (With the addition 

of these counties to the other 2 counties already 

in the service area in Vermont, the service area 

now will cover the entire state of Vermont.) 

Virginia Aetna HealthFund 

 (CDHP/HDHP) 

221, 222, 

224, 225 

Cities of Danville and Lynchburg and 

entire counties of Amherst, Appomattox, 

Campbell, and Pittsylvania 

Virginia Kaiser Foundation 

Health Plan MidAtlantic States 

E31, E32, 

E34, E35 

City of Fredericksburg and entire counties of 

King George, Stafford, and Spotsylvania; 

Portions of counties by these zip codes: 

Caroline - 22546, 22580, 22538, 22535; 

Culpeper - 22736; 

Fauquier - 22720, 20119, 22728; 

Hanover - 23015; Louisa - 23024, 23117; 

Orange - 22508, 22567, 22960; and 

Westmoreland – 22443 

 

20
State Plan Name 3 Digit Code General Location of New Area 

Virginia Optima Health Plan 9R1, 9R2 City of Charlottesville and entire of Albemarle, 

Buckingham, Greene, Madison, Nelson, and 

Orange 

Washington Aetna HealthFund 

 (CDHP/HDHP) 

221, 222, 

224, 225 

Entire counties of Clark, Klickitat and 

Skamania 

Wisconsin Aetna HealthFund 

 (CDHP/HDHP) 

221, 222, 

224, 225 

Entire counties of Adams, Ashland, Barron, 

Bayfield, Brown, Buffalo, Burnett, Calumet, 

Chippewa. Clark, Columbia, Crawford, Dane, 

Dodge, Door, Douglas, Dunn, Eau Claire, 

Florence, Fond Du Lac, Forest, Grant, Green, 

Green Lake, Iowa, Iron, Jackson, Juneau, 

Kewaunee, La Crosse, Lafayette, Langlade, 

Lincoln, Manitowoc, Marathon, Marinette, 

Marquette, Menominee, Monroe, Oconto, 

Oneida, Outagamie, Pepin, Pierce, Polk, 

Portage, Price, Richland, Rock, Rusk, St. 

Croix, Sauk, Sawyer, Shawano, Taylor, 

Trempealeau, Vernon, Vilas, Washburn, 

Waupaca, Waushara, Winnebago, and Wood 

(With the addition of these counties to the 

other 9 counties already in the service area in 

Wisconsin, the service area now will cover the 

entire state of Wisconsin). 

Wyoming Aetna HealthFund 

 (CDHP/HDHP) 

221, 222, 

224, 225 

Entire state of Wyoming 

Wyoming Altius Health Plans 9K1, 9K2, 

9K4, 9K5, 

DK4, DK5 

Entire county of Uinta 

21