1

ATTACHMENT 1 – FEHB PROGRAM 

TABLE 1 

PLAN LEAVING THE FEHB PROGRAM 

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

another FEHB plan during Open Season will not have health benefits for 2013. 

State Plan Name 3 Digit Plan 

Code

General 

Location

Ohio HMO Health Ohio L41, L42 Northeast 

Ohio

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 2013. 

State Plan Name 3 Digit Plan

Code

Area Dropped

Illinois Aetna Open Access IK1, IK2 Chicago area

Indiana Aetna Open Access IK1, IK2 Northern Indiana area

Pennsylvania HealthAmerica

Pennsylvania High 

Deductible Health Plan

YW1, YW2 Central Pennsylvania

Pennsylvania HealthAmerica 

Pennsylvania HMO 

SW4, SW5 Central Pennsylvania 
2

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 2013. 

State Plan Name 3 Digit Plan 

Code

Area Dropped

Virginia M.D. IPA JP1, JP2 The following cities: Charlottesville,

Colonial Heights, Emporia, Hopewell, 

Petersburg, and Richmond.

 

The following counties: Albemarle, 

Amelia, Caroline, Charles City, 

Chesterfield, Cumberland, Dinwiddie, 

Fluvanna, Goochland, Greensville, 

Hanover, Henrico, King William, 

King and Queen, Louisa, Lunenburg, 

New Kent, Nottoway, Powhatan, 

Prince Edward, Prince George, Sussex, and

Westmoreland

TABLE 4 

PLAN NAME CHANGE 

State 2012 Plan Name (Old) 3 Digit Plan 

Codes

2013 Plan Name (New)

Ohio AultCare HMO 3A1, 3A2,

3A4, 3A5

AultCare Health Plan
3

TABLE 5

NEW PLANS ENTERING THE FEHB PROGRAM 

State Plan Name Plan Type 3 Digit 

Plan 

Code

General Location

California Anthem Blue Cross 

Select HMO of CA

HMO B31, B32 Counties of Imperial, Kern, Los 

Angeles, Orange, Riverside, San 

Bernardino, San Diego, and Ventura 

Guam, 

Palau, and 

Northern 

Mariana 

Islands

Calvo’s SelectCare HMO B41, B42 All of Guam, Palau, and Northern 

Mariana Islands

Illinois Blue Cross Blue 

Shield of Illinois

HMO A21, A22 Chicago area and surrounding 

counties of Boone, Cook, Dupage, 

Kane, Lake, McHenry, Peoria, 

Sangamon, St. Clair, and Winnebago

Indiana Humana Health of 

Ohio

HMO A61, A62

A64, A65

Counties of Dearborn, Franklin, 

Ohio, Ripley, and Union

Kentucky Humana Health of 

Ohio

HMO A61, A62

A64, A65

Counties of Boone, Campbell, 

Gallatin, Grant, Kenton and 

Pendleton

Ohio Humana Health of 

Ohio

HMO A61, A62

A64, A65

Counties of Adams, Brown, Butler, 

Clermont, Clinton, Highland 

Hamilton, and Warren

Texas Aetna Whole 

Health

HMO ES1, ES2 Counties of Fort Bend, Harris and 

Montgomery

Virginia Aetna Whole 

Health

HMO D91, D92 Cities of Bedford, Lexington, 

Martinsville, Radford, Roanoke and 

Salem;

Counties of Bedford, Bland, 

Botetourt, Carroll, Craig, Floyd,

Franklin, Giles, Henry, Montgomery,

Pulaski, Roanoke, Tazewell and 

Wythe

Wisconsin Aetna Whole 

Health 

HMO F71, F72 Cities of Green Lake, Jefferson, 

Marquette, and Shawano;

Counties of Brown, Calumet, Dodge, 

Door, Fond Du Lac, Kenosha, 

Kewaunee, Manitowoc, Marinette, 

Milwaukee, Oconto, Outagamie, 

Ozaukee, Racine, Rock, Sheboygan, 

Walworth, Washington, Waukesha, 

Waushara, and Winnebago
4

TABLE 6 (continued on next page)

PLANS ADDING NEW OPTIONS AND ENROLLMENT CODES

(Please also refer to Table 9 for the information on the Aetna HealthFund Value Plan, a

new HMO Basic option, in 41 states and the District of Columbia.)

State Plan Name New Option New 3

Digit

Plan

Code

General Location

California UnitedHealthcare 

of California

Standard 

CY4,

CY5

Southern and Central California:

Counties of Los Angeles, 

Orange, San Diego, Riverside, 

San Bernardino, Ventura, Kern, 

Kings, Fresno, and Madera

District of 

Columbia

CareFirst 

BlueChoice

High 

Deductible 

Health Plan

(HDHP)

(HealthyBlue 

Advantage)

B61, B62 All of District of Columbia

Idaho SelectHealth Plan Standard SF4, SF5 Counties of Ada, Adams, 

Bannock, Bear Lake, Blaine, 

Boise, Camas, Canyon, Caribou, 

Cassia, Elmore, Franklin, Gem, 

Gooding, Idaho, Jerome, 

Lincoln, Minidoka, Oneida, 

Owyhee, Payette, Twin Falls, 

Valley, and Washington

Maryland CareFirst 

BlueChoice

HDHP 

(HealthyBlue 

Advantage)

B61, B62 All of Maryland

New York Independent 

Health 

Association

Standard C54, C55 Western New York

Oregon Kaiser 

Foundation 

Health Plan of 

the Northwest

Basic B51, B52 Counties of Clackamas, 

Columbia, Marion, Multnomah, 

Polk, Washington, and Yamill;

Portions of Benton county with 

the following zip codes: 97330, 

97331, 97333, 97339 and 97370;

Portions of Hood River county 

with the following zip codes: 

97014, 97031, 97041, and 

97044;

Portions of Linn county with the 

zip codes: 97321, 97322, 97335, 

97355, 97358, 97360, 97374, 

and 97389
5

Utah SelectHealth Plan Standard SF4, SF5 Counties of Beaver, Box Elder 

(except for 84313 and 84329), 

Cache, Davis, Duchesne, 

Garfield, Iron, Juab, Kane, 

Millard, Morgan, Piute, Rich, 

Salt Lake, Sanpete, Sevier, 

Summit, Tooele (except for 

84034 & 84083), Uintah, Utah, 

Wasatch, Washington, Wayne, 

and Weber

Virginia CareFirst 

BlueChoice

HDHP

(HealthyBlue 

Advantage)

B61, B62 Northern Virginia 

Washington Kaiser 

Foundation 

Health Plan of 

the Northwest

Basic B51, B52 Counties of Clark and Cowlitz;

Lewis county with the following 

zip codes: 98591, 98593 and 

98596; 

Wahkiakum county with the 

following zip codes: 98612 and 

98647; 

Skamania county with the 

following zip codes: 98605, 

98610, 98639, 98648, 98651 and 

98671

TABLE 7

SERVICE AREA EXPANSIONS WITH NEW ENROLLMENT CODES

State Plan Name Plan 

Type

New 3 

Digit Plan 

Codes

General Location

North Dakota Sanford Health Plan HMO C91, C92, 

C94, C95

All of North Dakota

Texas FirstCare HMO CZ1, CZ2 Counties of Lamb, Hale, Floyd, Hockley,

Crosby, Terry, Lubbock, Lynn, and Garza

CN1, CN2 Counties of Taylor, Callahan, and Eastland

ET1, ET2 Counties of Robertson, Brazos, Grimes, 

Madison, and Washington

B71, B72 Counties of Bell, Bosque, Coryell, Falls,

Hamilton, Hill, Limestone, and McLennan

Washington Aetna Open Access HMO C31, C32 Spokane and Seattle area counties of: Adams, 

Asotin, Benton, Chelan, Clallam, Columbia, 

Cowlitz, Douglas, Ferry, Franklin, Garfield, 

Grant, Grays Harbor, Island, Jefferson, King, 

Kitsap, Kittitas, Lewis, Lincoln, Mason, 

Okanogan, Pacific, Pend Orieille, Pierce, San 

Juan, Skagit, Snohomish, Spokane, Stevens, 

Thurston, Wahkiakum, Walla Walla, 

Whatcom, Whitman, and Yakima
6

TABLE 8

SERVICE AREA EXPANSIONS WITHOUT NEW ENROLLMENT CODES

State Plan Name Plan 

Type

3 Digit 

Plan Code

General Location of New Area

Arkansas Aetna 

HealthFund

HDHP 224, 225 County of Greene

Colorado Kaiser 

Foundation 

Health Plan of 

Colorado

HMO 651, 652, 

654, 655

Portions of Larimer County with the following zip codes: 

80511, 80512, 80515, 80517, 80521, 80522, 80523, 80524, 

80525, 80526, 80527, 80528, 80532, 80535, 80536, 80545, 

80547, 80549, 80550, 80553, 80612, 82063.

Portions of Weld County with the following zip codes: 

69128, 69145, 80524, 80546, 80549, 80550, 80551, 80610, 

80611, 80612, 80615, 80620, 80622, 80624, 80631, 80632, 

80633, 80634, 80638, 80639, 80644, 80645, 80646, 80648, 

80649, 80650, 80652, 80654, 80729, 80732, 80742, 80754, 

82082.

Portions of Morgan County with the following zip codes: 

80649, 80654, 80742.

Portion of Adams County with the following zip code: 

80654

Florida Aetna 

HealthFund

HDHP 224, 225 Counties of Hendry, Calhoun, Liberty, and Hardee

Idaho SelectHealth 

Plan

HMO SF1, SF2 Counties of Ada, Adams, Bannock, Bear Lake, Blaine, 

Boise, Camas, Canyon, Caribou, Cassia, Elmore, Franklin, 

Gem, Gooding, Idaho, Jerome, Lincoln, Minidoka, Oneida, 

Owyhee, Payette, Twin Falls, Valley, and Washington

Iowa UnitedHealthcare 

Plan of the River 

Valley Inc.

HMO YH1, YH2 Counties of Emmet, Dickinson, Clay, Buena Vista, 

Pocahontas, and Webster in Northeast Iowa

Massachusetts Fallon 

Healthcare

HMO JG1, JG2 Cities of Acushnet, Attleboro, Berkley, Carver, Boston, 

Dartmouth, Dighton, Fairhaven, Fall River, Freetown, 

Lakeville, Marion, Mattapoisett, Middleborough, New 

Bedford, North Attleboro, Plymouth, Rehoboth, Rochester, 

Seekonk, Somerset, Swansea, Wareham, and Westport

Counties of Bristol and Plymouth

Michigan Healthplus of MI HMO X51, X52 Counties of Huron and Iosco

Townships of Huron, Gore, Bloomfield, Rubicon, Sigel, 

Sand Beach, Paris, and Sherman

Missouri Aetna 

HealthFund

HDHP 224, 225 County of Neshoba

Missouri Aetna Open 

Access

HMO HY1, HY2 Counties of Andrew and Clinton

Montana Aetna 

HealthFund

HDHP 224, 225 County of Gallatin

Utah SelectHealth 

Plan

HMO SF1, SF2 Counties of Garfield, Kane, Piute, Rich, Uintah, and 

Wayne
7

TABLE 9 (continued on the following remaining pages)

PLAN SEPARATING A SERVICE AREA AND CREATING NEW ENROLLMENT 

CODES IN ADDITION TO THE EXISTING CODE, AND OFFERING A NEW OPTION 

WITH NEW ENROLLMENT CODES

Aetna HealthFund will have five separate enrollment codes for its nationwide Consumer 

Driven Health Plan (CDHP) product for 2013. 

Enrollment codes 221 and 222 for the current CDHP product will remain the same only for 

the nine states listed below*. The cost sharing (out-of-pocket costs) for codes 221 and 222 

for the nine states listed below will be different in 2013. Employees who live or work in the 

nine states listed below may also enroll in codes 221 or 222. 

This does not affect members enrolled in the Aetna HealthFund’s High Deductible Health 

(HDHP) Plan under enrollment codes 224 and 225. These HDHP members will remain 

enrolled in codes 224 and 225. It will not affect cost-sharing for these members.

*State Plan Name 3 

Digit

Plan

Code

General Location

Alaska Aetna 

HealthFund 

CDHP

221

222

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 

California Aetna 

HealthFund 

CDHP

221

222

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 

Hawaii, 

Indiana, 

Ohio. 

Oklahoma,

South 

Carolina, 

Texas,

Wisconsin

Aetna 

HealthFund 

CDHP

221

222

All of the state
8

New for 2013, enrollees in Aetna HealthFund’s current CDHP product, who live or work in 

the forty-one states listed below** can change from enrollment codes 221 and 222 to a new 

enrollment code available to them for their service area listed below (F51, F52, EP1, EP2, 

G51, G52, H41, and H42) in 2013. Enrollees who change will have lower 2013 premiums 

but will have the same benefits as the 2012 CDHP product.

Enrollees who do not change their enrollment code from 221 or 222 to a new enrollment 

code (F51, F52, EP1, EP2, G51, G52, H41, or H42) for their service area listed below will 

remain enrolled in codes 221 or 222. However, the enrollees will pay a higher premium and 

higher cost-sharing (out-of-pocket costs) if they do not change.

Aetna will also offer a new option called the Aetna Value Plan, in the 41 states listed below** .

Aetna HealthFund will not accept any new enrollments for the CDHP under enrollment codes

221 or 222 in the forty-one states listed below**. However, you may continue to enroll in the 

High Deductible Health Plan option under enrollment codes 224 or 225 in the forty-one states 

listed below**. 

 

State** Plan Name Plan 

Type

3 Digit 

Plan 

Code for 

2013

General Location

Alabama Aetna 

HealthFund

CDHP F51, F52 Counties of Autauga, Baldwin, Bibb, Blount, 

Bullock, Calhoun, Chambers, Cherokee, 

Chilton, Choctaw, Clarke, Clay, Cleburne, 

Coffee, Colbert, Coosa, Covington, Crenshaw, 

Cullman, Dale, Dallas, De Kalb, Elmore, 

Escambia, Etowah, Fayette, Franklin, Geneva, 

Henry, Houston, Jackson, Jefferson, Lamar, 

Lauderdale, Lawrence, Lee, Limestone, 

Lowndes, Macon, Madison, Marion, Marshall, 

Mobile, Monroe, Montgomery, Morgan, Perry, 

Pickens, Pike, Russell, St. Clair, Shelby, 

Sumter, Talladega, Tallapoosa, Tuscaloosa, 

Walker, Washington, Wilcox and Winston 

HMO 

(Value

Plan)

F54, F55

Arizona Aetna 

HealthFund 

CDHP G51,G52 All of Arizona

HMO

(Value

Plan)

G54,G55
9

Arkansas Aetna 

HealthFund 

CDHP F51, F52 Counties of Arkansas, Baxter, Benton, 

Boone, Carroll, Clark, Clay, Cleburne, 

Columbia, Conway, Craighead, Crawford, 

Crittenden, Cross, Faulkner, Franklin, 

Fulton, Garland, Grant, Greene, Hot Spring, 

Independence, Jackson, Jefferson, Johnson, 

Lawrence, Lee, Lincoln, Logan, Lonoke, 

Madison, Marion, Miller, Mississippi,

Monroe, Montgomery, Newton, Ouachita, 

Perry, Phillips, Poinsett, Polk, Pope, Prairie, 

Pulaski, Randolph, Saline, Scott, Sebastian, 

Sharp, St. Francis, Stone, Union, Van 

Buren, Washington, White, Woodruff and 

Yell 

HMO 

(Value

Plan) 

F54, F55

Colorado Aetna 

HealthFund 

CDHP G51,G52 All of Colorado

HMO

(Value

Plan)

G54,G55

Connecticut Aetna 

HealthFund 

CDHP EP1, EP2 All of Connecticut 

HMO 

(Value

Plan)

EP4, EP5

Delaware Aetna 

HealthFund

CDHP EP1, EP2 All of Delaware

HMO

(Value

Plan)

EP4, EP5

District of 

Columbia

Aetna 

HealthFund 

CDHP F51, F52 All of District of Columbia

HMO 

(Value

Plan)

F54, F55

Florida Aetna 

HealthFund 

CDHP F51, F52 Counties of Alachua, Baker, Bay, Bradford, 

Brevard, Broward, Calhoun, Charlotte, Citrus, 

Clay, Collier, Columbia, Duval, Escambia, 

Flagler, Gadsden, Gilchrist, Hardee, Hendry, 

Hernando, Highlands, Hillsborough, Holmes, 

Indian River, Jefferson, Lake, Lee, Leon, Levy, 

Liberty, Manatee, Marion, Martin, Miami-Dade, 

Monroe, Nassau, Okaloosa, Okeechobee, 

Orange, Osceola, Palm Beach, Pasco, Pinellas, 

Polk, Putnam, St. Lucie, Santa Rosa, Sarasota, 

Seminole, St. Johns, Sumter, Suwannee, Union, 

Volusia, Wakulla, Walton and Washington 

HMO 

(Value

Plan)

F54, F55
10

Georgia Aetna 

HealthFund

CDHP F51, F52 All of Georgia

HMO

(Value

Plan)

F54, F55

Idaho Aetna 

HealthFund 

CDHP H41,H42 Counties of Ada, Adams, Bannock, Bear Lake, 

Benewah, Bingham, Blaine, Boise, Bonner, 

Bonneville, Boundary, Butte, Canyon, Cassia, 

Custer, Elmore, Franklin, Fremont, Gem, 

Gooding, Jefferson, Jerome, Kootenai, Latah, 

Madison, Minidoka, Nez Perce, Oneida, 

Owyhee, Payette, Shoshone, Twin Falls, Valley, 

Washington 

HMO 

(Value

Plan)

H44, H45

Illinois Aetna 

HealthFund 

CDHP H41, H42 Counties of Alexander, Bond, Boone, Brown, 

Bureau, Calhoun, Champaign, Christian, Clark, 

Clay, Clinton, Coles, Cook, Crawford, De Kalb, 

Douglas, DuPage, Edgar, Edwards, Effingham, 

Fayette, Ford, Franklin, Fulton, Gallatin, 

Greene, Grundy, Hamilton, Hardin, Henry, 

Iroquois, Jackson, Jasper, Jefferson, Jersey, Jo 

Daviess, Johnson, Kane, Kankakee, Kendall, 

Knox, La Salle, Lake, Lawrence, Lee, 

Livingston, Logan, Macon, Macoupin, Madison, 

Marion, Marshall, Mason, Massac, 

McDonough, McLean, McHenry, Menard, 

Monroe, Montgomery, Morgan, Ogle, Peoria, 

Perry, Piatt, Pope, Pulaski, Randolph, Rock 

Island, St. Clair, Saline, Sangamon, Schuyler, 

Scott, Stark, Stephenson, Tazewell, Union, 

Vermilion, Wabash, Washington, Wayne, 

White, Whiteside, Will, Williamson, 

Winnebago, Woodford 

 

HMO 

(Value

Plan)

H44, H45

Iowa Aetna 

HealthFund 

CDHP H41, H42 All of Iowa

HMO 

(Value

Plan)

H44, H45
11

Kansas Aetna 

HealthFund 

CDHP G51,G52 Counties of Allen, Anderson, Atchison, Barton, 

Bourbon, Brown, Butler, Chase, Chautauqua, 

Cherokee, Cheyenne, Clark, Clay, Cloud, 

Coffey, Comanche, Cowley, Crawford, 

Dickinson, Doniphan, Douglas, Elk, Ellis, 

Ellsworth, Finney, Ford, Franklin, Geary, 

Graham, Grant, Gray, Greeley, Greenwood, 

Hamilton, Harper, Harvey, Haskell, Hodgeman, 

Jefferson, Jewell, Johnson, Kearny, Kingman, 

Labette, Leavenworth, Lincoln, Linn, Logan, 

Lyon, Marion, Marshall, McPherson, Meade, 

Miami, Montgomery, 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, Woodson, 

Wyandotte

HMO 

(Value

Plan)

G54,G55

Kentucky Aetna 

HealthFund 

CDHP H41, H42 Counties of Adair, Allen, Anderson, Ballard, 

Barren, Bell, Boone, Bourbon, Boyd, Boyle, 

Bracken, Breathitt, Breckinridge, Bullitt, Butler, 

Caldwell, Calloway, Campbell, Carlisle, 

Carroll, Carter, Casey, Christian, Clark, Clinton, 

Crittenden, Cumberland, Daviess, Edmonson,

Elliott, Estill, Fayette, Floyd, Franklin, Fulton, 

Gallatin, Garrard, Grant, Graves, Grayson, 

Green, Greenup, Hancock, Hardin, Harlan, 

Harrison, Hart, Henderson, Henry, Hopkins, 

Jefferson, Jessamine, Johnson, Kenton, Knott, 

Larue, Lawrence, Letcher, Lewis, Lincoln, 

Livingston, Logan, Lyon, Madison, Magoffin, 

Marion, Marshall, Martin, Mason, McCracken, 

McCreary, McLean, Meade, Mercer, Metcalfe, 

Monroe, Morgan, Muhlenberg, Nelson, Ohio, 

Oldham, Owen, Pendleton, Perry, Pike, Pulaski, 

Robertson, Russell, Scott, Shelby, Simpson, 

Spencer, Taylor, Todd, Trigg, Trimble, Union, 

Warren, Washington, Wayne, Webster, Whitley, 

Woodford 

HMO 

(Value

Plan)

H44, H45
12

Louisiana Aetna 

HealthFund 

CDHP F51, F52 Parishes of Acadia, Allen, Ascension, 

Assumption, Avoyelles, Beauregard, Bienville, 

Bossier, Caddo, Calcasieu, Caldwell, Cameron, 

Catahoula, Claiborne, De Soto, East Baton 

Rouge, East Carroll, East Feliciana, Evangeline, 

Franklin, Grant, Iberia, Iberville, Jackson, 

Jefferson, Jefferson Davis, La Salle, Lafayette, 

Lafourche, Lincoln, Livingston, Madison, 

Morehouse, Natchitoches, Orleans, Ouachita, 

Plaquemines, Pointe Coupee, Rapides, Red 

River, Richland, Sabine, Saint Bernard, Saint 

Charles, Saint Helena, Saint James, Saint 

Landry, Saint Martin, Saint Mary, Saint

Tammany, St John The Baptist, Tangipahoa, 

Tensas, Terrebonne, Union, Vermilion, 

Washington, Webster, West Baton Rouge, West 

Carroll, West Feliciana and Winn. 

Portions of the following parish as defined by 

the following zip codes: Concordia -71326, 

71334, and 71377

HMO 

(Value

Plan)

F54, F55

Maine Aetna 

HealthFund 

CDHP EP1, EP2 All of Maine

HMO 

(Value 

Plan)

EP4, EP5

Maryland Aetna 

HealthFund 

CDHP F51, F52 All of Maryland

HMO 

(Value

Plan)

F54, F55

Massachusetts Aetna 

HealthFund 

CDHP EP1, EP2 Counties of Barnstable, Berkshire, Bristol, 

Dukes, Essex, Franklin, Hampden, Hampshire, 

Middlesex, Norfolk, Plymouth, Suffolk and 

Worcester 

HMO

(Value

Plan)

EP4, EP5

Michigan Aetna 

HealthFund 

CDHP G51,G52 All of Michigan

HMO

(Value

Plan)

G54, G55
13

Minnesota Aetna 

HealthFund 

CDHP H41, H42 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, LeSueur, 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, Yellow 

Medicine 

HMO

(Value

Plan)

H44, H45

Mississippi Aetna 

HealthFund 

CDHP H41, H42 Counties of Adams, Alcorn, Amite, Attala, 

Benton, Bolivar, Calhoun, Carroll, Chickasaw, 

Claiborne, Clarke, Clay, Coahoma, Copiah, 

Covington, De Soto, Forrest, George, Grenada, 

Hancock, Harrison, Hinds, Holmes, Issaquena, 

Itawamba, Jackson, Jefferson Davis, Jones, 

Lafayette, Lamar, Lauderdale, Lawrence, 

Leake, Lee, Leflore, Lincoln, Lowndes, 

Madison, Marion, Marshall, Monroe, Newton, 

Neshoba, Noxubee, Oktibbeha, Panola, Pearl 

River, Perry, Pike, Pontotoc, Prentiss, Quitman, 

Rankin, Scott, Simpson, Smith, Stone, 

Sunflower, Tallahatchie, Tate, Tippah, 

Tishomingo, Tunica, Union, Walthall, Warren 

,Washington, Wayne, Webster, Yalobusha, 

Yazoo 

HMO 

(Value

Plan)

H44, H45
14

Missouri Aetna 

HealthFund 

CDHP G51,G52 Counties of Adair, Andrew, Atchison, Audrain, 

Barry, Barton, Bates, Benton, Boone, Buchanan,

Caldwell, Callaway, Camden, Cape Girardeau, 

Carroll, Cass, Cedar, Chariton, Christian, Clark, 

Clay, Clinton, Cole, Cooper, Crawford, Dade, 

Dallas, Daviess, De Kalb, Dent, Douglas, 

Franklin, Gasconade, Gentry, Greene, Grundy, 

Harrison, Hickory, Henry, Holt, Howard, 

Howell, Jackson, Jasper, Jefferson, Knox, 

Laclede, Lafayette, Lawrence, Lewis, Lincoln, 

Linn, Livingston, Macon, Madison, Maries, 

McDonald, Mercer, Miller, Moniteau, Monroe, 

Montgomery, Morgan, Newton, Nodaway, 

Osage, Ozark, Pettis, Phelps, Platte, Polk, 

Pulaski, Putnam, Ralls, Randolph, Ray, Saint

Clair, Saline, Schuyler, Scotland, Shannon, St. 

Charles, St. Francois, St. Louis, St. Louis City, 

Ste. Genevieve, Stone, Sullivan, Taney, Texas, 

Vernon, Warren, Washington, Webster, Worth, 

Wright 

HMO 

(Value

Plan)

G54, G55

Montana Aetna 

HealthFund 

CDHP H41, H42 South, Southeast and Western MT –

Counties of Beaverhead, Big Horn, Blaine, 

Broadwater, Carbon, Cascade, Chouteau, 

Custer, Daniels, Deer Lodge, Fallon, Fergus, 

Flathead, Gallatin, Glacier, Golden Valley, 

Granite, Hill, Jefferson, Judith Basin, Lake, 

Lewis And Clark, Liberty, Lincoln, Meagher, 

Mineral, Missoula, Musselshell, Park, 

Petroleum, Phillips, Pondera, Powder River, 

Powell, Prairie, Ravalli, Richland, Rosebud, 

Sanders, Sheridan, Silver Bow, Stillwater, 

Sweet Grass, Teton, Toole, Treasure, Valley, 

Wheatland and Yellowstone 

HMO 

(Value

Plan)

H44, H45

Nebraska Aetna 

HealthFund 

CDHP H41,H42 All of Nebraska

HMO 

(Value

Plan)

H44, H45

Nevada Aetna 

HealthFund 

CDHP G51,G52 Counties of Las Vegas – Carson City, 

Churchill, Clark, Douglas, Elko, Humboldt, 

Lander, Lyon, Mineral, Nye, Pershing, Storey, 

Washoe, White Pine 

HMO 

(Value

Plan)

G54, G55

New 

Hampshire

Aetna 

HealthFund 

CDHP EP1, EP2 All of New Hampshire

HMO 

(Value

Plan)

EP4, EP5
15

New Jersey Aetna 

HealthFund 

CDHP EP1, EP2 All of New Jersey

HMO 

(Value

Plan)

EP4, EP5

New Mexico Aetna 

HealthFund 

CDHP G51,G52 Counties of Albuquerque, Dona Ana and 

Hobbs areas - Bernalillo, Chaves, Cibola, Dona 

Ana, Lea, Los Alamos, Luna, Otero, San Juan, 

Sandoval, Santa Fe, Torrance, Valencia

HMO 

(Value

Plan)

G54, G55

New York Aetna 

HealthFund 

CDHP EP1, EP2 Counties of Albany, Allegany, Bronx, Broome, 

Cattaraugus, Cayuga, Chautauqua, Chemung, 

Chenango, Clinton, Columbia, Cortland, 

Delaware, Dutchess, Erie, Essex, Franklin, 

Fulton, Genesee, Greene, Hamilton, Herkimer, 

Jefferson, Kings, Lewis, Livingston, Madison, 

Monroe, Montgomery, Nassau, New York, 

Niagara, Oneida, Onondaga, Ontario, Orange, 

Orleans, Oswego, Otsego, Putnam, Queens, 

Rensselaer, Richmond, Rockland, Saratoga, 

Schenectady, Schoharie, Schuyler, Seneca, 

Steuben, Suffolk, Sullivan, Tioga, Tompkins, 

Ulster, Warren, Washington, Wayne, 

Westchester, Wyoming, and Yates counties and 

portions of the following counties as defined by 

the zip codes below:

Saint Lawrence - 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, 13699

HMO

(Value

Plan)

EP4, EP5
16

North 

Carolina

Aetna 

HealthFund 

CDHP F51, F52 All of North Carolina

HMO

(Value

Plan)

F54, F55

North Dakota Aetna 

HealthFund 

CDHP H41, H42 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, Trail, Walsh, Ward 

and Wells 

HMO

(Value

Plan)

H44, H45

Oregon Aetna 

HealthFund 

CDHP H41, H42 Counties of Baker, Benton, Clackamas, 

Clatsop, Columbia, Coos, Crook, Curry, 

Deschutes, Douglas, Gilliam, Harney, Hood 

River, Jackson, Jefferson, Josephine, Lane, 

Lincoln, Linn, Malheur, Marion, Multnomah, 

Polk, Tillamook, Umatilla, Union, Wasco, 

Washington, Yamhill

HMO

(Value

Plan)

H44, H45

Pennsylvania Aetna 

HealthFund

CDHP H41,H42 All of Pennsylvania 

HMO

(Value

Plan)

H44, H45

Rhode Island Aetna 

HealthFund 

CDHP EP1, EP2 All of Rhode Island

HMO 

(Value

Plan)

EP4, EP5

South Dakota Aetna 

HealthFund 

CDHP G51,G52 Counties of Rapid City and Sioux Falls - Bonne 

Homme, Clay, Custer, Fall River, Lawrence, 

Lincoln, Meade, Minnehaha, Pennington, 

Turner, Union, Yankton

HMO

(Value

Plan)

G54, G55
17

Tennessee Aetna 

HealthFund 

CDHP F51, F52 Cities of Jackson and Anderson

Counties of Bedford, Benton, Bledsoe, Blount, 

Bradley, Campbell, Cannon, Carroll, Carter, 

Cheatham, Chester, Claiborne, Cocke, Coffee, 

Crockett, Davidson, Decatur, DeKalb, Dickson, 

Dyer, Fayette, Franklin, Gibson, Giles, 

Grainger, Greene, Grundy, Hamblen, Hamilton, 

Hancock, Hardeman, Hardin, Hawkins, 

Haywood, Henderson, Henry, Houston, 

Humphreys, Jefferson, Johnson, Knox, Lake, 

Lauderdale, Lawrence, Lewis, Lincoln, Loudon, 

Macon, Madison, Marion, Marshall, Maury, 

McMinn, McNairy, Meigs, Montgomery, 

Moore, Morgan, Obion, Roane, Robertson, 

Rutherford, Scott , Sequatchie, Sevier, Shelby, 

Smith, Stewart, Sullivan, Sumner, Tipton, 

Trousdale, Unicoi, Union, Van Buren, Warren, 

Washington, Weakley, Williamson, Wilson 

HMO

(Value

Plan)

F54, F55

Utah Aetna 

HealthFund 

CDHP G51,G52 Counties of Beaver, Box Elder, Cache, Carbon, 

Davis, Duchesne, Emery, Garfield, Iron, Juab, 

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

San Juan, Sanpete, Sevier, Summit, Tooele, 

Uintah, Utah, Wasatch, Washington, Wayne, 

Weber 

HMO 

(Value

Plan)

G54, G55

Vermont Aetna 

HealthFund 

CDHP EP1, EP2 All of Vermont

HMO 

(Value

Plan)

EP4, EP5
18

Virginia Aetna 

HealthFund 

CDHP F51, F52 Counties of Albemarle, Alleghany, Amelia, 

Amherst, Appomattox, Arlington, Bedford, 

Bland, Botetourt, Bristol, Buchanan, 

Buckingham, Campbell, Caroline, Carroll, 

Charles City, Charlotte, Chesterfield, Clarke, 

Covington City, Craig, Culpeper, Cumberland, 

Dickenson, Dinwiddie, Essex, Fairfax, 

Fauquier, Floyd, Fluvanna, Franklin, Frederick, 

Galax City, Giles, Gloucester, Goochland, 

Grayson, Hanover, Henrico, Henry, Isle Of 

Wight, James City, King And Queen, King 

George, King William, Lancaster, Lee, Loudon, 

Louisa, Lunenburg, Martinsville City, Mathews, 

Middlesex, Montgomery, Nelson, New Kent, 

Northumberland, Norton City, Nottoway, 

Patrick, Pittsylvania, Powhatan, Prince Edward, 

Prince George, Prince William, Pulaski, 

Radford, Roanoke, Roanoke City, Russell, 

Salem, Scott, Shenandoah, Smyth, 

Southampton, Spotsylvania, Stafford, Surry, 

Sussex, Tazewell, Warren, Washington, 

Westmoreland, Wise, Wythe and York counties, 

plus the cities of Alexandria, Charlottesville, 

Chesapeake, Colonial Heights, Covington, 

Danville, Fairfax, Falls Church, Franklin, 

Fredericksburg, Galax, Hampton, Hopewell, 

Lynchburg, Manassas, Manassas Park, 

Martinsville, Newport News, Norfolk, Norton, 

Petersburg, Poquoson, Portsmouth, Richmond, 

Roanoke, Suffolk, Virginia Beach, 

Williamsburg and Winchester

HMO 

(Value

Plan)

F54, F55
19

Washington Aetna 

HealthFund 

CDHP G51,G52 Counties of Adams, Asotin, Benton, Chelan, 

Clallam, Clark, Columbia, Cowlitz, Douglas, 

Ferry, Franklin, Garfield, Grant, Grays Harbor, 

Island, Jefferson, King, Kitsap, Kittitas, 

Klickitat, Lewis, Lincoln, Mason, Okanogan, 

Pacific, Pend Oreille, Pierce, San Juan, Skagit, 

Skamania, Snohomish, Spokane, Stevens, 

Thurston, Wahkiakum, Walla Walla, Whatcom, 

Whitman, Yakima 

HMO 

(Value

Plan)

G54, G55

West Virginia Aetna 

HealthFund 

CDHP F51, F52 Counties of Barbour, Berkeley, Boone, 

Braxton, Brooke, Cabell, Calhoun, Clay, 

Doddridge, Fayette, Gilmer, Greenbrier, 

Hampshire, Hancock, Harrison, Jackson, 

Jefferson, Kanawha, Lewis, Lincoln, Logan, 

Marion, Marshall, Mason, McDowell, Mercer, 

Mineral, Mingo, Monongalia, Monroe, Morgan, 

Nicholas, Ohio, Pleasants, Preston, Putnam, 

Raleigh, Ritchie, Roane, Summers, Taylor, 

Tyler, Upshur, Wayne, Webster, Wetzel, Wirt, 

Wood, Wyoming

HMO 

(Value

Plan)

F54, F55

Wyoming Aetna 

HealthFund 

CDHP H41,H42 All of Wyoming

HMO

(Value

Plan)

H44, H45