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 GEHA Indemnity 

Benefit Plan - Elevate option (Plan Codes 254, 256, 255) (the lowest-cost nationwide 

plan option for 2020 as determined by OPM). 

State Plan Name 2019 Enrollment 

Code

General Location

New York MVP Health 

Care 

GA4, GA6, GA5 

MX4, MX6, MX5

M94, M96, M95 

MF4, MF6, MF5

GV4, GV6, GV5 

Albany, Broome, Cayuga, Chenango, 

Clinton, Columbia, Cortland, 

Delaware, Dutchess, Essex,

 Franklin, Fulton, Genesee, Greene, 

Hamilton, Herkimer, Jefferson, 

Lewis, Livingston, Madison, Monroe, 

Montgomery, Oneida, Onondaga, 

Ontario, Orange, Orleans, Oswego, 

Otsego, Putnam, Rensselaer, 

Rockland, Saratoga, Schenectady, 

Schoharie, Seneca, St. Lawrence, 

Steuben, Sullivan, Tioga, Tompkins, 

Ulster, Warren, Washington, Wayne, 

Westchester, Wyoming and

Yates counties

Pennsylvania Highmark 

Choice Company 

NP1, NP3, NP2 Allegheny, Armstrong, Beaver, 

Bedford, Blair, Butler, Cambria, 

Clarion, Clearfield, Crawford, Elk, 

Erie, Fayette, Greene, Huntingdon, 

Indiana, Jefferson, Lawrence, 

McKean, Mercer, Potter, Somerset, 

Venango, Warren, Washington and 

Westmoreland counties
2

TABLE 2

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 2020. 

 

TABLE 3 

PLAN TERMINATING OPTION AND ENROLLMENT CODES 

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

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

during Open Season. 

State Plan Name Terminating 

Options

(end of 2019)

Terminating 

Codes 

(end of 2019)

Option and Codes for 

2020 

Utah SelectHealth Plan High SF1, SF3, SF2 Standard - SF4, SF6, SF5

State Plan Name 2019

Enrollment 

Code

Area Dropped

Colorado Kaiser Foundation Health 

Plan of Colorado 

651, 653, 652

654, 656, 655

N41, N43, N42

Eagle, Garfield, Grand, Routt, and 

Summit counties 

Zip codes: 80423, 80424, 80426, 

80435, 80443, 80463, 80497, 80498, 

81620, 81631, 81632, 81637, 81645, 

81649, 81655, 81657, 81658 

Washington Kaiser Permanente 

Washington Options 

Federal 

L11, L13, L12 

L14, L16, L15 

San Juan County

Washington Kaiser Foundation Health 

Plan of Washington 

541, 543, 542

544, 546, 545

San Juan County 
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TABLE 4 

PLANS ADDING NEW OPTIONS AND ENROLLMENT CODES 

State Plan Name New Option 2020

Enrollment

Codes

General Location 

All States Aetna Advantage Advantage Z24, Z26, Z25 Portions of all 50 States 

and DC 

District of 

Columbia 

Aetna Open 

Access and Aetna 

Saver Plan

Saver QQ4, QQ6, QQ5 Washington, DC 

District of 

Columbia 

CareFirst 

BlueChoice

Blue Value Plus B64, B66, B65 Washington, DC 

Georgia Kaiser Foundation 

Health Plan of 

Georgia, Inc. 

Basic LA1, LA3, LA2 Barrow, Bartow, Bibb, 

Bleckley, Bryan, Bulloch, 

Butts, Carroll, Chatham, 

Chattahoochee, Cherokee, 

Clarke, Clayton, Cobb, 

Coweta, Crawford, Dawson, 

DeKalb, Douglas, 

Effingham, Evans, Fayette, 

Forsyth, Fulton, Gwinnett, 

Hall, Haralson, Harris, 

Heard, Henry, Houston, 

Jones, Lamar, Laurens, 

Liberty, Madison, Marion, 

Meriwether, Monroe, 

Muscogee, Newton, Oconee, 

Oglethorpe, Paulding, Peach, 

Pickens, Pike, Pulaski, 

Rockdale, Spalding, Twiggs, 

and Walton counties 

Hawaii HMSA Plan Standard 874, 876, 875 Entire state of Hawaii

Illinois MercyCare Health 

Plans

Standard EY4, EY6, EY5 Boone and Winnebago 

counties 
4

Maryland Aetna Open 

Access and Aetna 

Saver Plan

Saver QQ4, QQ6, QQ5 Entire state of Maryland

Maryland CareFirst 

BlueChoice

Blue Value Plus B64, B66, B65 Entire state of Maryland

Michigan Priority Health Value Y41, Y43, Y42 Alcona, Allegan, Alpena, 

Antrim, Arenac, Barry, Bay, 

Benzie, Berrien, Branch, 

Calhoun, Cass, Charlevoix, 

Cheboygan, Clare, Clinton, 

Crawford, Eaton, Emmet, 

Genesee, Gladwin, Grand 

Traverse, Gratiot, Hillsdale, 

Huron, Ingham, Ionia, Iosco, 

Isabella, Jackson, 

Kalamazoo, Kalkaska, Kent, 

Lake, Lapeer, Leelanau, 

Livingston, Macomb, 

Manistee, Mason, Mecosta, 

Midland, Missaukee, 

Montcalm, Monroe, 

Montmorency, Muskegon, 

Newaygo, Oakland, Oceana, 

Ogemaw, Osceola, Oscoda, 

Otsego, Ottawa, Presque 

Isle, Roscommon, Saginaw, 

Sanilac, Shiawassee, St. 

Clair, St. Joseph, Tuscola, 

Van Buren, Washtenaw, 

Wayne, and Wexford

counties

New 

Jersey

GHI Health Plan HDHP 811, 813, 812 Bergen, Essex, Hudson, 

Middlesex, Monmouth, 

Morris, Passaic, Somerset, 

Sussex, and Union counties

New 

Mexico

Presbyterian 

Health Plan

Wellness PS1, PS3, PS2 Entire state of New Mexico
5

New York GHI Health Plan HDHP 811, 813, 812 Boroughs of Manhattan, 

Brooklyn, Bronx, Queens, 

and Staten Island, Nassau, 

Suffolk, Rockland, 

Westchester Broome, 

Cayuga, Chemung, 

Columbia, Cortland, 

Delaware, Dutchess, 

Franklin, Greene, Hamilton, 

Herimer, Jefferson, Lewis,

Madison, Oneida, 

Onondaga, Orange, Oswego, 

Otsego, Putnam, St. 

Lawrence, Schuyler, 

Steuben, Sullivan, Tioga, 

Tompkins, and Ulster 

counties 

Virginia Aetna Open 

Access and Aetna 

Saver Plan

Saver QQ4, QQ6, QQ5 Arlington, Caroline, Clarke, 

Fairfax, Fauquier, Greene, 

King George, Loudoun, 

Madison, Orange, Prince 

William, Rappahannock, 

Spotsylvania, Stafford, and 

Westmoreland counties 

Cities of Alexandria, 

Fairfax, Falls Church, 

Fredericksburg, Manassas, 

and Manassas Park

Virginia CareFirst 

BlueChoice

Blue Value Plus B64, B66, B65 Cities of Alexandria and 

Fairfax; Arlington County; 

town of Vienna; Counties of 

Fairfax, and Prince William 

(east of route 123) 

Wisconsin MercyCare Health 

Plan

Standard EY4, EY6, EY5 Green, Jefferson, Rock, and 

Walworth counties 
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TABLE 5 

SERVICE AREA EXPANSIONS WITHOUT NEW ENROLLMENT CODES

State Plan Name Plan Option 2020

Enrollment 

Codes

Location of Areas

Colorado Kaiser Foundation 

Health Plan of Colorado 

High

 Standard 

Basic

651, 653, 652

654, 656, 655

N41, N43, N42

Clear Creek County 

Zip codes: 80436, 80444 

Larimer County 

Zip code: 82070 

Michigan Health Alliance Plan 

(HAP)

High 

Standard 

521, 523, 522 

GY4, GY6, GY5

Lenawee County

Ohio Medical Mutual of Ohio Standard 

Basic 

YF4, YF6, YF5 

YF1, YF3, YF2 

Adams, Miami, and 

Warren counties 

Virginia Kaiser Foundation 

Health Plan of the MidAtlantic States, Inc. 

High

Standard

Basic

E31, E33, E32 

E34, E36 ,E35 

T71, T73, T72

Fauquier County Zip 

codes: 

20115, 20137, 20144, 

20117, 20184, 20186, 

20187, 20198, 22639, 

22642, 22643 

TABLE 6

SERVICE AREA EXPANSIONS ADDING

NEW ENROLLMENT CODES

State FEHB Plan

Name

Plan 

Option

2020 New

Enrollment Codes

Location of Areas

Pennsylvania UPMC Health Plan High

Standard 

HDHP

YS1, YS3, YS2 

YT4, YT6, YT5 

YS4, YS6, YS5

Berks, Clinton, Cumberland, 

Dauphin, Juniata, Lackawanna, 

Lancaster, Lehigh, Luzerne, 

Lycoming, Mifflin, Northampton, 

Northumberland, Perry, Schuylkill, 

Snyder, Sullivan, Susquehanna, 

Tioga, Union, and Wayne counties 
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TABLE 7 

NEW PLAN ENTERING THE FEHB PROGRAM

State FEHB Plan

Name

Plan 

Option

2020 New 

Enrollment Codes

Location of Areas

All States GEHA Indemnity 

Benefit Plan

Elevate Plus

Elevate

251, 253, 252 

254, 256, 255 

Nationwide 

Alabama UnitedHealthcare 

Insurance Co., Inc. 

Choice Primary 

Advantage 

High Y81, Y83, Y82 Entire state of Alabama

Alabama UnitedHealthcare 

Insurance Co., Inc. 

Choice Plus 

Primary 

Advantage 

High AS1, AS3, AS2 Entire state of Alabama

Arizona UnitedHealthcare 

Insurance Co., Inc.

Choice Primary 

Advantage 

High VD1, VD3, VD2 Maricopa, Mohave, Pima, Pinal, and

Yavapai counties

Arizona UnitedHealthcare 

Insurance Co., Inc.

Choice Plus 

Primary 

Advantage 

High WF1, WF3, WF2 Maricopa, Mohave, Pima, Pinal, and 

Yavapai counties

Arkansas UnitedHealthcare 

Insurance Co., Inc.

Choice Primary 

Advantage 

High Y81, Y83, Y82 Entire state of Arkansas

Arkansas UnitedHealthcare 

Insurance Co., Inc.

Choice Plus 

Primary 

Advantage 

High AS1, AS3, AS2 Entire state of Arkansas
8

District of 

Columbia

UnitedHealthcare 

Insurance Co., Inc.

Choice Primary 

Advantage 

High Y81, Y83, Y82 Washington, DC

District of 

Columbia 

UnitedHealthcare 

Insurance Co., Inc.

Choice Plus 

Primary 

Advantage 

High AS1, AS3, AS2 Washington, DC

Florida UnitedHealthcare 

Insurance Co., Inc.

Choice Primary 

Advantage 

High Y81, Y83, Y82 Entire state of Florida

Florida UnitedHealthcare 

Insurance Co., Inc.

Choice Plus 

Primary 

Advantage 

High AS1, AS3, AS2 Entire state of Florida

Georgia UnitedHealthcare 

Insurance Co., Inc.

Choice Primary 

Advantage 

High Y81, Y83, Y82 Butts, Carroll, Cherokee, Clayton, 

Cobb, Coweta, Dawson, DeKalb, 

Douglas, Fayette, Forsythe, Fulton, 

Gwinnett, Haralson, Heard, Henry, 

Jasper, Morgan, Newton, Paulding, 

Putnam, Rockdale, Spaulding, and 

Walton counties

Georgia UnitedHealthcare 

Insurance, Co., 

Inc. Choice Plus 

Primary 

Advantage 

High AS1, AS3, AS2 Butts, Carroll, Cherokee, Clayton, 

Cobb, Coweta, Dawson, DeKalb, 

Douglas, Fayette, Forsythe, Fulton, 

Gwinnett, Haralson, Heard, Henry, 

Jasper, Morgan, Newton, Paulding, 

Putnam, Rockdale, Spaulding, and 

Walton counties

Illinois UnitedHealthcare 

Insurance Co., Inc.

Choice Primary 

Advantage 

High Y81, Y83, Y82 Entire state of Illinois
9

Illinois UnitedHealthcare 

Insurance Co., Inc.

Choice Plus 

Primary 

Advantage 

High AS1, AS3, AS2 Entire state of Illinois

Iowa UnitedHealthcare 

Insurance Co., Inc.

Choice Primary 

Advantage 

High Y81, Y83, Y82 Entire state of Iowa

Iowa UnitedHealthcare 

Insurance Co., Inc.

Choice Plus 

Primary 

Advantage 

High AS1, AS3, AS2 Entire state of Iowa

Kentucky UnitedHealthcare 

Insurance Co., Inc.

Choice Primary 

Advantage 

High Y81, Y83, Y82 Entire state of Kentucky

Kentucky UnitedHealthcare 

Insurance Co., Inc.

Choice Plus 

Primary 

Advantage 

High AS1, AS3, AS2 Entire state of Kentucky

Louisiana UnitedHealthcare 

Insurance Co., Inc.

Choice Primary 

Advantage 

High Y81, Y83, Y82 Entire state of Louisiana

Louisiana UnitedHealthcare 

Insurance Co., Inc.

Choice Plus 

Primary 

Advantage 

High AS1, AS3, AS2 Entire state of Louisiana

Maryland UnitedHealthcare 

Insurance Co., Inc.

Choice Primary 

Advantage 

High Y81, Y83, Y82 Entire state of Maryland
10

Maryland UnitedHealthcare 

Insurance Co., Inc.

Choice Plus 

Primary 

Advantage 

High AS1, AS3, AS2 Entire state of Maryland

Mississippi UnitedHealthcare 

Insurance Co., Inc.

Choice Primary 

Advantage 

High Y81, Y83, Y82 Entire state of Mississippi

Mississippi UnitedHealthcare 

Insurance Co., Inc.

Choice Plus 

Primary 

Advantage 

High AS1, AS3, AS2 Entire state of Mississippi

Missouri UnitedHealthcare 

Insurance Co., Inc.

Choice Primary 

Advantage 

High Y81, Y83, Y82 Bollinger, Butler, Cape Girardeau, 

Clark, Clinton, Crawford, Dent, 

Dunklin, Franklin, Gasconade, 

Greene, Howell, Iron, Jefferson, 

Lewis, Lincoln, Madison, Marion, 

Mississippi, Monroe, Montgomery, 

New Madrid, Oregon, Pemiscot, 

Perry, Phelps, Pike, Ralls, Randolph, 

Reynolds, Ripley, Scott, Shannon, 

St. Charles, St. Clair, St. Francois, 

St. Louis, St. Louis City, Ste. 

Genevieve, Stoddard, Texas, 

Warren, Washington, Wayne, and 

Williamson counties
11

Missouri UnitedHealthcare 

Insurance, Co., 

Inc. Choice Plus 

Primary 

Advantage 

High AS1, AS3, AS2 Bollinger, Butler, Cape Girardeau, 

Clark, Clinton, Crawford, Dent, 

Dunklin, Franklin, Gasconade, 

Greene, Howell, Iron, Jefferson, 

Lewis, Lincoln, Madison, Marion, 

Mississippi, Monroe, Montgomery, 

New Madrid, Oregon, Pemiscot, 

Perry, Phelps, Pike, Ralls, Randolph, 

Reynolds, Ripley, Scott, Shannon, 

St. Charles, St. Clair, St. Francois, 

St. Louis, St. Louis City, Ste. 

Genevieve, Stoddard, Texas, 

Warren, Washington, Wayne, and 

Williamson counties 

Nevada UnitedHealthcare 

Insurance Co., Inc.

Choice Primary 

Advantage

High VD1, VD3, VD2 Entire state of Nevada

Nevada UnitedHealthcare 

Insurance Co., Inc.

Choice Plus 

Primary 

Advantage 

High WF1, WF3, WF2 Entire state of Nevada

New Mexico True Health New 

Mexico

High EL1, EL3, EL2 Entire state of New Mexico

North Carolina UnitedHealthcare 

Insurance Co., Inc.

Choice Primary 

Advantage 

High Y81, Y83, Y82 Entire state of North Carolina

North Carolina UnitedHealthcare 

Insurance Co., Inc.

Choice Plus 

Primary 

Advantage 

High AS1, AS3, AS2 Entire state of North Carolina
12

Pennsylvania UnitedHealthcare 

Insurance Co., Inc.

Choice Primary

Advantage 

High Y81, Y83, Y82 Entire state of Pennsylvania

Pennsylvania UnitedHealthcare 

Insurance Co., Inc.

Choice Plus 

Primary 

Advantage 

High AS1, AS3, AS2 Entire state of Pennsylvania

Oregon UnitedHealthcare 

Insurance Co., Inc.

Choice Primary 

Advantage 

High VD1, VD3, VD2 Entire state of Oregon

Oregon UnitedHealthcare 

Insurance Co., Inc.

Choice Plus 

Primary 

Advantage 

High WF1, WF3, WF2 Entire state of Oregon

Tennessee UnitedHealthcare 

Insurance Co., Inc.

Choice Primary 

Advantage 

High Y81, Y83, Y82 Entire state of Tennessee

Tennessee UnitedHealthcare 

Insurance Co., Inc.

Choice Plus 

Primary 

Advantage 

High AS1, AS3, AS2 Entire state of Tennessee

Texas UnitedHealthcare 

Insurance Co., Inc.

Choice Primary 

Advantage 

High Y81, Y83, Y82 Entire state of Texas

Texas UnitedHealthcare 

Insurance Co., Inc.

Choice Plus 

Primary 

Advantage 

High AS1, AS3, AS2 Entire state of Texas
13

Virginia UnitedHealthcare 

Insurance Co., Inc.

Choice Primary 

Advantage 

High Y81, Y83, Y82 Entire state of Virginia

Virginia UnitedHealthcare 

Insurance, Co., 

Inc. Choice Plus 

Primary 

Advantage 

High AS1, AS3, AS2 Entire state of Virginia

Washington UnitedHealthcare 

Insurance Co., Inc.

Choice Primary 

Advantage 

High VD1, VD3, VD2 Entire state of Washington

Washington UnitedHealthcare 

Insurance Co., Inc.

Choice Plus 

Primary 

Advantage 

High WF1, WF3, WF2 Entire state of Washington

Wisconsin Quartz Health 

Benefit Plans 

Corporation 

High 

Standard 

TF1, TF3, TF2 

TF4, TF6, TF5

Adams, Buffalo, Columbia, 

Crawford, Dane, Dodge, Fond du 

Lac, Grant, Green, Green Lake, 

Iowa, Jackson, Jefferson, Juneau, 

La Crosse, Lafayette, Rock, Sauk,

Trempealeau, Vernon, Walworth, 

Waukesha, and Waushara counties