United States 

Office of 

Personnel Management 

The Federal Government’s Human Resources Agency

Benefits Administration Letter 

Number: 04-404 Date: October 4, 2004 

Subject: 2004 Federal Employees Health Benefits (FEHB) Program Open Season: 

Significant Plan Changes

PURPOSE

This letter transmits significant events affecting certain plans during the upcoming FEHB Open Season. 

Some of these events will require action on the part of agencies and enrollees. Also note the plans that 

are dropping out of the Program at the end of 2004. Since employees in these plans must enroll in new 

plans during open season if they are to continue insurance coverage in 2005, we ask that you distribute 

this list widely within your agencies. 

These end-of-year changes such as plan terminations are already available on the web site on the plan 

changes page. Visit www.opm.gov/insure/health and you will find a link directly to the health plan 

changes for 2005. There is also a link from the Human Resources page to the plan changes. 

We encourage you and your employees to visit the web site at www.opm.gov/insure for the most up to 

date information. We will update these pages on a regular basis throughout the open season. 

TERMINATIONS 

Table 1: Plans Dropping Out of the FEHB Program for 2005 

Table 2: Plans Reducing Their Service Areas by Terminating an Enrollment Code 

What Must Employees Do? 

• Employees in terminating plans (Table 1) or in terminating codes (Table 2) must choose a new 

health plan during open season.

• New Coverage. Coverage under an enrollee’s new health plan will be effective the first day of 

the pay period beginning on or after January 1, 2005; for most employees this will be January 9, 

2005. Enrollees will remain covered and receive benefits under the old plan until coverage under 

the new plan becomes effective.

What Must You Do? 

• You must notify employees in the terminating plans and enrollment codes to select new plans. 

Advise your employees that if they do not choose new health plans, they will not have coverage 

in 2005.
• We strongly recommend that you distribute copies of these lists to each employee, along with 

your agency’s notice about open season.

• We also recommend that you follow-up with employees in these plans and remind them to select 

new plans.

• Belated changes. Some employees still might not get the word to change plans during open 

season. We encourage you to be liberal in accepting belated open season changes from

employees enrolled in terminating plans/enrollment codes.

What Will Health Plans Do? 

• Plan Notification: The plans in tables 1 and 2 have been instructed to notify enrollees of the 

need to select new health plans for 2005. However, because some plans’ enrollment and address 

lists may not be up-to-date, we encourage you to accept belated changes.

SERVICE AREA REDUCTIONS 

Table 3: Plans Reducing Their Service Areas Without Terminating an Enrollment Code 

What Must Employees Do? 

• Enrollees in the service areas being terminated must elect new health plans for 2005. Enrollees 

who do not choose new health plans will have to travel to their plan’s remaining service area to 

receive full benefits. 

OTHER CHANGES 

Table 4: New Plans Entering the Program for 2005 

Table 5: Existing plans offering a High Deductible Health Plan (HDHP) without new enrollment codes 

Table 6: Existing and/or new plans offering HDHP with new enrollment codes

Table 7: Service Area Expansions With New Enrollment Codes 

What Must Employees Do? 

• Enrollees in these plans must make an enrollment change to enroll in the new code for their 

service area or elect another health plan during the open season. 

What Must You Do? 

• We strongly recommend that you distribute a copy of these lists to each employee, along with 

your agency’s notice to employees about open season.

• If you do not distribute the lists, remind employees to check their new health plan brochures 

carefully to see if there have been any changes to their plans’ service areas that will affect them.

2
Table 8: Service Area Expansions Without New Enrollment Codes 

What Must You Do? 

• You must include these new plans and expanded service areas when you count the number of 

eligible employees and place your orders for brochures. 

Table 9: Plan Name Changes 

Table 10: Plans Adding an Option 

Table 11: Plans Adding a Point Of Service Product 

Table 12: Plans Renaming an Option 

Table 13: Plan Mergers 

What Must Employees Do? 

• Secret Service is merging with SAMBA for 2005. Enrollees in code Y7 will be enrolled in the 

new SAMBA standard option, code 444 (self only) or 445 (self and family). Enrollees should 

read the new SAMBA brochure carefully because there are major benefit changes from the plan 

they currently have. If enrollees do not want to be in this plan option, they must elect another 

health plan during the open season.

• Cimarron Health Plan is merging with Lovelace Health Plan. Enrollees in Cimarron (PX) will be 

automatically transferred into Lovelace Health Plan (Q1) unless they select another health plan 

during open season. 

Table 14: Code Mergers 

What Must Employees Do? 

• Nothing, unless they want to select another plan during open season. Payroll offices will 

automatically move enrollees into the surviving code.

Table 15: Plans Splitting a Service Area 

Table 16: Service Area Movement 

SPECIAL NOTICE 

Secret Service (enrollment code Y7) and SAMBA (enrollment code 44), both nationwide fee-for-service 

plans open to specific groups are merging their plans. Beginning in 2005, SAMBA is the surviving plan 

and it will have two options. Members of both organizations will be able to join either option. Unless the 

enrollees switch to another plan or option during open season, current SAMBA enrollees will 

automatically be enrolled in the high option and current Secret Service enrollees will automatically be 

enrolled in the standard option.

 Frank D. Titus 

 Assistant Director 

 for Insurance Services 

Attachments 

3
TABLE 1 

PLANS DROPPING OUT OF THE FEHB PROGRAM FOR 2005 

Employees in these plans who do not change health plans during open season will not have health 

benefits for 2005. 

State Plan Name Code

Alabama HealthSpring of Alabama, Inc. DF 

Indiana M*Plan IN

TABLE 2 

PLANS REDUCING THEIR SERVICE AREAS 

BY TERMINATING AN ENROLLMENT CODE 

Enrollees in this enrollment code who do not change health plans during open season will not have 

health benefits for 2005. 

State Plan Name General Location Code Terminated 

Florida Vista Healthplan Pensacola RK

TABLE 3 

PLANS REDUCING THEIR SERVICE AREAS 

WITHOUT TERMINATING AN ENROLLMENT CODE 

Enrollees in the area 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 2005. 

State Plan Name Code Area Dropped 

Colorado PacifiCare of Colorado D6 Counties of: Larimer and Weld 

Hawaii Kaiser Foundation Health Plan 

Hawaii 

63 The Island of Kauai 

Illinois John Deere Health Plan YH Counties of: Bureau, De Witt, Knox, La 

Salle, Livingston, McLean, Marshall, Peoria, 

Stark, Tazewell, Warren, and Woodford 

TABLE 4 

NEW PLANS ENTERING THE PROGRAM FOR 2005 

State Plan Name Code General Location 

Delaware Coventry Health Care of Delaware 2J Most of Delaware 

Georgia Coventry Health Care of Georgia L5 Atlanta greater metropolitan area 

Maryland Coventry Health Care of Delaware IG Most of Maryland 

Missouri Community Health Plan IC Northeast Kansas and Northwest Missouri 

Nebraska Coventry Health Care of Nebraska IE Omaha metropolitan area 

New Jersey Coventry Health Care of Delaware 2J Southern New Jersey

Nevada NevadaCare IF Clark County

Oklahoma GlobalHealth, Inc. IM Oklahoma City

Pennsylvania Coventry Health Care of Delaware 2J Southeastern Pennsylvania

South Carolina Carolina Care Health Plan IB All Counties in South Carolina 

Wisconsin Prevea Health Plan ID Wisconsin 

4
TABLE 5 

EXISTING PLANS OFFERING A HIGH DEDUCTIBLE HEALTH PLAN (HDHP) WITHOUT 

NEW ENROLLMENT CODES

State Plan Name Code

Alaska Aetna HealthFund 22

Alabama Aetna HealthFund 22

Arkansas Aetna HealthFund 22

Arizona Aetna HealthFund 22

California Aetna HealthFund 22

California Universal Care 6Q

Colorado Aetna HealthFund 22

Connecticut Aetna HealthFund 22

Delaware Aetna HealthFund 22

District of Columbia Aetna HealthFund 22 

Florida Aetna HealthFund 22

Georgia Aetna HealthFund 22

Illinois Aetna HealthFund 22

Illinois Group Health Plan, Inc. MM 

Illinois OSF Health Plans 9F 

Indiana Advantage Health Solutions 6Y 

Indiana Aetna HealthFund 22

Iowa Coventry Health Care of Iowa SV 

Kansas Aetna HealthFund 22

Kentucky Aetna HealthFund 22

Louisiana Coventry Health Care of Louisiana BJ 

Louisiana Coventry Health Care of Louisiana JA 

Maryland Aetna HealthFund 22

Massachusetts Aetna HealthFund 22

Michigan Aetna HealthFund 22

Mississippi Aetna HealthFund 22

Missouri Aetna HealthFund 22

Missouri Group Health Plan, Inc. MM 

North Carolina Aetna HealthFund 22 

Nevada Aetna HealthFund 22

New Hampshire Aetna HealthFund 22 

New Jersey Aetna HealthFund 22 

New York Aetna HealthFund 22 

Ohio Aetna HealthFund 22

Ohio Aultcare 3A

Oklahoma Aetna HealthFund 22

TABLE 5 

5
(CONT’D.) 

EXISTING PLANS OFFERING A HIGH DEDUCTIBLE HEALTH PLAN (HDHP) WITHOUT 

NEW ENROLLMENT CODES 

State Plan Name Code

Pennsylvania Aetna HealthFund 22

South Carolina Aetna HealthFund 22 

Tennessee Aetna HealthFund 22

Texas Aetna HealthFund 22

Virginia Aetna HealthFund 22

Washington Aetna HealthFund 22

TABLE 6 

EXISTING AND/OR NEW PLANS OFFERING HDHP WITH NEW ENROLLMENT CODES 

State Plan Name Codes

Nationwide GEHA 34

Nationwide Mailhandlers 48

Delaware Coventry Health Care of Delaware 2J 

Georgia Coventry Health Care of Georgia L5 

Kansas Coventry Health Care of Kansas 

(Kansas City) 

9H 

Kansas Coventry Health Care of Kansas (Wichita) 7G 

Maryland Coventry Health Care of Delaware IG 

New Jersey Coventry Health Care of Delaware 2J 

Pennsylvania Coventry Health Care of Delaware 2J 

Pennsylvania (Greater Pittsburgh 

area) 

HealthAmerica Y6

Pennsylvania (Central Pennsylvania 

area) 

HealthAmerica YW

Pennsylvania (Northeastern 

Pennsylvania area) 

HealthAmerica YN

Pennsylvania (Southeastern 

Pennsylvania area) 

HealthAmerica 9N

TABLE 7 

SERVICE AREA EXPANSIONS WITH NEW ENROLLMENT CODES 

State Plan Name New Code General Location 

Colorado Aetna 9E Counties in the Denver area: 

Adams, Arapahoe, Boulder, 

Denver, Douglas, El Paso, 

Elbert, Fremont, Jefferson, 

Larimer, Mesa, Pueblo, and 

Teller 

Colorado Humana CoverageFirst 7T Counties in the Denver area: 

Adams, Arapahoe, 

Broomfield, Denver, Douglas, 

and Jefferson 

6
TABLE 7 

(CONT’D.) 

SERVICE AREA EXPANSIONS WITH NEW ENROLLMENT CODES 

State Plan Name New Code General Location 

Florida Humana CoverageFirst YG Counties in the Orlando area:

 Lake, Orange, Osceola, and 

Seminole 

Illinois Aetna IK Counties in the Chicago 

area: Cook, DuPage, Kane, 

Kankakee, Lake, McHenry,

and Will 

Indiana Aetna IK County in Northern IN: 

Lake 

Kansas Aetna KS Counties in the Kansas City, 

KS area: Atchison, Douglas, 

Franklin, Johnson, 

Leavenworth, Miami, and 

Wyandotte 

Kentucky Humana CoverageFirst 6N Counties in the Lexington 

area: Anderson, Bath, 

Bourbon, Boyle, Bracken, 

Clark, Estill, Fayette, 

Fleming, Franklin, Garrard, 

Harrison, Jessamine, 

Madison, Menifee Mercer, 

Montgomery, Nicholas, 

Owen, Powell, Robertson, 

Scott, and Woodford 

Louisiana Humana CoverageFirst 9J Parishes in the New Orleans 

area: Jefferson, Lafourche, 

Orleans, Plaquemines, Saint 

Bernard, Saint Charles, Saint 

James, Saint John the 

Baptist, Saint Mary, Saint 

Tammany, Tangipahoa, 

Terrebonne, and Washington 

Louisiana Humana CoverageFirst 9L Parishes in the Baton Rouge 

area: Ascension, 

Assumption, East Baton 

Rouge, East Feliciana, 

Iberville, Livingston, Pointe 

Coupee, Saint Helena, West 

Baton Rouge, and West 

Feliciana 

Louisiana Humana CoverageFirst 9S Parishes in the Shreveport 

area: Bienville, Bossier, 

Caddo Claiborne, De Soto, 

Jackson, Lincoln, Red River, 

Sabine, and Webster 

7
TABLE 7 

(CONT’D.) 

SERVICE AREA EXPANSIONS WITH NEW ENROLLMENT CODES 

State Plan Name New

Code 

General Location 

Missouri Aetna KS Counties in the Kansas City, MO area:

Buchanan, Cass, Clay, Jackson, 

Lafayette, Platte, and Ray

Nevada Health Plan Of Nevada 2L Counties of: Lyon, Mineral, and 

Washoe 

Ohio Aetna ND Entire Counties in the Columbus area:

Coshocton, Delaware, Fairfield, Fayette, 

Guernsey, Hocking, Knox, Licking, 

Madison, Marion, Morgan, Morrow, 

Muskingum, Noble, Perry, Pickaway, 

Pike, Ross, Scioto, and Union; 

Partial Counties in the Columbus area: 

Adams County – Towns of: 

Bentonville, Blue Creek, Cherry Fork, 

Lynx, Manchester, Peebles, Seaman, 

Stout, West Union, and Winchester; 

Franklin County – Towns of: Amlin, 

Blacklick, Brice, Canal Winchester, 

Columbus, Dublin, Galloway, Grove 

City, Groveport, Harrisburg, Hilliard, 

Lockbourne, New Albany, 

Reynoldsburg, and Westerville 

Pennsylvani

a 

HealthAmerica PN Counties of: Chester and Delaware 

Washington PacifiCare Northwest Region 

(formerly PacifiCare of Oregon) 

SA Counties of: Grays Harbor, King, Lewis, 

Mason Pierce, Snohomish, and Thurston 

TABLE 8 

SERVICE AREA EXPANSIONS WITHOUT NEW ENROLLMENT CODES 

State Plan Name Code General Location of New Area 

Alabama Aetna HealthFund 

(Consumer-Driven) 

22 Counties of: Lamar and Pickens 

Alaska Aetna HealthFund 

(Consumer-Driven) 

 

 

 

22 Counties in the Anchorage and 

Fairbanks areas: Aleutians East, 

Aleutians West, Anchorage, Bethel, 

Bristol Bay, Denali, Dillingham,

Juneau, Kenai Peninsula, Ketchikan 

Gateway, Kodiak Island, Lake and 

Peninsula, Matanuska Susitna, Nome, 

North Slope, Skagway Yakutat 

Angoon, Southeast Fairbanks, Valdez 

Cordova, and Yukon Koyukuk 

8
TABLE 8 

(CONT’D.) 

SERVICE AREA EXPANSIONS WITHOUT NEW ENROLLMENT CODES 

State Plan Name Code General Location of 

New Area 

Arizona Aetna HealthFund 

(Consumer-Driven) 

 

22 Counties in the Phoenix 

and Tucson areas: 

Apache, Cochise, 

Coconino Gila, Graham, 

Greenlee, La Paz, 

Maricopa, Mohave, 

Navajo, Pima, Pinal, 

Santa Cruz, Yavapai, 

and Yuma

Arkansas Aetna HealthFund

(Consumer-Driven) 

 

22 Counties of Eastern 

Arkansas: Crittenden, 

Cross, Lee, Mississippi, 

Phillips, and St. Francis 

Colorado Aetna HealthFund

(Consumer-Driven) 

 

22 Counties in the Denver 

area: Adams, Arapahoe, 

Boulder, Broomfield, 

Clear Creek, Denver, 

Douglas, El Paso, 

Elbert, Fremont, Gilpin, 

Jefferson, Larimer, 

Mesa, Pueblo, Teller, 

and Weld 

Delaware Aetna HealthFund

(Consumer-Driven) 

22 Entire State

Florida Aetna HealthFund

(Consumer-Driven) 

 

22 Counties in the 

Jacksonville area: 

Baker, Clay, Duval, 

Flagler, Nassau, and St. 

Johns; 

Counties in the Miami 

area: Broward and 

Miami-Dade; 

Counties in the Orlando 

area: Lake, Orange, 

Osceola, Seminole, and 

Sumter; 

Counties in the Tampa 

area: Charlotte, 

Hillsborough, Manatee, 

Pasco, Pinellas, Polk, 

and Sarasota. 

9
TABLE 8 

(CONT’D.) 

SERVICE AREA EXPANSIONS WITHOUT NEW ENROLLMENT CODES 

State Plan Name Code General Location of New Area 

Illinois Aetna HealthFund

(Consumer-Driven) 

22 Counties in the Chicago area: Grundy

and Kendall; 

Counties of Southwestern Illinois: 

Alexander, Bond, Calhoun, Clinton, 

Fayette, Jersey, Macoupin, Madison, 

Monroe, Montgomery, Randolph, and 

St. Clair 

Illinois Health Alliance HMO FX Counties of: Alexander, Boone, Clay, 

Crawford, Edwards, Hamilton, 

Jefferson, Knox, Lawrence, Massac, 

Marion, Pope, Pulaski, Richland, Stark, 

Wabash, Wayne, White and Winnebago 

Indiana Advantage Health Solutions 6Y Entire counties of: Benton, Newton, 

and Warren. 

Partial counties by zip codes: 

Bartholomew (47203), Clay (47841, 

47846), and Owen (47427, 47433, and 

47868) 

Indiana Aetna HealthFund

(Consumer-Driven) 

22 Counties of Eastern Indiana: Dearborn, 

Franklin, Ohio, and Switzerland 

Kansas Aetna HealthFund

(Consumer-Driven) 

22 Counties in the Kansas City and 

Southeastern Kansas areas: Allen, 

Anderson, Atchison, Chautauqua, 

Douglas, Franklin, Johnson, 

Leavenworth, Miami, Montgomery, and 

Wyandotte 

Kansas Coventry Health Care of Kansas 7W Counties of: Chase, Chautauqa, Coffey,

Elk, Geary, Morris, Riley, Wilson, and 

Woodson 

Kansas Coventry Health Care of Kansas HA Counties of Kansas: Brown, Osage, 

Pottawatomie, and Wabaunsee. 

Counties of Missouri: Barton, 

Christian, Dade, Dallas, Greene, Jasper, 

Lawrence, Newton, Polk, Vernon, and 

Webster 

Kentucky Aetna RD Counties of Northern Kentucky: 

Boone, Campbell, Gallatin, Grant, 

Kenton, and Pendleton 

Kentucky Aetna HealthFund

(Consumer-Driven) 

22 Counties of: Boone, Boyd, Campbell, 

Carter, Fulton, Gallatin, Grant, 

Greenup, Kenton, Lawrence, Lewis, 

Mason, and Pendleton 

Louisiana Vantage Health Plan, Inc. MV Parishes in the Shreveport/Alexandria 

10
areas: DeSoto, Grant, LaSalle, and 

Sabine 

TABLE 8 

(CONT’D.) 

SERVICE AREA EXPANSIONS WITHOUT NEW ENROLLMENT CODES 

State Plan Name Code General Location of New Area 

Massachusetts AetnaHealthFund

(Consumer-Driven) 

22 Counties in the Boston area: 

Barnstable, Berkshire, Bristol, Essex, 

Franklin, Hampden, Hampshire, 

Middlesex, Norfolk, Plymouth, 

Suffolk, and Worcester 

Michigan Aetna HealthFund

(Consumer-Driven) 

22 Counties in the Detroit area: 

Livingston, Macomb, Monroe, 

Oakland, Washtenaw, and Wayne 

Michigan HealthPlus of Michigan X5 Northern Oakland County

Mississippi Aetna HealthFund

(Consumer-Driven) 

22 Counties of Northern Mississippi: 

Alcorn, Benton, Bolivar, Calhoun, 

Chickasaw, Coahoma, DeSoto, 

Grenada, Itawamba, Lafayette, Lee, 

Lowndes, Marshall, Monroe, Panola, 

Pontotoc, Prentiss, Quitman, Tate, 

Tippah, Tunica, and Union 

Missouri Aetna HealthFund

(Consumer-Driven) 

22 Counties in the Kansas City, MO and 

St. Louis areas: Buchanan, Cass, 

Clay, Clinton, Crawford, Franklin, 

Henry, Jackson, Jefferson, Lafayette, 

Lincoln, Platte, Ray, St. Charles, St. 

Francois, St. Louis, St. Genevieve, 

and Warren 

Nevada Aetna HealthFund

(Consumer-Driven) 

22 Counties in the Las Vegas area: 

Clark and Nye 

New Hampshire Aetna HealthFund 

(Consumer-Driven) 

22 Counties of: Belknap, Carroll, 

Cheshire, Coos, Hillsborough, 

Merrimack, Rockingham, and 

Stafford 

New York Aetna HealthFund 

(Consumer-Driven) 

22 Counties in Upstate NY in the 

Rochester/Syracuse areas: Albany, 

Broome, Cayuga, Chemung, 

Chenango, Columbia, Cortland, 

Delaware, Fulton, Genesee, Greene, 

Herkimer, Livingston, Madison, 

Monroe, Montgomery, Oneida, 

Onondaga, Ontario, Orleans, 

Oswego, Rensselaer, Saratoga, 

Schenectady, Schuyler, Seneca, 

Steuben, Tioga, Tompkins, Warren, 

Washington, Wayne, and Yates 

11
TABLE 8 

(CONT’D.) 

SERVICE AREA EXPANSIONS WITHOUT NEW ENROLLMENT CODES 

State Plan Name Code General Location of New Area 

New York MVP Health Care M9 Counties of: Cortland and Jefferson 

New York MVP Health Care MX Rockland County

North Carolina Aetna HealthFund 

(Consumer-Driven) 

 

22 Counties in the Raleigh/Durham areas: 

Alamance, Bladen, Caswell, Chatham,

Cumberland, Durham, Franklin, 

Granville, Greene, Harnett, Johnston, 

Lee, Lenoir, Nash, Orange, Person, 

Robeson, Sampson, and Wake; 

Counties in the Charlotte area and 

Central NC: Anson, Cabarrus, 

Cleveland, Gaston, Iredell, Lincoln, 

Mecklenburg, Rowan, Rutherford, 

Stanly, and Union 

Ohio Aetna 7D Entire Counties in the Toledo area: 

Allen, Hancock, Hardin, Henry, Lucas, 

Putnam, Sandusky, and Seneca; 

Partial Counties in the Toledo area: 

Auglaize - Towns of Buckland and 

Lima; Erie – Towns of Berlin Heights, 

Birmingham, Castalia, Huron, Kelleys

Island, Milan, Sandusky, and Vermilion; 

Fulton – Towns of Metamora and 

Swanton; Huron – Towns of Collins, 

Greenwich, New London, and 

Wakeman; 

Wood – Towns of Grand Rapids, 

Haskins, Millbury, Northwood, 

Perrysburg, Rossford, Stony Ridge, and 

Walbridge 

Ohio Aetna HealthFund

(Consumer-Driven) 

22 Counties in the Cincinnati area: Adams, 

Brown, Butler, Champaign, Clark, 

Clermont, Clinton, Darke, Greene, 

Hamilton, Highland, Logan, Miami, 

Montgomery, Preble, Shelby, and 

Warren; 

Counties in the Cleveland area: 

Ashland, Ashtabula, Carroll, 

Columbiana, Cuyahoga, Geauga, 

Harrison, Holmes, Jefferson, Lake, 

Lorain, Mahoning, Medina, Portage, 

Richland, Stark, Summit, Trumbull, 

Tuscarawas, and Wayne; 

Counties in the Columbus and Central 

Ohio areas: Athens, Belmont, 

12
Coshocton, Delaware, Fairfield, Fayette, 

Franklin, Gallia, Guernsey, Hocking, 

Jackson, Knox, Lawrence, Licking, 

Madison, Marion, Meigs, Monroe, 

TABLE 8 

(CONT’D.) 

SERVICE AREA EXPANSIONS WITHOUT NEW ENROLLMENT CODES 

State Plan Name Code General Location of New Area 

Ohio Aetna HealthFund

(Consumer-Driven) 

 

22 (Cont’d.)Counties in the Columbus 

and Central Ohio areas: Morgan, 

Morrow, Muskingum, Noble, Perry, 

Pickaway, Pike, Ross, Scioto, Union, 

Vinton, and Washington; 

Counties in the Toledo area: Allen, 

Auglaize, Crawford, Defiance, Erie, 

Fulton, Hancock, Hardin, Henry,

Huron, Lucas, Mercer, Ottawa, 

Paulding, Putnam, Sandusky, 

Seneca, Van Wert, Williams, Wood, 

and Wyandot 

Oklahoma Aetna HealthFund

(Consumer-Driven) 

22 Counties in the Oklahoma City and 

Tulsa areas: Adair, Atoka, Bryan, 

Cherokee, Choctaw, Coal, Craig, 

Creek, Delaware, Haskell, Johnston, 

Kay, Latimer, Le Flore, Lincoln, 

Mayes, Muskogee, Noble, Nowata, 

Okmulgee, Osage, Ottawa, Pawnee, 

Payne, Pittsburg, Pushmataha, 

Rogers, Tulsa, Wagoner, and 

Washington 

Pennsylvania Aetna Health Fund 

(Consumer-Driven) 

22 Counties in the Pittsburgh area: 

Allegheny, Armstrong, Beaver, 

Blair, Butler, Cambria, Clarion, Erie, 

Fayette, Greene, Indiana, Jefferson, 

Lawrence, Mercer, Somerset, 

Washington, and Westmoreland 

Pennsylvania HealthAmerica 26 Clarion County

South Carolina Aetna HealthFund 

(Consumer-Driven) 

22 York County 

South Dakota Avera Health Plan, Inc. AV Roberts County

Tennessee Aetna HealthFund

(Consumer-Driven) 

22 Counties in the Memphis area: 

Carroll, Dyer, Fayette, Gibson, Lake, 

Lauderdale, Obion, Shelby, Tipton, 

and Weakley;

Counties in the Nashville area: 

Bedford, Cannon, Cheatham, Coffee, 

Davidson, DeKalb, Dickson, 

Franklin, Giles, Lawrence, Lewis, 

Lincoln, Macon, Maury,

Montgomery, Moore, Robertson, 

13
Rutherford, Smith, Sumner, 

Trousdale, Williamson, and Wilson 

TABLE 8 

(CONT’D.) 

SERVICE AREA EXPANSIONS WITHOUT NEW ENROLLMENT CODES 

Texas Aetna HealthFund

(Consumer-Driven) 

22 Counties in the Austin area: Bastrop, 

Bell, Blanco, Burnet, Caldwell, 

Fayette, Hays, Lee, Travis, and 

Williamson; 

Counties in the Dallas/Ft. Worth 

areas: Camp, Cherokee, Collin, 

Cooke, Dallas, Delta, Denton, Ellis, 

Erath, Fannin, Franklin, Freestone, 

Grayson, Gregg, Harrison, 

Henderson, Hill, Hood, Hopkins, 

Hunt, Johnson, Kaufman, Lamar, 

Marion, Montague, Morris, Navarro, 

Palo Pinto, Parker, Rains, Red River, 

Rockwall, Smith, Somervell, Tarrant, 

Titus, Upshur, Van Zandt, Wise and 

Wood; 

Counties in the Houston area: 

Austin, Brazoria, Chambers, 

Colorado, Fort Bend, Galveston, 

Grimes, Hardin, Harris, Jasper, 

Jefferson, Liberty, Matagorda, 

Montgomery, Newton, Orange, San 

Jacinto, Tyler, Walker, Waller, and 

Wharton; 

Counties in the San Antonio area: 

Atascosa, Bandera, Bexar, Comal, 

De Witt, Guadalupe, Kendall, 

Lavaca, Medina, and Wilson 

Utah Altius Health Plan 9K Iron County

Virginia Aetna HealthFund

(Consumer-Driven) 

22 County in the Richmond area and 

Central VA: Culpeper 

Virginia MDIPA JP Counties of: Frederick and 

Shenandoah; City of Winchester 

Washington KPS Health Plan VT, L1 Counties of: Adams, Asotin, Benton, 

Chelan, Columbia, Douglas, Ferry, 

Franklin, Garfield, Grant, Kittitas, 

Klickitat, Lincoln, Okanogan, Pend 

Oreille, Spokane, Stevens, Walla 

Walla, Whitman, and Yakima

West Virginia The Health Plan of the 

Upper Ohio Valley

U4 Tucker County

Wisconsin Dean Health Plan WD Adams County

14
TABLE 9 

PLAN NAME CHANGES 

State Plan Name (Old) Code Plan Name (New) 

National Aetna Health WQ, 2X, 9E, 2U, 

IK, RD, KS, P3, 

Y1, JC, ND, 7D, 

SL, YE, UB, 6J, 

P1, PU, 8G, 8J 

Aetna 

Arizona PacifiCare Desert Region A3 PacifiCare of Arizona 

District of Columbia Aetna Health JN Aetna Open Access 

Northern/Central/Southern 

Maryland 

Aetna Health JN Aetna Open Access 

Nevada PacifiCare Desert Region K9 PacifiCare of Nevada 

North Dakota Heart of America HMO RU Heart of America Health Plan 

Oregon PacifiCare of Oregon 7Z PacifiCare Northwest Region 

Northern/Central/Richmond, 

Virginia 

Aetna Health JN Aetna Open Access 

Washington PacifiCare of Oregon 7Z, SA PacifiCare Northwest Region 

TABLE 10 

PLANS ADDING AN OPTION 

Enrollees who do not choose the Standard Option will automatically be enrolled in the High 

Option. 

State Plan Name Code New Option 

Nationwide SAMBA 44 Standard Option

California Kaiser Foundation Health Plan of California 59, 62 Standard Option 

Colorado Kaiser Foundation Health Plan of Colorado 65 Standard Option

District of Columbia Kaiser Foundation Health Plan of Mid-Atlantic E3 Standard Option

Florida Av-Med ML Standard Option

Georgia Kaiser Foundation Health Plan of Georgia F8 Standard Option

Kansas Coventry Health Care of Kansas (Wichita) 7W Standard Option 

Kansas Coventry Health Care of Kansas (Kansas City) HA Standard Option 

Kentucky United Healthcare of Ohio 3U Standard Option 

Maryland Kaiser Foundation Health Plan of Mid-Atlantic E3 Standard Option

Massachusetts Fallon Community Health Plan JV Standard Option

New York GHI HMO Select, Inc. 6V, X4 Standard Option

Ohio United HealthCare of Ohio 3U Standard Option 

Virginia Kaiser Foundation Health Plan of Mid-Atlantic E3 Standard Option 

TABLE 11 

PLANS ADDING A POINT OF SERVICE PRODUCT 

State Plan Name Code General Location 

Kentucky United Healthcare of Ohio 3U Northern Kentucky

Montana New West Health Services NV Most of Montana 

15
New York Independent Health Assoc. QA Western New York 

Ohio United Healthcare of Ohio 3U Cincinnati, Dayton, and Springfield 

areas 

TABLE 12 

PLANS RENAMING AN OPTION 

State Plan Name Code Option (2004) Option (2005) 

District of Columbia Aetna Open Access 

(formerly Aetna Health) 

JN Standard Option Basic Option 

Northern/Central/Southern 

Maryland 

Aetna Open Access 

(formerly Aetna Health) 

JN Standard Option Basic Option 

Northern/Central/Richmond, 

Virginia 

Aetna Open Access 

(formerly Aetna Health) 

JN Standard Option Basic Option 

TABLE 13 

PLAN MERGERS 

Enrollees in Secret Service (code Y7) will be moved to SAMBA standard option, code 444 and 445. 

If they want to be in the SAMBA high option or in another plan, they must make a change during 

open season. 

Enrollees in Cimarron Health Plan will automatically be transferred into Lovelace Health Plan 

unless they select another health plan during open season. 

State Merging Plans Codes Surviving Plan Surviving Codes 

Nationwide Secret Service (Y7) 

merged w/SAMBA (44) 

Y7, 44 SAMBA 44 

New Mexico Cimarron Health Plan (PX) 

merged w/Lovelace (Q1) 

PX, Q1 Lovelace Q1 

TABLE 14 

CODE MERGERS 

Payroll offices will automatically move enrollees into the surviving code unless the enrollees select 

another health plan during open season. 

State Plan Name Code (2004) Code (2005) 

Michigan Bluecare Network of Michigan KN K5 

Michigan Bluecare Network of Michigan KF KR 

New York Capital District Physicians’ Health Plan PW, QB SG 

Pennsylvania Health America VJ 26

TABLE 15 

PLANS SPLITTING A SERVICE AREA 

In 2005, enrollment code PU will cover Dallas/Ft. Worth only. Enrollment code 8G will cover the 

Houston, Texas area. If you live and/or work in the Houston area and want to remain in this plan, 

you must change to the new enrollment code (8G) or select another health plan during open season. 

State Plan Name General Location Code (2004) Code (2005) 

Texas Aetna Counties in the Houston area: Austin, Brazoria, 

Chambers, Colorado, Fort Bend, Galveston, 

Grimes, Hardin, Harris, Jefferson, Liberty,

PU 8G

16
Matagorda, Montgomery, Orange, San Jacinto, 

Walker, Waller, and Wharton 

TABLE 16 

SERVICE AREA MOVEMENT 

Plan will move the counties listed below from enrollment code 4N to enrollment code SW. 

Enrollees in code 4N who live in the counties listed below must make an enrollment change to the 

new code for their service area (code SW) or elect another health plan during the open season. If 

you live in one of the counties listed below and do not make the necessary change to the new code, 

you will pay the higher code 4N premium. 

State Plan Name Code (2004) Code (2005) General Location 

Pennsylvani

a 

HealthAmerica 4N SW Counties of: Clinton, Columbia, 

Lycoming, and Montour 

17