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COBRA & Early Retirees - Open Enrollment

STATE OF INDIANA EARLY RETIREE AND COBRA PARTICIPANTS

If you elected to continue your State health coverage through COBRA or Early Retiree Insurance, you are eligible to make Open Enrollment changes for the 2020 plan year. Similar to an active participant, you may elect to change plans, coverage levels, add or remove dependents (if applicable) and elect to participate in the Non-Tobacco Use Agreement (NTUA) for an effective date of January 1, 2020.

As a COBRA or Early Retiree participant, your Open Enrollment elections are not completed through PeopleSoft.  All changes must be completed by paper including the 2020 Non-Tobacco Use Agreement (NTUA).  If you do not wish to participate in the Non-Tobacco Use Agreement or make changes to your health plan election, no action is needed.

IMPORTANT DATES

All changes and additions must be mailed to HRPro postmarked no later than November 20, 2019 and will be effective January 1, 2020.

  • Non-Tobacco Use Agreement (NTUA): If you only wish to participate in the NTUA for 2020, you must complete and return the Non-Tobacco Use Agreement to HRPro by November 20, 2019.
    • Participants who fail to complete and return the NTUA by the deadline will not be eligible for the premium reduction in 2020.
      • Please note: If you do not participate in an Anthem medical plan, you DO NOT need to complete the Non-Tobacco Use Agreement.
  • 2020 Open Enrollment Changes: If you wish to make changes to your health plan elections for 2020, you must complete and return the State of Indiana Health Care Plan Enrollment Form to HRPro by November 20, 2019.
    • Please note: If you elect COBRA or Early Retiree Insurance but do not complete the State of Indiana Health Care Plan Enrollment Form, your current coverage will roll-over.
      • If you are eligible for the 2020 Wellness Premium Discount, your premium will automatically be reduced.
      • If you are enrolled in the 2019 Wellness CDHP, your plan defaults to CDHP 1 unless you make a new selection.

Both the 2020 NTUA and the Enrollment Form should be returned to the following address:

HRPro
Attn: SOI Billing Department
1025 N. Campbell Road
Royal Oak, MI 48067

Plan Rates and Summaries

2020 COBRA and Early Retiree Monthly Plan Rates

2020 Plan Comparison - This document includes information related to office visits, inpatient, ER, urgent care, wellness and prevention and medicine as they relate to each plan.

2020 Maximum Exposure Calculations - Please note these examples assume employee takes advantage of the Non-Tobacco Use Incentive and costs are incurred within the Anthem provider network.

CDHP 1

CDHP 2

Traditional Plan

Prescription Coverage

Carrier Contact Information

Federal Notices

Creditable Coverage Notice

Notice regarding Medicaid and the Children’s Health Insurance Program (CHIP)

USERRA (Military Leave) Notice

HIPAA Notice of Privacy Practices

NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT OF 1996

WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998

HIPAA NOTICE OF SPECIAL ENROLLMENT RIGHTS

Nondiscrimination Notice

Notice Regarding Wellness Program