| Plan | Coverage | Bi-Weekly Employee Rate | Bi-Weekly Employer Rate | Bi-Weekly Total Rate | Annual Employee Rate | Annual Employer Rate | Annual Employer HSA Contribution |
|---|---|---|---|---|---|---|---|
| CDHP 1 |
Single Family |
$68.06 $135.32 |
$331.80 $983.94 |
$399.86 $1,119.26 |
$1,769.56 $3,518.32 |
$8,626.80 $25,582.44 |
$1,124.76 $2,249.52 |
| CDHP 1 w/ Non-Tobacco Use Incentive |
Single Family |
$33.06 $100.32 |
$331.80 $983.94 |
$364.86 $1,084.26 |
$859.56 $2,608.32 |
$8,626.80 $25,582.44 |
$1,124.76 $2,249.52 |
| CDHP 2 |
Single Family |
$82.58 $188.66 |
$344.76 $1,009.86 |
$427.34 $1,198.52 |
$2,147.08 $4,905.16 |
$8,963.76 $26,256.36 |
$787.80 $1,575.60 |
| CDHP 2 w/ Non-Tobacco Use Incentive |
Single Family |
$47.58 $153.66 |
$344.76 $1,009.86 |
$392.34 $1,163.52 |
$1,237.08 $3,995.16 |
$8,963.76 $26,256.36 |
$787.80 $1,575.60 |
| Traditional |
Single Family |
$141.02 $399.08 |
$375.06 $1,070.46 |
$516.08 $1,469.54 |
$3,666.52 $10,376.08 |
$9,751.56 $27,831.96 |
$0.00 $0.00 |
| Traditional w/ Non-Tobacco Use Incentive |
Single Family |
$106.02 $364.08 |
$375.06 $1,070.46 |
$481.08 $1,434.54 |
$2,756.52 $9,466.08 |
$9,751.56 $27,831.96 |
$0.00 $0.00 |
| Dental |
Single Family |
$1.32 $3.42 |
$10.38 $27.30 |
$11.70 $30.72 |
$34.32 $88.92 |
$269.88 $709.80 |
$0.00 $0.00 |
| Vision |
Single Family |
$0.48 $3.36 |
$1.86 $2.40 |
$2.34 $5.76 |
$12.48 $87.36 |
$48.36 $62.40 |
$0.00 $0.00 |
Indiana State Personnel Department