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Plan Rates

  • Download the full chart of rates for State of Indiana Employees (2021)

    PlanCoverage 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     		$68.84
    $138.80     		$216.48
    $651.30     		$285.32
    $790.10     		$1,789.84
    $3,608.80     		$5,628.48
    $16,933.80     		$1,124.76
    $2,249.52
    CDHP 1 w/ Non-Tobacco Use Incentive Single
    Family     		$33.84
    $103.80     		$216.48
    $651.30     		$250.32
    $755.10     		$879.84
    $2,698.80     		$5,628.48
    $16,933.80     		$1,124.76
    $2,249.52
    CDHP 2 Single
    Family     		$81.90
    $186.54     		$229.44
    $677.22     		$311.34
    $863.76     		$2,129.40
    $4,850.04     		$5,965.44
    $17,607.72     		$787.80
    $1,575.60
    CDHP 2 w/ Non-Tobacco Use Incentive Single
    Family     		$46.90
    $151.54     		$229.44
    $677.22     		$276.34
    $828.76     		$1,219.40
    $3,940.04     		$5,965.44
    $17,607.72     		$787.80
    $1,575.60
    Traditional Single
    Family     		$134.40
    $374.64     		$259.74
    737.82     		$394.14
    $1,112.46     		$3,494.40
    $9,740.64     		$6,753.24
    $19,183.32     		$0.00
    $0.00
    Traditional w/ Non-Tobacco Use Incentive Single
    Family     		$99.40
    $339.64     		$259.74
    737.82     		$359.14
    $1,077.46     		$2,584.40
    $8,830.64     		$6,753.24
    $19,183.32     		$0.00
    $0.00
    Wellness Incentive Rates       
    CDHP 1 Single
    Family     		$54.44
    $95.60     		$216.48
    $651.30     		$270.92
    $746.90     		$1,415.44
    $2,485.60     		$5,628.48
    $16,933.80     		$1,124.76
    $2,249.52
    CDHP 1 w/ Non-Tobacco Use Incentive Single
    Family     		$19.44
    $60.60     		$216.48
    $651.30     		$235.92
    $711.90     		$505.44
    $1,575.60     		$5,628.48
    $16,933.80     		$1,124.76
    $2,249.52
    CDHP 2 Single
    Family     		$67.50
    $143.34     		$229.44
    $677.22     		$296.94
    $820.56     		$1,755.00
    $3,726.84     		$5,965.44
    $17,607.72     		$787.80
    $1,575.60
    CDHP 2 w/ Non-Tobacco Use Incentive Single
    Family     		$32.50
    $108.34     		$229.44
    $677.22     		$261.94
    $785.56     		$845.00
    $2,816.84     		$5,965.44
    $17,607.72     		$787.80
    $1,575.60
    Traditional Single
    Family     		$120.00
    $331.44     		$259.74
    $737.82     		$379.74
    $1,069.26     		$3,120.00
    $8,617.44     		$6,753.24
    $19,183.32     		$0.00
    $0.00
    Traditional w/ Non-Tobacco Use Incentive Single
    Family     		$85.00
    $296.44     		$259.74
    $737.82     		$344.74
    $1,034.26     		$2,210.00
    $7,707.44     		$6,753.24
    $19,183.32     		$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     		$0.42
    $3.06     		$1.74
    $2.22     		$2.16
    $5.28     		$10.92
    $79.56     		$45.24
    $57.72     		$0.00
    $0.00