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Plan Rates

  • Download the full chart of rates for State of Indiana Employees (2022)

    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
    $68.84
    $138.80
    $230.16
    $690.18
    $299.00
    $828.98
    $1,789.84
    $3,608.80
    $5,984.16
    $17,944.68
    $1,124.76
    $2,249.52
    CDHP 1 w/ Non-Tobacco Use Incentive Single
    Family
    $33.84
    $103.80
    $230.16
    $690.18
    $264.00
    $793.98
    $879.84
    $2,698.80
    $5,984.16
    $17,944.68
    $1,124.76
    $2,249.52
    CDHP 2 Single
    Family
    $81.90
    $186.54
    $243.12
    $716.10
    $325.02
    $902.64
    $2,129.40
    $4,850.04
    $6,321.12
    $18,618.60
    $787.80
    $1,575.60
    CDHP 2 w/ Non-Tobacco Use Incentive Single
    Family
    $46.90
    $151.54
    $243.12
    $716.10
    $290.02
    $867.64
    $1,219.40
    $3,940.04
    $6,321.12
    $18,618.60
    $787.80
    $1,575.60
    Traditional Single
    Family
    $134.40
    $374.64
    $273.42
    $776.70
    $407.82
    $1,151.34
    $3,494.40
    $9,740.64
    $7,108.92
    $20,194.20
    $0.00
    $0.00
    Traditional w/ Non-Tobacco Use Incentive Single
    Family
    $99.40
    $339.64
    $273.42
    $776.70
    $372.82
    $1,116.34
    $2,584.40
    $8,830.64
    $7,108.92
    $20,194.20
    $0.00
    $0.00
    Wellness Incentive Rates
    CDHP 1 Single
    Family
    $54.44
    $95.60
    $230.16
    $690.18
    $284.60
    $785.78
    $1,415.44
    $2,485.60
    $5,984.16
    $17,944.68
    $1,124.76
    $2,249.52
    CDHP 1 w/ Non-Tobacco Use Incentive Single
    Family
    $19.44
    $60.60
    $230.16
    $690.18
    $249.60
    $750.78
    $505.44
    $1,575.60
    $5,984.16
    $17,944.68
    $1,124.76
    $2,249.52
    CDHP 2 Single
    Family
    $67.50
    $143.34
    $243.12
    $716.10
    $310.62
    $859.44
    $1,755.00
    $3,726.84
    $6,321.12
    $18,618.60
    $787.80
    $1,575.60
    CDHP 2 w/ Non-Tobacco Use Incentive Single
    Family
    $32.50
    $108.34
    $243.12
    $716.10
    $275.62
    $824.44
    $845.00
    $2,816.84
    $6,321.12
    $18,618.60
    $787.80
    $1,575.60
    Traditional Single
    Family
    $120.00
    $331.44
    $273.42
    $776.70
    $393.42
    $1,108.14
    $3,120.00
    $8,617.44
    $7,108.92
    $20,194.20
    $0.00
    $0.00
    Traditional w/ Non-Tobacco Use Incentive Single
    Family
    $85.00
    $296.44
    $273.42
    $776.70
    $358.42
    $1,073.14
    $2,210.00
    $7,707.44
    $7,108.92
    $20,194.20
    $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