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Governor Eric J. Holcomb
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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