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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