Plan Rates
Download the full chart of rates for State of Indiana Employees (2021)
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$216.48
$651.30$285.32
$790.10$1,789.84
$3,608.80$5,628.48
$16,933.80$1,124.76
$2,249.52CDHP 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
$2,249.52CDHP 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
$1,575.60CDHP 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
$1,575.60Traditional 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
$0.00Traditional 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
$0.00Wellness 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
$2,249.52CDHP 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
$2,249.52CDHP 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
$1,575.60CDHP 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
$1,575.60Traditional 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
$0.00Traditional 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
$0.00Dental Single
Family$1.32
$3.42$10.38
$27.30$11.70
$30.72$34.32
$88.92$269.88
$709.80$0.00
$0.00Vision 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