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Indiana State Personnel Department

2012 plan rates 2012 plan rates

Effective dates

Health, dental, vision, Health Savings Accounts and Flexible Spending Accounts changes/enrollments will be effective January 1, 2012. Life insurance changes/enrollments that do not require Evidence of Insurability with approval from AUL will be effective Jan. 8, 2012, for payroll A and Jan. 1, 2012, for payroll B.

Deductions for health, dental and vision will begin:
Payroll A: Dec. 21, 2011 (7 days at old plans & rates; 7 days for new plans & rates)
Payroll B: Dec. 28, 2011 (full 2012 rates)

Deductions for the Flexible Spending Accounts and Health Savings Accounts will begin on the following dates:
Payroll A: Jan.4, 2012
Payroll B: Jan. 11, 2012

2012 Rates

Plan Coverage Bi-Weekly Employee Rate Bi-Weekly Employer Rate Bi-Weekly Total Rate Annual Employee Rate Annual Employer Rate
CDHP 1 Single
Family
$30.67
$40.82
$153.35
$482.92
$184.02
$523.74
$797.42
$1,061.32
$3,987.10
$12,555.92
CDHP 1 w/ Non-tobacco incentive Single
Family
$5.67
$15.82
$153.35
$482.92
$159.02
$498.74
$147.42
$411.32
$3,987.10
$12,555.92
CDHP 2 Single
Family
$55.51
$110.90
$170.63
$517.60
$226.14
$628.50
$1,443.26
$2,883.40
$4,436.38
$13,457.60
CDHP 2 w/ Non-tobacco incentive Single
Family
$30.51
$85.90
$170.63
$517.60
$201.14
$603.50
$793.26
$2,233.40
$4,436.38
$13,457.60
Trad PPO Single
Family
$151.27
$376.40
$196.55
$569.44
$347.82
$945.84
$3,933.02
$9,786.40
$5,110.30
$14,805.44
Trad PPO w/ Non-tobacco incentive Single
Family
$126.27
$351.40
$196.55
$569.44
$322.82
$920.84
$3,283.02
$9,136.40
$5,110.30
$14,805.44
Dental Single
Family
$1.20
$3.16
$10.02
$26.36
$11.22
$29.52
$31.20
$82.16
$260.52
$685.36
Vision Single
Family
$0.17
$2.52
$1.47
$1.64
$1.64
$4.16
$4.42
$65.52
$38.22
$42.64
Flexible Spending Accounts Medical Limited Purpose
Medical (HSA Holders) and/or
Dependent Care Admin Fee
$2.00 $0.00 $2.00 $52.00 $0.00

To view rates for early retirees, COBRA and the annual total rates: View entire rate chart

Health Savings Accounts

HSA Account Coverage Initial Contribution* Bi-Weekly Contribution Monthly Contribution Maximum Annual ER Contribution
HSA 1 w/CDHP 1 Single
Family
$561.60
$1,124.76
$21.60
$43.26
$46.80
$93.73
$1,123.20
$2,249.52
HSA 2 w/CDHP 2 Single
Family
$336.96
$673.92
$12.96
$25.92
$28.08
$56.16
$673.92
$1,347.84

*Initial contribution as listed above apply to employees with a CDHP effective between 1/1/12 thru 6/1/12 and with an open HSA. CDHPs effective after 6/1/12 but before 12/1/12 and with an open HSA, will receive 1/2 of the initial contribution.

Employees participating in CDHPs are reminded that they must open an HSA in order to receive the state's HSA contribution or the bank will charge a set-up fee.