State of Indiana Employee Health Benefits Christy Tittle Benefits Division Director Indiana State Personnel Department

State of Indiana Welborn Summary of Benefits for 2010

Rates PlanCoverage Bi-Weekly Employee Rate Bi-Weekly Employer Rate Bi-Weekly Total Rate Early Retirees (Monthly) COBRA (Monthly) Annual Employee Rate Annual Employer Rate CDHP 1 Single$10.00$128.34$138.34$299.74$305.73$260.00$3, Family$10.00$399.24$409.24$886.69$904.42$260.00$10, CDHP 1 Single$0.00$ $278.07$283.63$0.00$3, W/ Non-Tobacco Use Incentive Family$0.00$ $865.02$882.32$0.00$10, CDHP 2 Single$31.00$149.46$180.46$391.00$398.82$806.00$3, Family$59.68$441.54$501.22$1,085.98$1,107.70$1,551.68$11, CDHP 2 Single$21.00$149.46$170.46$369.33$376.72$546.00$3, W/ Non-Tobacco Use Incentive Family$49.68$441.54$491.22$1,064.31$1,085.60$1,291.68$11, Traditional PPO Single$86.56$181.26$267.82$580.28$591.88$2,250.56$4, Family$231.16$505.02$736.18$1,595.06$1,626.96$6,010.16$13, Traditional PPO Single$76.56$181.26$257.82$558.61$569.78$1,990.56$4, W/ Non-Tobacco Use Incentive Family$221.16$505.02$726.18$1,573.39$1,604.86$5,750.16$13, Welborn HMO Single$58.49$181.26$239.75$519.46$529.85$1,520.74$4, Family$139.04$505.02$644.06$1,395.46$1,423.37$3,615.04$13, Welborn HMO Single$48.49$181.26$229.75$497.79$507.75$1,260.74$4, W/ Non-Tobacco Use Incentive Family$129.04$505.02$634.06$1,373.80$1,401.28$3,355.04$13,130.52

What can be customized? Eligibility - School corporations can define eligible employees as full-time, part-time or a minimum number of hours/per week. The rate split – School corporations shall not pay more than the state; the school corporation employee shall pay at least the amount paid by a state employee. Contributions to an HSA - Your school can decide if you will contribute, how much you will contribute and which financial institution(s) you will use. HSA Accounts CoverageInitial Contribution Bi-Weekly Contribution Monthly Contribution Maximum Annual Employer Contribution HSA 1 Single Family $ $ $26.46 $52.89 $57.33 $ $1, $2, HSA 2 Single Family $ $ $15.90 $31.74 $34.45 $68.77 $ $ Example of state of Indiana employer contributions to state employee HSAs

What cannot be changed? Plan design. The plan designs set by the state are offered to all participants where available. All benefit-eligible employees in your school corporation must be included. You cannot split out employees by classification/groups. Definition of a dependent.

Who is an eligible dependent? Spouse: One’s wife or husband. Children: Unmarried dependent natural, step-, foster-or legally adopted children, children who reside in the employee’s home for whom the employee or spouse have been appointed legal guardian. Dependent Children Age Limit: End of the calendar-year of 19 th birthday, unless they are a full-time student, full-time student on a medically necessary leave or disabled dependent. – Full-time students are covered until the end of the calendar year of their 23 rd birthday. – Disabled dependents need to provide documentation to prove they have not had a break in coverage in excess of 63 days immediately prior to enrolling, certification of their incapacity prior to age 19 and an Attending Physician’s Statement certifying the disability.

What are the fees? The Information Fee (similar to a monthly premium) plus $1.25 per employee per month for COBRA administration.

The insurance carriers will: – Send billing inquiries and adjustments. – Administer COBRA. School corporations will administer HIPAA and FMLA. How will the plan be administered?

When will benefit eligibility begin and end? Annual Open Enrollment will occur at the same time as the Open Enrollment for state employees. – Benefit changes will be effective January 1 st Newly hired and eligible employees’ benefits will be effective the first of the month following their date of hire. Terminated employees’ benefits will end on the last day of the month in which they separate employment.

How will enrollment information be communicated? Group Benefit Coordinator responsibilities: – Communicate benefit options and other annual enrollment information for current and new employees State Personnel Department will provide any updated plan information to the Group Benefit Coordinator for annual enrollment – Complete enrollment of current and new employees on the medical plans – Update carriers with eligibility information – Inform group payroll department of benefit adjustments

How to get started Contact Marcus Bowling at Anthem Or Christy Tittle

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