State of IndianaEmployee Health Benefits

Christy TittleBenefits Division Director

Indiana State Personnel Department

Retail Rx (Up to a 30-day supply)

Mail Order Rx (Up to a 90-day supply)

Standard co-pay

Generic $10 co-pay $20 co-pay

Formulary 20%

min $30, max $50 20%

min $60, max $100 Brand

(Non-Formulary) 40%

min $50, max $70 40%

min $100, max $140

Specialty

40% min $75, max $150

30-day supply

CDHP 1 CDHP 2 Traditional PPO In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network

Deductible Single $2,500 $1,500 $500 $1,000

Family $5,000 $3,000 $1,000 $2,000

Out-of-pocket maximum

Single $4,000 $3,000 $2,000 $4,000

Family $8,000 $6,000 $4,000 $8,000

Office Visit 20% 40% 20% 40% 20% 40%

Inpatient 20% 40% 20% 40% 20% 40%

Emergency Room 20% 40% 20% 40% 20% 40%

Urgent Care 20% 40% 20% 40% 20% 40%

Wellness and Prevention 0%

(No deductible) 40%

(No deductible) 0%

(No deductible) 40%

(No deductible) 0%

(No deductible) 40%

(No deductible)

Prescription Drug Summary below applies to all three plans

CDHP 1, CDHP 2, Traditional PPO

State of Indiana Anthem Benefit Comparison Summary of Benefits for 2010

DeductibleSingle

Family

Out-of-pocket maximumSingle

Family

Office VisitInpatientEmergency RoomUrgent Care

Prescription Drugs

OTC Select Drugs

Generic

Formulary

Brand (Non Formulary)

Biopharmaceutical Drugs/Injectable Drugs

* Subject to Deductible80% coverage

$0

$0

$2,000

$4,000

$20 co-pay

Retail (30-day supply)

$5 co-pay

$10 co-pay

$20 co-pay

60% coverage $40 min, $100 max

*$500 co-pay

*$75 co-pay

*$35 co-pay

In-Network

State of Indiana Welborn Summary of Benefits for 2010

Rates

Plan CoverageBi-Weekly

Employee RateBi-Weekly

Employer RateBi-Weekly Total

RateEarly Retirees

(Monthly)COBRA

(Monthly) Annual

Employee RateAnnual

Employer Rate

CDHP 1Single $10.00 $128.34 $138.34 $299.74 $305.73 $260.00 $3,336.84

Family $10.00 $399.24 $409.24 $886.69 $904.42 $260.00 $10,380.24

CDHP 1Single $0.00 $128.34 $128.34 $278.07 $283.63 $0.00 $3,336.84

W/ Non-Tobacco Use IncentiveFamily $0.00 $399.24 $399.24 $865.02 $882.32 $0.00 $10,380.24

CDHP 2 Single $31.00 $149.46 $180.46 $391.00 $398.82 $806.00 $3,885.96

Family $59.68 $441.54 $501.22 $1,085.98 $1,107.70 $1,551.68 $11,480.04

CDHP 2 Single $21.00 $149.46 $170.46 $369.33 $376.72 $546.00 $3,885.96

W/ Non-Tobacco Use IncentiveFamily $49.68 $441.54 $491.22 $1,064.31 $1,085.60 $1,291.68 $11,480.04

Traditional PPOSingle $86.56 $181.26 $267.82 $580.28 $591.88 $2,250.56 $4,712.76

Family $231.16 $505.02 $736.18 $1,595.06 $1,626.96 $6,010.16 $13,130.52

Traditional PPOSingle $76.56 $181.26 $257.82 $558.61 $569.78 $1,990.56 $4,712.76

W/ Non-Tobacco Use IncentiveFamily $221.16 $505.02 $726.18 $1,573.39 $1,604.86 $5,750.16 $13,130.52

Welborn HMOSingle $58.49 $181.26 $239.75 $519.46 $529.85 $1,520.74 $4,712.76

Family $139.04 $505.02 $644.06 $1,395.46 $1,423.37 $3,615.04 $13,130.52

Welborn HMOSingle $48.49 $181.26 $229.75 $497.79 $507.75 $1,260.74 $4,712.76

W/ Non-Tobacco Use IncentiveFamily $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

Coverage Initial Contribution

Bi-Weekly Contribution

Monthly Contribution

Maximum Annual Employer Contribution

HSA 1 SingleFamily

$687.96$1375.14

$26.46$52.89

$57.33$114.60

$1,375.92$2,750.28

HSA 2 SingleFamily

$413.40$825.24

$15.90$31.74

$34.45$68.77

$826.80$1650.48

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 19th 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 23rd 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 1st

• 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 Anthem317-287-7744

Marcus.bowling@anthem.comOr

Christy Tittle 317-232-3241

ctittle@spd.in.gov

State Personnel Benefits

Benefit Web sitehttp://www.in.gov/spd/2528.htm

Benefit E-mailSPDBenefits@spd.in.gov

Questions????