COBRA & Early Retirees - Open Enrollment
State of Indiana Early Retiree and COBRA Participants
If you decide to elect to continue your coverage, please be aware you are also eligible to make Open Enrollment changes for the 2024 plan year. Similar to an active participant, you may elect to change plans, coverage level, add or remove dependents (if applicable) and elect to participate in the Non-Tobacco Use Agreement (NTUA) for the 2024 plan year effective January 1, 2024.
As a COBRA or Early Retiree participant, your Open Enrollment elections are not completed through PeopleSoft. All changes must be completed by paper including the 2024 Non-Tobacco Use Agreement (NTUA). If you do not wish to participate in the Non-Tobacco Use Agreement or make changes to your health plan election, no action is needed.
IMPORTANT DATES
All changes and additions must be mailed to HRPro postmarked no later than November 15, 2023 and will be effective January 1, 2024.
- Non-Tobacco Use Agreement (NTUA): If you only wish to participate in the NTUA for 2024, you must complete and return the Non-Tobacco Use Agreement to HRPro by November 15, 2023.
- Participants who fail to complete and return the NTUA by the deadline will not be eligible for the premium reduction in 2024.
- Please note: If you do not participate in an Anthem medical plan, you DO NOT need to complete the Non-Tobacco Use Agreement.
- Participants who fail to complete and return the NTUA by the deadline will not be eligible for the premium reduction in 2024.
- 2024 Open Enrollment changes: If you wish to make changes to your health plan elections for 2024, you must complete and return the State of Indiana Health Care Plan Enrollment Form to HRPro by November 15, 2023.
- Please note: If you elect COBRA or Early Retiree Insurance but do not complete the State of Indiana Health Care Plan Enrollment Form, your current coverage will roll-over.
Both the 2024 NTUA and the Enrollment Form should be returned to the following address:
HRPro
Attn: SOI Billing Department
1025 N. Campbell Road
Royal Oak, MI 48067
Plan Summaries
CDHP 1
CDHP 2
Traditional Plan
Plan Rates and Comparison
- 2024 COBRA and Early Retiree Monthly Plan Rates
- 2024 COBRA and Early Retiree Plan Comparison
- 2024 Maximum Exposure Calculations - Please note these examples assume employee takes advantage of the Non-Tobacco Use Incentive and costs are incurred within the Anthem provider network.
Federal Notices
- Creditable Coverage Notice | Download notice
- Notice regarding Medicaid and the Children’s Health Insurance Program (CHIP) | Download notice
- USERRA (Military Leave) Notice | Download notice
- HIPAA Notice of Privacy Practices | Download notice
- NEWBORNS’ AND MOTHERS’ HEALTH PROTECTION ACT OF 1996 | Download notice
- WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998 | Download notice
- HIPAA NOTICE OF SPECIAL ENROLLMENT RIGHTS | Download notice
- Nondiscrimination Notice | Download notice
- Notice Regarding Wellness Program | Download notice
- Your Rights and Protections Against Surprise Medical Bills | Download notice