2012 Retiree Medical Care Plan Rates

Retirees Under Age 65

PPO $900 Deductible for Retirees
Monthly Retiree Premiums
One participant	$   499.79
One participant and child(ren)	$   996.93
Participant and spouse	$1,218.74
Family	$1,384.06

COBRA

IU PPO $400 Deductible
Monthly Premiums	Medical
One participant	$ 546.95
One participant and child(ren)	$1,083.42
Participant and spouse	$1,326.98
Participant and family	$1,506.71

IU PPO $900 Deductible
Monthly Premiums	Medical
One participant	$  499.79
One participant and child(ren)	$  996.93
Participant and spouse	$1,218.74
Participant and family	$1,384.06

IU HDHP PPO
Monthly Premiums	Medical
One participant	$260.15
One participant and child(ren)	$518.91
Participant and spouse	$634.37
Participant and family	$720.43

IU Health Quality Partners Exclusive Provider
Monthly Premiums	Medical
One participant	$  489.66
One participant and child(ren)	$  976.72
Participant and spouse	$1,194.04
Participant and family	$1,356.02

The above health care plans are available to residents of the following areas:

• IU PPO $900 Deductible:  All areas of Indiana, as well as outside the state.
• IU PPO $400 Deductible:  All areas of Indiana, as well as outside the state.
• IU HDHP PPO:  All areas of Indiana, as well as outside the state.
• IU Health Quality Partners: Eligibility is limited to employees residing in the following counties: Blackford, Boone, Brown, Carroll, Clinton, Delaware, Green, Hamilton, Hancock, Hendricks, Henry, Howard, Johnson, Lawrence, Madison, Marion, Monroe, Morgan, Owen, Putnam, Shelby, Tipton, & Tippecanoe.