The Trust offers you a variety of medical plan designs ranging from traditional preferred provider (PPO) plans with a lower deductible to high deductible, consumer-driven Health Savings Account (HSA) health plans. UnitedHealthcare is the network provider for all of our medical plans.

Participating municipalities can also buy optional dental and vision coverage at competitive rates through the Aim Medical Trust. Cigna is our partner for group dental and vision coverage providing easy and cost-effective care. Members also have the option to buy group life insurance through our partnership with MetLife.

Click on the button below to download a PDF version of the 2021 Benefits Plan.

2021 HDHP and HRA Medical and Prescription Plan Options

PLAN HIGHLIGHTS $2800 HDP
Plan 7
$2800 HDP
Plan 8
$3000 HDP
Plan 9
$3500 HDP
Plan 10
$4000 HDP
Plan 11
$6500 HDP
Plan 12
$5000 HDP
Plan 13
UnitedHealthcare Choice Plus In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
DEDUCTIBLE
Individual $2,800 $5,600 $2,800 $5,600 $3,000 $6,000 $3,500 $7,000 $4,000 $8,000 $6,500 $13,000 $5,000 $10,000
Family $5,600 $11,200 $5,600 $11,200 $6,000 $12,000 $7,000 $14,000 $8,000 $16,000 $13,000 $26,000 $10,000 $20,000
COINSURANCE (APPLIED AFTER DEDUCTIBLE IS MET)
Paid by Insurance 100% 80% 80% 60% 80% 60% 80% 60% 80% 60% 100% 60% 100% 80%
Paid by Individual 0% 20% 20% 40% 20% 40% 20% 40% 20% 40% 0% 40% 0% 20%
OUT-OF-POCKET MAXIMUM (INCLUDES DEDUCTIBLE AND MEDICAL COPAYS)
Individual $2,800 $8,450 $4,350 $8,450 $6,000 $12,000 $4,750 $9,250 $6,250 $12,500 $6,500 $16,250 $6,250 $12,250
Family $5,600 $16,900 $8,700 $16,900 $12,000 $24,000 $9,500 $18,500 $12,500 $25,000 $13,000 $32,500 $12,500 $24,500
CO-PAYMENTS (PAID BY INDIVIDUAL)
PCP Office Visit (PP/Non-PP) 0%* 20%* 10%* / 20%* 40%* 10%* / 20%* 40%* 10%* / 20%* 40%* 10%* / 20%* 40%* 0%* 40%* 0%* 20%*
SCP Office Visit (PP/Non-PP) 0%* 20%* 10%* / 20%* 40%* 10%* / 20%* 40%* 10%* / 20%* 40%* 10%* / 20%* 40%* 0%* 40%* 0%* 20%*
Virtual Visit 0%* n/a 20%* n/a 20%* n/a 20%* n/a 10%* n/a 0%* n/a 0%* n/a
Urgent Care 0%* 20%* 20%* 40%* 20%* 40%* 20%* 40%* 20%* 40%* 0%* 40%* 0%* 20%*
Emergency Room 0%* 0%* 20%* 20%* 20%* 20%* 20%* 20%* 20%* 20%* 0%* 0%* 0%* 0%*
Inpatient Hospital 0%* 20%* 20%* 40%* 20%* 40%* 20%* 40%* 20%* 40%* 0%* 40%* 0%* 20%*
WELLNESS BENEFIT
No Charge Not Covered No Charge Not Covered No Charge Not Covered No Charge Not Covered No Charge Not Covered No Charge Not Covered No Charge Not Covered
PRESCRIPTIONS (PAID BY INDIVIDUAL)
Tier 1 0%* 0%* 20%* 20%* 20%* 20%* 20%* 20%* 20%* 20%* 0%* 0%* $10 $10
Tier 2 0%* 0%* 20%* 20%* 20%* 20%* 20%* 20%* 20%* 20%* 0%* 0%* $30 $30
Tier 3 0%* 0%* 20%* 20%* 20%* 20%* 20%* 20%* 20%* 20%* 0%* 0%* $60 $60
Specialty 0%* n/a 20%* n/a 20%* n/a 20%* n/a 20%* n/a 0%* n/a $100 n/a
LIFETIME MAXIMUM IS UNLIMITED FOR ALL PLAN OPTIONS

 

Notes:
*After deductible
Medical and prescription copayments accumulate towards the out-of-pocket maximum.
Premium rates are calculated for new municipal members based upon underwriting requirements set forth by the Indiana Department of Insurance.
PP – Premium Provider Designation
Non-PP – Non-Premium Provider Designation

2021 PPO Medical and Prescription Plan Options

PLAN HIGHLIGHTS $500 PPO
Plan 1
$750 PPO
Plan 2
$1000 PPO
Plan 3
$1000 PPO Prim Adv
Plan 4
$1500 PPO
Plan 5
UnitedHealthcare Choice Plus In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
DEDUCTIBLE
Individual $500 $1,000 $750 $1,500 $1,000 $2,000 $1,000 $5,000 $1,500 $3,000
Family $1,000 $2,000 $1,500 $3,000 $2,000 $4,000 $2,000 $10,000 $3,000 $6,000
COINSURANCE (APPLIED AFTER DEDUCTIBLE IS MET)
Paid by Insurance 80% 60% 80% 60% 80% 60% 50% 50% 80% 60%
Paid by Individual 20% 40% 20% 40% 20% 40% 50% 50% 20% 40%
OUT-OF-POCKET MAXIMUM (INCLUDES DEDUCTIBLE AND MEDICAL COPAYS)
Individual $3,000 $6,000 $3,250 $6,500 $3,500 $7,000 $6,500 $10,000 $4,000 $8,000
Family $6,000 $12,000 $6,500 $13,000 $7,000 $14,000 $13,000 $20,000 $8,000 $16,000
CO-PAYMENTS (PAID BY INDIVIDUAL)
PCP Office Visit (PP/Non-PP) $15 / $25 40%* $15 / $25 40%* $15 / $25 40%* $0 50%* $15 / $25 40%*
SCP Office Visit (PP/Non-PP) $30 / $50 40%* $30 / $50 40%* $30 / $50 40%* $100 50%* $30 / $60 40%*
Virtual Visit $0 n/a $0 n/a $0 n/a $0 n/a $0 n/a
Urgent Care $75 40%* $75 40%* $75 40%* $50 50%* $75 40%*
Emergency Room $250 $250 $250 $250 $250 $250 50%* 50%* $250 $250
Inpatient Hospital 20%* 40%* 20%* 40%* 20%* 40%* 50%* 50%* 20%* 40%*
WELLNESS BENEFIT
No Charge Not Covered No Charge Not Covered No Charge Not Covered No Charge Not Covered No Charge Not Covered
PRESCRIPTIONS (PAID BY INDIVIDUAL)
Tier 1 $10 $10 $10 $10 $15 $15 $5 $5 $20 $20
Tier 2 $30 $30 $30 $30 $30 $30 $50 $50 $40 $40
Tier 3 $40 $40 $50 $50 $50 $50 $100 $100 $60 $60
Specialty $100 n/a $100 n/a $100 n/a $250 n/a $100 n/a
LIFETIME MAXIMUM IS UNLIMITED FOR ALL PLAN OPTIONS

 

Notes:
*After deductible
Medical and prescription copayments accumulate towards the out-of-pocket maximum.
Premium rates are calculated for new municipal members based upon underwriting requirements set forth by the Indiana Department of Insurance.
PP – Premium Provider Designation
Non-PP – Non-Premium Provider Designation

Dental Plan Options

DELTA DENTAL Option 1 Option 2
Deductible (Single / Family) $50 / $150 $50 / $150
Coinsurance (Preventable / Basic / Major / Ortho Services) 100 / 80 / 50 / 50 100 / 80 / 50 / 50
Annual Dental Maximum (per insured) $1,500 $1,000
Lifetime Child Ortho maximum (to age 19) $1,500 $1,000
Out-of-network Fee Schedule Fee Schedule
Endodontics & Periodontics Basic Basic
MONTHLY PREMIUM RATES (GUARANTEED THROUGH DECEMBER 31 2021)
Employee Only $26.32 $24.41
Employee / Spouse $52.66 $48.81
Employee / Child(ren) $71.12 $64.68
Family $106.88 $97.63

 

Notes:
*Includes KidsCare Plan–2 exams and 1 pair of glasses every year.
Dental and vision coverage is available to municipalities participating in the medical plan. Dental and vision coverage can be provided as a contributory, non-contributory or voluntary insurance benefit.
The Aim Medical Trust is a multiple employer welfare arrangement. The multiple employer welfare arrangement may not be subject to all of the insurance laws and regulations of Indiana. State insurance guaranty funds are not available for the Aim Medical Trust.

Vision Plan Options

VSP VISION CARE Option 1 Option 2 Option 3
Exam Copay $10 $15 $10
Materials Copay $20 $25 $20
Frequency (Exam / Lenses / Frames) 12 / 12 / 24 12 / 24 / 24 12 / 12 / 24*
MONTHLY PREMIUM RATES (GUARANTEED THROUGH DECEMBER 31 2023)
Employee Only $6.15 $4.59 $7.08
Employee / Spouse $12.33 $9.20 $14.15
Employee / Child(ren) $13.16 $9.82 $15.15
Family $21.05 $15.70 $24.20

 

Notes:
*Includes KidsCare Plan–2 exams and 1 pair of glasses every year.
Dental and vision coverage is available to municipalities participating in the medical plan. Dental and vision coverage can be provided as a contributory, non-contributory or voluntary insurance benefit.
The Aim Medical Trust is a multiple employer welfare arrangement. The multiple employer welfare arrangement may not be subject to all of the insurance laws and regulations of Indiana. State insurance guaranty funds are not available for the Aim Medical Trust.

 

 

 

Basic Life and AD&D Plan Options

PLAN HIGHLIGHTS Plan 1 Plan 2 Plan 3 Plan 4
Class Description All FTA Employees All FTA Employees All FTA Employees All FTA Employees
Life Benefit $25,000 $50,000 1 x Basic Annual Earnings to $50,000 Max 2 x Basic Annual Earnings to $100,000 Max
AD&D Benefit $25,000 $50,000 1 x Basic Annual Earnings to $50,000 Max 2 x Basic Annual Earnings to $100,000 Max
AGE REDUCTION SCHEDULE
35% @ 65 35% @ 65 35% @ 65 35% @ 65
50% @ 70 50% @ 70 50% @ 70 50% @ 70
65% @ 75 65% @ 75 65% @ 75 65% @ 75
Terminate @ retirement Terminate @ retirement Terminate @ retirement Terminate @ retirement
Guaranteed Issue $25,000 $50,000 $50,000 $100,000
Dependent Life: Spouse / Child(ren)
Option 1
$2,500 / $2,500
(14 days to 6 mos $250)
$2,500 / $2,500
(14 days to 6 mos $250)
$2,500 / $2,500
(14 days to 6 mos $250)
$2,500 / $2,500
(14 days to 6 mos $250)
Dependent Life: Spouse / Child(ren)
Option 2
$10,000 / $10,000
(14 days to 6 mos $1,000)
$10,000 / $10,000
(14 days to 6 mos $1,000)
$10,000 / $10,000
(14 days to 6 mos $1,000)
$10,000 / $10,000
(14 days to 6 mos $1,000)
Employee Contributions Non-contributory Non-contributory Non-contributory Non-contributory
Minimum Participation 100% 100% 100% 100%
MONTHLY PREMIUM RATES (GUARANTEED THROUGH DECEMBER 31st 2021)
Life Rate per $1,000 of Benefit $0.199 $0.199 $0.199 $0.199
AD&D Rate per $1,000 of Benefit $0.020 $0.020 $0.020 $0.020
Monthly Premium Per Person $5.48 per month $10.95 per month
Dependent Life Rate per Family Unit
Option 1
$1.50 $1.50 $1.50 $1.50
Dependent Life Rate per Family Unit
Option 2
$6.00 $6.00 $6.00 $6.00

 

Notes:
*Life plan offers Value Added Features such as: Accelerated Life Benefits, Life Conversion, Beneficiary Assistance – Delivering The Promise
MetLife: A+ Superior Best Rating
MetLife reserves the right to review, and if necessary, adjust the pricing for any group who:
– Requests a non-standard Plan design,-Has 25% or more retirees,
– Has 75 lives or more, and who’s population is composed of 75% or more police/fire
The Aim Medical Trust is a multiple employer welfare arrangement. The multiple employer welfare arrangement may not be subject to all of the insurance laws and regulations of Indiana. State insurance guaranty funds are not available for the Aim Medical Trust.

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