Benefits Plans

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. Delta Dental is our partner for group dental and VSP is the Trust’s partner for vision insurance. Members also have the option for life and accidental death and dismemberment (AD&D) insurance and short-term and long-term disability programs through Standard Insurance Company.

Click on the button below to download a PDF version of the 2024 Benefits Plans.

2024 Medical, Prescription, and Ancillary Plan Options

UnitedHealthcare creates and publishes Machine-Readable Files on behalf of the Aim Medical Trust. To link to the Machine-Readable Files, please click on the following URL: transparency-in-coverage.uhc.com.

2024 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		 $2500
Plan 6
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
DEDUCTIBLE
Individual $500 $1,000 $750 $1,500 $1,000 $2,000 $1,000 $5,000 $1,500 $3,000 $2,500 $5,000
Family $1,000 $2,000 $1,500 $3,000 $2,000 $4,000 $2,000 $10,000 $3,000 $6,000 $5,000 $10,000
COINSURANCE (APPLIED AFTER DEDUCTIBLE IS MET)
Paid by Insurance 80% 60% 80% 60% 80% 60% 50% 50% 80% 60% 80% 60%
Paid by Individual 20% 40% 20% 40% 20% 40% 50% 50% 20% 40% 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 $5,000 $10,000
Family $6,000 $12,000 $6,500 $13,000 $7,000 $14,000 $13,000 $20,000 $8,000 $16,000 $10,000 $20,000
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%* $15 / $25 40%*
SCP Office Visit (PP/Non-PP) $30 / $50 40%* $30 / $50 40%* $30 / $50 40%* $100 50%* $30 / $60 40%* $30 / $60 40%*
Virtual Visit $0 n/a $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%* $75 40%*
Emergency Room $250 $250 $250 $250 $250 $250 $250 + 50%* $250 + 50%* $250 $250 $250 $250
Inpatient Hospital 20%* 40%* 20%* 40%* 20%* 40%* 50%* 50%* 20%* 40%* 20%* 40%*
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
PRESCRIPTIONS (PAID BY INDIVIDUAL)
Tier 1 $10 $10 $10 $10 $15 $15 $5 $5 $20 $20 $20 $20
Tier 2 $30 $30 $30 $30 $30 $30 $50 $50 $40 $40 $40 $40
Tier 3 $40 $40 $50 $50 $50 $50 $100 $100 $60 $60 $60 $60
Specialty $100 n/a $100 n/a $100 n/a $250 n/a $100 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

2024 HDHP and HRA Medical and Prescription Plan Options

PLAN HIGHLIGHTS $3000 HDP
Plan 7		 $3000 HDP
Plan 8		 $3000 HDP
Plan 9		 $3500 HDP
Plan 10		 $4000 HDP
Plan 11		 $6500 HDP
Plan 12		 $5000 HRA
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 $3,200 $6,000 $3,200 $6,000 $3,200 $6,000 $3,500 $7,000 $4,000 $8,000 $6,500 $13,000 $5,000 $10,000
Family $6,400 $12,000 $6,400 $12,000 $6,400 $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 $3,200 $8,500 $4,350 $9,000 $6,000 $12,000 $4,750 $9,250 $6,250 $12,500 $6,500 $16,250 $6,250 $12,250
Family $6,400 $17,000 $8,700 $18,000 $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)
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

Dental Plan Options

DELTA DENTAL Option 1 Option 2 Option 3
Deductible (Single / Family) $50 / $150 $50 / $150 $50 / $150
Coinsurance (Preventable / Basic / Major / Ortho Services) 100 / 80 / 50 / 50 100 / 80 / 50 / 50 100% Preventive* / 80% Minor*
Annual Dental Maximum (per insured) $1,500 $1,000 $1,000
Lifetime Child Ortho maximum (to age 19) $1,500 $1,000 Not Included
Out-of-network Fee Schedule Fee Schedule Fee Schedule
Endodontics & Periodontics Basic Basic Not Included
MONTHLY PREMIUM RATES (GUARANTEED THROUGH DECEMBER 31 2024)
Employee Only $26.32 $24.41 $14.14
Employee / Spouse $52.66 $48.81 $28.10
Employee / Child(ren) $71.12 $64.68 $40.46
Family $106.88 $97.63 $60.10

Notes:
* Dental Option 3 includes coverage for Preventive and Minor services only. Minor services include fillings and crown repair.
Dental coverage is available to municipalities participating in the medical plan.
Dental coverage can be provided as a contributory, non-contributory, or voluntary insurance benefit.

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 2024)
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:
* Vision Option 3 includes KidCare Plan with 2 exams and 1 pair of glasses every year.
Vision coverage is available to municipalities participating in the medical plan. =
Vision coverage can be provided as a contributory, non-contributory, or voluntary insurance benefit.

Basic Life and AD&D Plan Options

PLAN HIGHLIGHTS Plan 1 Plan 2 Plan 3 Plan 4
Class Description All Full Time Active Employees All Full Time Active Employees All Full Time Active Employees All Full Time Active 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) $2,500 / $2,500 $2,500 / $2,500 $2,500 / $2,500 $2,500 / $2,500
Dependent Life: Spouse / Child(ren) $10,000 / $10,000 $10,000 / $10,000 $10,000 / $10,000 $10,000 / $10,000
Employee Contributions Non-contributory Non-contributory Non-contributory Non-contributory
Minimum Participation 100% 100% 100% 100%
MONTHLY PREMIUM RATES (Guaranteed through December 31 2025)
Life Rate per $1,000 of Benefit $0.140 $0.140 $0.140 $0.140
AD&D Rate per $1,000 of Benefit $0.020 $0.020 $0.020 $0.020
Monthly Premium Per Person $4.00 per month $6.00 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 and Portability, and an additional Line of
Duty Benefit for Public Safety Members (additional $50,000 or 100% of AD&D benefit if loss is suffered in line of duty)
The Standard: A+ Standard and Poor Rating
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.

Voluntary Life and AD&D Coverage

PLAN HIGHLIGHTS Voluntary Life / AD&D Coverage
Class Description All FTA Employees
EMPLOYEE SCHEDULE OF BENEFITS
Benefit Options Coverage in increments of $10000
Maximum Benefit $500000
Guarenteed Issue Amount $250000
AD&D Benefit Matches Life Benefit
Age Reduction Schedule 35% @ 65
50% @ 70
65% @ 75
Terminates at Retirement
SPOUSE SCHEDULE OF BENEFITS
Benefit Options Coverage in increments of $5000
Maximum Benefit $250000
Guarenteed Issue Amount $50000
AD&D Benefit Matches Life Benefit
Age Reduction Schedule 35% @ 65
50% @ 70
65% @ 75
Terminates at Retirement
CHILD(REN) SCHEDULE OF BENEFITS
Benefit Options $10000 Benefit
Guarenteed Issue Amount Full Benefit
AD&D Benefit Matches Life Benefit
VOLUNTARY LIFE/AD&D MONTHLY PREMIUM RATES (Guaranteed though December 31 2025)
Employee and Spouse Coverage
Age Bands Rate per $1000 Benefit for Life / AD&D Combined
0 – 24 $0.155
25 – 29 $0.155
30 – 34 $0.166
35 – 39 $0.195
40 – 44 $0.243
45 – 49 $0.355
50 – 54 $0.534
55 – 59 $0.831
60 – 64 $1.049
65 – 69 $1.469
70 – 75 $3.813
Child(ren) Coverage (to age 26)
$0.23 (one rate covers all children in a family)

• Employee must elect coverage to purchase spouse or dependent coverage
• Spouse elected amount may not exceed 100% of the employee elected amount
• Members Basic Life benefits plus Voluntary Life benefits may not exceed 8 times annual earnings
• Dependent Child Coverage extends from live birth to age 26

Notes:
Municipality must elect Basic Life/AD&D coverage with The Standard to purchase Voluntary Life/AD&D
When first eligible for coverage, all members may select coverage up to the guaranteed issue amount without submitting evidence of insurability. Each year all enrolled employees and spouses may
increase their benefit amount by up to two increments of coverage, not to exceed the guaranteed issue amount, without providing evidence of insurability. Evidence of insurability is required for those
members whose evidence of insurability was not approved by The Standard during any prior period of eligibility.
Coverage includes Conversion, Portability, Accelerated Death Benefit
The Standard: A+ Standard and Poor Rating
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.

Short-Term Disability Coverage

PLAN HIGHLIGHTS Plan 1 Plan 2 Plan 3 Plan 4
Class Description All FTA Employees All FTA Employees All FTA Employees All FTA Employees
Employee Contributions Employer Paid Employer Paid Employer Paid Employer Paid
SCHEDULE OF BENEFITS
Benefit Percentage 66.67% 66.67% 66.67% 66.67%
Maximum Weekly Benefit $350 $750 $1000 $1500
Benefit Waiting Period – Accident 7 Days 7 Days 7 Days 7 Days
Benefit Waiting Period – Sickness 7 Days 7 Days 7 Days 7 Days
Maximum Benefit Period 90 Days 90 Days 90 Days 90 Days
Definition of Earnings Base salary excluding commissions bonuses and overtime Base salary excluding commissions bonuses and overtime Base salary excluding commissions bonuses and overtime Base salary excluding commissions bonuses and overtime
Pre-existing Condition Limitation None None None None
Maternity Covered the same as any other illness Covered the same as any other illness Covered the same as any other illness Covered the same as any other illness
PREMIUM RATES (Guaranteed through December 31 2025)
STD Rate per $10 of Weekly Benefit $0.330 $0.330 $0.330 $0.330

• Coverage is non-occupational covering disabilities occurring off the job
• STD benefits may be reduced by deductible income. State Disability and/or Own Medical Leave Benefits under Paid Family Medical Leave Laws are considered deductible income.
• Coverage is employer-paid; STD benefits are taxable

Notes:
The Standard: A+ Standard and Poor Rating
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.

Long-Term Disability Coverage

PLAN HIGHLIGHTS Plan 1 Plan 2 Plan 3 Plan 4
Class Description All FTA Employees All FTA Employees All FTA Employees All FTA Employees
Employee Contributions Employer Paid Employer Paid Employer Paid Employer Paid
SCHEDULE OF BENEFITS
Benefit Percentage 60% 60% 60% 60%
Maximum Monthly Benefit $3000 $3000 $3000 $3000
Benefit Waiting Period 90 Days 90 Days 90 Days 90 Days
Maximum Benefit Period To SSNRA To SSNRA To SSNRA To SSNRA
Own Occupation Period 24 Months 24 Months 24 Months 24 Months
Definition of Earnings Base salary excluding commissions bonuses and overtime Base salary excluding commissions bonuses and overtime Base salary excluding commissions bonuses and overtime Base salary excluding commissions bonuses and overtime
Pre-existing Condition Limitation 3 / 12 3 / 12 3 / 12 3 / 12
Mental / Nervous Substance Abuse Limitation 24 Months 24 Months 24 Months 24 Months
PREMIUM RATES (Guaranteed through December 31 2025)
LTD Rate per $100 of Covered Monthly Benefit $0.405 $0.405 $0.405 $0.405

• LTD benefits may be reduced by deductible income. Worker’s compensation and primary/dependent Social Security benefits are considered deductible income
• Includes a survivors benefit that pays a lump sum equal to three times the LTD benefit
• Coverage includes a $25,000 Reasonable Accommodation Expense Benefit, which reimburses employers for workplace modifications that enable employees to return to work or remain at work. The Reasonable Accommodation Expense Benefit is separate from the LTD claim payment.

Notes:
The Standard: A+ Standard and Poor Rating
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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