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2017 Anthem PPO High Deductible Health Plan (Anthem PPO HDHP)

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Premium rates | Plan highlights | Preventive care | Behavioral health | Vision | Prescriptions | Health Savings Account | Contacts | Publications

2017 UPDATE

For 2017, if you are enrolled in either the Anthem PPO HDHP or the Anthem PPO $500 Deductible plan you will receive a brand new Anthem medical card in the mail. The new cards have new group numbers and new member identification numbers.

In addition, your medical card will now also contain the information for your prescription coverage. This one card can be used at all of your medical, pharmacy, and vision providers.

You will need to use your new Anthem card at all of your providers starting January 1st. Please be sure to provide your new insurance card to each of your health providers as well as your pharmacy provider. Any claims submitted under the old insurance card will be denied.

Premium Rates

The employee contribution to the medical plan premiums are deducted from the employee’s paycheck before taxes.  The employee’s contribution rate is based on the employee’s annual base salary at the time payroll runs each month. For School of Medicine full-time faculty who receive a portion of their pay from an IU Health or VA paycheck, the annual base salary includes both the IU base salary and certain IU Health fixed and/or variable compensation, as determined by the School of Medicine.

Employee contributions to the premium costs can be reduced with the Tobacco-Free Premium Reduction Incentive. An employee can complete an affidavit indicating the employee and/or spouse does not use tobacco and will not in the future.  Completing the affidavit will reduce the employee’s premium contribution by $25 per month for the employee or spouse, or $50 for both.  For more information regarding this incentive, go to the Tobacco-Free Incentive page.

 
Monthly Employee Contribution
Employee’s Annual Base Salary*
Coverage
Below
$35,000
$35,000 -
$59,999
$60,000 -
$99,999
$100,000 -
$149,999
$150,000 -
$199,999
$200,000 -
$249,999
$250,000
and Above
Employee only
 $40.06
 $53.61
 $70.04
 $86.49
 $102.93
 $122.90
 $139.83
Employee & Child(ren)
 $79.89
 $106.91
 $139.72
 $172.53
 $205.33
 $241.32
 $274.57
Employee & Spouse
 $97.65
 $130.72
 $170.81
 $210.92
 $251.01
 $299.69
 $340.97
Family
 $110.90
 $148.45
 $199.70
 $246.57
 $293.46
 $340.34
 $387.22

* The employee’s salary band is determined by the annual base salary at the time payroll runs each month. For School of Medicine full-time faculty, annual base salary includes IU base salary and IU Health and/or VA salary, as determined by IUSM.

Calculating Premiums

Below is an example of how to calculate the employee’s monthly premium for an employee who:

$ 130.72 (employee contribution)
-    50.00 (Tobacco-free Affidavit reduction)
$  80.72 (monthly employee premium)

*The University also contributes annually to the employee’s HSA:  $1,300 for employee-only coverage level or $2,600 for all other coverage levels.

Plan Highlights

The Anthem PPO HDHP plan includes comprehensive coverage for medical, prescription, behavioral health, and organ transplant services with no pre-existing condition limits or waiting periods. After enrolling, coverage is effective from the first day of eligibility. There is no lifetime maximum benefit on medical services. 

Maximum Allowable Amount
This amount is also sometimes referred to as Covered Charges, Usual & Reasonable (U&R) charges, or Usual & Customary (U&C) charges. Benefits for Covered Services are based on the Maximum Allowable Amount, which is the maximum amount the Plan will pay for a given service. Network Providers accept the Maximum Allowable Amount as payment in full with no balance billing.

When a Non-Network Provider is used, the Member is responsible for any balance due between the Non-Network Provider’s charge and the Maximum Allowable Amount in addition to any Co-insurance, Deductibles, and/or non-covered charges. Co-insurance/Maximums are calculated based upon the Maximum Allowable Amount, not the Provider’s charge.

Deductible
Deductible means the specified dollar amount of covered charges that must be paid by the Member before Anthem will begin to pay benefits for the remainder of the calendar year. When one or more family members are covered, the family deductible must be met before services are covered for any member—there is no individual deductible for those enrolled in employee/spouse, employee/child(ren), or family coverage. The family deductible can be satisfied by one or more family members.  Deductible(s) apply to covered services listed with a percentage (%) co-insurance including prescription drugs.

Co-Insurance
Once the deductible has been met for the plan year, the member moves into the co-insurance phase where they share in the cost of covered services.  For example, if the plan pays 80%, the member’s co-insurance is 20% up to the maximum allowable amount. However, when choosing a Non-Network provider, the member is responsible for any balance due after the plan payment.

Out-of-Pocket Maximum
All Deductibles and Co-insurance apply toward the Out-of-Pocket Maximum including prescription drugs (this excludes Non-Network Human Organ and Tissue Transplants). Once the employee-only or family Out-of-Pocket Maximum is satisfied, no additional Co-insurance will be required for the member or family for the remainder of the Plan Year (except for Non-Network Human Organ and Tissue Transplant services). Network and Non-Network deductibles, co-insurance, and out-of-pocket maximums are separate and do not accumulate toward each other.

For questions regarding benefit coverage, claims, and provider networks:

 

Anthem PPO HDHP Member Costs

 
Deductible Phase
(up to $1,300 employee only or $2,600 family)
Co-insurance Phase
(after deductible and up to $2,600 employee only or $5,200 family)
Out-of-Pocket Max
(after having paid the deductible and co-insurance)
You pay this much
You pay this much
You pay this much
Preventive      
Medical services and ACA prescriptions
0%
0%
0%
All other preventive prescriptions
20%
20%
0%
Non-preventive      
Medical services and prescriptions
100%
20%
0%

 

Preventive Services and Prescriptions

Preventive care services are covered at no cost (1) when network providers are used and (2) when services are consistent with the U.S. Preventive Services Task Force guidelines and nationally recognized schedules. Preventive care is generally provided when there are no current symptoms or prior history of a diagnosed medical condition associated with the service. 

You may call Anthem customer service using the number on your ID card for additional information about these services or view the federal government’s websites:

Behavioral Health Services

Mental health and Substance Abuse benefits are provided in accordance with Federal Mental Health Parity. Benefits are covered as any other illness through Anthem Behavioral Health.  Prior authorization is required.

For additional questions about Mental Health / Chemical Dependency coverage, claims and provider network, contact Anthem Behavioral Health at 844-736-0920

Vision Wear Benefit

The vision wear benefit is provided through Anthem Blue View Vision.

The vision benefit is a “carve-out” benefit meaning that it is included in the member’s enrollment in the medical plan, but the covered vision services have their own schedule of benefits and network providers separate from medical benefits. Additionally, the medical plan deductibles and co-insurance do not apply to vision benefits, and the amount the member pays for vision services do not accumulate toward the medical plan deductible or out-of-pocket maximums.

The vision benefit is for routine eye care and corrective eye care only. For medical treatment of the eyes, visit a medical network eye care physician. Medical eye care includes services for such conditions as eye injuries, glaucoma, and retinal detachment. The medical deductible, co-insurance and out-of-pocket maximums apply to medical eye services.

Benefits include:

Prescription Benefit

Express Scripts, the Pharmacy Benefit Manager (PBM), manages the prescription drug benefit under contract with the State of Indiana and Indiana University. Express Scripts maintains the Preferred Drug list (also known as a Formulary), manages a network of retail pharmacies and operates Mail Service and Specialty Drug pharmacies. This benefit covers most prescription drugs, plus insulin and some over-the-counter (OTC) diabetes supplies and certain other OTC items considered preventive under the Health Care Reform Act. Certain medications are subject to limitations and may require prior authorization for continued use.

Express Scripts pharmacy network includes most retail chain pharmacies, such as CVS, Walmart, Target, and most supermarket and club pharmacy chains. To locate network pharmacies, check prescription coverage and costs visit the Express Scripts Web site at www.expressscripts.com/iu.

Retail Pharmacy Prescription Drugs (up to 30-day supply)

Mail Service Pharmacy Prescription Drugs (up to 90-day supply) and Specialty Drugs

For more plan specifics go to the Express Scripts PBM page or review the Anthem PPO HDHP Plan Booklet.

Health Savings Account

The Health Savings Account (HSA), administered by the Nyhart Company, is a special tax-advantaged bank account that can be used to pay for IRS-qualified health expenses for you, your spouse or tax dependent.  You must be an eligible individual, according to IRS requirements, in order to qualify for and make tax-free contribution to an HSA.

Enrollment in the Anthem PPO HDHP allows enrollment in the Health Savings Account (HSA).  Enrollment in the HSA requires a minimum $300 annual contribution in order to receive the IU contribution. Those not eligible for tax-free HSA contributions may waive the HSA.

With enrollment in the HSA, up until September 1, IU will make a contribution to the employee’s HSA account in the following amount:

For more plan specifics go to the Health Savings Account page.

Customer Service Contacts

Medical - Anthem
Member Services: 844-736-0920
www.anthem.com (select Blue Access PPO)
BlueCard network providers outside of Indiana:
800-810-2583 or www.bcbs.com

Prescription - Express Scripts
Member Services: 800-988-1794
Mail Order Services: 800-988-1794
www.expressscripts.com/iu

Vision - Anthem Blue View Vision
Member Services: 866-723-0515
www.anthem.com

Health Savings Account – The Nyhart Company
Member Services: 800-284-8412
Email:
iu.nyhart.com (available after account is opened)

IU – University Human Resources
Benefit Questions: 812-855-1286
Benefit Email:

Publications, Forms, and Resources

Publications and Forms

Helpful Resources

Available Programs

includes employee with child(ren), employee with spouse and family coverage levels

 


For all plans, to access information on background and licensing of individual doctors, nurses, chiropractors and pharmacists, please visit the Indiana Professional Licensing Agency website.