Indiana University

University Human Resource Services

Compare 2017 Medical Care Plans Distinguishing Features

IU Health HDHP
Anthem PPO HDHP
Anthem PPO $500 Deductible
Network Availability
Indiana counties: Adams, Allen, Bartholomew, Benton, Blackford, Boone, Brown, Carroll, Cass, Clay, Clinton, Crawford, Daviess, Decatur, DeKalb, Delaware, Dubois, Elkhart, Fayette, Fountain, Fulton, Gibson, Greene, Hamilton, Hancock, Hendricks, Henry, Howard, Huntington, Jackson, Jay, Johnson, Knox, LaGrange, La Porte, Lawrence, Madison, Marion, Marshall, Martin, Miami, Monroe, Montgomery, Morgan, Noble, Orange, Owen, Parke, Perry, Pike, Posey, Pulaski, Putnam, Randolph, Rush, Scott, Shelby, Spencer, St. Joseph, Starke, Steuben, Sullivan, Tippecanoe, Tipton, Union, Vanderburgh, Vermillion, Vigo, Wabash, Warren, Warrick, Wayne, Wells, White and Whitley.
Nationwide and Overseas
Nationwide and Overseas
Provider Network
Only from IU Health network providers
Anthem Blue Access and Blue Card PPO providers
Anthem Blue Access and Blue Card PPO providers
HSA Contributions IU Contribution:
$1,600 for employee only coverage
$3,200 for all other coverage levels
Contribution is deposited with the employee’s second paycheck in January

Employee Contribution:
Minimum $300 ($25 monthly)
Maximum $1,800 employee only coverage
Maximum $3,550 all other coverage levels
For those age 55+, an additional $1,000 catch-up
IU Contribution:
$1,300 for employee only coverage
$2,600 for all other coverage levels
Contribution is deposited with the employee’s second paycheck in January

Employee Contribution:
Minimum $300 ($25 monthly)
Maximum $2,100 employee only coverage
Maximum $4,150 all other coverage levels
For those age 55+, an additional $1,000 catch-up
Not applicable.
Medical
In-Network Benefits
Deductibles $2,500 for employee only coverage
$5,000 for all other coverage levels
Applies to all non-preventive medical services and non-preventive prescriptions.
$1,300 for employee only coverage
$2,600 for all other coverage levels
Applies to all non-preventive medical services and non-preventive prescriptions.
$500 for each individual
$1,500 for family maximum
Applies to all non-preventive medical services (does not include prescriptions).
Co-insurance After deductible, member pays 20%. After deductible, member pays 20%. After deductible, member pays 20%.
Out-of-Pocket Maximum $3,000 for employee only coverage
$6,000 for all other coverage levels
After the deductible and co-insurance equals the Out-of-Pocket Maximum, then there is no further cost for in-network services or pharmacy.
$2,600 for employee only coverage
$5,200 for all other coverage levels
After the deductible and co-insurance equals the Out-of-Pocket Maximum, then there is no further cost for in-network services or pharmacy.
$2,400 for each individual
$7,200 for family maximum
After the deductible and co-insurance equals the Out-of-Pocket Maximum, then there is no further cost for in-network services.
Out-of-Network Benefits
Deductibles No out-of-network benefits, except emergency. $2,600 employee only coverage
$5,200 all other coverage levels
$900 for each individual
$2,700 for family maximum
Co-insurance After deductible, member pays 40%. After deductible, member pays 40%.
Out-of-Pocket Maximum $5,200 for employee only coverage
$10,400 for all other coverage levels
After the deductible and co-insurance equals the Out-of-Pocket Maximum, then there is no further cost for out-of-network services or pharmacy.
$6,850 for each individual
$13,700 for family maximum
After the deductible and co-insurance equals the Out-of-Pocket Maximum, then there is no further cost for out-of-network services.
In-Network Preventive Services
Plan pays 100%.
Plan pays 100%. Plan pays 100%.
Emergency Room
20% co-insurance after deductible
20% co-insurance after deductible.
$150 co-pay per visit (waived if admitted).
Urgent Care In-Network: Subject to deductible, then 20% co-insurance
Out-of-Network: Paid as in-network when 50+ miles from home
In-Network: Subject to deductible, then 20% co-insurance
Out-of-Network: Subject to deductible, then 40% co-insurance
In-Network: $75 co-pay
Out-of-Network: Subject to deductible, then 40% co-insurance
Mental Health Covered as any other illness through IU Health network providers. Prior authorization is required.
Covered as any other illness through Anthem Behavioral Health. Prior authorization is required.
Covered as any other illness through Anthem Behavioral Health. Prior authorization is required.
Prescription Drugs
In-Network Benefits Retail (up to 30-day supply):
Subject to deductible, then 20% co-insurance

Mail Order (up to 90-day supply):
Subject to deductible, then 20% co-insurance

Preventive prescriptions are not subject to the deductible. Specialty drugs are only available through Mail Order
Retail (up to 30-day supply):
Subject to deductible, then 20% co-insurance

Mail Order (up to 90-day supply):
Subject to deductible, then 20% co-insurance

Preventive prescriptions are not subject to the deductible. Specialty drugs are only available through Mail Order
Retail
(up to 30-day supply)
Tier 1 - $8
Tier 2 - $25
Tier 3 - $45
Mail Order
(up to 90-day supply)
Tier 1 - $20
Tier 2 - $62
Tier 3 - $112
Out-of-pocket Maximum
Employee Only Coverage: $4,200
All Other Coverage Levels: $6,000
(Specialty drugs only available through Mail Order.)
Out-of-Network Benefits No out-of-network benefits. Retail (up to 30-day supply):
Subject to deductible, then 40% co-insurance

Mail Order: Not covered
Retail (up to 30-day supply):
Subject to deductible, then 50% co-insurance

Mail Order: Not covered
Preventive Prescription Exceptions (In-Network Only) Plan pays 100% for generic contraceptives, pediatric sodium fluoride, low dose aspirin, folic acid, Vitamin D for age 65 and older, Tamoxifen, Raloxifene, and iron. 100% coverage for Tobacco cessation products and nicotine replacement (up to 180 day supply annually). Over the counter products require a prescription for coverage.
Vision Care
Exams and Eyewear Routine eye exam ($10 co-pay) and eyewear (frames, lenses, and contacts) with specific allowances. IU Health members use EyeMed network and ID card; Anthem PPO members use Blue View Vision network and their Anthem medical card.