Indiana University

University Human Resources

2017 IU Health High Deductible Health Plan (IU Health HDHP)

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

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
 $35.59
 $47.72
 $62.53
 $77.33
 $92.14
 $110.07
 $125.31
Employee & Child(ren)
 $70.99
 $95.19
 $124.72
 $154.24
 $183.77
 $214.41
 $243.95
Employee & Spouse
 $86.79
 $116.37
 $152.46
 $188.56
 $224.65
 $268.41
 $305.56
Family
 $98.56
 $132.16
 $178.24
 $220.43
 $262.63
 $304.81
 $347.02

Calculating Premiums

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

$ 116.37 (employee contribution)
-    50.00 (Tobacco-free Affidavit reduction)
$   66.37 (monthly employee premium)

The University also contributes annually to the employee’s HSA:  $1,600 for employee-only coverage level or $3,200 for all other coverage levels.

IU Health Network Availability

The IU Health HDHP plan exclusively uses the IU Health provider network. The county listing below serves as a reference as to which counties have IU Health provider hospitals and a larger selection of specialist providers. These counties are as follows:

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.

Employees living or working outside of these counties who choose to enroll in the IU Health HDHP would not be prohibited from doing so. The plan is open to anyone who feels that the IU Health network is adequate for them. To search for an in-network IU Health provider by location, visit www.iuhealthplans.org/iuhealth.

Plan Highlights

The IU Health HDHP plan exclusively uses IU Health Plans participating providers. This plan does not offer out-of-network benefits except in the case of an emergency, urgent care when more than 50 miles from home, or for a dependent of an Indiana-Resident employee when the dependent lives out of the state of Indiana for reasons other than medical treatment. Dependent coverage out-of-state includes primary and urgent care in addition to emergency care covered as an in-network benefit. Contact IU Health customer service if you will be covering an out-of-state dependent for more information.

The IU Health 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. 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 IU Health Plans 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.

Out-of-Pocket Maximum
All Deductibles apply toward the Out-of-Pocket Maximum including prescription drugs. Once the employee-only or family Out-of-Pocket Maximum is satisfied, no additional Deductible or Co-insurance will be required for the member or family for the remainder of the Plan Year.

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

IU Health HDHP Member Costs

 
Deductible Phase
(up to $2,500 employee only or $5,000 family)
Co-insurance Phase
(after deductible and up to $3,000 employee only or $6,000 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 IU Health 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 IU Health network providers.  Prior authorization is required.

For additional questions about Mental Health / Chemical Dependency coverage, claims and provider network, contact IU Health Plans at 800-873-2022.

Vision Wear Benefit

The vision wear benefit is provided through EyeMed 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 and out-of-pocket maximums apply to medical eye services.

Benefits include:

For network providers, claims and questions you can download the “EyeMed Members” app through the Apple iTunes store on your iPhone, iPad or iPod Touch or call member services at 866-804-0982 for assistance.

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 IU Health 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 IU Health 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 – IU Health Plans
Member Services: 800-873-2022 or 317-816-5170
Email:
www.iuhealthplans.org

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

Vision - EyeMed Vision
Member Services: 866-804-0982
www.eyemed.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

 

Questions and Answers

Q: What is Transition of Care?  What do I do if I am in the middle of medical treatment when I enroll?

A: Transition of care coverage is medical coverage that may be available to you and/or your dependents if you are a new member of IU Health Plans or your doctor leaves an IU Health Plans network.  Transition of care coverage allows you to continue to receive treatment for covered services with a doctor and/or facility that does not participate in an IU Health Plan’s network. This coverage is for a defined period of time until the safe transfer of care to an in-network doctor and/or facility can be arranged.

 

 


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.