2017 IU Health High Deductible Health Plan (IU Health HDHP)
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.
Employee’s Annual Base Salary*
|Employee & Child(ren)|
|Employee & Spouse|
Below is an example of how to calculate the employee’s monthly premium for an employee who:
- Enrolls in the IU Health HDHP plan
- With coverage level Employee w/Spouse
- Annual IU salary of $51,548
- Signed affidavit confirming employee and spouse do not use tobacc
$ 116.37 (employee contribution)
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.
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.
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.
- IU Health HDHP Benefit Summary
- IU Health HDHP Federal Summary of Benefits and Coverage
- IU Health HDHP Plan Booklet
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 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.
- The in-network deductible is $2,500 for employee-only coverage level or $5,000 for all other coverage levels (employee/child(ren), employee/spouse, or family).
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.
- The in-network co-insurance is 20%.
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.
- The in-network out-of-pocket maximums are $3,000 for employee-only coverage level or $6,000 for all other coverage levels (employee/child(ren), employee/spouse, or family).
For questions regarding benefit coverage, claims, and provider networks:
- IU Health Plans Member Services: 800-873-2022
IU Health HDHP Member Costs
(up to $2,500 employee only or $5,000 family)
(after deductible and up to $3,000 employee only or $6,000 family)
(after having paid the deductible and co-insurance)
|Medical services and ACA prescriptions|
|All other preventive prescriptions|
|Medical 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.
- Preventive medical services include physical exams, well-child visits, immunizations, lab tests (e.g., Pap, PSA, cholesterol), contraceptive services (e.g., IUD’s and sterilization), and other screening diagnostic services like mammograms and colonoscopies.
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:
- Preventive health services
- Clinical Guidelines and Recommendations
- Advisory Committee on Immunization Practices
- Affordable Care Act mandated preventive prescriptions—are covered at 100%, no deductible, no co-insurance. These include: contraceptives requiring a prescription—generic and brands without a generic equivalent; pediatric sodium fluoride, low dose aspirin, folic acid, Vitamin D2 and D3 for members age 65 and above; iron; Tamoxifen; Raloxifene; and Tobacco cessation products and nicotine replacement (up to 180 day supply annually). Only the preventive strength, dosage, and form of these medicines are covered.
- All other preventive prescriptions listed on the preventive drug list are covered at 80%—no deductible applies.
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.
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.
- A routine eye exam every 12 months, with a $10 copay.
- Frames, lenses and contacts covered with specific allowances and copays for in-network providers, see the Vision Benefit Summary for more specifics:
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.
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)
- In-Network: member pays 20% after deductible (no deductible on Preventive Rx)
- Out-of-Network: no coverage
Mail Service Pharmacy Prescription Drugs (up to 90-day supply) and Specialty Drugs
- In-Network: member pays 20% after deductible (no deductible on Preventive Rx)
- Out-of-Network: no coverage
For more plan specifics go to the Express Scripts PBM page or review the IU Health HDHP Plan Booklet.
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:
- $1,600 for IU Health HDHP employee-only coverage level.
- $3,200 for all other IU Health HDHP coverage levels (employee/child(ren), employee/spouse, or family).
For more plan specifics go to the Health Savings Account page.
Medical – IU Health Plans
Member Services: 800-873-2022 or 317-816-5170
Prescription - Express Scripts
Member Services: 800-988-1794
Mail Order Services: 800-988-1794
Vision - EyeMed Vision
Member Services: 866-804-0982
Health Savings Account – The Nyhart Company
Member Services: 800-284-8412
iu.nyhart.com (available after account is opened)
IU – IU Human Resources
Benefit Questions: 812-855-1286
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.