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2017 Anthem PPO $500 Deductible Health Plan

The Anthem Preferred Provider Organization (PPO) $500 Deductible Health Plan includes comprehensive coverage for medical, prescription, vision, behavioral health, and organ transplant services with no pre-existing condition limits or waiting periods.

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Plan Basics

Overview

This is a traditional deductible plan. With this plan, the individual deductible must be met by each family member before plan benefits are paid for services. You may visit any doctor or hospital, but you receive a higher level of benefits when you use Blue Access PPO providers.

Annual Deductible

The deductible is the amount you must pay out of pocket before the plan will begin to pay benefits. The deductible applies to all covered services except emergency room and in-network urgent care centers, preventive care, prescription drugs (except drugs administered in a Physician’s office), and transplants. Each of your family members’ coverage begins after their individual deductible for is met.

In-Network: $500 individual (per member)/$1,500 family maximum
Out-of-Network: $900 individual (per member)/$2,700 family maximum

Network and Non-Network deductibles are separate and do not accumulate toward each other.

Co-Insurance

Co-insurance is the percent of a covered health care service you pay after you have paid your deductible. For this plan, once a family member meets the individual deductible for the plan year, that participant moves into the co-insurance phase.

In-Network: 20% after deductible
Out-of-Network: 40% after deductible

Out-of-Pocket Maximum

The out-of-pocket maximum is the most you will have to pay during a policy period for health care services. Once you have reached your out-of-pocket maximum, the plan begins to pay 100% of the allowed amount for covered services. All co-insurances and deductibles apply towards this maximum.

In-Network: $2,400 per member/$7,200 per family
Out-of-Network: $6,850 per member/$13,700 per family

No family member may contribute more than $2,400 toward the family out-of-pocket maximum.

Prescription Benefit

Retail (up to 30-day supply)
Tier 1 - $8/Tier - 2 $25/Tier 3 - $45
Non-Covered Drugs (with Network Discount) – Member pays 100%

Mail Order (up to 90-day supply) and Specialty
Tier 1 - $20/Tier 2 - $62/Tier 3 - $112
Non-Covered Drugs (with Network Discount) – Member pays 100%

There is a separate out-of-pocket maximum for in-network prescriptions: $4,200 for employee-only/$6,000 all other coverage levels. Once this out-of-pocket maximum is met the plan pays 100% of in-network covered prescriptions for the remainder of the plan year.

View detailed plan information about the Anthem PPO $500 Deductible Plan (PDF)

Top Frequently Asked Questions

Below are answers to the most frequently asked questions regarding the Anthem PPO $500 Deductible Plan.  

Where can I find my Anthem ID Card?

Once your enrollment in the plan has been processed, Anthem will mail you an official membership packet and ID card(s).

If you need proof of coverage before your permanent card arrives, you can print a temporary ID card (PDF).

If you’ve lost your permanent ID card, you can request a new one by logging on to Anthem and choosing the “Request an ID card” link, or by calling Anthem Customer Service at 844-736-0920.

Does this plan include enrollment in a Health Savings Account (HSA)? 

No. You must be enrolled in a High Deductible Health Plan (HDHP) to be eligible for enrollment in the HSA. However, you may be interested in enrolling in the Tax Saver Benefit (TSB) plan Healthcare Reimbursement Account, another tax-advantaged account that can be used to pay for IRS-qualified health expenses for you, your spouse, and your tax dependents. More information can be found on the Tax Saver Benefit (TSB) plan pages.

What are preventive services?

Preventive services are covered at no cost when network providers are used. Preventive 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 can view the Summary of Preventive Services (PDF) or call Anthem Customer Service for more information.

How do I find a health care provider?

The plan uses Anthem Blue Access in Indiana and Blue Cross & Blue Shield (“Blue Card” providers) in other states and overseas. Once enrolled in the plan, you can use the Castlight Health tool or logon to Anthem to find in-network providers.

What pharmacies can I 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 website.

Does the plan include Vision Wear coverage?

Yes. Vision Wear coverage is provided through Anthem Blue View Vision. Coverage is included in your enrollment in the medical plan, but vision services have their own schedule of benefits and network providers separate from medical benefits. Visit the Vision Wear benefit page for more information.

More Anthem PPO $500 FAQs

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

IU Human Resources 
Benefit Questions: 812-856-1234
Benefit Email:

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