Human Resources

No. The plan covers medical, prescription, behavioral health, and transplant services the same as other IU employee medical plans.

Yes. IU-sponsored employee medical plans do not have any pre-existing condition limits on new enrollees or when an employee moves from one IU plan to another.

No.

Each year during Open Enrollment you may choose to move to any of the available IU medical plans.

If you were enrolled in the HSA with your IU Health HDHP enrollment, and you switch to the Anthem PPO $500 Deductible Plan then any of your unused contributions in your HSA will remain in your account to use for health expenses, but you will not be eligible to receive the IU contribution in the next year and you cannot make payroll contributions of your own. When you are no longer enrolled in the HSA, you will then be responsible for the account maintenance fees on the HSA. See Fee Schedule for details.

If you change your enrollment to the Anthem PPO HDHP, you will be able to remain enrolled in the HSA.

No. You can see any physician or specialist in the IU Health Plans network without a referral. 

In-Network:

• Deductible: $2,700 employee-only coverage / $5,400 all other coverage levels
• Coinsurance: 20% after deductible
• Out-of-pocket Maximum: $3,400 employee-only coverage / $6,800 all other coverage levels

The deductible is the amount you must pay out-of-pocket before the plan will begin to pay benefits.

For HDHPs, the individual deductible only applies if you are enrolled in employee-only coverage. When one or more family members are enrolled, amounts each family member pays for healthcare expenses are credited to the family deductible. When these individual expenses add up to the family deductible, the plan will begin paying its share of the cost of healthcare expenses for members of the family. The family deductible can be satisfied by one or more family members.

You and your spouse are subject to the family deductible collectively. This means the plan will begin paying benefits for you and your spouse once the family deductible has been met either by one of you or both of you combined.

The deductible applies to all covered medical services and prescriptions (except for preventive services and prescriptions).

The deductible does not apply to non-covered services or to preventive medical services and preventive prescriptions. See the list of preventive prescriptions and the list of preventive medical services.

Once you have met your deductible, you enter the coinsurance phase. Coinsurance is the percent of a covered healthcare service you pay after you have paid your deductible. Under this plan there is a 20% coinsurance on most in-network services including medical, prescription, and behavioral health. You will remain in the coinsurance phase until you hit your out-of-pocket maximum for the year.

The out-of-pocket maximum is the most you’ll have to pay for covered services in a plan year. After you spend this amount on deductibles and coinsurance, the plan begins to pay 100% of the allowed amount for covered services.

Like the deductible, the individual out-of-pocket maximum only applies if you are enrolled in employee-only coverage. When one or more family members are enrolled, amounts each family member pays for healthcare expenses are credited to the family out-of-pocket maximum. When these individual expenses add up to the family out-of-pocket maximum, the plan will begin paying for 100% of covered healthcare expenses for all members of the family. The family out-of-pocket maximum can be satisfied by one or more family members.

Costs for services or charges not covered or excluded under the plan do not apply.

You can log in to Caremark.com to view your prescription history or check with your pharmacy to determine the full cost of the prescription.

Yes. Medical, prescription and behavioral health costs for covered services paid out-of-pocket apply to the deductible. Likewise, all costs for covered services apply to the out-of-pocket maximum.

No. Prescriptions from an in-network pharmacy are covered with a 20% coinsurance. Because brand drugs are generally higher in cost, the 20% coinsurance generally results in a higher out-of-pocket cost.

Maybe. If you are not contributing to a Health Savings Account (HSA), you can use your Healthcare FSA for any healthcare-related expenses approved by the IRS at any time..

If you are contributing to an HSA, you cannot use your FSA funds to pay for services that apply to your HDHP deductible. When enrolled in both accounts, your FSA funds can only be used to pay for dental and vision services and post-deductible medical and prescription expenses. However, you can use your HSA to pay for services that apply to your HDHP deductible.

The plan exclusively uses the IU Health Plans network of doctors and facilities within Indiana. There are no out-of-network benefits. You can search for an in-network provider using the online provider search tool.

Outpatient prescription drug benefits for all IU-sponsored employee medical plans are through CVS Caremark. Most retail chain and supermarket pharmacies are in-network including CVS, Wal-Mart, Target, Kroger, K-Mart, Marsh, and Meijer. You can search for in-network pharmacies by logging on to Caremark.com.

Prescriptions filled at an out-of-network pharmacy (such as Walgreens) are not covered.

are no out-of-network benefits. You can search for an in-network provider using the online provider search tool.

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, but please remember that this plan does not have out-of-network benefits. Search for an in-network provider.

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.

Preventive care services are covered at 100% when (1) network providers are used and (2) when services are consistent with the U.S. Preventive Services Task Force guidelines and nationally recognized schedules. View a list of Preventive Medical Services here.

You can view the list of preventive services covered by IU-sponsored medical plans or call IU Health customer service at the number on your ID card for additional information.

Federal guidance on preventive care is available at the following links:

• Preventive Health Services
• Clinical Guidelines and Recommendations
• Advisory Committee on Immunization Practices

The Affordable Care Act (ACA) requires preventive prescriptions to be covered at 100% with no deductible and no coinsurance. These include contraceptives requiring a prescription (generic and brands without a generic equivalent); pediatric sodium fluoride, low dose aspirin, folic acid; 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.

Not necessarily.

If you are not yet drawing Social Security and are covered by a group health plan (such as one of IU’s medical plans), you can postpone Medicare enrollment without penalty until you retire. When your IU medical coverage ends, you will be eligible for an 8-month Special Enrollment Period (SEP) to enroll in Medicare. There is no late enrollment penalty if you sign up for Medicare during your SEP. Note that the SEP does not apply if you are enrolled in COBRA. 

If you are drawing Social Security, then you are automatically enrolled in Medicare Part A and cannot disenroll.

Enrolling in Medicare greatly affects your eligibility to make or receive tax-free contributions to a Health Savings Account (HSA). Learn more about these rules on the Medicare and HSA web page.

With regards to your medical coverage, nothing changes. The Anthem PPO HDHP will be your primary insurance coverage and all medical claims would go through the IU plan first. There is no real benefit to being on both Medicare Part A and an IU medical plan.

However, enrolling in Medicare does affect your eligibility to make or receive tax-free contributions to a Health Savings Account (HSA). Learn more about these rules on the Medicare and HSA web page.

Yes. The vision benefit is provided through EyeMed and is included in your enrollment in the IU Health HDHP plan. Covered vision services have their own schedule of benefits and network providers separate from your medical benefits. The medical plan deductibles and coinsurance do not apply to vision benefits, and the amount you pay for vision services does not accumulate toward the medical plan deductible or out-of-pocket maximums. Visit the Vision Benefit web page for more information.

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, coinsurance and out-of-pocket maximums apply to medical eye services.

Benefits include:

• A routine eye exam each plan year, with a $10 copay.
• Frames, lenses and contacts covered with specific allowances and copays for in-network providers. See the Vision Benefit page for more information.