Anthem PPO $500 Deductible Health Plan

Open Enrollment is November 5-16

See the 2019 premium rates.

Prescription plan formulary changes affect this plan and the out-of-pocket maximum for in-network prescriptions will increase for 2019.

Learn about all the changes to the benefit plans for 2019 at the Open Enrollment website.

Open Enrollment

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.

Top FAQs Customer Service Resources & Forms

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.

2018 Monthly Premium

Monthly Employee Contribution
Employee’s Annual Base Salary*
Below $35K
$35K -
$59K
$60K -
$99K
$100K -
$149K
$150K -
$199K
$200K -
$249K
$250K
and Above
Employee-only
$135.65
$163.96
$212.74
$254.02
$296.85
$341.29
$387.38
Employee & child(ren)
$257.74
$311.52
$404.21
$482.65
$564.01
$648.45
$736.03
Employee & spouse
$359.48
$434.49
$563.77
$673.17
$786.64
$904.42
$1,026.57
Family
$406.96
$491.87
$638.23
$762.07
$890.54
$1,023.88
$1,162.15

* The employee’s salary band is determined by the 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, annual base salary includes both IU base salary and certain IU Health fixed and/or variable compensation, as determined by the School of Medicine.

K=1,000

Employee contributions are deducted before taxes.

Subtract $25 per month for an employee or spouse ($50 for both) who do not use tobacco and complete a tobacco-free affidavit.

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.

Coinsurance

Coinsurance 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 coinsurance 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 coinsurances 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%

Retail at CVS Pharmacy (up to 90-day supply)
Tier 1 - $20 / Tier 2 - $62 / Tier 3 - $112
Non-Covered Drugs (with Network Discount) – Member pays 100%

Mail Order (up to 90-day supply) and Specialty (up to 30-day supply)
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: $4,250 for employee-only/$6,100 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.

Additional Services

The following programs are a part of the Anthem PPO HDHP Plan:

Sometimes you just need a doctor. Using the Internet, you can connect to one anytime, anywhere – whether it is the middle of the night or the middle of a road trip. Sign up for LiveHealth Online and have a face-to-face conversation on your computer or mobile device.

Web site

Flyer (PDF)

Identity protection is available when you have active medical coverage with Anthem. If there is an issue with your identity, just call AllClear ID. A dedicated investigator will help you recover financial losses, restore your credit, and help return your identity to its proper condition.

Web site

Flyer (PDF)

Saving money is good. Saving money on things that are good for you is even better. With Special Offers, you can get discounts on products and services that help promote better health and well-being.

Flyer (PDF)

Learn more in the Plan Summary Chart (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’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 Preventive Medical 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 log on to Anthem to find in-network providers.

What pharmacies can I use?

CVS Caremark 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 CVS Caremark 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 - CVS Caremark
Member Services: 866-234-6952
Mail Order Services: 866-234-6952
www.caremark.com

Vision - Anthem Blue View Vision
Member Services: 866-723-0515
www.anthem.com

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