Guide to Health Plans

Types of health plans at IU

As an IU employee, you might choose from several types of health insurance:

A PPO plan features a network of contracted doctors and facilities who provide services at discounted rates. While you can choose providers outside the network, you’ll face a separate deductible, higher coinsurance, and additional charges above the allowed amount.

This refers to anyone covered by your health plan. It could be you, your spouse, or your child. Also known as an enrollee or participant.

Choosing a healthcare provider

Using in-network providers is key to receiving the highest level of healthcare benefits.

A network is a group of physicians, hospitals, and other healthcare providers that have contracted to provide services to plan members at a discounted rate.

When you use in-network providers

Staying in-network usually means lower out-of-pocket costs for you:

  • Deductibles, coinsurance, and out-of-pocket maximums are lower.
  • You are not responsible for charges above the plan’s allowed amounts.
  • Preventive services are paid at 100%.
  • Services requiring approval are authorized in advance.

When you use out-of-network providers

Going out-of-network often results in higher costs:

  • Deductibles, coinsurance, and out-of-pocket maximums are higher.
  • You are responsible for charges above the plan’s allowed amount (called “balance billing”). These charges can be significant.
  • Preventive services are not paid at 100%.
  • You may have to request authorization or risk being responsible for charges since out-of-network providers are not required to authorize services in advance.

Cost sharing: paying for your health care

Throughout this site, you will see references to cost sharing when talking about paying for your health plans. Cost sharing is the share of costs covered by your insurance that you pay out of your own pocket. This term generally includes deductibles, coinsurance, and copayments, or similar charges, but it doesn't include premiums, balance billing amounts for non-network providers, or the cost of non-covered services. 

We'll break down this process and these terms here.

How it works:

  • You pay a certain amount of your healthcare costs upfront (deductible).
  • Then, you share the costs with the insurance (coinsurance) until you reach a yearly limit (out-of-pocket maximum).
  • After that, the plan covers the rest of your healthcare costs for the remainder of the year.

This is the discounted maximum amount that in-network medical providers or pharmacies are “allowed” to charge you for covered services. Because they have an agreement with your insurance company (Anthem), you’ll pay less than you would if you used an out-of-network provider.

This is the percentage of the cost of a covered service that you pay. For most IU plans, the in-network coinsurance is 20%. This means you pay 20% of the cost for in-network services, and your plan pays 80%. This cost-sharing continues until your expenses hit the annual out-of-pocket maximum.

Keep in mind that out-of-network services have their own separate deductible and coinsurance rates.

This is a fixed dollar amount that you pay for a covered healthcare service. For example, you might have a $75 copayment for urgent care.

Your deductible is the amount you pay for covered health services before your insurance starts to pay. For IU’s plans, you pay 100% of your medical costs at a discounted rate up to your deductible.

Preventive care services are covered at 100% from the start, so they don’t count toward your deductible.

Each plan has a different deductible, so it’s important to know yours.

This is the most you’ll pay for covered health services in a plan year. Once you reach this limit, your plan pays 100% of covered charges for the rest of the year.

Deductibles, coinsurance, and copays all count toward the out-of-pocket maximum.

Note: There is a separate out-of-pocket maximum for in-network prescription copays on the PPO $500 Deductible Plan.

These are high-cost medications used to treat complex conditions. They are often injected or infused and may require special handling or administration.

Learn more on the prescription drugs page.

How your deductible works depends on whether you have a high deductible health plan or a traditional medical plan:

For an HDHP, all covered services, including prescriptions, are subject to the deductible except for:

  • Wellness/preventive medical services
  • Preventive prescriptions

If you have employee-only coverage, you only need to meet the individual deductible.

For family coverage, everyone’s healthcare expenses count toward the family deductible. Once the family deductible is met, the plan starts paying for everyone.

Deductibles work a bit differently for traditional plans such as the Anthem PPO $500 deductible plan, IU SAA, or IU resident plan.

Exceptions to the deductible

With these plans, you don’t have to pay deductible for

  • Emergency room copays
  • In-network urgent care center copays
  • Preventive medical services
  • Prescription drugs (except drugs administered in a physician’s office)
  • Transplants

Individual and family deductibles

For these plans, both individual and family deductibles apply. Each family member’s healthcare expenses count toward both their individual deductible and the family’s total deductible.

The plan begins sharing costs in two ways:

  • When an individual meets their deductible (for example, $500), the plan starts paying its share for that person’s healthcare
  • When the family’s combined expenses reach the family deductible (for example, $1,500), the plan begins covering healthcare for all family members—even if some haven’t met their individual deductibles

Note that no family member can contribute more toward the family deductible than their individual deductible amount.

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