Human Resources

No. The plan covers medical, prescription, behavioral health, and transplant services the same as other IU employee medical plans.  The difference is primarily in the deductibles and copays.

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 enroll in the HSA with your Anthem PPO HDHP enrollment, and you switch to the Anthem PPO $500 Deductible Plan in a future year, you will no longer be eligible to make contributions to an HSA in the new year because you will no longer be enrolled in an HDHP. This means that you will not be eligible to receive IU’s contribution in the next year and you cannot make payroll contributions of your own. However, any unused contributions in your HSA from previous years will remain in your account to use for health expenses, and your HSA account will convert to an individual  account (non-IU-sponsored HSA account). When this happens, you will then be responsible for the HSA account maintenance fees. See the Schedule of Fees for details.

For 2024

In-Network:

• Deductible: $1,900 employee-only coverage / $3,800 all other coverage levels
• Coinsurance: 20% after deductible
• Out-of-pocket Maximum: $3,800 employee-only coverage / $7,600 all other coverage levels

Out-of-Network:

• Deductible: $3,800 employee-only coverage / $7,600 all other coverage levels
• Coinsurance: 40% after deductible
• Out-of-pocket Maximum: $7,600 employee-only coverage / $15,200 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 any additional family members are enrolled on your plan (meaning you’ve elected employee + spouse, employee + children, or family coverage level), the 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 all 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, which means that the plan will pay 80% of the allowable amount for an in-network procedure, service or prescription while you must pay 20%. The out-of-network coinsurance is generally 40%. 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 on your plan, 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. These include amounts above the maximum allowable amount when out-of-network providers are used.

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 and prescription costs for covered services paid out-of-pocket apply to the deductible and out-of-pocket maximum.

No. All prescriptions from an in-network pharmacy – brand and generic – are covered with a 20% coinsurance. However, because brand drugs are typically more expensive, the 20% coinsurance for them can result 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 during the plan year.

If you are contributing to an HSA, you cannot use your FSA funds to pay for services that apply to your HDHP deductible – meaning medical or prescription costs. When enrolled in both FSA and HSA accounts, your FSA funds can only be used to pay for dental and vision services up until your deductible is met. Once you meet your deductible, then your FSA funds can be used for medical and prescription expenses.

However, you can always use your HSA to pay for medical and prescription services that are applied to your HDHP deductible.

This plan uses the Anthem Blue Access PPO network in Indiana, the Anthem National PPO (BlueCard PPO) network in other states, and the Anthem Blue Cross Blue Shield Global Core network overseas. Once enrolled in the plan, you can find in-network providers by logging in to Anthem.com or the Sydney Health app and using the Find Care tool.

Anthem’s telehealth provider, LiveHealth Online, also offers virtual visits for acute care, and with psychiatry, psychology allergy, and dermatology providers. Visit livehealthonline.com to learn more.

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.

Walgreens is not an in-network pharmacy. Prescriptions filled at an out-of-network pharmacy (such as Walgreens) can only be reimbursed up to the cost of the drug or the plan cost, whichever is less.

This plan uses the Anthem Blue Access PPO network in Indiana, the Anthem National PPO (BlueCard PPO) network in other states, and the Anthem Blue Cross Blue Shield Global Core network overseas.

Once enrolled in the plan, you can find in-network behavioral health providers by logging in to Anthem.com or the Sydney Health app and using the Find Care tool.

Anthem’s telehealth provider, LiveHealth Online, also offers virtual visits with psychiatry and psychology providers. Visit livehealthonline.com to learn more.

Yes. Anthem has negotiated discounts with network providers and pharmacies. You receive the highest level of benefits when you use them.

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

You can view the list of preventive services covered by IU-sponsored medical plans or call the Anthem customer service 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 certain 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. See the No Cost Share Medication List.  

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, and you are age 65 or older, 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, as long as you have been continuously covered by your IU medical plan. Note that the SEP does not apply if you enroll in COBRA after you leave IU. 

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—even just Part A—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 Anthem Blue View Vision. This coverage is included with your medical plan enrollment, but vision services have their own schedule of benefits and network separate from medical benefits. Additionally, 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, you should visit a medical 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.

Vision 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.

Related Benefits

• AllClear ID Protection
• Anthem Discounts
• Health Savings Account (HSA)
• Prescription Benefit
• Telehealth
• Travel Coverage
• Vision Benefit