Anthem PPO High Deductible Health Plan (Anthem PPO HDHP)
The Anthem Preferred Provider Organization High Deductible Health Plan (Anthem PPO HDHP) includes comprehensive coverage for medical, prescription, vision, behavioral health, and organ transplant services with no pre-existing condition limits or waiting periods. When you elect the Anthem PPO HDHP, you are also eligible to elect a Health Savings Account (HSA), a special tax-advantaged bank account to help cover your out-of-pocket healthcare costs.
Account Access
Resources
Plan Basics
Overview
This plan combines traditional medical coverage with a Health Savings Account (HSA). Under this plan, all covered services (except preventive services/prescriptions) are subject to the annual deductible. The deductible is a dollar amount of out-of-pocket costs you must pay each year before the plan will begin paying its share of your healthcare expenses. The nice thing about this plan is that you can pay for that deductible (and other qualified healthcare expenses like coinsurance) using the tax-free funds in your HSA. Once the deductible has been met, most in-network services are covered with a 20% coinsurance.
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. You can visit any provider or facility, but you receive a higher level of benefits when you use in-network providers.
Monthly Premiums
Your monthly premium is determined by your level of coverage and your base salary. Contributions are deducted before tax. You can reduce your monthly premium by $15 for yourself or your spouse (or $30 for both) by certifying that you do not use tobacco products each year.
2024 Premiums
Employee’s Annual Base Salary* |
|||||||
$66,949 |
$99,999 |
$149,999 |
$199,999 |
$249,999 |
and Above |
||
| Employee-only | $47.82 | $63.98 | $83.27 | $104.90 | $127.32 | $155.06 | $179.96 |
| Employee & child(ren) | $86.06 | $115.17 | $149.89 | $188.80 | $229.17 | $279.10 | $323.92 |
| Employee & spouse | $126.72 | $169.55 | $220.67 | $277.96 | $337.41 | $410.90 | $476.89 |
| Family | $153.01 | $204.76 | $266.46 | $335.65 | $407.44 | $496.19 | $575.85 |
* The employee’s salary band is determined by the annual base salary at the time payroll runs each month.
Faculty appointed as 10-month academic employees who do not receive pay in the summer will have medical plan premiums caught up when they return in August. This means premiums from June, July, and August will be deducted from the August paycheck.
For School of Medicine full-time faculty who are dually employed by IU Health or the VA, the annual base salary includes both IU base salary and IU Health compensation, as determined by the School of Medicine.
K=1,000
2024 Cost Shares
Deductible
- In-Network: $1,900 for employee-only coverage / $3,800 all other coverage levels
- Out-of-Network: $3,800 for employee-only coverage / $7,600 all other coverage levels
Coinsurance
- In-Network: 20% after deductible
- Out-of-Network: 40% after deductible
Out-of-Pocket Maximum
- In-Network: $3,800 for employee-only coverage / $7,600 all other coverage levels
- Out-of-Network: $7,600 for employee-only coverage / $15,200 all other coverage levels
- In-Network: $0 (plan pays 100% - not subject to deductible)
- Out-of-Network: 40% after deductible
In- and out-of-network deductibles and out-of-pocket maximums are separate and do not accumulate toward each other.
Vision Benefit
Visit the Vision page for details about your vision coverage.
Vision coverage is included with your enrollment in an IU-sponsored medical plan, but vision services have their own schedule of benefits and network providers separate from your medical plan. Additionally, amounts paid for vision services do not apply to your medical plan’s out-of-pocket maximum. Benefits include:
- A routine eye exam for each covered member every 12 months with a $10 copay.
- Frames, lenses, and contacts are covered with specific allowances and copays for in-network providers.
Prescription Benefit
Visit the CVS Caremark page for details about your prescription coverage.
Retail (up to 90-day supply)
- In-Network: 20% after deductible
- Out-of-Network: Members can submit a claim form and receipt to CVS Caremark for potential reimbursement. The amount reimbursed will be equal to the CVS Caremark price or the purchase price (less any member cost-share), whichever is lowest. Approved claims will count towards the plan’s annual in-network deductible and out-of-pocket maximum.
Mail Order (up to 90-day supply)
- In-Network: 20% after deductible
- Out-of-Network: Not covered
Specialty (up to 30-day supply)
- In-Network: 20% after deductible
- Out-of-Network: Not covered
Preventive medications listed on the No Cost Share Medication List are covered at 100% by the plan. These include items such as generic contraceptives, bowel preps, statins, and tobacco cessation products.
Medications on the HDHP Preventive Rx List are covered with a 20% coinsurance and no deductible.
All prescription cost shares apply towards the annual HDHP out-of-pocket maximum.
Additional Services
The following programs are available to Anthem PPO HDHP members:
- Sydney Health App – Access your account information including claims history and ID cards, find a physician, or estimate costs for care from your smartphone or tablet 24/7.
- LiveHealth Online Telehealth – Use Anthem’s LiveHealth Online to virtually visit with an urgent, allergy, or dermatology care provider for just $59 per visit. You can also schedule virtual visits with a licensed psychologist, psychiatrist, or therapist.
- AllClear ID Protection – Identity repair, credit monitoring, and identity monitoring from AllClear ID is provided to all Anthem members at no cost. Visit allclearid.com/anthem to enroll. Renewal required annually.
- Learn to Live Emotional Well-Being – Digital support and resources to help you and your family live your happiest, healthiest lives including 1:1 coaching, support teams, webinars, and more.
- Discounts – Find discounts on products and services that help promote better health including vision and hearing services, fitness trackers, gym memberships, and more.
- Complimentary Clinical Review – If you are someone with a complex medical condition, you may want to learn as much as possible about your diagnosis, available treatment options, or a second opinion about the typical treatment plans that may be right for you. Through an exclusive offering for Anthem members, you can now receive a virtual Complimentary Clinical Review from top-ranked experts in specialties such as heart, cancer, gynecology and urology at the Cleveland Clinic. This clinical review is available to you at no extra cost.
Top Frequently Asked Questions
Below are answers to the most frequently asked questions regarding the Anthem PPO HDHP.
Where can I find my Anthem ID Card?
Once your enrollment in the plan has been processed, usually within 7-10 business days after your enrollment, Anthem will mail physical ID cards to your home address on file.
Cards can also be accessed digitally by logging in to Anthem.com or the Sydney Health app.
If you lose your physical ID card, you can print or request a new one be mailed to you by logging in to Anthem.com or by calling Anthem Customer Service at 844-736-0920.
What is a Health Savings Account (HSA)?
The Health Savings Account (HSA) is a tax-advantaged bank account that can be used to pay for IRS-qualified health expenses for you, your spouse, and your tax dependents. Enrollment in the Anthem PPO HDHP allows enrollment in the HSA. For more information, visit the Health Savings Account page.
What are preventive services?
Preventive services are routine healthcare services including 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 list of preventive medical services or call Anthem Customer Service at 844-736-0920 for more information. Preventive services are covered at no cost when in-network providers are used.
How do I find a health care provider?
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.
What pharmacies can I use?
The CVS Caremark pharmacy network includes most retail chain pharmacies, such as CVS, Walmart, Target, and most supermarket and club pharmacy chains. Walgreens is not an in-network pharmacy. To locate network pharmacies or check prescription coverage and costs log in to Caremark.com or the Caremark app.
Does my health insurance include vision and vision wear coverage?
Yes. Vision and vision wear coverage 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. Visit the Vision benefit page for more information.
Does my health insurance cover me while I’m traveling?
Yes, IU medical plans use 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. Visit the Travel Coverage page to learn about the travel services available to you as an IU employee, and to understand how your healthcare coverage works if you experience medical needs or emergencies while away from home.
Customer Service Contacts
Medical - Anthem
Member Services: 844-736-0920
Precertification: 866-643-7087
Blue Access PPO providers in Indiana: www.anthem.com
BlueCard PPO providers nationwide: provider.bcbs.com
BCBS Global Core providers internationally:
bcbsglobalcore.com or 800-810-2583
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
Health Savings Account – WEX
Member Services: 800-284-8412
Email:
www.benefit-info.com/iu/ (available after account is opened)
IU Human Resources
Email:
Phone: 812-856-1234