Human Resources

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.

For this type of plan, each family member has an individual deductible, and the family as a whole has a family deductible maximum. As medical expenses are incurred, the amount each family member pays toward these expenses is credited to their individual deductible and also to the family deductible maximum.

There are two ways the plan will begin to pay its share of the cost of healthcare expenses for a particular individual within the family.

• If an individual meets their individual deductible of $500, the plan begins to pay its share of the cost of healthcare expenses for that individual only, but not for the other family members.
• If the family deductible maximum of $1500 is met by three or more family members, the plan begins to pay its share of the cost of healthcare expenses for all members of the family whether or not they’ve met their own individual deductibles.

Each enrollee may contribute no more than the amount of the individual deductible listed above to the family deductible maximum.

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.

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, which means that the insurance pays 80% of the allowable charge for your medical service, 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, each family member has an individual out-of-pocket maximum, and the family as a whole has a family out-of-pocket maximum. As medical expenses are incurred, the amount each family member pays toward these expenses is credited to their individual out-of-pocket maximum and to the family out-of-pocket maximum.

There are two ways the plan will begin to pay 100% of covered charges for healthcare expenses for a particular individual within the family.

• If an individual meets their individual out-of-pocket maximum ($2,700), the plan begins to pay 100% of covered charges for that individual only, but not for the other family members.
• If the family out-of-pocket maximum ($7,200) is met, the plan begins to pay 100% of covered charges for all members of the family whether or not they’ve met their own individual out-of-pocket maximums.

Each enrollee may contribute no more than the amount of the individual out-of-pocket maximum listed above to the family out-of-pocket maximum.

Note that covered charges for prescription drugs do not count towards the medical out-of-pocket maximum. Additional items excluded from the out-of-pocket maximum include non-network provider charges above the maximum allowable amount, adjustments to covered charges for services that were not pre-certified, and out-of-network transplant services.

This plan has an out-of-pocket maximum for in-network prescriptions that is separate from the medical out-of-pocket maximum. Once prescription expenses reach the out-of-pocket maximum—$ 6,800/individual or $11,200/family—the plan will pay 100% of covered charges for in-network prescriptions for the remainder of the plan year. Medical expenses do not count toward the prescription out-of-pocket maximum.

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. 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. You can search for in-network pharmacies by logging on to Caremark.com.

Specialty medications are managed through Archimedes. These are high-cost drugs that treat complex/chronic conditions and often require special handling or administration. Most specialty medications will need to be filled by Acaria Health, the home delivery pharmacy that Archimedes partners with.

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.

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.

The vision benefit is for routine eye care and corrective eye care only. For medical treatment of the eyes, you should 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.