Medical Plans Overview
High Deductible Health Plan (HDHP)
IU offers one HDHP that meets the IRS requirements for allowing eligible employees and the university to make tax-free contributions to an employee-owned Health Savings Account (HSA). An HSA can be used tax-free free to pay for medical expenses, like deductibles and coinsurance, or saved to use in the future, even if you leave IU or retire.
IU’s HDHP includes comprehensive medical coverage; however, the deductible and out-of-pocket maximums are applied differently than a traditional PPO plan (e.g., the $500 Deductible plan), and there are IRS eligibility restrictions when enrolling in the HSA, so reading the plan details is important.
Anthem PPO HDHP (more information)
This plan has a nationwide and global network of providers. There are out-of-network benefits, however; you pay less when network providers are used. The in-network deductible ($1,800 employee-only / $3,600 all other coverage levels) applies to all covered services and prescriptions except preventive medical services and certain preventive prescriptions.
After the deductible is met, a 20% coinsurance applies to all covered services and prescriptions until an out-of-pocket maximum ($3,600 employee-only / $7,200 all other coverage levels) is met. Both the deductible and coinsurance count toward the out-of-pocket maximum.
The university contribution to an employee’s HSA is $1,300 for employee-only coverage and $2,600 for all other coverage levels.
Traditional Deductible Plan
Anthem PPO $500 Deductible Plan (more information)
This plan uses Anthem’s nationwide and global network of providers. There are out-of-network benefits, however; you pay less when network providers are used. The in-network deductible ($500 individual / $1,500 family maximum) applies to all covered services except preventive medical services, emergency room and in-network urgent care, prescription drugs (except those administered in a physician’s office), and transplants.
This plan has flat-dollar copays for emergency and in-network urgent care visits. After the deductible is met, a 20% coinsurance applies to covered services until the out-of-pocket maximum ($2,400 individual / $7,200 family maximum) is met. Both the deductible and coinsurance count toward the out-of-pocket maximum.
This plan also has flat-dollar copays for retail and mail order prescription based on a tiered drug list. In general, Tier 1 is generic drugs, Tier 2 is preferred brand drugs, and Tier 3 includes non-preferred drugs. There is an annual out-of-pocket maximum for in-network prescriptions that is separate from the medical out-of-pocket maximum.
Employees enrolled in this plan are not eligible for the Health Savings Account (HSA).
Comparing IU’s Medical Plan Options
Preventive care is covered at 100% for all plans
In-network preventive care is covered at no cost when the services received are consistent with the U.S. Preventive Services Task Force guidelines and nationally recognized schedules. Preventive care services may include:
- Routine and periodic wellness exams.
- Routine immunizations for adults and children.
- Screening tests such as colonoscopies, mammograms, bone density testing, cancer screenings, and cholesterol labs.
- Women’s health services including oral contraceptives, IUDs, hormone implants, injections, and sterilization.
- Pediatric fluoride, low dose aspirin, and tobacco cessation products (up to certain limits).
Call Anthem or IU Health customer service at the number on your ID card for additional information about these services or view the federal government’s websites:
- Preventive health services
- Clinical Guidelines and Recommendations
- Advisory Committee on Immunization Practices
Similarities between the plans
- No pre-existing condition limits or waiting periods..
- Both plans offer a travel benefit for covered medical services that aren't available within 100 miles of the member’s home.
- Services are comprehensive and include medical, prescription, behavioral health, transplants, durable medical equipment, home health care, skilled nursing, therapy, and chiropractic services.
- Both plans have a nationwide and overseas network of providers, and offer out-of-network benefits.
- Both plans include a vision and vision wear benefit.
- Both plans have annual out-of-pocket maximums to protect you from high costs.. Once the maximum is met, each plan pays 100% for in-network covered services for the remainder of the year.
- No lifetime maximum benefit on medical services.
Differences between the Plans
- Premiums. The higher the deductible, the lower the premiums.
- Deductible and prescription benefits. How the deductible and prescription benefit are structured in an HDHP versus a traditional plan.
- Out-of-pocket expenses/maximums Deductibles, coinsurance, and copays vary in structure and amounts.
- Health Savings Account (HSA). A unique taxadvantaged health savings account (HSA) is available to those enrolled in an HDHP.