Indiana University
Benefits Change Connection

Selecting a Medical Plan

Eligible employees may enroll in any of the medical care plans sponsored by IU, as long as the employee resides in the area (zip code) that the plan is offered. The specific plans available are listed below.

Plans	Availabilty
IU PPO $900 Deductible	Available in all areas of Indiana and outside the state
Blue Preferred Primary POS	Gary, Kokomo, New Albany, Louisville, Indianapolis, Bloomington, and South Bend areas

Which Medical Plan is Best?

Employees often ask this question. Choosing a medical plan is a personal decision that should be based on the unique medical needs and preferences of each employee. Each type of medical plan has features that may be considered advantageous by some employees or limited by others. No one can tell you which plan to select, but below are some areas that you will want to consider.

Provider Networks

What network does the plan use? Are your providers in the network? Does the plan have Out-of-network benefits?
If your providers are not In-Network, are you willing to change providers? (Out-of-Network costs, especially amounts above U&R, can be significant.)
Is the network a local or national network? If you travel extensively or have family members living away from home will the network meet your needs?

Covered Services

All plans cover most recommended preventive services with no deductible. These services include mammograms, childhood immunizations, annual physicals, pap tests, and most other commonly recommended screening tests.
All plans cover a comprehensive eye exam without a deductible.
Do you have special needs such as medical equipment, prosthetics, therapies, or skilled
nursing? If so, you will want to ask how these are paid in the plans you are considering.
If you use maintenance prescription drugs, what will the copays be in each plan? Are you
willing to change prescriptions to have a lower copay?

Total Plan Costs

What is the total cost of each medical plan you are considering? The total cost includes both what you will pay in paycheck contributions (premiums) and what you will pay when you receive services (out-of-pocket expenses). Both are important. Don’t automatically reject the PPO $900 Deductible plan without considering the total cost of alternative plans.
Have you considered the TSB Plan to save money on out-of-pocket costs?

Convenience and Flexibility

Does the plan require selecting a PCP to manage your care?
Do you need referrals for specialists?
Will you receive provider bills, explanations of payment and other paperwork? (Generally, an HMO involves much less paperwork.)

A Word About Using Out-of-Network Providers

PPO and POS plans have benefits, although at a reduced level, when you receive care from Out-of-Network providers. Both plans do generally pay In-Network benefits when you need care for an emergency, an urgent medical need when traveling, or when you have prior approval from the Plan Administrator before you receive care. However, even in these cases, Out-of-Network providers may bill you for their charges in excess of the Usual & Reasonable reimbursement paid by the plan. These charges can be significant. It is important to note that plans do not always have a provider in every specialty in every geographic region. For this reason, you may need to travel somewhat in order to receive In-Network benefits, for example, to the IU Medical Center.

It is also important to know that network providers may sometimes refer patients to an Out-of-Network provider. Such a referral does not mean that the services will be paid at an In-Network benefit level. It is always the patient’s responsibility to verify the network status of a referral physician or facility by using the plan’s Web site directory or by calling the number on the back of the member ID card.