2012 Medical Care Plans
On this page: IU PPO $900 Deductible | IU PPO $400 Deductible | IU HDHP PPO & HSA | IU Health Quality Partners Exclusive Provider
> Comparison table of all the plans
Similarities
- There are no pre-existing condition limits or waiting periods. After enrolling, coverage is effective from the first day of eligibility.
- Services are comprehensive and include those that are traditionally covered by medical insurance: medical, prescription, behavioral health, transplants, durable medical equipment, home health care, skilled nursing, physical, occupational, and speech therapies, and chiropractic services.
- Each plan's out-of-pocket expenses vary, but the types of services covered under the plans are the same.
- Preventive services are covered at 100% when In-Network providers are used. Preventive services include physical exams, well-child visits, immunizations, lab tests (e.g., Pap, PSA, cholesterol), and other screening diagnostic services like mammograms and colonoscopies.
- Each plan has annual out-of-pocket maximums for individual and family levels. Once the maximum is met, the plan pays 100% for in-network covered services for the remainder of the year.
- There is no lifetime maximum benefit on medical services.
- All plans cover a routine "wellness" eye exam with no copay or deductible.
Differences
- Premiums
- Out-of-pocket expenses (deductibles and copays)
- Residency requirements
- A unique tax-advantaged savings plan that is available to participants in the HDHP PPO & Health Savings Account
- Video: Break Away and Get Ahead with the HDHP Plan (requires Adobe Flash player plug-in)
IU PPO $900 Deductible Plan (more information)
IU pays 80% of in-network medical costs once the plan deductible is reached. Preventive services are covered at 100% when In-Network providers are used.
Retail and mail order prescription copays are 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. For drugs not on the list, the member pays 100% of the plan's discounted prescription cost.
IU PPO $400 Deductible Plan (more information)
IU pays 80% of in-network medical costs once the plan deductible is reached. Preventive services are covered at 100% when In-Network providers are used.
Retail and mail order prescription copays are 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. For drugs not on the list, the member pays 100% of the plan's discounted prescription cost.
IU HDHP PPO & Health Savings Account (more information)
This plan is somewhat different than traditional medical plans--it includes both comprehensive medical coverage (IRS-qualified High Deductible Healthcare Plan--HDHP) and a tax-advantaged savings account. The deductible applies to all covered services except preventive medical services and preventive prescriptions. Preventive services are covered at 100% when In-Network providers are used. After the deductible is met, a 20% copay applies to all covered services until the out-of-pocket maximum is met. The deductible and out-of-pocket maximums are applied differently than a traditional plan, and there are IRS eligibility restrictions on other medical coverage, so reading the plan details is important.
The true advantage of this plan is the personal savings account that is set up in the employee's name. The savings account is contributed to by the university and the employee. These savings can be used tax free to pay for medical expenses, like deductibles and copays, or saved to use in the future, even in retirement.
IU Health Quality Partners Exclusive Provider Plan (more information)
This plan has no deductible and fixed-dollar copays for many in-network services (inpatient admissions, office visits, urgent care, emergency services). There is a 10% copay on some outpatient services such as MRIs, CAT scans, ultrasound, and xrays. Preventive services are covered at 100% when In-Network providers are used. Enrollees are required to designate a primary care physician for routine care and coordination of overall care.
Retail and mail-order prescription copays are 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. For drugs not on the list, the member pays 100% of the plan's discounted prescription cost.
Eligibility for this plan is limited to employees residing in the following counties: Blackford, Boone, Brown, Carroll, Clinton, Delaware, Greene, Hamilton, Hancock, Hendricks, Henry, Howard, Johnson, Lawrence, Madison, Marion, Monroe, Morgan, Owen, Putnam, Shelby, Tipton, and Tippecanoe.
For all plans, to access information on background and licensing of individual doctors, nurses, chiropractors and pharmacists, search and verify licensing online or call (toll free) 888-333-7515.
