University Human Resource Services

IU HDHP PPO & Medical Savings Plan

This is a new plan for 2009—the IU HDHP PPO & Medical Savings Plan. The plan combines comprehensive medical coverage, a tax-advantaged savings account, and Health Risk and Biometric Assessment features.

Just like other IU-sponsored medical plans, the HDHP PPO provides access to high quality health care through Anthem’s provider network. The plan pays a large part of medical costs after the deductible is met and employee expenses are limited by an annual out-of-pocket maximum. The HDHP PPO does have a higher deductible; however, the deductible is offset by university and employee contributions to a health savings account.

The medical savings feature is a Health Savings Account (HSA)—an IRS-qualified feature that provides substantial tax savings and participant flexibility. The university will make a contribution to the employee’s account, and the employee can decide whether to make contributions above a required minimum. The account is owned by the employee. This means that account balances roll over from year to year, even when an employee leaves the university. The account has the flexibility to be used for current medical expenses or money can be left in the account to save for health care expenses during retirement. Balances of $1,000 or more may be placed in an array of investment options. Contributions, interest, and investment earnings are not subject to federal, state, or FICA taxes. The university pays the monthly banking fees for the savings account.

Because the plan is different than other plans offered by the university, it is important to read and understand the plan provisions and tax features before enrolling.

IRS Qualifying Requirements

In addition to the university’s eligibility requirements, the IRS has other enrollment requirements. The employee must:

be a U.S. citizen or resident alien age 18 or older with a U.S. address (not a PO Box);
have a valid Social Security Number;
have no health coverage, as an employee or dependent, other than an HDHP except for certain IRS-allowed insurance, e.g., dental, vision, accident/disability, long-term care, per diem hospitalization, or specific disease coverage;
not be enrolled in Medicare Part A or B (those eligible but not enrolled still qualify); and
not be claimed as a dependent on anyone else’s tax return.

Note: Domestic partners are eligible to be covered under an employee’s HDHP; however, in accordance with IRS regulations, the university’s savings account family contribution does not apply to a domestic partner that is not the employee’s tax dependent and tax-free distributions cannot be made from the savings account for the partner’s health expenses.

HDHP PPO Highlights

The plan includes comprehensive coverage for medical, prescription, behavioral health, and organ transplant services with no pre-existing condition limits.
The plan deductible is $1,150 for employee-only coverage and $2,300 when one or more family members are covered. In accordance with IRS regulations, the deductible works differently than the PPO $900 Deductible plan.
- The deductible applies to ALL medical expenses except preventive services—this means that benefits for prescriptions and behavioral health services are not paid until the deductible is met.
- The family deductible must be met before services are covered for any member—there is no separate individual deductible for those enrolled in employee/spouse, employee/child(ren), or family coverage.
Once the deductible is met, the plan pays 80% of in-network medical costs including prescription and behavioral health.
Copays are limited by an out-of-pocket maximum—when the deductible and copays reach the maximum, there is no copay for the remainder of the year. Out-of-pocket maximums are $2,500 for employee-only coverage and $5,000 when one or more family members are covered. (There is no lower individual out-of-pocket maximum for those enrolled in employee/spouse, employee/child(ren), or family coverage.)
Preventive services are covered at 80%—no deductible applies.

Monthly Rates
	Employee Contributions	With "Additional IU Subsidy"*
Employee	$ 5.00	$ 3.50
Employee/Child(ren)	$10.00	$ 7.00
Employee/Spouse	$10.00	$ 7.00
Family	$10.00	$ 7.00
*Additional IU Subsidy is for Staff employees in Support or Service positions with a base salary of less than $28,143.

Medical Savings Highlights

Enrolling in the IU HDHP PPO & Medical Savings Plan during Open Enrollment authorizes JP Morgan Chase to open a health savings account in the employee’s name.
The university makes a $250 contribution to the savings account for employee-only coverage and $500 when one or more family members are covered.
The employee makes a $250 required minimum contribution and decides whether to make additional contributions up to the IRS-allowed maximum.
- The maximum annual contribution (IU contribution plus the employee contribution) for 2009 is $3,000 for employee-only and $5,950 for those who cover one or more family members.
- Employees age 55 or older are allowed “catch-up” contributions up to an additional $1,000 annually.
An array of investment options are available for balances of $1,000 or more.
Contributions and interest/investment earnings on the account can be used tax-free for medical expenses.
The account is owned by the employee and any account balance rolls over from year to year, even when an employee leaves the university.
When enrolled in the IU HDHP PPO & Medical Savings Plan, TSB and/or HRA accounts can only be used for certain expenses: dental, vision, or medical care after the HDHP deductible is met.

Health Risk and Biometric Assessments & 24-Hour Nurse Line

Health Risk Assessments - Employees and covered spouses or domestic partners are requested to complete a Web-based health risk assessment through HealthMedia. The program includes out bound calls by Clarian Health to members for assistance with managing current and potential diseases.
Biometric Assessments - Employees are requested to complete a Biometric Assessment to establish a baseline for basic medical factors (basic blood test for sugar, cholesterol, etc. and blood pressure measurement), either through on-campus testing or through the employee’s primary care provider.
24-Hour Nurse Line - For access to information and advice about medical issues 24 hours a day, 7 days a week.

Enrolling in the IU HDHP PPO & Medical Savings Plan

Online enrollment is required for those electing the IU HDHP PPO & Medical Savings Plan. An online Open Enrollment system will be available in Benefits Self Service for a limited time—November 3 through November 14. Instructions on accessing this feature through OneStart will be sent to employees by email, or campus mail for employees without email.

Those without Web access who wish to enroll in the IU HDHP PPO & Medical Savings Plan may contact a campus Human Resource office for assistance.

Things you can do…

Medical Services

Contact the plan administrator, Anthem, at 800-345-2460 or visit the Anthem Web site for questions about coverage, claims, and provider networks.
Locate a network medical provider by consulting the Anthem Provider Directory.
Obtain information about precertification of a medical procedure by calling Anthem Utilization Review at 800-345-4348.
Print the Anthem temporary ID card (PDF).
Get coverage when out-of-state or overseas.
Call Anthem Behavioral Health at 800-345-2460 for questions about Mental Health/Chemical Dependency coverage, claims and provider networks.

Prescription Drugs (Rx)

Print the NextRx Prescription Drug claim form (PDF).

Mail order

Print Anthem's prescription mail order form (PDF).
Log into Wellpoint NextRx to complete the mail order form online. (Form must be submitted manually.)
Call 800-962-8192 to check on the status of mail order prescriptions.

Medical Savings Plan

Change your contribution during the year by completing the Medical Savings Contribution Change Form.
Contact JP Morgan Chase HSA Member Services at 1-866-566-7101 or visit the Chase HSA Online Services site.

For all plans, to access information on background and licensing of individual doctors, nurses, chiropractors and pharmacists, call Indiana Health Professions Bureau (toll free) 888-333-7515.