Indiana University provides a Transparency tool to all employees and their adult family members enrolled in an IU-sponsored medical plan. The tool helps employees find in-network medical services based on price and quality of care.
The healthcare system can be complex and confusing, but Castlight's Transparency tool makes healthcare decision-making easier. And, prices for medical services are usually not known until the bill is received, which could be weeks after an appointment. The Transparency tool allows plan members to search for primary care doctors; know where they are in their deductible; and estimate personalized costs for medical services based on their plan enrollment.
Learn more and register for the tool at hr.iu.edu/benefits/castlight.html.
As an incentive for the non-use of tobacco and to promote a healthy life, the University provides the IU Tobacco-free Program which includes two features.
- Tobacco cessation assistance is fully paid by the University. This assistance covers the cost of employee and spouse/domestic partner participation in Alere Wellbeing's Quit for Life™ program when enrolled in an IU-sponsored medical plan.
- $25 per month for an employee or spouse ($50 for both) who do not use tobacco will be deducted from the employee's contribution to the medical plan. The employee must sign a Tobacco-free Affidavit each year. Employees who are not tobacco-free at the time of signing the affidavit are eligible for this reduction after verification to the University stating they have completed the Quit for Life program.
For details, see the Open Enrollment packet and visit hr.iu.edu/benefits/gethealthy.html.
Using in-network providers is key to receiving the highest level of healthcare benefits. Services from a provider other than an in-network one are considered out-of-network, except for emergency or urgent care away from home. For better understanding, see the definitions below.
Plan members who receive in-network services have lower out-of-pocket expenses.
- Deductibles, co-insurance, and out-of-pocket maximums are lower.
- The member is not responsible for charges above the plan's allowed amounts.
- Preventive services are paid at 100% (no cost to the member).
- Services requiring approval are authorized in advance. The member is not responsible for non-covered services.
Plan members who receive out-of-network services have higher out-of-pocket expenses.
- Deductibles, co-insurance, and out-of-pocket maximums are higher.
- The member is responsible for charges above the plan's allowed amounts. This can result in significant financial exposure. For example:
An employee has a total knee replacement done at an in-network facility, but the employee chooses an out-of-network surgeon. The surgeon charges $9,500 and the plan's allowed amount for this procedure is $2,100. In addition to the higher out-of-network deductible and co-insurance, the employee is responsible for the $7,400 difference between billed charges and the allowed amount.
- Preventive services are not paid at 100%; the member must pay the difference.
- Out-of-network providers are not required to authorize services in advance. The member may have to request authorization or risk being responsible to pay for non-covered services.
- Even when emergency or urgent care services from out-of-network providers are covered with in-network deductibles and co-insurance, the member is still responsible for charges above the allowed amount, which can be significant.
An exclusive provider plan, such as IU Health Quality Partners, does not cover out-of-network services other than emergency care, urgent care when away from home, and services authorized by the plan in advance.
Network and non-network deductibles, co-insurance, and out-of-pocket maximums are separate and do not accumulate toward each other.
A provider includes hospitals, outpatient facilities, physicians, labs, radiology facilities, pharmacies, and other healthcare professionals.
An in-network provider has contracted with the Plan administrator to provide healthcare services to plan members at discounted rates called allowed amounts. In-network providers accept these amounts as payment in full which means members are not billed above the allowed amount.
An out-of-network provider has not contracted to provide healthcare services at discounted rates. The plan member is responsible for paying amounts above the allowed amount. Even when an in-network refers an out-of-network provider, out-of-network benefits still apply unless approved in advance by the Plan.
Beginning January 1, 2014, for the HDHP PPO, $500 Deductible, and $900 Deductible plans, the annual eye exam coverage will be converted from a medical benefit to a separate Vision benefit administered by Anthem Blue View Vision. Those enrolled in an IU PPO medical plan will receive the vision benefit with no separate enrollment. Benefits include:
- A routine eye exam every 12 months, with a $10 copay.
- Frames, lenses, and contacts covered with specific allowances and co-pays for in-network providers.
- In-network providers include IU Eye Care Centers, LensCrafters, Pearle Vision, Sears, Target, 1-800Contacts, and other independent eye care professionals.
The Vision Wear Program (Voluntary Benefits Program) administered by EyeMed will be discontinued December 31, 2013.
Note: Medical eye exams, such as for treatment of glaucoma or retinal detachment, remain a covered benefit under medical plans; however, they will be subject to the medical plan deductible and co-insurance.