University Human Resources
2015 Medical Care Plans
Similarities between the medical plans
- 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, chiropractic services, and vision wear.
- 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.
- Each plan offers a Vision Wear Benefit.
- 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.
Preventive care services for all plans
Preventive care services are covered at no cost (1) when network providers are used and (2) when services are consistent with the U.S. Preventive Services Task Force guidelines and nationally recognized schedules. Preventive care is generally provided when there are no current symptoms or prior history of a diagnosed medical condition associated with the service. Preventive services include contraceptive services and most birth control pills, physical exams, well-child visits, immunizations, lab tests (e.g., Pap, PSA, cholesterol), certain cancer preventive prescriptions, and other screening diagnostic services like mammograms and colonoscopies.
A detailed description of preventive services can be found at hr.iu.edu/pubs/misc/preventive_services.pdf.
Differences between the Medical Plans
- Out-of-pocket expenses (deductible levels, co-pays, and co-insurance)
- Provider networks. The PPO plans have a nationwide network and provide out-of-network benefits. The IU Health HDHP is an exclusive network with limited or no out-of-network benefits.
- Residency requirements e.g., IU Health HDHP is only available in certain counties
- How the deductible is structured in an HDHP plan versus a traditional plan (i.e., $900/$500 Deductible plans)
- How the prescription benefit is structured in an HDHP plan versus a traditional plan
- A unique tax-advantaged health savings account (HSA) plan available to participants enrolled in either the PPO HDHP plan or the IU Health HDHP
IRS-qualified High Deductible Healthcare Plans—HDHP
IU offers two HDHP medical plans that meet 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 co-insurance, or saved to use in the future, even in retirement.
Both HDHP plans include comprehensive medical coverage; however, provider networks, the member’s share of medical costs (deductibles and co-insurance), premiums, and the university’s contribution to the employee’s HSA differ between the plans
In an HDHP plan the deductible and out-of-pocket maximums are applied differently than a traditional PPO plan (e.g., the $500 and $900 Deductible plans), and there are IRS eligibility restrictions on enrolling in other medical coverage, so reading the plan details is important.
IU Health High Deductible Health Plan (more information)
The IU Health HDHP plan, new for 2015, exclusively uses the IU Health provider network and its affiliates, so eligibility is limited to employees residing in specific counties within Indiana—see the plan summary for specifics.
There are no out-of-network benefits except in the case of an emergency, urgent care when more than 50 miles from home, or for a dependent of an Indiana-resident employee when the dependent lives outside the state of Indiana for reasons other than medical treatment.
The plan deductible ($2,500 employee-only/$5,000 all other coverage levels) applies to all covered services except preventive medical services and preventive prescriptions. Preventive medical services are covered at 100% when IUH network providers are used. After the deductible is met, there is no co-insurance and covered services are paid 100% by the plan for the remainder of the plan year.
The university contribution to an employee’s HSA only partially covers the deductible--$1,600 employee-only/$3,200 all other coverage levels. The member is responsible for the difference between the IU contribution and the deductible ($900 difference for employee-only/$1,800 for all other coverage levels).
PPO High Deductible Health Plan (more information)
This plan has a nationwide network of providers. There are out-of-network benefits, however; the member pays less when network providers are used. The in-network deductible ($1,300 employee-only/$2,600 all other coverage levels) applies to all covered services except preventive medical services and preventive prescriptions. Preventive medical services are covered at 100% when PPO providers are used. After the deductible is met, a 20% co-insurance applies to all covered services until an out-of-pocket maximum ($2,500 employee-only/$5,000 all other coverage levels) is met. Both the deductible and co-insurance count toward the maximum.
The university contribution to an employee’s HSA is equal to the deductible--$1,300 employee-only/$2,600 all other coverage levels.
Traditional Deductible Plans
These plans are the same except for the deductible and premiums.
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. There is an out-of-pocket maximum after which services are covered at 100% for the remainder of the plan year.
Retail and mail order prescription co-pays 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. There is an out-of-pocket maximum on in-network prescription co-pays.
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.