Choosing a Medical Plan
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. Preventive services include contraceptive services and most birth control pills, physical exams, well-child visits, immunizations, lab tests (e.g., Pap, PSA, cholesterol), and other screening diagnostic services like mammograms and colonoscopies.
- 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 care includes routine services, such as wellness exams, immunizations, screenings, women’s health (e.g., contraception), and certain over-the-counter medications.
Download a detailed description of preventive services (PDF).
Differences between the Medical Plans
- Out-of-pocket expenses (deductible levels, co-pays, and co-insurance)
- 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
- Residency requirements e.g., IU Health HDHP is only available in certain counties
- A unique tax-advantaged health savings account (HSA) plan available to participants enrolled in either the PPO HDHP plan or the IU Health HDHP
Download plan-specific summaries
- IU Health HDHP Benefit Summary (PDF)
- PPO HDHP Benefit Summary (PDF)
- PPO $500 Deductible Benefit Summary (PDF)
- PPO $900 Deductible Benefit Summary (PDF)
Find prescription information on the Express Scripts web site