phone mail2 mobile email AskHR-1-rev AskHR-1-rev askhr-1-rev
Human Resources

Open Enrollment

Understanding In-Network and Out-of-Network Benefits

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.

An exclusive provider plan, such as IU Health HDHP, does not cover out-of-network services other than emergency care and urgent care when away from home, certain children living outside Indiana, and services authorized by the plan in advance.

In-network

  • Lower out-of-pocket costs (e.g., deductible and coinsurance).
  • Deductibles, coinsurance, 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%.
  • Services requiring approval are authorized in advance.

Out-of-network

  • Higher out-of-pocket costs (e.g., deductible and coinsurance).
  • Deductibles, coinsurance, and out-of-pocket maximums are higher.
  • The member is responsible for charges above the plan’s allowed amounts, these changes can be significant.
  • Preventive services are not paid at 100%.
  • Out-of-network providers are not required to authorize services in advance. The member may have to request authorization or risk being responsible for charges.
  • When emergency or urgent care services from out-of- network providers are covered with in-network deductibles and coinsurance, the member is responsible for charges above the allowed amount. These can be significant.

Things you can do

 

Things To Do

 

Page updated: September 2017

IU Human Resources
Poplars E165, 400 E. 7th St., Bloomington, IN 47405