2012 HDHP PPO & Health Savings Account

On this page: HDHP PPO Highlights | Things you can do

On a different page: Health Savings Account

Watch these short slide presentations to get the most out of the Plan

Get detailed info from answers to questions asked by employees

The plan includes comprehensive coverage for medical, prescription, behavioral health, and organ transplant services with no pre-existing condition limits.
The plan deductible is $1,200 for employee-only coverage and $2,400 when one or more family members are covered. In accordance with IRS regulations, the deductible works differently than the PPO $900 or $400 Deductible plans.
- The deductible applies to all medical expenses except preventive services and preventive prescriptions.
- 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.
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 prescriptions are covered at 80%—no deductible applies.
Wellness/Preventive services are covered at 100%—no deductible applies.

Coverage	Monthly Employee Contribution Employee’s Annual Base Salary
Coverage	Below $30,000	$30,000 - $49,999	$50,000 - $99,999	$100,000 - $149,999	$150,000 - $199,999	$200,000 - $249,999	$250,000 and Above
Employee only	$25.51	$35.71	$48.46	$61.21	$73.96	$86.72	$99.47
Employee and Child(ren)	$50.87	$71.22	$96.66	$122.10	$147.53	$172.97	$198.41
Employee and Spouse	$62.19	$87.07	$118.17	$149.26	$180.36	$211.46	$242.55
Family	$70.63	$98.88	$134.20	$169.51	$204.83	$240.14	$275.46

Employee contributions are deducted before taxes.
Subtract $25 per month for an employee or spouse ($50 for both) who do not use tobacco.

Things you can do…

See the HDHP PPO Benefit Summary (PDF) for information about services and copays.
Contact the plan administrator, Anthem, at 800-345-2460 or visit the Anthem Web site for questions about coverage, claims, and provider networks.
Print the Anthem temporary ID card (PDF).

Things you can do…

Locate a network medical provider by consulting the Anthem Web site.
Obtain information about precertification of a medical procedure by calling Anthem Utilization Review at 800-345-4348.
Call Anthem Behavioral Health at 800-345-2460 for questions about Mental Health/Chemical Dependency coverage, claims and provider networks.
Talk to a registered nurse when symptoms are present, but the doctor’s office is closed. Call the 24-Hour Nurse Line at 1-866-895-5835 and press option #1.
Get coverage when out-of-state or overseas.

Things you can do…

See the HDHP PPO Benefit Summary (PDF) for information about copays and tiers.
Visit IU's Medco Web page to learn about the Medco Prescription Manager and how to use it.
Review the Medco Preventive Drug List (PDF)

Things you can do…

Visit IU's Health Savings Account web page to learn about the HSA and how to use it.