Compare 2012 Medical Care Plans Distinguishing Features

	HDHP PPO & Health Savings Account (HSA)	IU Health Quality Partners (IUHQP)	PPO $900 Deductible	PPO $400 Deductible
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Residency Requirement	No residency requirement.	Residents of Blackford, Boone, Brown, Carroll, Clinton, Delaware, Green, Hamilton, Hancock, Hendricks, Henry, Howard, Johnson, Lawrence, Madison, Marion, Monroe, Morgan, Owen, Putnam, Shelby, Tipton, & Tippecanoe.	No residency requirement.	No residency requirement.
MEDICAL
IU Contribution to HSA	$1,200 for employee-only coverage; $2,400 if family members covered.	Not applicable.	Not applicable.	Not applicable.
Provider Network	Full benefits from Anthem Blue Access and Blue Card PPO providers in other states.	Benefits only from IUHQP providers. Designation of a Primary Care Physician (PCP) is required.	Full benefits from Anthem Blue Access and Blue Card PPO providers in other states.	Full benefits from Anthem Blue Access and Blue Card PPO providers in other states.
In-Network Benefits
Deductibles	$1,200 employee-only/$2,400 when family members are covered. Applies to all services except preventive and preventive Rx.	No deductible. (See below for hospital and outpatient copays.)	$900 individual/$2,700 family maximum.	$400 individual/$1,200 family maximum.
Copays	After deductible, member pays 20%.	$30 primary care/$40 specialist office visit. $400 hospital admission. $200 outpatient facility visit. 15% other services.	After deductible, member pays 20%.	After deductible, member pays 20%.
Out-of-Pocket Maximum	After the deductible and copays equal $2,500 ($5,000 family), then there is no copay.	After copays equal $2,400 ($7,200 family), then there is no copay.	After the deductible and copays equal $2,400 ($7,200 family) then there is no copay.	After the deductible and copays equal $2,400 ($7,200 family), then there is no copay.
Out-of-Network Benefits
Deductibles	$2,400 individual/$4,800 family maximum.	No Out-of-Network benefits, except emergency.	$900 individual/$2,700 family maximum.	$900 individual/$2,700 family maximum.
Copays	After deductible, member pays 40%.		After deductible, member pays 30%.	After deductible, member pays 30%.
Out-of-Pocket Maximum	After the deductible and copays equal $5,000 ($10,000 family), then there is no copay.		After the deductible and copays equal $3,000 ($9,000 family), then there is no copay.	After the deductible and copays equal $3,000 ($9,000 family), then there is no copay.
In-Network Preventive Services	Plan pays 100%.	Plan pays 100%.	Plan pays 100%.	Plan pays 100%.
In-Network Routine Vision Exam	One eye exam per year, plan pays 100%.	One eye exam per year, plan pays 100%.	One eye exam per year, plan pays 100%.	One eye exam per year, plan pays 100%.
Emergency Room	20% copay after deductible.	$150 copay per visit (waived if admitted)	$150 copay per visit (waived if admitted)	$150 copay per visit (waived if admitted)
Urgent Care	20% copay after deductible.	$75 copay per visit.	$75 copay per visit.	$75 copay per visit.
Mental Health	Covered as any other illness through Anthem Behavioral Health. Prior authorization is required.	Covered as any other illness through IUHQP designated providers. Prior authorization is required.	Covered as any other illness through Anthem Behavioral Health. Prior authorization is required.	Covered as any other illness through Anthem Behavioral Health. Prior authorization is required.
PRESCRIPTION DRUGS (Rx)
In-Network copays	Retail (up to 30-day supply): 20% copay after deductible.* Mail Order (up to 90-day supply): 20% copay after deductible.* Specialty drugs only available through Mail Order.	Retail (up to 30-day supply): Tier 1 - $8 Tier 2 - $25 Tier 3 - $45 Mail Order (up to 90-day supply): Tier 1 - $20 Tier 2 - $62 Tier 3 - $112 Specialty drugs only available through Mail Order.
Out-of-Network copays	Retail (up to 30-day supply): 40% copay after deductible.* Mail Order Not covered	Retail (up to 30-day supply): 50% copay Mail Order Not covered
	*No deductible on preventive prescriptions