2013 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 $1,250 for employee-only coverage and $2,500 when one or more family members are covered. In accordance with IRS regulations, the deductible works differently than the PPO $900, $400 Deductible, or IUHQP plans.
- The deductible applies to all medical and prescription 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.
Co-insurance is limited by an out-of-pocket maximum—when the deductible and co-insurances reach the maximum, there is no co-insurance 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.)
Contraceptives requiring a prescription—generic and brands without a generic equivalent—are covered at 100%, no deductible, no co-pay.

Preventive medical services are covered at 100% when In-Network providers are used —no deductible applies. Preventive services include physical exams, well-child visits, immunizations, lab tests (e.g., Pap, PSA, cholesterol), contraceptive services (e.g., IUD’s and sterilization ), and other screening diagnostic services like mammograms and colonoscopies.

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	$28.93	$39.74	$53.25	$66.77	$80.28	$93.81	$107.33
Employee and Child(ren)	$57.69	$79.26	$106.22	$133.19	$160.15	$187.11	$214.08
Employee and Spouse	$70.52	$96.90	$129.86	$162.82	$195.78	$228.75	$261.71
Family	$80.09	$110.04	$147.48	$184.91	$222.35	$259.78	$297.21
* The employee’s salary band is determined by the annual base salary at the time payroll runs each month.

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 & HSA Benefit Summary (PDF) for information about services and co-insurance.
See the Summary of Benefits and Coverage (SBC) in the Healthcare Reform format.

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 & HSA Benefit Summary (PDF) for information about services and co-insurance.
Visit IU's Medco/Express Scripts Web page to learn about the Medco/Express Scripts Prescription Manager and how to use it.
Review the Medco/Express Scripts Preventive Drug List (PDF)
Review Preventive Medical Services (PDF)

Things you can do…

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