University Human Resource Services
Compare 2013 Medical Care Plans Distinguishing Features
Residency Requirement |
No residency requirement. | No residency requirement. | Residents of Blackford, Boone, Brown, Carroll, Clinton, Delaware, Greene, Hamilton, Hancock, Hendricks, Henry, Howard, Johnson, Lawrence, Madison, Marion, Monroe, Morgan, Owen, Putnam, Shelby, Tipton, & Tippecanoe. | No residency requirement. | ||||
Provider Network |
Full benefits from Anthem Blue Access and Blue Card PPO providers in a nationwide PPO network. | Full benefits from Anthem Blue Access and Blue Card PPO providers in a nationwide PPO network. | 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 a nationwide PPO network. | ||||
IU Contribution to HSA |
$1,250 for employee-only coverage; $2,500 if family members covered. (There is an annual $300 minimum employee contribution.) | Not applicable. | Not applicable. | Not applicable. | ||||
| Medical | ||||||||
In-Network Benefits |
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Deductibles |
$1,250 employee-only/$2,500 when family members are covered. Applies to all services except preventive medical services and preventive prescriptions. | $900 individual/$2,700 family maximum. | $400 deductible employee-only/$1,200 family coverage. | $400 individual/$1,200 family maximum. | ||||
Co-insurance |
After deductible, member pays 20%. | After deductible, member pays 20%. | After deductible, member pays 20%. | After deductible, member pays 20%. | ||||
Out-of-Pocket Maximum |
After the deductible and co-insurance together equal $2,500 ($5,000 family), then there is no co-insurance. | After the deductible and co-insurance equal $2,400 ($7,200 family) then there is no co-insurance. | After deductible, co-insurance equal $2,400 ($7,200 family), then there is no co-insurance. | After the deductible and co-insurance equals $2,400 ($7,200 family), then there is no co-insurance. | ||||
Out-of-Network Benefits |
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| Deductibles |
$2,400 individual/$4,800 family maximum. | $900 individual/$2,700 family maximum. | No Out-of-Network benefits, except emergency. | $900 individual/$2,700 family maximum. | ||||
| Co-insurance |
After deductible, member pays 40%. | After deductible, member pays 30%. | After deductible, member pays 30%. | |||||
| Out-of-Pocket Maximum |
After the deductible and co-insurance equals $5,000 ($10,000 family), then there is no co-insurance. | After the deductible and co-insurance equals $3,000 ($9,000 family), then there is no co-insurance. | After the deductible and co-insurance equals $3,000 ($9,000 family), then there is no co-insurance. | |||||
| 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% co-insurance after deductible. | $150 co-pay per visit (waived if admitted) | $150 co-pay per visit (waived if admitted) | $150 co-pay per visit (waived if admitted) | ||||
| Urgent Care |
20% co-insurance after deductible. | $75 co-pay per visit. | $75 co-pay per visit. | $75 co-pay per visit. | ||||
| Mental Health |
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. | 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. | ||||
| Prescription Drugs | ||||||||
In-Network Co-insurance |
Retail (up to 30-day supply): 20% co-insurance after deductible. Mail Order (up to 90-day supply): 20% co-insurance after deductible. (Deductible does not apply to the preventive drug list.) |
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Out-of-Network Co-insurance |
Retail (up to 30-day supply): 40% co-insurance after deductible. Mail Order Not covered |
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Preventive Prescription Exceptions (In-Network Only) |
Plan pays 100% for generic contraceptives, pediatric sodium floride, low dose aspirin, folic acid, and iron. 100% coverage for Tobacco cessation products and nicotine replacement (up to 180 day supply annually). | |||||||
| Exclusions | ||||||||
Exclusion (examples) |
• Services not medically necessary as determined by the Plan Administrator • Custodial care, convalescent, “long-term” nursing, or residential care • Cosmetic surgery, procedures, and drugs • Services, supplies, and drugs for obesity or weight control, except surgery for morbid obesity • Supportive devices for the feet, and routine foot care • Immunizations and exams required as a condition of employment, for licensing, or for other purposes such as camps or travel • Experimental/Investigative services • Artificial insemination; fertilization (such as in-vitro, GIFT, ZIFT) or procedures and testing related to fertilization; reversal of sterilization; infertility drugs and related services following the diagnosis of infertility • Drugs, devices, or services related to sex transformation, male or female sexual or erectile dysfunction or inadequacy regardless of the cause • Drugs in excess of limits established by the plan • Non-sedating (3rd generation) antihistamines, such as Zyrtec and Allegra • Services and supplies used to treat conditions to the extent that, according to generally accepted Professional Standards, such conditions are not amenable to favorable modification through medical treatment • Sclerotherapy for the treatment of varicose veins of the lower extremities. | |||||||