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2013 PPO $900 Deductible Medical Care Plan

On this page: General Info | Medical Services | Prescription Drugs

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	$65.66	$86.44	$112.41	$138.38	$164.35	$190.32	$216.29
Employee and Child(ren)	$130.97	$172.41	$224.21	$276.01	$327.81	$379.62	$431.42
Employee and Spouse	$160.10	$210.77	$274.10	$337.42	$400.75	$464.08	$527.40
Family	$181.83	$239.36	$311.27	$383.19	$455.11	$527.02	$598.95
* 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.

General Information

Things you can do…

See the PPO $900 Deductible Benefit Summary (PDF) for information about services and copays.
See the Summary of Benefits and Coverage (SBC) in the Healthcare Reform format (coming soon).
Contact the Anthem customer service center at 800-345-2460 for questions about network providers, coverage, claim status, and benefits. Or visit the Anthem Web site.
Print the Anthem temporary ID card (PDF).

Medical Services (includes Mental Health)

Things you can do…

Locate a list of network physicians and specialists at Anthem’s 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.

Prescription Drugs (Rx)

Things you can do now…

See the PPO $900 Deductible Benefit Summary (PDF) for information about co-insurance and tiers.
Visit IU's Medco/Express Scripts Web page to learn about the Medco/Express Scripts Prescription Manager and how to use it.

For all plans, to access information on background and licensing of individual doctors, nurses, chiropractors and pharmacists, search and verify licensing online or call (toll free) 888-333-7515.