2019 BENEFITS GUIDE Benefits designed with you in mind - IU Health
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2019 BENEFITS GUIDE Benefits designed with you in mind
Benefits designed with you in mind
This guide provides information about your benefits with
Indiana University Health. Use it as your go-to source when you
are first enrolling for your benefits, when changing your benefits at
open enrollment or throughout the year as a benefits resource.
QUESTIONS?
If you have questions about your benefits, need to
change or cancel your elections, or want additional
information about new enrollment, contact:
Human Resources Shared Services
(all entities except IU Health Physicians)
T 317.962.7900 | T 877.849.5724 (toll free)
BenefitsHRSS@iuhealth.org
IU Health Physicians
Human Resources Service Line
T 317.962.0700 | scantoiuhphr@iuhealth.org
This guide provides general benefit plan and enrollment information only. For specific details,
conditions and exclusions, please refer to the official summary plan descriptions (SPDs) and the
official plan document. If there is a discrepancy between this guide and an official SPD or plan
document, the official plan document will govern.
| For more information, visit team.myiuhealth.org/benefits | 2
See inside for:
Benefits checklist........................................................................................................... 4
Eligibility information.............................................................................................. 5 – 6
Enrollment information........................................................................................... 7 – 8
Medical plans
Medical plans overview................................................................................... 9 – 12
Pharmacy benefits......................................................................................... 13 – 14
Medical plan rates.................................................................................................. 15
Health reimbursement arrangement credit......................................................... 16
Health savings account.......................................................................................... 17
Flexible spending accounts........................................................................... 18 – 19
Healthy Results® – IU Health team member well-being program......................... 20
Accident and critical illness plans.............................................................................. 21
Dental insurance and rates................................................................................ 22 – 23
Vision insurance and rates................................................................................. 24 – 25
Life insurance and rates..................................................................................... 26 – 31
Short-term disability insurance and rates........................................................ 32 – 34
Long-term disability insurance and rates......................................................... 35 – 36
Paid time off.................................................................................................................. 37
Retirement plans................................................................................................. 38 – 39
Enhanced benefits: discounts and perks.................................................................. 40
Employee Assistance Program................................................................................... 41
Adoption Assistance Program.................................................................................... 41
Who to contact..................................................................................................... 42 – 43
Glossary............................................................................................................... 44 – 48
How you and your insurer share costs - example.................................................... 49
Compliance notices............................................................................................. 50 – 54
| For more information, visit team.myiuhealth.org/benefits | 3
Benefits checklist When to enroll
PREPARE: Newly hired/eligible team members: Make
Review this guide and go to team.myiuhealth.org/benefits for additional your elections within 31 days of your hire date/
information.
status change.
Estimate your out-of-pocket costs for medical, dental and vision care—if you
want to contribute to a flexible spending account or health savings account— Current team members: Make any desired
to help cover these expenses with pretax dollars. elections or changes during the open enrollment
ENROLL: period.
Log in to Lawson > Employee Self-Service (ESS). Learn how on page 7.
Your next opportunity to enroll won’t be until
Elect your benefits and review your confirmation. open enrollment for 2020 benefits, unless
Print a copy for your records prior to logging off. you experience a qualifying life event, such as
Submit dependent verification documentation if you enroll a dependent. marriage, divorce, or the birth or adoption
See list of acceptable documents on page 5. of a child.
CONFIRM:
Check your first pay stub after your benefits effective date to make sure your
elections are reflected correctly.
Contact Human Resources immediately if you see any problems:
Human Resources Shared Services (all entities except IU Health Physicians)
T 317.962.7900 | T 877.849.5724 (toll free) | BenefitsHRSS@iuhealth.org
IU Health Physicians
Human Resources Service Line | T 317.962.0700 | scantoiuhphr@iuhealth.org
| For more information, visit team.myiuhealth.org/benefits | 4
Who’s eligible for benefits
ELIGIBLE TEAM MEMBERS
You are eligible for benefits if you are a full-time or part-time team member scheduled to work at least 48 hours per Acceptable proof of
pay period.
eligibility documentation
(All financial information should be
ELIGIBLE DEPENDENTS marked out.)
Dependents eligible for coverage under your medical, If you are enrolling your spouse in medical Legal spouse – A copy of the first page
dental and/or vision plans include the following: coverage, you must complete and submit of the most recently filed federal income
a “Questionnaire for Medical Coverage of tax return Form 1040 that indicates
■■ Legally married spouse a Spouse”—available on the My IU Health “married filing jointly” or “married filing
separately.” Your spouse’s name must
■■ Children* to the end of the month of their 26th birthday team portal. The questionnaire will help appear on the line provided after the
■■ Any age adult child who is permanently and totally determine whether your spouse is eligible “married filing separately” status.
disabled (A permanently and totally disabled child must for “primary” or “secondary” coverage If you are recently married and have not
have been continuously covered as a dependent child under an IU Health medical plan. filed a joint 1040, please provide a copy
prior to enrolling in an IU Health plan.) of your recent valid/legal certificate/
■■ Children* who are required by a qualified medical child license, which must include date of
support order (QMCSO) to be covered by the plan and are (1) not claimed as a dependent with the IRS by the team marriage.
member and/or (2) do not reside with the team member Child/adult child up to age 26 – A
*Children include natural or legally adopted (or placed for adoption) children of the team member, the team member’s legal copy of any one of the following: birth
spouse; children for whom the team member, the team member’s legal spouse is the court-appointed legal guardian. certificate, legal adoption papers, official
court order, legal guardianship papers or
For more information, please see the Eligible dependents form on the My IU Health team portal: qualified medical child support order.
My Life & Career > My Benefits > Benefits Forms; or contact Human Resources. Disabled child over the age of 26 – A
copy of any one of the above acceptable
PROOF OF ELIGIBILITY documents for any child/adult child,
the first page of the most recently filed
If you enroll a dependent (spouse or child) in an IU Health medical, dental or vision plan, you must provide proof
Form 1040 that indicates the child as
of eligibility (as outlined on the right) to Human Resources within 31 days from your official hire date/status a dependent and a statement from a
change. You only need to submit documentation once for each dependent. physician certifying that the dependent
child cannot work to provide self-support
If acceptable documentation is not provided for an enrolled dependent, the coverage for that dependent will not due to a permanent and total disability.
become effective, and the next opportunity to enroll the dependent will be during the next open enrollment period For more information, please
see Acceptable Proof of Eligibility
or a qualifying event.
Documentation on
team.myiuhealth.org/benefits.
| For more information, visit team.myiuhealth.org/benefits | 5
Who’s eligible for benefits continued
WORKING SPOUSE RULE
Working spouses of enrolled team members will, in most situations, be required
to join their employer’s group medical coverage for “primary” coverage. They
still may choose to be covered under an IU Health medical plan for “secondary”
coverage. (Secondary coverage applies only to claims not paid by one’s primary
health plan.)
Your spouse may enroll in IU Health medical plans for “primary coverage” if
he/she is:
■■ self employed
■■ retired
■■ unemployed
■■ works for a company that does not provide a credible level of coverage
The working spouse rule applies only to medical coverage and does not apply
to dental, vision or any other dependent benefits. This provision does not affect
eligibility for primary coverage under any IU Health medical, dental or vision
plans for eligible dependent children.
Don’t forget to submit the Questionnaire for Medical Coverage of a Spouse to help
determine eligibility. See box on page 5.
| For more information, visit team.myiuhealth.org/benefits | 6
Enrollment information
BENEFITS AVAILABLE TO YOU
You choose the benefits important to you and your family, and IU Health shares
When to enroll
in the cost of your coverage. Choose carefully—once the open enrollment period
Newly hired/eligible team members: Make your elections within 31 days of your
ends, changes are only allowed when a qualified life event occurs. hire date/status change.
Current team members: Make any desired elections or changes during the open
IU HEALTH PAYS: YOU PAY AT A SPECIAL GROUP RATE: enrollment period.
Your next opportunity to enroll won’t be until open enrollment for 2020 benefits,
■■ 60 to 90 percent of the cost of your ■■ Vision insurance
unless you experience a qualifying life event, such as marriage, divorce, or the
medical insurance*
■■ Supplemental employee life birth or adoption of a child.
■■ Half the cost of your dental insurance insurance
for the basic option (IU Health will also
pay a portion of the cost for the high ■■ Dependent life insurance
option plan) HOW TO ENROLL
■■ Voluntary accident and
dismemberment insurance Enrolling is simple using Employee Self-Service. This is the same tool team
■■ Your basic life insurance
members use to update their home address, phone number and emergency
■■ Short-term disability
■■ Your basic long-term disability insurance contacts, as well as to modify federal and/or state tax withholdings, and to
insurance
■■ A contribution to your health savings check benefits such as paid time off balances and pay stubs.
account**
From an IU Health computer connected to the IU Health network:
■■ A health reimbursement arrangement
credit** ■■ Log in to Lawson (lawprod.iuhealth.org) with your network ID and password
■■ Select Employee Self-Service from the left-hand margin of the screen
*Depending upon your earnings group and elected plan coverage ■■ Select Benefits
**Depending on whether you enroll in one of the HSA-based or HRA medical plans, and eligibility status.
■■ Select “New Hire Enrollment” if you are a new team member; otherwise select
In addition, depending on the type of medical coverage you pick, you can elect to “Open Enrollment”
make pretax contributions to:
■■ A health savings account Enrolling during
■■ A flexible spending account
open enrollment?
See “How to enroll during open enrollment”
As permitted by law, your cost for medical, dental, vision, flexible spending on team.myiuhealth.org/benefits for full
accounts and voluntary accident coverage is deducted from your pay on a pretax enrollment instructions, including information
on how to enroll from a computer not connected
basis. This saves you money because you pay no federal, state or local income
to the IU Health network.
taxes or Social Security taxes on the dollars you spend for these benefits.
| For more information, visit team.myiuhealth.org/benefits | 7
Enrollment information continued Qualified life events
The IRS limits changes during the year
because it allows you to pay for most of
When coverage begins your benefits on a tax-free basis. You are
Newly hired/eligible team members: Benefits will be effective on the first of the allowed to make changes to your medical,
month following your official hire date/status change, unless the plan has a dental, vision, voluntary accident and flexible
waiting period (Basic Life: six months of active service in a benefits-eligible position spending account benefits during the year
waiting period; Long-Term Disability: 12 months of active service in a benefits- only if you have a qualified event resulting
eligible position waiting period).
in a “change in family status.” You may
Current team members: Benefits elected during the 2019 open enrollment period be able to add or drop coverage and/or
will take effect on Jan. 1, 2019. dependents if:
■■ You get married, divorce or legally separate
AFFORDABLE CARE ACT (ACA) AND ■■ Your child is born or adopted, or becomes
HEALTH INSURANCE MARKETPLACE EXCHANGE disqualified or requalifies for dependent
The Affordable Care Act (ACA) was passed in 2010. This law extended medical coverage
coverage access to nearly everyone in the U.S. and eliminated some restrictions ■■ One of your dependents dies
on key benefits. The ACA includes the individual mandate, which requires nearly
■■ You or your spouse has a change in
all Americans to have medical coverage or pay a penalty (when they file their
employment status that changes eligibility
annual tax returns).
for benefits
If you are eligible for coverage through IU Health, this is likely your best option ■■ Your spouse has a change in benefits coverage during his/her employer’s
to meet the individual mandate. The plans offered through IU Health are enrollment period
comprehensive and affordable. ■■ You are taking an unpaid leave of absence
Another option, especially for those not eligible for IU Health coverage, is to ■■ You, your spouse or tax dependent becomes entitled to or loses Medicare or
access affordable coverage through a competitive private health insurance Medicaid coverage
market—the Health Insurance Marketplace Exchange. Available to everyone, the To change coverage under one of these situations, you must complete the
Marketplace Exchange offers “one-stop” shopping to find/compare private health necessary forms within 31 days of the event and submit them to Human
insurance options. Visit healthcare.gov to learn more. Marketplace Exchange Resources. In most of these instances, your change is effective the first of the
information for Indiana and states where IU Health team members reside is month following the date of the “change in family status.” You may only apply for
located on the My IU Health team portal under My Life & Career > My Benefits > an increase in your life insurance (subject to the insurance company’s approval)
Benefit Plans Compliance. during open enrollment.
You may drop or decrease your supplemental and dependent life insurance
IU Health offers eligible team members the option to enroll in an IU Health
coverage at any time during the year by completing a cancellation form. Your change
medical plan. IU Health is providing information about the Marketplace Exchange
is effective the first of the month following the date the request is received.
to team members to fulfill the requirements of the law.
| For more information, visit team.myiuhealth.org/benefits | 8
Medical plans
IU Health offers eligible team HSA MEDICAL PLAN AND HSA MEDICAL SAVER PLAN – The HSA-based
If you are dually employed members four different medical medical plans provide lower premiums but potentially higher out-of-pocket
by IU Health Physicians and plans. Two health savings account costs. Plan members are responsible for paying the full cost of services—except
(HSA)-based medical plans—HSA for eligible pharmacy expenses and qualified preventive care services—until
Indiana University School
Medical Plan and HSA Medical Saver meeting the annual deductible. Once the deductible is met, the plan begins to
of Medicine as a faculty
pay coinsurance based on where care is received. HSA-based medical plans
member (.75 full-time Plan—a health reimbursement
allow team members to contribute funds to a personal health savings account
equivalent or above), arrangement (HRA) medical plan
on a pretax basis, which can be used to pay for eligible medical, dental and
your medical insurance and a traditional preferred provider
vision expenses. IU Health will make a “pre-funded” employer contribution to
is available only through organization (PPO) plan are available.
participating team members’ HSA accounts.
Indiana University.
Team members can choose their
HRA MEDICAL PLAN – Similar to the HSA-based medical plans, this plan
providers and facilities, with the provides lower premiums but potentially higher out-of-pocket costs. Plan
percentage of care covered by the plan based on where care is received members are responsible for paying the full cost of services—except for office
(IU Health/Community Health Network, Encore/Aetna or out of network). visit copays, urgent care copays, eligible pharmacy expenses and qualified
For all plans, the highest level of coverage is offered when IU Health providers preventative care services—prior to meeting the deductible. The HRA plan is
and facilities are used. Precertification is required for most inpatient and particularly suitable for team members 65 or older on Medicare plans, military
outpatient treatments. insurance plans and other types of coverage that preclude them from receiving
IU Health HSA contributions or depositing pretax dollars to an HSA account;
You may select Employee; Employee & Spouse; Employee & Child(ren); or Family
instead HRA plan members will receive a credit toward their deductible.
coverage from any of the plans offered through IU Health.
TRADITIONAL PPO PLAN – This plan provides higher premiums for team
members who want the convenience of copays for office visits and pharmacy
Provider listings and medical
expenses. Like the other plans, eligible pharmacy expenses and preventive care
plans’ summary of benefits
and coverage (SBC) for all services are covered at no cost if services are received at IU Health, Community
the medical plan offerings or an Encore/Aetna facility.
are available on the
IU Health Plans website
DID YOU KNOW?
at myiuhealthplans.com.
This site also includes These medical plans include a $35 copay for eye exam and a 35 percent discount
summaries about each on glasses (in-network providers only). Visit myiuhealthplans.com for more details.
plan, pharmacy information
and FAQs. You can reach
IU Health Plans Customer
Service at 866.895.5975.
| For more information, visit team.myiuhealth.org/benefits | 9
Choose the best medical plan for you
With four medical plans to choose from, it can be difficult to choose the plan
that is right for you—but help is here. An online medical cost estimator can help
you estimate your benefits and costs.
This tool helps you:
■■ Measure how your healthcare choices and behaviors can impact your personal
budget
■■ See how your plan choices impact your premium costs, out-of-pocket expenses
and tax savings
■■ Choose the benefits that meet your needs
Here’s how to get started:
Step 1: Log in to Lawson.
Step 2: On the left-hand side of the screen, select Employee Self-Service >
Benefits > Health & Welfare > Medical Cost Estimator.
Step 3: The tool will automatically load your medical coverage and
information for your enrolled spouse and/or dependent(s) from Lawson.
Step 4: You can update each person’s health profile to adjust medical plan
costs, anticipated conditions or general healthcare utilization. In general, you
should select lower utilization if you primarily use preventative care and/or a few
episodes for minor illnesses or chronic conditions. If you reach or almost reach
your out-of-pocket maximum each year, you should select higher utilization.
Step 5: Once you’ve compared your estimated costs with each medical plan,
use this information to make your benefits elections.
| For more information, visit team.myiuhealth.org/benefits | 10Compare your medical plans
The chart below highlights the various medical plan options:
HSA MEDICAL AND HRA MEDICAL PLAN TRADITIONAL PPO MEDICAL PLAN
HSA MEDICAL SAVER PLANS
Deductible, copays, coinsurance Deductible applies to all plan participants regardless Deductible, coinsurance and out-of-pocket maximums Deductible, coinsurance and out-of-pocket maximums
and out-of-pocket maximums of where care is received. are based on where services are received. are based on where services are received.
Coinsurance and out-of-pocket maximums are based Copays and pharmacy expenses will apply toward the Copays and pharmacy expenses will apply toward the
on where services are received. out-of-pocket maximums. out-of-pocket maximums.
Pharmacy expenses apply toward the deductible and Team members enrolled at the family coverage level— Team members enrolled at the family coverage level—
out-of-pocket maximums. Employee & Spouse, Employee & Child(ren) or Family: Employee & Spouse, Employee & Child(ren) or Family:
Team members enrolled at the family coverage Once you meet an individual deductible, coinsurance Once you meet an individual deductible, coinsurance
level—Employee & Spouse, Employee & Child(ren) begins for that individual. begins for that individual.
or Family: You must meet the full family deductible Team members in Premium Cost Group A: Team members in Premium Cost Group A:
before the plan begins to pay. – Your deductible is reduced—after HRA credit – Your deductible is eliminated if care is provided by an
Team members in Premium Cost Group A enrolled is applied—if care is provided by an IU Health/ IU Health/Community provider/facility.
at the individual coverage level: Community provider/facility. – Your out-of-pocket maximum is reduced to $2,500
–Y
our out-of-pocket maximum is reduced to $2,500 – Your out-of-pocket maximum is reduced to $2,500 if you are enrolled at the individual coverage level
for the HSA Medical and $3,000 for the HSA if you are enrolled at the individual coverage level and care is provided by an IU Health/Community
Medical Saver plan if care is provided by an and care is provided by an IU Health/Community provider/facility.
IU Health/Community provider/facility. provider/facility.
IU Health IU Health’s contribution to the HSA: IU Health Plans’ credit: N/A
contribution/credit – $700* (individual) – $700* (individual)
– $1,400* (family) – $1,400* (family)
Balance carries over year to year (even if team members Balance carries over year to year (up to $5,000)
are no longer enrolled in an HSA-based medical plan or – Forfeited if no longer enrolled in the HRA Medical
leave employment) Plan or leave employment
Tax advantage You may contribute pretax dollars to your HSA and to a You are not eligible to contribute to your HRA, but you You are eligible to contribute pretax dollars to a health
limited-purpose flexible spending account (eligible dental are eligible to contribute pretax dollars to a health flexible spending account (eligible medical, dental and
and vision expenses only). flexible spending account (eligible medical, dental and vision expenses).
vision expenses).
Accident/Critical Illness Plan You’ll be automatically enrolled in free Accident and Plan available at a cost to you Plans available at a cost to you
Critical Illness plans to help offset the high deductible.
Medical/Pharmacy expenses You are responsible for full cost of services, including Plan copays for primary care provider, specialist, and Plan copays for primary care provider, specialist, and
prescriptions, prior to meeting the deductible (except urgent care visit prior to meeting the deductible (except urgent care visit prior to meeting the deductible (except
for preventive care services provided by an IU Health/ for preventive care services provided by an IU Health/ for preventive care services provided by an IU Health/
Community or Encore/Aetna provider/facility). Community or Encore/Aetna provider/facility) Community or Encore/Aetna provider/facility)
DID YOU KNOW? IU Health Video Visits allow you to see a provider in minutes using a smartphone, tablet or
computer. You can use IU Health Video Visits for common conditions such as bronchitis, cough,
flu, pink eye, rashes, sinus symptoms and many other minor, low-intensity conditions.
For more information, visit iuhealth.org/virtual-visits-app.
*Amount will be prorated on a quarterly basis depending upon when coverage begins.
| For more information, visit team.myiuhealth.org/benefits | 11Compare your medical plans continued
The chart below highlights the various medical plan options:
HSA MEDICAL PLAN HSA MEDICAL SAVER PLAN HRA MEDICAL PLAN TRADITIONAL PPO MEDICAL PLAN
IU Health/ Encore/ Out of IU Health/ Encore/ Out of IU Health/ Encore/ Out of IU Health/ Encore/ Out of
Community Aetna Network Community Aetna Network Community Aetna Network Community Aetna Network
Individual $1,500 $2,000 $2,500 $2,500 $3,000 $3,500 $1,500 $2,000 $2,500 $600 $1,200 $1,200
Annual
deductible*
Family $3,000 $4,000 $5,000 $5,000 $6,000 $7,000 $3,000 $4,000 $5,000 $1,200 $2,400 $2,400
IU Health HRA Individual $700 $700 $700
credit/HSA N/A
contribution Family $1,400 $1,400 $1,400
Team member Individual $2,800** $2,800**
HSA contribution N/A N/A
limits Family $5,600** $5,600**
Coinsurance after deductible
10% 30% 50% 20% 40% 60% 10% 30% 50% 20% 40% 60%
Your share of covered charges
Individual $3,750 $5,500 $6,500 $4,250 $6,250 $7,500 $3,750 $5,500 $6,500 $3,750 $5,500 $6,500
Out-of-pocket
maximum***
Family $7,500 $11,000 $13,000 $8,500 $12,500 $15,000 $7,500 $11,000 $13,000 $7,500 $11,000 $13,000
Primary Care $25 copay $25 copay $25 copay $25 copay
10% after 30% after 50% after 20% after 40% after 60% after 50% after 60% after
Office visit
deductible deductible deductible deductible deductible deductible deductible deductible
Specialist $40 copay $40 copay $40 copay $40 copay
Urgent care visit 10% after deductible 20% after deductible $25 copay $25 copay
Emergency room visit (if not
admitted)—nonemergency care 10% after deductible 20% after deductible 10% after deductible $250 copay (waived if admitted)
at ER is not covered
Physician/Facilities network IU Health Business Solutions/Community Health Network, Encore/Aetna, Out of Network
Deductible, copays and coinsurance apply toward the above out-of-pocket maximum amounts
* PPO medical plan: Deductible eliminated for Premium Cost Group A team members if care is received at an IU Health/Community provider/facility. HRA medical plan: Deductible is reduced--once HRA credit is applied—for Premium Cost Group A team members
if care is received at an IU Health/Community provider/facility. HSA-based medical plans: Deductible applies to all groups—regardless of where care is received. (Note: If enrolled in an HSA-based medical plan at the family coverage level—Employee & Spouse,
Employee & Children or Family—you must meet the full family deductible before the plan begins to pay.)
** Team members age 55 or older may contribute an additional $1,000 annually.
*** PPO, HRA and HSA medical plans: Team member’s out-of-pocket maximum is reduced to $2,500 for Premium Cost Group A team members enrolled at the individual coverage level if care is provided by an IU Health/Community provider/facility.
HSA Saver medical plan: Team member’s out-of-pocket maximum is reduced to $3,000 for Premium Cost Group A team members enrolled at the individual coverage level if care is provided by an IU Health/Community provider/facility.
| For more information, visit team.myiuhealth.org/benefits | 12DID YOU KNOW?
Pharmacy benefits
Maintenance medications
Team members enrolled in an IU Health medical plan are able to take advantage For more information about the prescription are used to treat chronic or
long-term conditions such as
of the convenience and lower copayment amounts offered at IU Health retail and drug benefits, visit the IU Health Plans website diabetes, high blood pressure
mail-order pharmacies, and at CVS and Kroger/Payless pharmacies. at myiuhealthplans.com. On the site, you will and cholesterol, and asthma.
find information about preventive medications,
Seven things you should know about your pharmacy benefits:
mail-order or emergency medications, IU Health retail pharmacies, CVS and
1 IU Health retail, CVS and Kroger/Payless pharmacies are in the preferred network, Kroger/Payless pharmacy locations, along with other details about this benefit.
allowing enrolled participants to take advantage of more pharmacy locations and Contact the Pharmacy Call Center phone number, 844.432.0704, for any
extended hours of service. additional questions you may have about pharmacy benefits.
2 You may choose to have 90-day supplies filled (except for specialty/biotech drugs) at
the convenient IU Health retail pharmacy sites or make arrangements for mail order.
3 If you are enrolled in the traditional PPO or the HRA medical plan, prescription copays
will count toward your out-of-pocket maximum. If you are enrolled in one of the
HSA-based medical plan offerings, pharmacy expenses will apply to both the annual
deductible and the annual out-of-pocket maximum.
4 It’s easy to transfer a prescription to an IU Health retail pharmacy. Just call the most
convenient location. If available, please have your prescription number, and the
IU Health pharmacy will call the out-of-network pharmacy and transfer the prescription
for you to fill at the lowest copay available.
5 You can fill prescriptions for emergency medications at any preferred pharmacy at the
lower copay amount. Emergency medications include prescriptions written outside
of normal business hours—such as antibiotics for severe infections or medication to
manage pain prescribed at an urgent care facility or emergency room. Emergency
medications do not include maintenance medications. If a preferred pharmacy is
not available, you can: (1) ask the pharmacist to call 844.432.0704 so you can fill
the prescription at the lower copay; or (2) submit a reimbursement form, which is
Save money on prescriptions
available at myiuhealthplans.com. Try to use the medications shown on the lowest tiers, 1
and 2, when possible. The list of formulary medications,
6 FDA-approved contraceptives and contraceptive counseling are covered. including low-cost generic drugs, is available on the
IU Health Plans site, myiuhealthplans.com. See table
7 Prescriptions for brand-name medications with generic equivalents will have a higher on page 13 to learn how much it will cost you to fill
copayment amount. prescriptions at an IU Health, CVS or Kroger/Payless
retail pharmacy, or at an out-of-network retail pharmacy.
| For more information, visit team.myiuhealth.org/benefits | 13Pharmacy benefits continued
Here is information for covered prescriptions filled at an IU Health retail pharmacy, a CVS pharmacy, a Kroger/Payless pharmacy or at another retail pharmacy.
HSA MEDICAL PLAN/
HRA** PPO**
HSA MEDICAL SAVER PLAN*
IU Health IU Health IU Health
CVS*** Out of Network CVS*** Out of Network CVS*** Out of Network
Kroger/Payless*** Kroger/Payless*** Kroger/Payless***
Tier 1 – Preferred
$4 $25 $4 $25
Generic
Tier 2 – Generic $10 $25 $10 $25
Tier 3 – Preferred
Brands and Selected 30% after deductible $30 $50 $30 $50
Generics
30-DAY
20% after deductible
SUPPLY Tier 4 – Non-
30% of cost 50% of cost 30% of cost 50% of cost
Preferred Brands
($50 minimum and ($150 minimum and ($50 minimum and ($150 minimum and
and Non-Preferred
$100 maximum) $300 maximum) $100 maximum) $300 maximum)
Generics
Tier 5 – Specialty/
25% of cost 25% of cost
Biotech (available
N/A ($75 minimum and N/A ($75 minimum and N/A
only at an IU Health
$250 maximum) $250 maximum)
retail pharmacy)
Tier 1 – Preferred
$10 N/A $10 N/A
Generic
Tier 2 – Generic $25*** N/A $25*** N/A
Tier 3 – Preferred
Brands and Selected $75*** N/A $75*** N/A
Generics
90-DAY
20% after deductible N/A
SUPPLY Tier 4 – Non-
30% of cost 30% of cost
Preferred Brands
($150 minimum and N/A ($150 minimum and N/A
and Non-Preferred
$300 maximum)*** $300 maximum)***
Generics
Tier 5 – Specialty/
Biotech (available
N/A N/A N/A N/A
only at an IU Health
retail pharmacy)
*Team members enrolled in the HSA-based medical plans will pay the full cost of their prescriptions for themselves and their enrolled dependents—with the exception of preventive prescriptions—until the annual HSA plan deductible is met.
Note: If enrolled at the family level—Employee & Spouse, Employee & Child(ren) or Family—you must meet the full family deductible before the plan begins to pay.
**The amounts will apply to the annual out-of-pocket maximum for team members enrolled in the traditional PPO or HRA-based medical plans.
*** 90-day supply and mail-order option only available at IU Health retail pharmacies and IU Health Mail Order. Restriction does not apply to IU Health Morgan, IU Health Southern Indiana Physicians and IU Health Paoli, Tipton and White
Memorial hospitals’ team members.
| For more information, visit team.myiuhealth.org/benefits | 142019 Medical plan rates
Your medical insurance premium costs based on premium cost groups deducted per pay period (26 pay periods per year) effective 2019*
HSA MEDICAL PLAN HSA MEDICAL SAVER PLAN HRA MEDICAL PLAN TRADITIONAL PPO PLAN
PREMIUM COSTS GROUPS Employee Only
FOR 2019**
Group A $27 $23 $31 $60
IU Health uses premium costs groups to
Group B $42.50 $34.50 $49 $82.50
make benefits more affordable to
those who earn less. Group C $58 $46 $67 $105
Group D $80 $63 $92 $149
Less than or equal to
GROUP A
$17.79/hour Employee & Child(ren)
GROUP B $17.80 to $22.99/hour Group A $40 $33 $47 $100
Group B $65 $52 $75.50 $144.50
GROUP C $23.00 to $60.00/hour
Group C $90 $71 $104 $189
More than or equal to Group D $130 $103 $150 $253
GROUP D
$60.01/hour
Employee & Spouse
Group A $48 $39 $56 $117
Group B $77.50 $61.50 $90 $168
Group C $107 $84 $124 $219
Group D $154 $123 $178 $297
Family
Group A $63 $51 $73 $155
Group B $101.50 $81 $117.50 $223.50
Group C $140 $111 $162 $292
Group D $206 $163 $238 $398
*Above rates may be reduced by participating in Healthy Results® and achieving certain levels.
**Unless you experience a qualifying life event, the group level you fall under on Jan. 1, 2019, will not change in 2019. | For more information, visit team.myiuhealth.org/benefits | 15Health reimbursement arrangement credit
Health reimbursement arrangement (HRA) plans are employer-sponsored HOW THE HRA CREDIT WORKS
accounts that help plan participants pay for medical expenses incurred before Once you have met a specified portion of your deductible (see adjusted
deductibles are met. deductible column below), the HRA credit will help cover the remaining portion.
ADJUSTED DEDUCTIBLE
The IU Health HRA medical plan offers copays for primary care and specialist DEDUCTIBLE HRA CREDIT* (your portion of the deductible
before credit is applied)
office, urgent care and pharmacy expenses. Eligible pharmacy expenses and
IU Health/ Individual $1,500 $700 $800
preventive services are covered at no cost. Plan participants are responsible for Community
provider or
the full cost of all other services until they reach their deductible; however, they’ll facility Family $3,000 $1,400 $1,600
receive a credit toward their deductible (see chart on the right).
Encore/Aetna Individual $2,000 $700 $1,300
provider or
Unlike the HSA-based plans, team members are not eligible to contribute pretax facility Family $4,000 $1,400 $2,600
dollars to their HRA. However, HRA plan participants are eligible to enroll in the Out-of-network Individual $2,500 $700 $1,800
provider or
traditional Health Flexible Spending Account to set aside pretax dollars to pay for facility Family $5,000 $1,400 $3,600
eligible medical, dental and/or vision expenses.
*If coverage begins in the first quarter of 2019. Amounts are prorated on a quarterly basis.
Remaining HRA credit balances carry over from year to year (up to a maximum
After claim is processed, IU Health Plans will issue you a reimbursement check
of $5,000) and may be accessed as long as you continue to be enrolled in the
for eligible expenses above the adjusted deductible amount (not to exceed
IU Health HRA medical plan.
$700 per individual, up to $1,400 if enrolled in family coverage). You will be
Note: The HRA credit does not apply toward pharmacy expenses. The pharmacy copay/
responsible to pay the provider. The deductible for team members in Premium
coinsurance does not apply to the deductible, but does apply toward the out-of-pocket
maximums. Cost Group A is reduced—after the HRA credit is applied—if care is provided by
an IU Health/Community provider or facility.
Newly hired/eligible team members: The HRA credit amount will be
prorated on a quarterly basis depending upon when coverage begins:
■■ Q1: Full amount
■■ Q2: $525 (individual) / $1,050 (family)
■■ Q3: $350 (individual) / $700 (family)
■■ Q4: $175 (individual) / $350 (family)
For questions regarding the HRA credit and balances, please contact IU Health
Plans Customer Service at 866.895.5975, Monday – Friday, 7 am – 7 pm.
| For more information, visit team.myiuhealth.org/benefits | 16Health savings account
The HSA-based medical plans are coupled with a tax-advantaged Health savings you can set up your investment elections anytime—even before you reach the
account (HSA) to help pay for eligible medical, dental, vision and hearing minimum $2,000 balance requirement to invest.
expenses, such as:
Only reimbursable charges incurred after the HSA effective date are eligible for
■■ Medical and dental deductibles, copayments and other out-of-pocket expenses
reimbursement from the HSA account.
not paid by your plan
■■ Routine eye exams, glasses or contacts A “limited-purpose FSA” is available to pay for eligible, nonreimbursed dental and
■■ Prescription drug copayments vision costs. (See pages 17 and 18 for information on limited-purpose FSAs.)
■■ Hearing exams and hearing aids
IU HEALTH CONTRIBUTION TO YOUR HEALTH SAVINGS ACCOUNT
■■ Adult orthodontia and temporomandibular joint disorder (TMJ) expenses
IU Health will make a contribution to your HSA the first pay of the month after
■■ Smoking-cessation programs
coverage is effective:
■■ Prescription nicotine withdrawal products
■■ $700 (individual)
■■ Weight loss programs if individual is diagnosed as obese (30+ body mass index)
■■ $1,400 (family)
■■ Over-the-counter medicines and drugs used to treat current illness (if your
doctor writes a prescription) Newly hired/eligible team members: The contribution amount will be prorated on
a quarterly basis depending upon when coverage begins:
The limits for 2019, which include both team member and employer
■■ Q1: Full amount
contributions, are $3,500 for individuals and $7,000 for families. Team members
age 55 or older may contribute an additional $1,000 annually. Unused HSA
■■ Q2: $525 (individual) / $1,050 (family)
funds roll over from year to year and stay with you through retirement, even if ■■ Q3: $350 (individual) / $700 (family)
you leave IU Health or no longer participate in the plan. Similar to a 401(k) or a ■■ Q4: $175 (individual) / $350 (family)
403(b) plan, members can choose to invest their HSA funds (minimum $2,000 REIMBURSEMENT OPTIONS FOR HEALTH SAVINGS ACCOUNT
balance requirement). The investment account is simple to access online, and Once enrolled in the HSA, you will receive a welcome package from Optum
(the plan administrator) with additional information about your HSA.
Am I eligible for an HSA contribution?
If any of the statements below apply to you, per Internal Revenue Service (IRS) You will be issued a debit card and may order a checkbook to pay for, or
regulations, you are not eligible to make or receive contributions to an HSA account reimburse yourself, for eligible expenses.
in 2019. However, you would still be eligible for the medical coverage associated
with an HSA medical plan. For general information about the HSA (including a listing of HSA-qualified
■■ You will be enrolled in Medicare (Parts A, B, C and/or D), Medicaid, CHAMPVA, expenses), please visit Optumbank.com.
Tricare or another non-health savings account-based medical plan
(i.e., through spouse or parent’s employer) in 2019
You can call Optum toll free at 844.326.7967. Customer service representatives
■■ You or your spouse will be enrolled in a health flexible spending account (FSA) in
2019 (i.e., through a prior employer)
are available 24 hours a day, 7 days a week.
■■ Your spouse will be enrolled in a Health Reimbursement Arrangement (HRA) or
Health Incentive Account (HIA) that may be used to pay for my eligible expenses
in 2019
| For more information, visit team.myiuhealth.org/benefits | 17Flexible spending accounts REIMBURSEMENT OPTIONS FOR FLEXIBLE SPENDING ACCOUNTS
■■ Debit card – You will be issued a debit card from the plans’ administrator, BPC,
Flexible spending accounts (FSAs) offer an to pay for eligible expenses.
DID YOU KNOW?
attractive way for you to pay many of your
■■ Check – BPC will process check reimbursements twice a week, Tuesdays and
You can enroll in a healthcare and dependent care expenses on a
Thursdays. Checks for claim reimbursement will be mailed to you from the BPC
flexible spending account tax-free basis. The money you deposit to these
even if you decide not to office on the payment date.
accounts goes in before taxes are figured. That
enroll in one of the – The minimum check amount is $25 unless the remaining balance in your
IU Health medical plans. means your taxable income is lower and you pay
account is less.
less in federal, state and Social Security taxes.
– The check stub with your reimbursement check will show you how much
IU Health offers three types of FSAs: has been deposited into your account and how much you have used to date.
■■ Direct deposit – Payments for reimbursement by direct deposit (into a checking
■■ Dependent Care FSA: to pay for eligible day care expenses
or savings account) will be processed on a daily basis. There is no minimum
■■ Health FSA: to pay for eligible medical, dental, vision and amount for claims reimbursed by direct deposit. You can check your
hearing expenses Explanation of Benefits online.
■■ Limited-Purpose FSA: to pay for eligible dental and vision expenses To register your BPC online account, go to bpcinc.com. The Registration/
(only available for team members who enroll in an HSA-based medical plan) Employer ID is BPCIUH.
See chart on page 18 to learn more about the FSAs. For questions, contact BPC at 877.272.8880 or benefits@bpcinc.com.
IU Health adopted a “$500 carryover” FSA option. This
allows team members to carry over up to $500 of their
unused health or limited-purpose FSA balance remaining at
the end of the year into the next plan year. This means you
can carry over up to $500 of your 2019 contributions to
pay for 2020 eligible expenses and it does not reduce the
annual contribution limit of $2,700.
It is important to remember Internal Revenue Service
regulations require that money in excess of the $500
carryover provision for the health and limited-purpose FSAs
and/or any money left in your dependent care accounts at
the end of the year is forfeited. So, if you do not use all
the money in your accounts, the unused balance cannot
be returned to you. However, you can avoid this by carefully
estimating expenses in advance.
| For more information, visit team.myiuhealth.org/benefits | 18Flexible spending accounts continued
OVERVIEW OF FLEXIBLE SPENDING ACCOUNTS
ACCOUNT ELIGIBILITY INFORMATION ANNUAL CONTRIBUTIONS
Dependent Care Flexible Spending Account You can elect to make contributions to a dependent care FSA if you have day care expenses for Maximum: $5,000
the following dependents while you work (and, if married, while your spouse is at work, is a full- (per family or $2,500 per spouse when
Go to the BPC website (bpcinc.com) to learn time student or is disabled): married and filling separate tax returns
about eligible expenses, the reimbursement allowed by the IRS)
■■ Your children under 13
process and to check your account balance/
activity. ■■ Your dependent who is physically or mentally disabled and incapable of self-care, including your
spouse or; child of any age
You’ll only be reimbursed up to the amount you’ve ■■ Your dependent parent or other dependent who spends at least eight hours a day in your home
contributed at any given point. However, if your
claims exceed that amount at any point, you can Eligible dependent care expenses include those for care in your home, in a babysitter’s home, at a
still submit the full claim. BPC will simply hold the licensed day care center or by a relative who is not your dependent.
excess claims and automatically reimburse you “Use it or lose it” applies – You must use all of the money in your account by Dec. 31, 2019, or you
when your next contribution occurs. will forfeit the amount not used. Claims incurred in 2019 must be submitted by March 31, 2020.
Health Flexible Spending Account You can elect to make contributions to a health FSA if you waived health coverage or if you Maximum: $2,700
enrolled in the HRA or the traditional PPO medical plan. Eligible expenses include any IRS-
Go to the BPC website (bpcinc.com) to learn about
deductible medical, dental, vision and hearing expenses not covered under your insurance plans,
eligible expenses, the reimbursement process and
such as:
to check your account balance/activity.
■■ Medical and dental deductibles, copayments and other out-of-pocket expenses not paid by your
plan
■■ Routine eye exams, glasses or contacts
■■ Prescription drug copayments
■■ Hearing exams and hearing aids
■■ Adult orthodontia and temporomandibular joint (TMJ) expenses
■■ Smoking-cessation programs
■■ Prescription nicotine withdrawal products
■■ Weight loss programs if individual is diagnosed as obese (30+ Body Mass Index)
■■ Over-the-counter medicines and drugs used to treat current illness (if your doctor writes a
prescription)
“Use it or lose it” applies – You may carry over up to $500 of your account balance into the
next plan year. Balances above $500 will be forfeited at the end of the current plan year. Claims
incurred in 2019 must be submitted by March 31, 2020.
Limited-Purpose Flexible Spending Account You can elect to make contributions to a limited-purpose FSA if you enroll in one of the HSA-based Maximum: $2,700
medical plans. Only eligible IRS-deductible dental or vision expenses—such as dental deductibles
Go to the BPC website (bpcinc.com) to learn or coinsurance, and routine eye exams, glasses, or contacts—not covered under these plans can be
about eligible expenses, the reimbursement reimbursed from this account. Funds in the account cannot be used for medical expenses.
process and to check your account balance/
“Use it or lose it” applies – You may carry over up to $500 of your account balance into the
activity.
next plan year. Balances above $500 will be forfeited at the end of the current plan year. Claims
incurred in 2019 must be submitted by March 31, 2020.
| For more information, visit team.myiuhealth.org/benefits | 19Participate in Healthy Results®
Healthy Results® – for access to best-in-class
programs and services to help
The IU Health team member well-being program you achieve and maintain your
best and healthiest life.
IU Health is committed to providing healthy work environments and well-being ■■ Health coaching: A skilled team
of certified health coaches helps Healthy Results Wellness Portal:
programs to empower team members to live their best and healthiest lives. My IU Health team portal > My Life &
you build confidence for improved Career > Staying Healthy
CULTURE OF WELL-BEING health. Common topics include Email: healthyresultsteam@iuhealth.org
IU Health works diligently to make the healthy choice the easy choice for team stress management, exercise, T 317.963.9355
members and guests by offering: nutrition, weight loss and
heart health.
■■ Healthy food options in cafeterias, vending machines and at meetings
■■ Indiana Tobacco Quitline: The
■■ Indoor and outdoor walking maps of most facilities, bicycle racks and clean, Indiana Tobacco Quitline is
well-lit stairwells to increase team member opportunities to be physically active Indiana's tobacco cessation
at work program. Participation is
■■ Fun, engaging, systemwide competitions to encourage health and develop free and confidential for all
camaraderie Indiana residents. The Quitline
gives you access to coaching
■■ Emotional and spiritual well-being resources, sanctuary spaces and toolkits to
sessions, online tools, videos and
help team members flourish and grow
community support.
HEALTHY RESULTS® PROGRAMS AND SERVICES: ■■ WW® (formerly Weight Watchers): Discounts are available for all team
AVAILABLE TO ALL TEAM MEMBERS members. Participation options include WW® Digital + Workshops (weekly
IU Health is proud to invest in your health through Healthy Results® by offering a workshops in the workplace or community plus access to online tools) or
variety of programs and services to enhance your health and well-being. Healthy WW® Digital (access to online tools).
Results® programs and services are available to all IU Health team members, ■■ Systemwide challenges: Each year Healthy Results® sponsors systemwide
with some programs also open to friends and family. challenges for all IU Health team members. The challenges include
opportunities to learn about and improve health, friendly competition with
Healthy Results® programs and services include: colleagues and exciting prizes.
■■ Wellness portal: Your one-stop shop to health and well-being resources at
■■ Incentives: All team members can benefit financially by participating in the
IU Health. Earn and track incentive points, access programs and track your Healthy Results® programs. Team members enrolled in an IU Health medical
activities, meals and self-care. plan receive a premium reduction. Benefits-eligible team members not enrolled
in an IU Health medical plan earn additional taxable income. For 2019, the
■■ Health Screenings: Know your numbers. Discover and track your blood pressure,
incentive earning levels are as follows:
weight, height, cholesterol and hemoglobin A1C values through a fasting blood
– Bronze (500 points) = $15/paycheck ($390/year)
draw. Free, on-site Health Screenings are available. Spouses of enrolled IU Health
team members are eligible to participate in a free biometric screening to know – Silver (1,000 points) = $25/paycheck ($650/year)
their numbers and engage in their health. – Gold (1,500 points) = $35/paycheck ($910/year)
| For more information, visit team.myiuhealth.org/benefits | 20Accident and critical illness plans
To offset medical plan deductibles and out-of-pocket expenses, IU Health is Following is an example showing potential benefits of accident coverage:
providing team members and their family members enrolling in the HSA Medical
or HSA Medical Saver plan free accident and critical illness insurance. Your Kathy’s Care received after injury Benefit paid
enrollment is guaranteed,* and there are no medical questions to answer—you daughter
Ambulance (ground) $200
suffers a
will be automatically enrolled. You will be enrolled in the low option for accident concussion Emergency care $50
insurance and in the $3,000 option for critical illness insurance. You can also during the
Physician follow up ($50 x 2) $100
purchase additional coverage. soccer game
against her Medical testing $100
Accident and critical illness insurance may help you be better prepared to take high school’s
Concussion $200
biggest rival.
care of out-of-pocket expenses related to an unforeseen accident or critical Broken tooth (repaired by crown) $200
illness to help lessen the financial burden of expenses, such as:
Total benefit – accident insurance $850
■■ Insurance deductibles and prescription copays
■■ Out-of-network doctor visits
■■ Physical or occupational therapy To learn more about the accident and critical illness insurance plans, their
■■ Alternative therapy premiums and enrollment, contact MetLife at 800.GET.MET8 (800.438.6388),
The accident and critical illness insurance plans are not intended to replace Monday – Friday from 8 am – 11 pm EST or go to MetLife's website.
your current medical insurance. Payments are made directly to you, not your Note: Enrollment is automatic if selecting 2019 coverage in one of the HSA-based
healthcare provider. medical plans.
Accident insurance: It provides you with a payment when you suffer injuries TEAM MEMBER-PAID ADDITIONAL COVERAGE
resulting from an accident—ranging from fractures, burns and dislocations to Team members not enrolling in an IU Health HSA-based medical plan may also
more severe injuries and treatments. enroll in the accident and critical illness insurance plans; however, the team
Critical illness insurance: It can help you cover unexpected medical and member will be responsible for premiums.
personal expenses if you are diagnosed with a serious illness. It provides a Premiums will be paid through convenient payroll deductions. You can select a
lump-sum payment of up to $3,000 if you experience certain covered conditions, low or high plan option for accident insurance and a $15,000 option for critical
such as heart attack, stroke and various other health conditions. illness insurance for yourself and eligible family members.
DID YOU KNOW? To enroll in or review the accident and critical illness insurance plans, go to
MetLife's website. Your enrollment is guaranteed,* and there are no medical
If you are enrolled in a critical illness plan, you will receive either a questions to answer as long as you enroll within 31 days of your official hire/
$50 or $75 check, depending on your coverage type, for completing a
preventive screening. Go to MetLife's website for details. status change date, or during open enrollment.
*Team members must be actively at work on the date the coverage is scheduled to become effective, or
coverage will not become effective until they return to work.
| For more information, visit team.myiuhealth.org/benefits | 21Dental insurance
Dental care is key to your overall
health. That’s why IU Health offers
If you are dually employed
two dental plans to help you care for
by IU Health Physicians and
your teeth.
Indiana University School
of Medicine as a faculty The Delta Dental plans combine the
member (.75 FTE or above), affordable cost of a dental point-of-
your dental insurance is service program with the flexibility of
available only through a traditional plan. Delta Dental offers
Indiana University. benefits through a network of dental
care providers to help you save time
and money.
HOW THE PLANS WORK
You can select either the “basic option” plan or the “high option” plan. IU Health
contributes the same premium amount toward either selection.
The “basic option” plan provides different levels of coverage based upon whether
the dentist is a member of the Delta Dental PPO network. The “high option”
plan provides the same level of reimbursement regardless of whether or not the
dentist is in-network.
See chart on the next page for more information about each plan, or contact
Delta Dental’s Customer Service department by calling 800.524.0149 or visit the
company’s website at deltadentalin.com.
You can request a dental ID card by registering
your account with deltadentalin.com and clicking
Print ID Card or downloading the Delta Dental
app on your mobile device.
| For more information, visit team.myiuhealth.org/benefits | 22You can also read
