2008 Medical Plans

Medical Plans Which Medical Plan is Best?

IU PPO $900 Deductible | IU PPO-Plus | Blue Preferred Primary POS | Definitions | Which Plan?

Employees often ask this question. Choosing a medical plan is a personal decision that should be based on the unique medical needs and preferences of each employee. Each type of medical plan has features that may be considered beneficial by some employees or limited by others. No one can tell you which plan to select, but below are some areas that you will want to consider. Medical plan customer service numbers for network and coverage inquiries are listed here.

Provider Networks

• What network does the plan use? Are your providers in the network?

• If your providers are not In-Network, are you willing to change providers or pay more for services? (Out-of-Network costs, especially amounts above Usual & Reasonable, can be significant.)

Covered Services

• All plans cover most recommended preventive services with no deductible. These services include mammograms, childhood immunizations, annual physicals, pap tests, and most other commonly recommended screening tests.

• All plans cover a routine "wellness" eye exam and diabetic preventive exam with no deductible, only a copay.

• The copays and deductibles are listed in the “2008 Medical Plans Distinguishing Features” table in the Medical, Dental, and TSB Enrollment Opportunities brocure (PDF). More details are provided in the plan summaries and plan booklets available on the UHRS Medical Plans pages.

• Do you have special needs such as medical equipment, prosthetics, therapies, or skilled nursing? If so, you will want to ask how these are paid in the plans you are considering.

• If you use maintenance prescription drugs, what will the copays be in each plan? Are you willing to change prescriptions to have a lower copay?

Total Plan Costs

• What is the total cost of each medical plan you are considering? The total cost includes both what you will pay in paycheck contributions (premiums) and what you will pay when you receive services (out-of-pocket expenses). Both are important. Don’t automatically reject the PPO $900 Deductible plan without considering the total cost of alternative plans. Looking at only one cost does not give a complete picture of how much you will pay for medical care.

• Have you considered the TSB Plan to save money on out-of-pocket costs?

A Word About Using Out-of-Network Providers

PPO and POS plans have benefits, although at a reduced level, when you receive care from Out-of-Network providers. All plans do generally pay In-Network benefits when you need care for an emergency, have an urgent medical need when traveling, or when you have prior approval from the Plan Administrator before you receive care. However, even in these cases, Out-of-Network providers may bill you for their charges in excess of the Usual & Reasonable reimbursement paid by the plan. These charges can be significant.

It is important to note that plans do not always have a provider in every specialty in every geographic region. For this reason, you may need to travel somewhat in order to receive In-Network benefits, for example, to the IU Medical Center.

It is also important to know that network providers may sometimes refer patients to an Out-of-Network provider. Such a referral does not mean that the services will be paid at an In-Network benefit level. It is always the patient’s responsibility to verify the network status of a referral physician or facility by using the plan’s Web site directory or by calling the number on the back of the member ID card.