2014 IU Health Plans Choice Plan

Below, you will find a snapshot of the IU Health Plans 2014 Choice HMO plan as well as links to its Summary of Benefits.

The IU Health Plans Choice HMO - POS plan offers: Our most comprehensive plan, with freedom to choose the doctors you want to see.

IU Health Medicare Choice HMO - POS Details

Cost: $108

In-Network

Out-of-Network

Enroll Now
Annual Deductible $0 $0  
Inpatient-Hospital/Mental Health $195 1-7 days 50%  
Skilled Nursing (No hospital stay required)

$0 1-5 days

$20 6-20 days

$80 21-100 days

50%  
Home Health $0 50%  
Primary Care Physician $10 50%  
Specialist $40 50%  
Chiropractor $20 50%  
Podiatry $10 50%  
Outpatient Surgery $195 50%  
Ambulance $150 50%  
Emergency $65 (worldwide) $65 (worldwide)  
Urgent Care $50 $50  
Durable Medical Equipment 20% 50%  
Diabetic Supplies $0 50%  
Diagnostic Tests/Lab $0 50%  
X-rays/Therapeutic Radiology $25 50%  
Diagnostic Radiology $125 50%  
Preventive Screenings $0 Not covered  
Annual Physical Exam $0 Not covered  
Fitness Center Membership up to $150 reimbursement/yr. Not covered  
Preventive Dental $10 Not covered  
Routine Vision Exam $0 Not covered  
Eyeglasses (lenses/frames) $40 Not covered  
Out-of-pocket Cost Protection $4,500 $4,500  
Plan Limit No limit $10,000  
Annual Deductible $0 $0  
Tier 1 (Preferred Generic)

$6 31 day

$16 90 day

Not covered  
Tier 2 (Non-preferred Generic)

$15 31 day

$42 90 day

Not covered

 
Tier 3 (Preferred Brand)

$42 31 day

$118 90 day

Not covered  
Tier 4 (Non-preferred Brand)

$95 31 day

$266 90 day

   
Tier 5 (Specialty) 33% 31 day Not covered  
Coverage Gap after $2,850 until out-of-pocket is reached $4,550

Tier 1 Preferred Gen.$10 31 day; $30 90 day

Tier 2 Non preferred Generic 72%

Tier 3-5 Brand 47.5%

Not Covered  
   Summary of Benefits Detailed Benefits Comparison

 

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact us about the plan. Limitations, copayments, and restrictions may apply. Benefits may change on January 1st of each year.

MODIFY DATE: 02/04/2014 10:04:59 AM PMMODIFIED BY: jnaffzig@iuhealth.org