2014 IU Health Plans Select Plan

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

The IU Health Plans Select Plan HMO offers: Extras, such as enhanced dental and vision, but does not include prescription drug coverage.

IU HEALTH MEDICARE SELECT Plan HMO Details

 

COST $0

Reduces your Part B Premium up to $25 ea. month

Enroll Now
Annual Deductible $0
Inpatient-Hospital/Mental Health

Days 1-7  $225/day and Mental Health Days 1-6
Days 7 or 8-90: $0/day

Skilled Nursing (No hospital stay required)

Days 1-5  $0/day

Days 6-20 $20/day

Days 21-100 $80/day

Home Health $0
Primary Care Physician $0
Specialist $30
Chiropractor $20
Podiatry $15
Outpatient Surgery $265
Ambulance  $150
Urgent Care $50
Durable Medical Equipment 20%
Diabetic Supplies $0
Diagnostic Tests/Lab $10
X-rays/Therapeutic Radiology

$25

Diagnostic Radiology $75
Preventive Screenings $0
Annual Physical Exam $0
Fitness Center Membership up to $150 reimbursement/yr.
Preventive Dental $10
Routine Vision Exam $0
Eyeglasses (lenses/frames) $40
Out-of-Pocket Maximum Protection $4,500
Plan Limit No Limit
Annual Deductible $0
Tier 1 (Preferred Generic) Not covered
Tier 2 (Non-preferred Generic) Not covered
Tier 3 (Preferred Brand) Not covered
Tier 4 (Non-preferred Brand) Not covered
Tier 5 (Specialty) Not covered
Coverage Gap after $2,850 until out-of-pocket is reached ($4,550) 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 9:56:26 AM PMMODIFIED BY: jnaffzig@iuhealth.org