COVID-19 Information & Updates

Latest on COVID-19: Testing & Vaccines
IU Health has a COVID-19 Resource Center with the latest information on testing, vaccines and more at iuhealth.org/covid19.

Connect with our Customer Solutions team
At IU Health Plans, we’re available to address all of your questions in a timely and efficient manner. Our Customer Solutions team is here to assist with any questions regarding your IU Health Plan benefits during this time.

Refill of a Prescription Medication
IU Health Plans has taken steps to design the best care for you during this COVID-19 outbreak. You may now take advantage of:

- Relaxed refill restrictions
For our Commercial and Medicare customers, IU Health Plans is waiving early refill limits on up to three, 30-day prescription supplies for maintenance medications at any in-network pharmacy, in all states. This change applies to maintenance medications only. 30-day overrides are not available for specialty medications or controlled substances.

- Free home delivery
Participating CVS Pharmacies in our network have waived charges for home delivery of all prescription medications. The Centers for Disease Control and Prevention (CDC) encourages people at higher risk for COVID-19 complications to stay at home as much as possible, so this convenient option can help you avoid leaving your home for refills or new maintenance prescriptions. As always, there is no charge for delivery of prescriptions filled by the CVS Caremark Mail Service pharmacy, when you choose the mail order service.

CVS Caremark mail order form
Contact your doctor’s office for a prescription. If you need your prescription filled anytime within the next week, you will need to ask your doctor to write two prescriptions for your long-term medicines, one that you can fill immediately at a participating pharmacy, and the second for the mail order to be mailed to CVS Caremark.

Mail the order form, along with your prescription(s) to be shipped by mail. Include your payment to the CVS Caremark Mail Service Pharmacy address printed on the form. You will be required to make your prescription drug payments using an electronic check, Bill Me Later®, or a credit card (VISA®, MasterCard®, Discover® or American Express®). You can also pay by check or money order. You should not send cash.

COVID-19 Information & Updates

Latest on COVID-19: Testing & Vaccines
IU Health has a COVID-19 Resource Center with the latest information on testing, vaccines and more at iuhealth.org/covid19.

Connect with our Customer Solutions team
At IU Health Plans, we’re available to address all of your questions in a timely and efficient manner. Our Customer Solutions team is here to assist with any questions regarding your IU Health Plan benefits during this time.

Refill of a Prescription Medication
IU Health Plans has taken steps to design the best care for you during this COVID-19 outbreak. You may now take advantage of:

- Relaxed refill restrictions
For our Commercial and Medicare customers, IU Health Plans is waiving early refill limits on up to three, 30-day prescription supplies for maintenance medications at any in-network pharmacy, in all states. This change applies to maintenance medications only. 30-day overrides are not available for specialty medications or controlled substances.

- Free home delivery
Participating CVS Pharmacies in our network have waived charges for home delivery of all prescription medications. The Centers for Disease Control and Prevention (CDC) encourages people at higher risk for COVID-19 complications to stay at home as much as possible, so this convenient option can help you avoid leaving your home for refills or new maintenance prescriptions. As always, there is no charge for delivery of prescriptions filled by the CVS Caremark Mail Service pharmacy, when you choose the mail order service.

CVS Caremark mail order form
Contact your doctor’s office for a prescription. If you need your prescription filled anytime within the next week, you will need to ask your doctor to write two prescriptions for your long-term medicines, one that you can fill immediately at a participating pharmacy, and the second for the mail order to be mailed to CVS Caremark.

Mail the order form, along with your prescription(s) to be shipped by mail. Include your payment to the CVS Caremark Mail Service Pharmacy address printed on the form. You will be required to make your prescription drug payments using an electronic check, Bill Me Later®, or a credit card (VISA®, MasterCard®, Discover® or American Express®). You can also pay by check or money order. You should not send cash.

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Employer Plans - Small Group

Learn more about our Small Group options to see what plan best suits your needs:

2023 Employer Plans - Small Group

Non-HSA Plans Summary of Benefits & Coverage (SBC) Schedule of Benefits (SOB)
Bronze 6650 Select Download Download
Bronze 6650 Download Download
Bronze 8200 Plus Download Download
Bronze 8200 Select Plus Download Download
Non-HSA Plans
Bronze 6650 Select

Summary of Benefits & Coverage

Schedule of Benefits

Bronze 6650

Summary of Benefits & Coverage

Schedule of Benefits

Bronze 8200 Plus

Summary of Benefits & Coverage

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Bronze 8200 Select Plus

Summary of Benefits & Coverage

Schedule of Benefits

HSA Plans Summary of Benefits & Coverage (SBC) Schedule of Benefits (SOB)
Bronze HSA 5600 Plus Download Download
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Bronze HSA 5700 Select Download Download
Bronze HSA 5700 Download Download
Bronze HSA 7050 Select Download Download
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HSA Plans
Bronze HSA 5600 Plus

Summary of Benefits & Coverage

Schedule of Benefits

Bronze HSA 5600 Select Plus

Summary of Benefits & Coverage

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Bronze HSA 5700 Select

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Schedule of Benefits

Bronze HSA 5700

Summary of Benefits & Coverage

Schedule of Benefits

Bronze HSA 7050 Select

Summary of Benefits & Coverage

Schedule of Benefits

Bronze HSA 7050

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA Plans Summary of Benefits & Coverage (SBC) Schedule of Benefits (SOB)
Silver 2250 Select Download Download
Silver 2250 Download Download
Silver 2700 Select Plus Download Download
Silver 2700 Select Download Download
Silver 2700 Plus Download Download
Silver 2700 Download Download
Silver 3200 Select Plus Download Download
Silver 3200 Select Download Download
Silver 3200 Plus Download Download
Silver 3200 Download Download
Silver 4000 Select Download Download
Silver 4000 Download Download
Silver 5000 Select Plus Download Download
Silver 5000 Select Download Download
Silver 5000 Plus Download Download
Silver 5000 Download Download
Silver 5500 Select Plus Download Download
Silver 5500 Select Download Download
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Silver 5500 Download Download
Non-HSA Plans
Silver 2250 Select

Summary of Benefits & Coverage

Schedule of Benefits

Silver 2250

Summary of Benefits & Coverage

Schedule of Benefits

Silver 2700 Select Plus

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Schedule of Benefits

Silver 2700 Select

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Silver 2700 Plus

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Silver 2700

Summary of Benefits & Coverage

Schedule of Benefits

Silver 3200 Select Plus

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Schedule of Benefits

Silver 3200 Select

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Schedule of Benefits

Silver 3200 Plus

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Schedule of Benefits

Silver 3200

Summary of Benefits & Coverage

Schedule of Benefits

Silver 4000 Select

Summary of Benefits & Coverage

Schedule of Benefits

Silver 4000

Summary of Benefits & Coverage

Schedule of Benefits

Silver 5000 Select Plus

Summary of Benefits & Coverage

Schedule of Benefits

Silver 5000 Select

Summary of Benefits & Coverage

Schedule of Benefits

Silver 5000 Plus

Summary of Benefits & Coverage

Schedule of Benefits

Silver 5000

Summary of Benefits & Coverage

Schedule of Benefits

Silver 5500 Select Plus

Summary of Benefits & Coverage

Schedule of Benefits

Silver 5500 Select

Summary of Benefits & Coverage

Schedule of Benefits

Silver 5500 Plus

Summary of Benefits & Coverage

Schedule of Benefits

Silver 5500

Summary of Benefits & Coverage

Schedule of Benefits

HSA Plans Summary of Benefits & Coverage (SBC) Schedule of Benefits (SOB)
Silver HSA 2250 Select Plus Download Download
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HSA Plans
Silver HSA 2250 Select Plus

Summary of Benefits & Coverage

Schedule of Benefits

Silver HSA 2250 Select

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Silver HSA 2250 Plus

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Silver HSA 2250

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Silver HSA 2800 Select Plus

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Silver HSA 2800 Select

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Silver HSA 2800 Plus

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Silver HSA 2800

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Silver HSA 3000 Select Plus

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Silver HSA 3000 Select

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Silver HSA 3000 Plus

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Silver HSA 3000

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Silver HSA 3500 Select Plus

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Silver HSA 3500 Select

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Silver HSA 3500 Plus

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Silver HSA 3500

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Silver HSA 4000 Select Plus

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Silver HSA 4000 Select

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Silver HSA 4000 Plus

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Silver HSA 4000

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Silver HSA 4500 Select Plus

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Silver HSA 4500 Select

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Silver HSA 4500 Plus

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Silver HSA 4500

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Silver HSA 5000-1 Select Plus

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Silver HSA 5000-1 Select

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Silver HSA 5000-1 Plus

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Silver HSA 5000-1

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Silver HSA 5000-2 Select

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Silver HSA 5000-2

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA Plans Summary of Benefits & Coverage (SBC) Schedule of Benefits (SOB)
Gold 500 Plus Download Download
Gold 500 Select Plus Download Download
Gold 500 Select Download Download
Gold 500 Download Download
Gold 750 Plus Download Download
Gold 750 Select Plus Download Download
Gold 750 Select Download Download
Gold 750 Download Download
Gold 1250 Plus Download Download
Gold 1250 Select Plus Download Download
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Gold 1250 Download Download
Gold 1500 Plus Download Download
Gold 1500 Select Plus Download Download
Gold 1500 Select Download Download
Gold 1500 Download Download
Gold 2500 Plus Download Download
Gold 2500 Select Plus Download Download
Gold 2500 Select Download Download
Gold 2500 Download Download
Non-HSA Plans
Gold 500 Plus

Summary of Benefits & Coverage

Schedule of Benefits

Gold 500 Select Plus

Summary of Benefits & Coverage

Schedule of Benefits

Gold 500 Select

Summary of Benefits & Coverage

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Gold 500

Summary of Benefits & Coverage

Schedule of Benefits

Gold 750 Plus

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Gold 750 Select Plus

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Gold 750 Select

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Gold 750

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Gold 1250 Plus

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Gold 1250 Select Plus

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Gold 1250 Select

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Gold 1250

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Gold 1500 Plus

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Gold 1500 Select Plus

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Gold 1500 Select

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Gold 1500

Summary of Benefits & Coverage

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Gold 2500 Plus

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Gold 2500 Select Plus

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Gold 2500 Select

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Gold 2500

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Schedule of Benefits

HSA Plans Summary of Benefits & Coverage (SBC) Schedule of Benefits (SOB)
Gold HSA 1500 Plus Download Download
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Gold HSA 2800 Plus Download Download
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HSA Plans
Gold HSA 1500 Plus

Summary of Benefits & Coverage

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Gold HSA 1500 Select Plus

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Gold HSA 1500 Select

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Gold HSA 2000

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Gold HSA 2800 Plus

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Gold HSA 2800 Select Plus

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Gold HSA 2800 Select

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Gold HSA 2800

Summary of Benefits & Coverage

Schedule of Benefits

2022 Employer Plans - Small Group

Non-HSA Plans Summary of Benefits & Coverage (SBC) Schedule of Benefits (SOB)
Bronze 6650 Select Download Download
Bronze 6650 Download Download
Bronze 8200 Plus Download Download
Bronze 8200 Select Plus Download Download
Non-HSA Plans
Bronze 6650 Select

Summary of Benefits & Coverage

Schedule of Benefits

Bronze 6650

Summary of Benefits & Coverage

Schedule of Benefits

Bronze 8200 Plus

Summary of Benefits & Coverage

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Bronze 8200 Select Plus

Summary of Benefits & Coverage

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HSA Plans Summary of Benefits & Coverage (SBC) Schedule of Benefits (SOB)
Bronze HSA 5600 Plus Download Download
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HSA Plans
Bronze HSA 5600 Plus

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Bronze HSA 5600 Select Plus

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Bronze HSA 5700 Select

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Bronze HSA 5700

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Bronze HSA 7050 Select

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Bronze HSA 7050

Summary of Benefits & Coverage

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Non-HSA Plans Summary of Benefits & Coverage (SBC) Schedule of Benefits (SOB)
Silver 2250 Select Download Download
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Silver 2500 Plus Download Download
Silver 2500 Select Plus Download Download
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Silver 5500 Plus Download Download
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Non-HSA Plans
Silver 2250 Select

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Silver 2250

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Silver 2500 Plus

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Silver 2500 Select Plus

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Silver 2500 Select

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Silver 3000 Plus

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Silver 3000 Select Plus

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Silver 3000 Select

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Silver 3000

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Silver 3500 Plus

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Silver 3500 Select Plus

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Silver 4000 Select

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Silver 4000

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Silver 5000 Plus

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Silver 5000 Select Plus

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Silver 5000 Select

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Silver 5000

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Silver 5500 Plus

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Silver 5500 Select Plus

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Silver 5500 Select

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Silver 5500

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Schedule of Benefits

HSA Plans Summary of Benefits & Coverage (SBC) Schedule of Benefits (SOB)
Silver HSA 2000 Select Download Download
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HSA Plans
Silver HSA 2000 Select

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Silver HSA 2000

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Silver HSA 2250 Plus

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Silver HSA 2250 Select Plus

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Silver HSA 2250 Select

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Silver HSA 2250

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Silver HSA 2800 Plus

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Silver HSA 2800 Select Plus

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Silver HSA 2800 Select

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Silver HSA 2800

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Silver HSA 2900 Select

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Silver HSA 2900

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Silver HSA 3000 Plus

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Silver HSA 3000 Select Plus

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Silver HSA 3000 Select

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Silver HSA 3000

Summary of Benefits & Coverage

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Silver HSA 3500 Plus

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Silver HSA 3500 Select Plus

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Silver HSA 3500 Select

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Silver HSA 3500

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Silver HSA 4000 Plus

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Silver HSA 4000 Select Plus

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Silver HSA 4000 Select

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Silver HSA 4000

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Silver HSA 4200 Select

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Silver HSA 4200

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Silver HSA 4500 Plus

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Silver HSA 4500 Select Plus

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Silver HSA 4500 Select

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Silver HSA 4500

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Silver HSA 5000-1 Plus

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Silver HSA 5000-1 Select Plus

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Silver HSA 5000-1 Select

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Silver HSA 5000-1

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Silver HSA 5000-2 Select

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Schedule of Benefits

Silver HSA 5000-2

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA Plans Summary of Benefits & Coverage (SBC) Schedule of Benefits (SOB)
Gold 500 Plus Download Download
Gold 500 Select Plus Download Download
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Gold 750 Plus Download Download
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Gold 2500 Plus Download Download
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Non-HSA Plans
Gold 500 Plus

Summary of Benefits & Coverage

Schedule of Benefits

Gold 500 Select Plus

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Gold 500 Select

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Gold 500

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Gold 750 Plus

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Gold 750 Select Plus

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Gold 750 Select

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Gold 750

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Gold 1250 Plus

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Gold 1250 Select Plus

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Gold 1250 Select

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Gold 1250

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Gold 1500 Plus

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Gold 1500 Select Plus

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Gold 1500 Select

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Gold 1500

Summary of Benefits & Coverage

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Gold 2500 Plus

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Gold 2500 Select Plus

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Gold 2500 Select

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Gold 2500

Summary of Benefits & Coverage

Schedule of Benefits

HSA Plans Summary of Benefits & Coverage (SBC) Schedule of Benefits (SOB)
Gold HSA 1500 Plus Download Download
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HSA Plans
Gold HSA 1500 Plus

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Gold HSA 1500 Select Plus

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Gold HSA 1500 Select

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Gold HSA 1500

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Gold HSA 1550 Select

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Gold HSA 1550

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Gold HSA 2000 Plus

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Gold HSA 2000 Select Plus

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Gold HSA 2000 Select

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Gold HSA 2000

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Gold HSA 2250 Plus

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Gold HSA 2250 Select Plus

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Gold HSA 2250 Select

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Gold HSA 2250

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Gold HSA 2800 Plus

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Gold HSA 2800 Select Plus

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Gold HSA 2800 Select

Summary of Benefits & Coverage

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Gold HSA 2800

Summary of Benefits & Coverage

Schedule of Benefits

Drug Formulary – Small Group

Formulary Summary of Benefits & Coverage (SBC) Schedule of Benefits (SOB)
2023 Small Group Drug Formulary Guide Download N/A
Formulary Summary of Benefits & Coverage (SBC) Schedule of Benefits (SOB)
2023 Small Group Drug Formulary Guide

Summary of Benefits & Coverage HEY

N/A