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Employer-Sponsored Plans - Frequently Asked Questions

Employer-Sponsored Plans - Frequently Asked Questions

At Indiana University Health Plans, we strive to provide guidance to our group members and their families. We know that finding and understanding your policy can come with questions or confusion, so we’ve gathered common questions about our employer plans and processes.

If you still have questions, or if you’d prefer to speak to one of our knowledgeable commercial representatives, please call 866.895.5975, 7 am – 7 pm, Monday through Friday.

Enrollment Questions

I’m an employer. Where can I go to get a quote from IU Health Plans for my employees?

IU Health Plans works with an exclusive group of brokers. If you would like to receive a quote from IU Health Plans, please contact us or contact your broker.

What is copay, deductible, maximum out-of-pocket and coinsurance?

A copay or copayment is the amount you will owe when you receive care or are prescribed medication.

A deductible is the amount you pay for care or a prescription in a calendar year before your insurance healthcare provider pays its portion. For example, with a $2,500 deductible plan, you pay the first $2,500 of covered services yourself.

After you have met your plan’s deductible amount, you usually pay only a copayment or coinsurance for covered services.

Some preventative services are paid for even before you’ve met your deductible. Review the list of covered preventive care services.

A Maximum Out-of-Pocket is the most you will have to pay for covered services in a plan year after spending this amount on deductibles, copayments and coinsurance. This does not include your monthly premium costs, or anything you may have spent for services your plan did not cover.

Coinsurance is a percentage you may be required to pay for the cost of covered services or prescription drugs. 

We know that reviewing your policy can result in many questions—most of which are related to the terms used. Review our glossary for more information about commonly used insurance terms and definitions.

What if I am currently receiving treatment for a medical condition outside of the IU Health Plans network?

If IU Health Plans approves Transition of Care, you will receive in-network coverage for that condition for a limited period of time. During this time, you will want to work with your doctor to transfer to an IU Health Plans healthcare provider.

Learn more about the transition of care process.

What size employer groups does IU Health Plans cover?

IU Health Plans will cover employer groups as small as 2 employees and greater.

What type of plans does IU Health Plans offer?

IU Health Plans offers fully insured, self-funded and level-funded products to employer groups.  Our plan designs include high deductible plans and point of services plans.

Plan Coverage Questions

May I choose my doctor?

Yes. You will have your choice of a wide variety of highly skilled doctors located in over 20 statewide facilities. You may choose to see any type of doctor you need, without a referral, as long as the doctor is in the IU Health Plans network. See our directory of doctors.

Are healthcare providers outside of the Indiana University Health system covered by IU Health Plans?

Yes. The IU Health Plans network includes many doctors and hospitals that are part of other healthcare systems and conveniently located in your community. Find healthcare providers in your neighborhood.

Do I have to use an IU Health facility or doctor?

While the IU Health Plans network is centered around the IU Health system, we partner with a number of primary care doctors, specialists and facilities to offer complete coverage for all of our members. To search for an IU Health Plans network healthcare provider, please visit our provider directory. While you may choose a healthcare provider outside of IU Health, your healthcare benefits will not be as strong.

What if I visit a doctor or hospital that is not part of the IU Health Plans network?

There is no coverage for out-of-network doctors or hospitals, with the exception of urgent and emergency care services. IU Health Plans covers emergency care services at any hospital when services are needed to treat, evaluate or stabilize an emergency medical condition, such as a vehicle accident or when there is difficulty breathing or severe bleeding.

More information about emergency care can be found in your Evidence of Coverage. You can find your Evidence of Coverage by logging into your member portal.

What should I do if my primary care doctor leaves the IU Health Plans network?

We understand the importance of finding and managing your health with a primary care doctor you trust. If your primary care doctor is no longer part of the IU Health Plans network, or you are new to IU Health Plans, we offer a transition of care period during which you can continue to receive coverage with your current doctor. This period allows time for you to explore our network of leading healthcare providers and helps create a seamless transition to a new doctor.

Learn more about the transition of care process.

Do I need a referral to see a specialist?

No. Referrals to network specialists for covered services are not required. However, coverage does depend on applicable copayments, deductibles and coinsurance. Remember to advise your primary care doctor about services received from a specialist so your doctor can maintain your complete medical record. In order to receive the highest level of payment for covered services, make sure you go to an in-network healthcare provider.

Is emergency care covered?

Please do not hesitate to seek medical attention. Federal law now requires that emergency room coverage at out-of-network facilities must be billed at the same rate as in-network facilities.

Do I have to pay for annual checkups, vaccines or screenings?

No. As an IU Health Plans member, you are not required to pay for annual preventive and wellness services.

What should I do if I need medical care after hours?

Many doctors’ offices have after-hours care or a doctor on call. If you have an urgent question, contact your doctor first. If you have a true emergency, call 911 or go to the nearest emergency room. With IU Health Plans, you also have access to urgent care centers in your community.

What should I do if I need medical care when I’m away from home?

Contact your doctor first for help with routine or urgent care questions. If you have a true emergency, please call 911 or go to the nearest emergency room.

I need help finding a primary care doctor. Where can I search for an in-network doctor?

IU Health Plans members can navigate to Find a Doctor or Facility, and choose their plan (Employer Plan, Individual Marketplace or Medicare Advantage) to search for a provider.

How does urgent care differ from emergency care?

Urgent care is a situation that is not an emergency but still requires prompt medical attention. Urgent care is defined as treatment that you need right away for an illness or injury that is not life-threatening, but that cannot wait for a doctor’s office appointment. Emergent Care is an accident or sudden unexpected illness that needs to be treated right away or it could result in loss of life, serious medical complications or permanent disability

What are IU Health Video Visits?

When an employer needs a simple solution for keeping their busy employees healthy, we can take care of it with the new IU Health Video Visits. Now, it’s even easier to see a highly skilled IU Health physician. IU Health Plans members can speak to a physician during the day, evening or weekend. All a patient needs is their laptop, smartphone or tablet and access to the internet.

Members can access the portal by downloading the IU Health Video Visit app, available on iOS or Android devices or via the Video Visit webpage.

Appointments are available from 8 am to 8 pm every day (hours may vary), and since they average less than 10 minutes, everyone can now easily stay healthy and on schedule.

There are no upfront costs at time of visit. Members will pay $49 or less per visit. Charges will be subject to copay or deductible and coinsurance.

How do I sign up for the member portal?

In the main navigation, click "Member Login." Next, select "sign up" and enter your Member ID, First Name, Last Name, Group Number and Date of Birth. Your Member ID and Group Number can be found on your member ID card. If you have difficulties logging in, please reach out to member services at 855.413.2432

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