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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Medicare Advantage Plans - Frequently Asked Questions

Medicare Advantage Plans - Frequently Asked Questions

At Indiana University Health Plans, we are dedicated to helping our Medicare Advantage members develop a complete understanding of our plans and processes as well as their benefits. Get to know more about our offerings by reviewing common questions.     

If you still have questions, or if you’d prefer to speak to one of our knowledgeable representatives, please contact our Customer Solutions Center at 800.455.9776 or TTY users should call Relay Indiana at 800.743.3333, 8 am – 8 pm, Monday through Friday.

Enrollment Questions

How do I find out if I’m eligible for IU Health Plans?

IU Health Plans offers a variety of plans in 51 counties across Indiana. Review our plans by county to see if IU Health Plans is available in your area. If you would prefer to speak with a Customer Solutions Representative over the phone please contact 317.963.9700/ 800.455.9776 (TTY/TDD 711).

From Oct. 1–Feb. 14, a representative will be available to speak to you 8 am – 8 pm, seven days a week. Beginning Feb. 15 through Sept. 30, a representative will be available from 8 am – 8 pm, Monday through Friday. You may receive assistance through alternative technology after hours, on weekends and holidays

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. 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.

Coinsurance is a percentage you may be required to pay as your share of the cost of services or prescription drugs.

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.

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

Is there a plan to fit my budget?

If you have limited income, you may qualify for financial discounts to help cover your monthly insurance premium and reduce prescription drug costs. Many people are eligible for these savings and don’t even know it. For more information about Extra Help, contact your local Social Security office or call 800.MEDICARE (800.633.4227), 24 hours a day, 7 days a week. TTY users should call 877.486.2048.

Where can I find a quote or enroll in Medicare Advantage?

IU Health Plans offers Medicare Advantage plan options. We recommend reviewing your plan options or, if you’re ready, get a quote now. If you would prefer an in-person consultation, call 866.308.2018 or request a consultation online.

How do I receive help with Medicare prescription drug costs?

Medicare beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. Extra Help can reduce the plan premium and prescription drug costs. Many people are eligible for these savings and don’t even know it. For more information about Extra Help, contact your local Social Security office or call 800.MEDICARE (800.633.4227), 24 hours a day, 7 days a week. TTY users should call 877.486.2048. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 states or the District of Columbia.

If you would like help with this application or understanding your options, free counseling is available through the Senior Health Insurance Information Program (SHIP) at 800.452.4800; TTY 866.846.0139 or go to Medicare.in.gov.

What is a Summary of Benefits document?

The Summary of Benefits will detail what costs your plan will cover, what you will pay and how it varies for different types of care. The Summary of Benefits also lists your monthly premium, deductibles and limits for out-of-pocket costs. You will receive a new Summary of Benefits every year you are enrolled in a plan and it's also available in your member portal.

What is an Evidence of Coverage document?

Your Evidence of Coverage will go into deeper detail about the benefits offered by your plan, including what your plan will cover and how it works. The document will also address any new changes to your plan that were implemented at the start of the year. You can find your plan specific Evidence of Coverage document by logging into your member portal.

When can I expect my ID card and welcome packet to come in the mail?

You should expect your ID card and welcome packet within 10 business days of IU Health Plans processing and approving your enrollment application. If you do not receive your information after 14 business days, please contact member services, at 800.455.9776, to verify your address and request a new card.

Plan Coverage Questions

May I choose my doctor?

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

May I keep my current doctor?

If your doctor is in the Directory of Doctors and Facilities, he or she is within the IU Health Plans network. If you are unable to find your doctor in the directory, he or she is likely not within the IU Health Plans network. Please contact our member services team at 800.455.9776 to assist you in finding a provider that meets your needs.

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

At IU Health Plans, we understand the importance of finding and managing your health with a doctor you trust. If your doctor is no longer part of the IU Health Plans network, or you are new to IU Health Plans, we can help you find a doctor that meets your needs. IU Health Plans offers a Transition of Care period during which you can continue to see and receive coverage with your current doctor. This period allows time for you to explore our network of leading healthcare providers and helps to create a seamless transition to a new doctor.

Learn more about the Transition of Care process.

How do I find healthcare providers and facilities in network?

To review the healthcare providers and facilities covered in our network, please visit our directory where you can search our healthcare providers and facility locations.

Do I need a referral to see a specialist?

No. Referrals to network specialists for covered services are not required; however, you must go to an in-network specialist. Coverage depends on applicable copayments 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.

Will my medicine be covered?

To find out if your current medications are covered, please search our comprehensive formulary (list of covered drugs).

If you learn that your prescriptions are not covered under your plan, you still have options. Review our to find out how IU Health Plans can help.

Where can I find a covered in-network pharmacy?

To find an in-network pharmacy in your community, search our pharmacy directory.

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

No. As an IU Health Plans Medicare Advantage member, you are not required to pay for Medicare-covered annual preventive and wellness services. Review the list of IU Health Plans covered yearly services, including preventative health services.

Where can I find information about what’s included in my Medicare Advantage plan?

To learn more about the services provided at no cost through your plan, please refer to your Evidence of Coverage or visit Medicare.gov. You can find your plan specific Evidence of Coverage by logging into your member portal.

If I get sick, how much do I have to pay?

This is a very real concern for many of our members. To better understand what you may have to pay, first refer to your Summary of Benefits document and your Evidence of Coverage document. Both of these documents contain information about what your plan covers and what you may be responsible for. These documents can be found on your member portal.

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. You also have access to urgent care centers, should your doctor be unavailable. Find the nearest urgent care center to you.

If you have a true emergency, call 911 or go to the nearest emergency room.

What are Part B drugs and how are they different from Part D drugs?

Part B drugs are defined by Medicare and include certain chemotherapy drugs, some injections at your doctor’s office and drugs you get at a dialysis facility. Part D drugs are ordered from a retail pharmacy or mail-order vendor and are listed on a formulary of covered drugs.

How do I sign up for the member portal?

In the main navigation, click "Member Login." Next, select "sign up" and enter your Membership Number, First Name, Last Name, Group Number and Date of Birth. Your Membership Number and Group Number can be found on your Membership card. If you have difficulties logging in, please reach out to member services at 800.455.9776.

Billing Questions

What premium payment options are available?

It is important to remember that your premium payment is due to IU Health Plans every month. See options below:

Paying by Check:
Members can also send a check via the mail. Please always provide the bottom portion of the invoice with your check in the mail and allow a minimum of 7 business days for IU Health Plans to receive and process your check.

Paying by automatic withdraw through SSN or bank account:

Our member services team can provide more information about these payment options. Call 800.455.9776 to speak with a representative.

Paying by Credit Card (Single Payment):
Call 800.455.9776, option 3 to speak with a Customer Solutions Center Associate.

Where do I pay my doctor?

IU Health Plans does not accept payment for providers. If you owe a payment for medical services to a provider, please contact the provider billing office using the phone number on the billing statement.

Please Note: IU Health does not process premium payments for IU Health Plans.

Where do I pay the hospital or medical facility?

IU Health Plans does not accept payment for hospitals or medical facilities. If you owe a payment for medical services, please contact the billing office using the phone number on the billing statement.

Please Note: IU Health does not process premium payments for IU Health Plans.

What is a drug coverage determination?

A drug coverage determination is any decision (an approval or denial) that IU Health Plans makes when you ask for coverage or payment of a drug that you believe IU Health Plans should provide.

You or your doctor and other prescribers can ask for a coverage determination.You can also appoint someone (such as a relative) to request a coverage determination for you. You can ask for a standard coverage determination; IU Health Plans will give you a decision in 72 hours.

You can also ask for an expedited (fast) coverage determination if you or your doctor or other prescriber believes that your health could be seriously harmed by waiting up to 72 hours for a decision. IU Health Plans will give you an answer in 24 hours.

If IU Health Plans denies your coverage determination, you have the right to request a redetermination appeal. Please see our section on Appeals and Grievances for information about your appeal rights or contact our Member Appeals Department at 866.823.1016 (TTY/TDD 711).

Prior Authorization Questions

What is a Prior Authorization?

A Prior Authorization is approval from a health plan that is required before you get some services or fill some prescriptions. This approval is needed in order for the service or prescription to be covered by your plan.

Why do I need a Prior Authorization?

Some services, like surgeries, hospitalizations or durable medical equipment, can be done or purchased at different types of places. IU Health Plans wants to ensure that you are using the appropriate services, at the appropriate place, and at the best time for your care plan. With the Prior Authorization process, we have nurses and other clinicians that review your plan of care to make sure you are receiving the best quality of care. Some prescriptions also require a prior authorization.

How do I get a Prior Authorization?

The physician or provider that is requesting the service should submit paperwork to IU Health Plans for review. Depending on the request, medical documentation is needed for a full review.

How long is a Prior Authorization good for?

A prior authorization can be set up for a certain number of visits or for a particular device (like a hospital bed). The authorization is not really for a length of time but rather related specifically to the services you and your provider are requesting.

What if I need a Prior Authorization immediately or after-hours?

Services requiring prior authorization must be called in by the provider prior to any services being done. This excludes emergency services, which do not require services to be prior authorized; these services can be called for authorization after services are provided.

Indiana University Health Plans is a Medicare Advantage organization with a Medicare contract. Enrollment in Indiana University Health Plans depends on contract renewal. Other pharmacies/physicians/providers are available in our network. Product types include HMO and HMO-POS. H7220_IUHMA1701 CMS Approved 11/10/2016