Medical & Prescription
At Purdue Polytechnic High School, medical health benefits represent a significant component of our compensation package because we believe we need to invest in programs that help our employees and their families stay healthy and protected. Purdue Polytechnic High School offers two competitive health plans to help protect you and your family from the high cost of medical care and services. The plan is administered by Anthem. Prescriptions are administered by CarelonRx.
Watch this video to learn about the difference between HDHPs and PPOs
Medical Highlights (In-Network)
HDHP
Type of Deductible
Embedded
Calendar Year Deductible (Individual / Family)
$3,300 / $6,600
Your Coinsurance
20%
Out-of-Pocket Maximum (Individual / Family)
$5,600 / $11,200
Physician Visit (Primary / Specialist)
Deductible, then coinsurance
Preventive Care Services
Covered 100%
Emergency Room Visit
Deductible, then coinsurance
Urgent Care Visit
Deductible, then coinsurance
PPO
Type of Deductible
Embedded
Calendar Year Deductible (Individual / Family)
$1,500 / $4,500
Your Coinsurance
20%
Out-of-Pocket Maximum (Individual / Family)
$5,000 / $10,000
Physician Visit (Primary / Specialist)
$25 / $50 copay
Preventive Care Services
Covered 100%
Emergency Room Visit
$250 copay, then coinsurance
Urgent Care Visit
$75 copay
Out-of-Network
Calendar Year Deductible (Individual / Family)
$9,600 / $19,200
Your Coinsurance
40%
Out-of-Pocket Maximum (Individual / Family)
$16,800 / $33,600
Out-of-Network
Calendar Year Deductible (Individual / Family)
$4,500 / $13,500
Your Coinsurance
40%
Out-of-Pocket Maximum (Individual / Family)
$15,000 / $30,000
The PPHS medical plans are embedded. An embedded deductible means that each person covered on the plan (employee, spouse, child) has a personal deductible. When each personal deductible is met, coverage begins for that individual only.
Features of High Deductible Health Plan (HDHP)
A health plan that has lower premiums and higher deductibles than traditional health plans. Only those enrolled in an HDHP are eligible to open and add tax-free money to a health savings account (HSA).
- No up-front copays for medical services (office visits, ER, etc.)
- All services track toward the calendar year deductible and out-of-pocket maximum except for in-network preventive services
- Preventive care services in-network covered at 100%, no annual maximum
- You ARE eligible to enroll in a Health Savings Account
Features of Preferred Provider Organization (PPO)
A health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost.
- Traditional health plan
- Copays apply to office visits and prescription drug costs
- Preventive care services in-network covered at 100%, no annual maximum
- You are NOT eligible to enroll in a Health Savings Account
- You ARE eligible to enroll in a Flexible Spending Account
Contact the provider of these benefits by calling this phone number or visiting this website: Anthem Customer Service:
(800) 295-4119 | www.anthem.com
WHAT IS A...
Deductible: Amount you have to pay for a covered medical expense before your coinsurance kicks in.
Coinsurance: A percentage of the claim amount you pay (after your deductible is met), while your insurance plan pays for the rest. For example: You pay 20% and the plan pays 80%.
Copay: Fixed fee you may need to pay for healthcare services (i.e., office visits, prescriptions).
Out-of-Pocket Maximum: You will not have to pay more than this amount during your plan year – once you reach it, your insurance plan will cover all additional expenses.
Rx Highlights (CarelonRx)
HDHP
Retail Pharmacy (30 day supply)
Tier 1 - Generic
Level 1: Deductible, then you pay 20% coinsurance Level 2: Deductible, then you pay 30% coinsurance
Tier 2 - Brand Name Formulary
Level 1: Deductible, then you pay 20% coinsurance Level 2: Deductible, then you pay 30% coinsurance
Tier 3 - Brand Name Non-Formulary
Level 1: Deductible, then you pay 20% coinsurance Level 2: Deductible, then you pay 30% coinsurance
Tier 4 - Specialty Medication (Preferred)
Level 1: Deductible, then you pay 20% coinsurance Level 2: Deductible, then you pay 30% coinsurance
Mail-Order Pharmacy (90 day supply)
Tier 1 - Generic
Deductible, then you pay 20% coinsurance
Tier 2 - Brand Name Formulary
Deductible, then you pay 20% coinsurance
Tier 3 - Brand Name Non-Formulary
Deductible, then you pay 20% coinsurance
Tier 4 - Specialty Medication (Preferred)
Deductible, then you pay 20% coinsurance
PPO
Retail Pharmacy (30 day supply)
Tier 1 - Generic
Level 1: $10 copay Level 2: $20 copay
Tier 2 - Brand Name Formulary
Level 1: $35 copay Level 2: $45 copay
Tier 3 - Brand Name Non-Formulary
Level 1: $75 copay Level 2: $85 copay
Tier 4 - Specialty Medication (Preferred)
Level 1: 25% with $350 max Level 2: 25% with $350 max
Mail-Order Pharmacy (90 day supply)
Tier 1 - Generic
$20 copay
Tier 2 - Brand Name Formulary
$88 copay
Tier 3 - Brand Name Non-Formulary
$188 copay
Tier 4 - Specialty Medication (Preferred)
25% with $350 max
TIERED PHARMACY NETWORK
Level 1 Pharmacies: CVS, Target, Walmart, Sam’s Club, Kroger, Meijer etc.
Level 2 Pharmacies: Walgreens, Rite Aid
Contact the provider of these benefits by calling this phone number or visiting this website: CarelonRx Customer Service:
(833) 419-0530 | carelonrxhelp@carelon.com| www.carelonrx.com
MEDICAL & Rx COSTS
(Based on 26 pays per year)
Employee Only
HDHP: $64.79
PPO: $97.61
Employee + Spouse
HDHP: $297.04
PPO: $468.56
Employee + Children
HDHP: $239.72
PPO: $361.18
Employee + Family
HDHP: $376.25
PPO: $667.69
QUESTIONS? CONTACT THE CARE LINE
Care Line is an NFP-sponsored program that is staffed by dedicated professionals to help you understand the benefit options made available to you. Whether you have concerns about a recent claim or bill, finding an in-network doctor or just some guidance on which medical plan is right for you and your family, the Care Line can help educate and advocate. The Care Line is available to all employees and children over 18 who are enrolled on the benefit plan.
Contact the Care Line at (844) 717-8777, or you can submit your questions at callthecareline.com.
The Care Line is open Monday - Friday from 8:00 am - 7:00 pm (EST).