MEDICAL
Medical 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. We offer a competitive medical plan to protect you and your family from the high cost of medical care and services. The plan is administered by Auxiant with Ascension Health. Our plan uses TrueRx for prescriptions.
Medical Highlights (In-Network)
HDHP
Type of Deductible
Non-Embedded
Calendar Year Deductible (Individual / Family)1,2
Tier 1: $2,000 / $3,000 Tier 2: $4,000 / $6,000
Your Coinsurance3
Tier 1: 10% Tier 2: 30%
Out-of-Pocket Maximum (Individual / Family)
Tier 1: $3,000 / $6,000 Tier 2: $5,000 / $10,000
Physician Visit (Primary / Specialist)
Tier 1: Deductible, then 10 % coinsurance Tier 2: Deductible, then 30 % coinsurance
Preventive Care Services4
Tier 1: Covered 100% Tier 2: Covered 100%
Emergency Room Visit
Tier 1: Deductible, then $200 Copay, then 10% coinsurance Tier 2: Deductible, then $350 Copay, then 30% coinsurance
Urgent Care Visit
Tier 1: Deductible, then 10% coinsurance Tier 2: Deductible, then 30% coinsurance
Out-of-Network
Out-of-Network Calendar Year Deductible
(Individual / Family)
$8,000 / $16,000
Out-of-Network Coinsurance
50%
Out-of-Pocket Maximum (Individual / Family)
$10,000 / $20,000
PPO
Type of Deductible
Embedded
Calendar Year Deductible (Individual / Family)1,2
Tier 1: $1,000 / $2,000 Tier 2: $2,000 / $4,000
Your Coinsurance3
Tier 1: 10% Tier 2: 30%
Out-of-Pocket Maximum (Individual / Family)
Tier 1: $3,000 / $6,000 Tier 2: $5,000 / $10,000
Physician Visit (Primary / Specialist)
Tier 1: $20 / $40 copay Tier 2: $40 / $60 copay
Preventive Care Services4
Tier 1: Covered 100% Tier 2: Covered 100%
Emergency Room Visit
Tier 1: $200 copay, then 10% coinsurance Tier 2: $350 copay, then 30% coinsurance
Urgent Care Visit
Tier 1: Deductible, then 10% coinsurance Tier 2: Deductible, then 30% coinsurance
Out-of-Network
Out-of-Network Calendar Year Deductible
(Individual / Family)
$3,000 / $9,000
Out-of-Network Coinsurance
50%
Out-of-Pocket Maximum (Individual / Family)
$9,000 / $27,000
The HDHP plan is non-embedded. A non-embedded deductible means that everyone (employee, spouse, child) works toward one shared deductible. When met collectively, coverage begins.
The PPO plan is 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.
1. When enrolling in a High Deductible Health Plan, all covered services are subject to the deductible except Preventive Care services.
2. Deductible year runs on the calendar year.
3. Coinsurance kicks in once the calendar year deductible is met.
4. Preventive care services include but are not limited to routine wellness exams, pelvic exams, pap testing, PSA tests, immunizations, and annual diabetic eye exam. Covers preventive care services rendered in a physician's office and outpatient service centers.
Contact the provider of these benefits by calling this phone number or visiting this website: Auxiant Customer Service - (800) 475-2232, www.auxiant.com
Tier 2: First Health Network
First Health Network will server as the secondary network for plan members. The Tier 2 deductible, co-insurance and out of pocket will apply towards all claims that are not in the Ascension Network, but are within the First Health Network. The First Health Network will also be utilized for claims outside the state of Indiana.
HEALTH PLAN COST
(Based on 26 pays per year)
HDHP Plan
Employee Only
$0.00
Employee + Spouse
$72.70
Employee + Child(ren)
$64.93
Employee + Family
$118.10
PPO Plan
Employee Only
$49.23
Employee + Spouse
$116.15
Employee + Child(ren)
$100.87
Employee + Family
$183.57
QUICK COMPARISON
2023-2024 Medical Plan offerings vs. 2024-2025 Medical Plan offerings
HDHP 4K (NEW for 2024-2025 plan year)
- Lower premiums (than the previous plan year)
- Additional $500 employer contribution to HSA
- Higher deductible and out of pocket maximum
HDHP 2K
- Same premiums (as the previous plan year)
- Same employer contribution to HSA
- Higher deductible and out of pocket maximum
PPO
- Lower Family deductible
- Higher premiums (than the previous plan year)
- Higher copays
*Town of Zionsville has partnered with WellBridge Surgical in Indianapolis. WellBridge delivers high quality surgical services directly to patients through transparent, fixed cost, upfront pricing. The quoted price includes the surgery cost, anesthesia, and facility charges all bundled in one lower price. WellBridge is an in-network provider with UMR. If you choose to use Wellbridge Surgical for your covered outpatient surgery, your coinsurance costs will be waived (deductible costs still apply).
PRESCRIPTION HIGHLIGHTS
(In-Network)
HDHP Plan
Retail Pharmacy (30-day supply)
Tier 1 - Generic
Deductible, then $15 copay
Tier 2 - Brand Name Formulary
Deductible, then $30 copay
Tier 3 - Brand Name Non-Formulary
Deductible, then $60
Tier 4 - Specialty Medication
Deductible, then you pay 20%
Mail-Order Pharmacy (90-day supply)
Tier 1 - Generic
Deductible, then $30 copay
Tier 2 - Brand Name Formulary
Deductible, then $60 copay
Tier 3 - Brand Name Non-Formulary
Deductible, then $120 copay
Tier 4 - Specialty Medication
Deductible, then you pay 20%
PPO Plan
Retail Pharmacy (30-day supply)
Tier 1 - Generic
$15 copay
Tier 2 - Brand Name Formulary
$30 copay
Tier 3 - Brand Name Non-Formulary
$60 copay
Tier 4 - Specialty Medication
20%
Mail-Order Pharmacy (90-day supply)
Tier 1 - Generic
$30 copay
Tier 2 - Brand Name Formulary
$60 copay
Tier 3 - Brand Name Non-Formulary
$120 copay
Tier 4 - Specialty Medication
20%
Questions about your prescription benefits? TrueRx Customer Service: (866) 921-4047, www.truerx.com TrueRx Pharmacist Help Desk: (833) 202-8783
True Rx online access & mobile app:
True Rx offers patients secure online Member Access with you in mind. This secure internet site and mobile app (available on iPhone and Android devices) allows access to health information whenever you need it by visiting truerx.com or searching True Rx in the app store. Click on the links below for more information:
FEATURES OF AN HDHP
- No copays for medical services until the deductible is met
- All services track toward the calendar year deductible and out-of-pocket maximum except for in-network preventive services
- In-network preventive care services are covered at 100%, with no annual maximum
- You ARE eligible to enroll in a Health Savings Account
HOW DOES AN HDHP WORK?
You must first meet your deductible (initial “out-of-pocket” amount)
Once your deductible is met, you will pay coinsurance and copays until you hit your out-of-pocket maximum
The out-of-pocket maximum is the most money you will pay toward healthcare costs in a year
Once you reach the out-of-pocket maximum, your plan pays 100% of all future healthcare expenses
FEATURES OF A PPO
- 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
HOW DOES A PPO WORK?
You do not need to meet your deductible before copays begin
Copays and other out-of-pocket costs all apply toward your deductible.
Once your deductible is met, your coinsurance will begin. Coinsurance and copays will continue until you meet the out-of-pocket maximum.
Once you reach the out-of-pocket maximum, your plan pays 100% of all future healthcare expenses
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 0% and the plan pays 100%.
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.
Auxiant Resources
