Coverage Chart: HRA Medical OOA Plan

Health Reimbursement Arrangement (HRA) Medical Out of Area Plan

The HRA Medical plan is coupled with an IU Health credit toward the deductible to help pay for eligible expenses once member has met a specified portion of their deductible (amount based upon coverage level and provider network). The participant is not eligible to contribute to their HRA credit, but is eligible to contribute pretax dollars to a traditional health care FSA. Team members and their dependents who enroll in this plan will automatically be enrolled in an Accident and Critical Illness plan paid by IU Health. Please refer to the online Team Member Handbook for additional information on the HRA and the Accident and Critical Illness plans.

IU Health HRA Credit / $700/Individual / $1,400/Family

The chart below provides a brief overview of the HRA Medical plan coverage. Additional plan information may be found on the IU Health Plans website at myiuhealthplans.com. In the event of a discrepancy, the group contract language prevails.

HRA Medical OOA Plan
Annual deductible / PHCS/MultiPlan = $1,500 Individual /$3,000 Family
Out of Network = $2,500 Individual /$5,000 Family
Office visit copayment/visit / PHCS/MultiPlan = 10% (after deductible satisfied)
Out of Network = 50% (after deductible satisfied)
Urgent care copayment/visit / 10% (after deductible satisfied)
ER copayment/visit for emergency treatment (if not admitted) – non-emergency care at ER is not covered / 10% (after deductible satisfied)
Coinsurance for inpatient or outpatient treatment * (chart shows the team member’s responsibility; plan pays balance of covered charges)
*Pre-certification is required for most inpatient and outpatient treatments / PHCS/MultiPlan = 10%(after deductible satisfied)
Out of Network = 50%(after deductible satisfied)
Out-of-pocket maximum (OOPM) / PHCS/MultiPlan = $3,750 Individual /$7,500 Family
Out of Network = $6,500 Individual /$13,000 Family
(Deductible, copays and coinsurance apply toward the above out-of-pocket maximum amounts)