Additional Details

Both of IU’s employee medical plans—the Anthem PPO HDHP & HSA and the Anthem PPO $500 Deductible Plan—cover the same medical, prescription, and vision services and use the same network of doctors and hospitals.

The $500 Deductible Plan might seem like the more affordable option, but the deductible is only part of the picture. To understand your true costs, it helps to look at your maximum exposure—the most you could pay in a year if you have significant medical expenses.

Let’s walk through a couple of examples to compare your potential costs under each plan. Keep in mind that using less healthcare would result in lower actual costs.

Scenario #1: Employee w/ spouse coverage

An employee in the $40,300–$70,399 salary band needs to cover their spouse. They’re both in their early 40s, and each takes two generic prescriptions daily.

Anthem PPO HDHP & HSA:

• Annual premium = $2,684.64
• Medical/prescription out-of-pocket maximum = $8,000 (includes $4,000 family deductible)
• Offset from IU’s HSA contribution = ($2,000)
• Maximum exposure = $8,684.64

Anthem PPO $500 Deductible Plan:

• Annual premium = $8,510.76
• Medical out-of-pocket maximum = $4,800 (includes $1,000 in deductibles)
• Prescription copays = $320*
• Offset from IU’s HSA contribution = $0 (not eligible for the HSA)
• Maximum exposure = $13,630.76

*This plan has flat-dollar copays for prescriptions, which don’t count toward the medical deductible or out-of-pocket maximum.

In this example, the employee's total costs could be up to $4,946.12 less with the HDHP than with the PPO $500 Deductible Plan.

Scenario #2: Employee only coverage

An employee in the Below $40,300 salary band elects employee-only coverage. He’s in good health, but wants to understand the most he could possibly spend out-of-pocket if he incurs major medical expenses during the year.

Anthem PPO HDHP & HSA:

• Annual premium = $582.48
• Medical/prescription out-of-pocket maximum = $4,000 (includes $2,000 deductible)
• Offset from IU’s HSA contribution = ($1,000)
• Maximum exposure = $3,582.48

• Annual premium = $2,043.96
• Medical out-of-pocket maximum = $2,400 (includes $500 deductible)
• Prescription copays = $0*
• Offset from IU’s HSA contribution = $0 (not eligible for HSA)
• Maximum exposure = $4,443.96

*This plan has flat-dollar copays for prescriptions, which don’t count toward the medical deductible or out-of-pocket maximum.

In this example, the employee’s maximum potential cost for the year is $861.48 less with the HDHP than with the PPO $500 Deductible Plan.  

Scenario #3: Family coverage (employee, spouse, two children)

An employee in the $70,400–$99,999 salary band covers their spouse and two children. One of the children has severe asthma requiring daily medication. They want to understand the most they could pay out of pocket if they experience major medical expenses during the year.

Anthem PPO HDHP & HSA:

• Annual premium = $4,219.20
• Medical/prescription out-of-pocket maximum = $8,000 (includes $4,000 family deductible)
• Offset from IU’s HSA contribution = ($2,000)
• Maximum exposure = $10,219.20

Anthem PPO $500 Deductible Plan:

• Annual premium = $13,309.20
• Medical out-of-pocket maximum = $7,200 (includes $1,500 family deductible)
• Prescription copays = $540*
• Offset from IU’s HSA contribution = $0 (not eligible for the HSA)
• Maximum exposure = $21,049.20

*This plan has flat-dollar copays for prescriptions, which don’t count toward the medical deductible or out-of-pocket maximum.

In this example, the family’s total potential costs could be nearly cut in half with the HDHP ($10,830 less) compared to the $500 Deductible Plan.

Key takeaways

In all of these examples, the HDHP & HSA is a better option financially. Here’s why:

Lower premiums: The HDHP offers significantly lower monthly premiums, allowing you to save money throughout the year.

IU’s HSA contribution: IU makes a generous contribution to your HSA each year you’re enrolled. You can use this money to pay for healthcare expenses tax-free for you, your spouse, and your tax-dependent children. 

Bigger picture savings: While the HDHP has a higher deductible, its lower premiums—combined with IU’s HSA contribution—often make it the more cost-effective option, especially for families with higher healthcare needs. Additionally, any unused HSA funds roll over each year and can be saved for future healthcare expenses, including those in retirement.

Learn more about the similarities and differences between the plans on pages 9 - 13 of the Open Enrollment Guide. 

These examples are for illustrative purposes only. Actual costs will vary based on your salary band, coverage level, plan usage, and prescription needs.

If you are age 65 or older, you can drop your IU employee medical coverage and enroll in Medicare while still working. However, doing so can affect your health savings account (HSA) eligibility, healthcare costs, coverage, and future eligibility for IU retiree medical benefits.

Before making any changes, consider the following:

Cost comparison: Your IU medical plan premium covers medical, vision, and prescription benefits. When comparing costs to Medicare, remember that it typically involves separate premiums for:

• Part A (hospital insurance — no cost for most people)

• Part B (medical insurance)

• Part D (prescription drug coverage)

• Medicare Supplement/Medigap plan (additional coverage to help pay your out-of-pocket costs, like as deductibles and copays)

Network access: Make sure your current doctors accept Medicare before you switch. Also, keep in mind that Medicare generally does not cover medical care outside the United States, vision services, or hearing aids, while IU’s employee plans do.

HSA impact: Medicare is not considered an HSA-qualified high-deductible health plan. Once you enroll in Medicare, the IRS no longer allows you to make or receive tax-free HSA contributions—including IU’s contributions. The account and the funds in it remain yours, but you won’t receive any future contributions.

Timing: If you apply for Medicare after age 65, your Part A coverage is backdated up to 6 months or to your 65th birthday, whichever is closest. Any HSA contributions made by you or IU during that retroactive period could be subject to taxes and penalties until they’re removed from your account.

Dependent needs: If you drop your IU employee medical coverage, your spouse and children will not be able to stay enrolled on your plan. They may be eligible for COBRA continuation coverage for up to 18 months, but they will lose access to IU’s active employee plan.

Eligibility for IU retiree benefits: To qualify for IU retiree medical coverage, you and your dependents must be enrolled in an IU employee medical plan when you retire.

If you and your spouse are both benefits-eligible IU employees, you have a few options for medical and dental coverage. You can:

1. Each enroll separately in employee-only coverage.
   • Each of you will pay the premium for your individual salary band and plan.
   • If you also need to cover children, then one of you will need to enroll in employee-only coverage, and the other in employee plus children coverage. It doesn't matter which parent enrolls them, as long as they are enrolled under only one parent. 
2. Enroll together in employee plus spouse or family coverage under the higher-compensated spouse.
   • You will pay the premium for the higher-compensated spouse's salary band and plan.
   • IU’s plans do not allow spouses to enroll under the lower-compensated employee’s salary band to reduce costs. However, if you each enroll separately, you can enroll your children under the lower-compensated spouse. 

The actual cost of coverage depends on each employee's salary band and selected plan. You can compare premiums and calculate your total household cost using the premium table. 

When weighing your options, make sure you also consider the differences in your out-of-pocket costs (deductibles, out-of-pocket maximums), HSA contribution limits, and employer HSA contributions for individual vs family coverage.

Your coverage costs depend on each employee's salary band, plan, and level of coverage. You can compare premiums and calculate your total household cost using the premium table. 

Here is an example:

• Spouse A salary band ($70,400 to $99,999): employee-only Anthem HDHP premium = $84.52
• Spouse B salary band ($40,300 to $70,399): employee-only Anthem HDHP premium = $64.94
  → Separate total = $84.52 + $64.94 = $149.46 per month
• Joint enrollment under higher-compensated spouse’s salary band (“$70,400 to $99,999”): employee + spouse Anthem PPO HDHP premium = $291.17 per month

In this case, separate enrollment saves $141.71 per month compared to enrolling under one plan.

When weighing your options, make sure you also consider the differences in your out-of-pocket costs (deductibles, out-of-pocket maximums), HSA contribution limits, and employer HSA contributions for individual vs family coverage.

Over the past five years, IU health plan data has consistently shown that, on average, covering a spouse costs approximately 30% more than covering an employee. For example, in 2024, IU paid an average of $8,000 in medical, pharmacy, and vision claims per employee. Claims for covered spouses averaged $10,750 for the same time period — a difference of nearly 34%.

Historically, IU has absorbed much of this additional cost, passing on only a portion to members through general premium increases. However, budget changes no longer allow the university to subsidize coverage to the same extent as in prior years. IU’s approach for 2026 is to adjust premiums to better align with actual utilization.

While the employer contribution to employee HSAs will be reduced in 2026, IU continues to offer one of the most generous HSA contributions among peers that offer an HDHP with HSA.

This chart shows employer HSA contributions for 2026. Not every institution offers an HDHP with HSA, but for those that do, the contribution amount is shown for the plan most similar to IU's. 

Each year, IU evaluates the benefit plan data and the fiscal year budget to determine if there will be any changes to benefits for the upcoming plan year.

Any updates are announced during Open Enrollment, which takes place each year in October and November. Employees are notified through multiple channels, including IU Today, email, U.S. mail, and the Open Enrollment website. This is the standard timeframe and process for employers to announce benefit updates for the upcoming year.

Recent communications from Indiana behavioral health providers about Anthem and Carelon Behavioral Health have created confusion and concern.

Coverage for mental health services and Anthem’s network of mental health providers are not changing for IU members in 2026. You don’t need to make any election changes during Open Enrollment to maintain your current mental health coverage. 

Along with coverage through IU's medical plans, employees have multiple access points to receive mental health care, including:

• Anthem network providers: Access in-network mental health professionals locally through Anthem’s national network.
• Marathon Health: Licensed counselors available in person or virtually for $35 per visit, typically within five business days.
• LiveHealth Online: Virtual therapy with in-network providers through Anthem.
• SupportLinc Employee Assistance Program (EAP): 24/7 support line and up to six free visits with a mental health provider per presenting issue, per year.

Details about access to mental health support, including crisis support and providers, can be found on the IU Workplace Mental Health site. 

For additional information related to Anthem and Carelon, providers can visit Anthem's FAQ page at anthem.com/indianabh.

Preventive medications are taken to help prevent illness or to keep a condition from worsening. IU's medical plans have two preventive drug lists, each with specific medications and coverage provisions. 

No-cost preventive medication list: Medications on this list are covered at no cost when prescribed for prevention. Examples include medicines and products for quitting smoking, medicines used prior to screenings, certain vaccines and immunizations, and most contraceptives. Check out the latest no-cost preventive drug list.

HDHP preventive medication list: If you’re enrolled in the Anthem PPO HDHP, certain preventive drugs are covered right away without having to meet your deductible first. You only pay the 20% coinsurance from the start of the plan year.

In 2026, the HDHP preventive drug list will be limited to generic medications and generic/brand-name diabetes medications only. Drugs on the list will continue to be covered with a 20% coinsurance and no deductible, while brand-name versions will be covered like any other medication, subject to the deductible and coinsurance. This change does not impact the no-cost preventive drug list or specialty medications. 

There are several ways to lower what you pay for medications under your IU medical plan.

Take advantage of preventive drug coverage. 

• No-cost preventive medications. Some medications are covered at no cost when prescribed for prevention. Examples include medicines and products for quitting smoking, medicines used prior to screenings, certain vaccines and immunizations, and most contraceptives. Check out the latest no-cost preventive drug list.
• No-deductible preventive medications. If you’re enrolled in the Anthem PPO HDHP, certain other preventive medications on the HDHP preventive drug list are covered right away without having to meet your deductible first. You only pay the 20% coinsurance from the start of the plan year. Beginning in 2026, this list will only include generics and brand-name/generic diabetes medications. The brand-name version of these drugs will still be covered, but you have to meet your deductible first.

Request generic alternatives whenever possible. Generics have the same active ingredients and effectiveness as their brand-name counterparts, and are FDA-approved, but typically cost far less. Make sure your provider marks your prescription as "okay to substitute" so the pharmacy knows to fill it with the generic alternative.

Automatic GoodRx pricing. Caremark's Cost Saver Program provides IU medical plan members with automatic access to GoodRx pricing on select generic medications. No signup is needed—just present your Anthem ID card at any network pharmacy. The program will compare the standard price with the GoodRx price and charge the lower amount, which also counts towards your deductible and out-of-pocket maximum.

Fill maintenance medications in 90-day supplies. Many maintenance medications, which are taken regularly to treat a wide range of ongoing or long-term conditions and illnesses, cost less per dose when filled as a 90-day supply through a network mail-order or retail pharmacy. It’s also more convenient and reduces the chance of missed doses.

Visit the IU health plan guide to learn about your medical plan options, how to find a provider, how cost-shares work, and definitions of common health plan terms like deductible and allowed amount.