Maximize Your Benefits

Maximize Your Benefits

Frequently Asked Questions

Q: What is the difference between a preventive service and a diagnostic service?

A: A preventive service is performed to improve your overall health. Preventive services include immunizations, annual physicals, mammograms, etc. A diagnostic service is performed to alleviate a diagnosed condition. An example would be if you mention to your doctor that you have been having migraines so he sends you to have an MRI. The MRI and any other testing associated with migraines would be considered diagnostic.

Q: I met my deductible, now what happens?

A: Once you or your family has met the plan’s deductible, the coinsurance will begin. This means that you will pay for a percentage of the cost of any claims that accrue after this point, often referred to as co-insurance. The breakdown of percentages depends on the medical plan as well as whether you are receiving services in-network vs. out-of-network. You can view co-insurance amounts here. (This will link to the Anthem comparison chart)

Q: What can I use my Health Savings Account (HSA) to pay for? Who determines the guidelines?

A: You can use your Health Savings Account to pay for any qualified medical expenses or prescriptions. Also, vision and dental expenses, such as glasses, contact lenses, eye exams, dental cleanings and orthodontia are all allowable expenses from your HSA. Medical supplies such as Band-Aids, crutches, test strips, and even contact solution are allowable as well. If you would like to see a more extensive list of eligible medical expenses click here.

Health Savings Account’s guidelines are set by the Internal Revenue Service (IRS).  Click here to review the IRS publications 502 & 969.

Q: Can I have a Health Savings Account (HSA) even though I am enrolled in Medicare?

A: No. If you are enrolled in Medicare, you are not eligible to continue a Health Savings Account. If you are enrolled in Medicare and still have funds in an HSA, the funds can be exhausted on eligible medical expenses.

Q: What are the Flexible Spending Account (FSA) limits for 2013?

A: The maximum contribution to a medical flexible spending account will be reduced in 2013 to $2,500 annually.  This applies to both the medical FSA and the limited purpose medical FSA.  The dependent care FSA will continue to have a $5,000 annual contribution limit. 

Another change that will impact limited purpose medical FSA users is that the minimum deductible will increase in 2013.  The minimum annual deductible for single coverage will be $1,250 for single coverage and $2,500 for family coverage.  You must meet these amounts within your health plan before you can use the limited purpose FSA money for medical expenses.  Until then, the money in the limited purpose FSA can only be used on dental and vision expenses. 

Q: What is my maximum exposure?

A: The total amount of expenses based on annual premiums, out-of-pocket maximum and HSA contributions (if they apply).  This total exposure is the amount you would incur in a “worst case” scenario.

Q: What is the cost breakdown if I am going to have a baby / major surgery?

A: Please click here to view examples.

Q: How do I determine which level of care I need (physician’s office, urgent care, emergency room, etc.)?

A: There is a higher cost associated with care as the setting changes from non-urgent to urgent to emergency. It is important to seek emergency care if you have symptoms that should never be ignored (signs of a heart attack, loss of consciousness, signs of a stroke, shortness of breath, etc.). For other symptoms, a visit to an urgent care facility or your physician’s office can save you time and money. If you need help in determining the level of care that you need call the Anthem 24/7 Nurseline at 888-279-5449 and a registered nurse will guide you in the right direction.

Q: How do I ‘shop around’ for my health care needs?

A: There are many things you can do to be a better consumer when it comes to your health care. Speak to your doctor about whether your prescriptions have a generic alternative that would be right for you. Use the cost tools at  and  at  to estimate the cost of services before you receive them if possible. Anthem’s Care Comparison tools will help you determine the cost of medical services as well as alternative providers.

Q: How do I manage two policies between myself and my spouse?

A: There are a few things to remember if you are covered under your spouse’s plan. First, your plan through the state will be the primary payer for your claims and your spouse’s plan will be secondary. For your spouse, the state’s plan will pay secondary to their own health plan.  As for dependents, there are a number of rules that govern who pays primary so it is best to contact Anthem customer service at 1-877-814-9709 for detailed information.  Remember, per IRS regulations, you are not eligible to have an HSA if you are covered under another health plan unless it is a qualified high deductible health plan.

Q: Why should I choose a CDHP over the Traditional PPO health plan?

A: All three plans cover the same services, but the CDHP is the lowest cost plan regardless of your age or health. (insert Maximum Exposure chart)

Q: How will my contraceptives be covered?

A: In accordance with Health Care Reform, generic and brand-name drugs that do not have a generic equivalent will be covered at 100% and will not be subject to the deductible.

Q: What does the term cafeteria plan mean?

A: Our medical, dental, vision and FSA plans are all under Section 125 plans (or cafeteria plans). This means that     each plan is independent. You can have any combination of plans without affecting the other plans offered. A cafeteria plan is a type of employee benefit plan offered pursuant to Section 125 of the Internal Revenue Code.  Its name comes from the earliest such plans that allowed employees to choose between different types of benefits, similar to the ability of a customer to choose among available items in a cafeteria.  Qualified cafeteria plans are excluded from gross income. 

The state offers a qualified cafeteria plan that allows you to select between three different medical plans and you can independently elect to enroll in dental, vision and life insurance.  All of these plans can be excluded from gross income by electing to participate in the Taxsaver program, often referred to as “after-tax” within PeopleSoft.  This means that your federal taxes are calculated after your premiums are deducted reducing the total amount of federal taxes you pay.

Q: What is the cost savings in “investing in your health”?

A: Making healthier food choices, exercising regularly and having your preventive services can save time and money. Here are some surprising statistics:
- 1 out of every 5 state of Indiana insured members have Diabetes, COPD, Asthma, Coronary Artery Disease or Heart Failure: this adds up to an average cost of $4,487 per diagnosed member per month.
- 30.8% of Hoosiers are considered obese.  Indiana’s obesity rate is the 8th highest in the country.  (Source:   F as in Fat:  How Obesity Threatens America’s Future 2011 Report).
- Indiana ranks 45th out of the 50 states in making Healthy Behavior choices (Source:  Gallup-Healthways Well-Being Index Survey 2011).  Healthy behavior choices include things like not smoking, eating healthy, weekly consumption of fruits/veggies and weekly exercising.