Vice President for Human Resources

For Purdue Incentive and Purdue Copay Participants

Tiered Lab Benefit FAQ

Choice Fund with HSA participants: See how you can save, too, by using a Tier 1 lab

• What labs are in Tier 1?
  
  
  Tier 1 labs include:
  

  • Laboratory Corporation of America (LabCorp)
  • Mid America Clinical Lab
  • Quest Diagnostic
  • Alverno Lab
  • IU Health Arnett Clinic doctor's offices and labs only (does not apply to hospital or urgent care facilities)
  • Purdue University Student Health Center (PUSH), West Lafayette Campus *
  • State Street Office Facility (SSOF), 1601 W. State Street, West Lafayette
  • IPFW, Walb Union, Room 234

  *Tell PUSH to send your lab work to Mid America Clinical Lab for processing. If your lab work is processed by one of these labs, then the plan will pay 100 percent of the lab charges. In addition, the plan will pay 100 percent for preventive lab screenings done by any Cigna in-network lab. A preventive screening is a test done for a symptom-free or disease-free individual as part of the individual's well visit. Your plan will pay 100 percent for preventive screenings as long as you use a lab in the Cigna network. Please refer to the preventive health coverage flier for more information.
• How can I find a Tier 1 lab?
  
  
  To find a Tier 1 lab, contact the labs directly via phone or website. Go to Purdue's tiered lab benefit Web page, and then click the gold "Tier 1 labs" link near the top of the page to open contact information for the labs.
• What labs are in Tier 2?
  
  
  All Cigna in-network labs that are not in Tier 1, including hospitals, doctors and other independent labs, are in Tier 2. You will pay 30 percent coinsurance for services done by Tier 2 labs. In addition, your plan will pay 100 percent for preventive screenings as long as you use a lab in the Cigna network. A preventive screening is a test done for a symptom-free or disease-free individual as part of the individual's well visit. Please refer to the preventive health coverage flier for more information.
• What labs are in Tier 3?
  
  
  Any out-of-network lab is in Tier 3. You will pay 50 percent coinsurance for out-of-network lab services.
• Do lab charges apply to my plan deductible?
  
  
  If you participate in the Copay or Incentive plan, then lab charges do not apply to your plan deductible. This means you will pay nothing for Tier 1 lab services, 30 percent coinsurance for Tier 2 lab services and 50 percent coinsurance for Tier 3 lab services, even if you have not met your deductible for the year. In addition, the coinsurance that you pay – 30 percent for Tier 2 and 50 percent for Tier 3 – does not count toward your plan's deductible amount.
• Do lab charges apply to my out-of-pocket maximum?
  
  
  If you participate in the Copay or Incentive plan, then lab charges do not apply to your out-of-pocket maximum. This means you will still pay 30 percent coinsurance for Tier 2 lab services and 50 percent for Tier 3 lab services, even if you have met your out-of-pocket maximum.
• What happens if the doctor does my lab work in his or her office?
  
  
  If your doctor sends your lab work to a Tier 1 lab for processing, then the plan will pay 100 percent. If your doctor sends your lab work to a Tier 2 lab for processing, then you will pay 30 percent coinsurance. If your doctor sends your lab work to a Tier 3 lab, then you will pay 50 percent coinsurance
  
  You will pay 30 percent for labs drawn and processed at your doctor's office, unless the lab work is a preventive screening. A preventive screening is a test done for a symptom-free or disease-free individual as part of the individual's well visit. Your plan will pay 100 percent for preventive screenings as long as you use a lab in the Cigna network. Please refer to the preventive health coverage flier for more information.
  
  Lab work drawn at an IU Health Arnett Clinic doctor's office will be covered at 100 percent, regardless of where it is processed, unless it's part of an urgent care or hospital visit.
• My doctor did a rapid strep test on my child in his office. Will the medical plan process this as a Tier 1 lab charge or as a Tier 2 lab charge?
  
  
  Labs processed at your doctor's office will be paid at the Tier 2 benefit level, which means you will pay 30 percent.
  
  Lab work drawn at an IU Health Arnett Clinic doctor's office will be covered at 100 percent, regardless of where it is processed, unless it's part of an urgent care or hospital visit.
• I need to have a pap smear. How will the tiered lab benefit work?
  
  
  When your doctor obtains a pap smear, he or she will send it to a lab to be processed. Please encourage your doctor to send the lab work to a Tier 1 lab so that you will pay nothing for the test. If your doctor sends the specimen to a Tier 2 lab, you will pay 30 percent. If your doctor sends it to a lab outside Cigna's network, then it will be Tier 3, and you will pay 50 percent.
  
  However, if the lab work is billed as a preventive screening, your plan will pay 100 percent as long as you use a lab in the Cigna network. A preventive screening is a test done for a symptom-free or disease-free individual as part of the individual's well visit. Please refer to the preventive health coverage flier for more information.
• My doctor removed a mole. What lab benefit applies?
  
  
  When your doctor does a biopsy of a mole or lesion, he or she will send it to a lab to be processed. Please encourage your doctor to send the lab work to a Tier 1 lab so that you will pay nothing for the test. If your doctor sends the specimen to a Tier 2 lab, you will pay 30 percent. If your doctor sends it to a lab outside Cigna's network, then it will be Tier 3, and you will pay 50 percent.
• What if I'm hospitalized and labs are done during my hospital stay?
  
  
  Labs done as part of a hospital stay will count toward your plan deductible and coinsurance.
• I'm having an outpatient surgery. If they do a lab as part of the surgery, how will it be paid?
  
  
  Labs done as part of your outpatient surgery will count toward your plan deductible and coinsurance.
• What happens if I have to go to the emergency room and they perform lab work?
  
  
  If you are on the Incentive or Choice Fund plans, then the labs will count toward your plan deductible and coinsurance. If you are on the Copay plan, the lab will be covered under the $200 emergency room copay. This is assuming that the emergency room processed the lab work and billed for it. If the emergency room sends the lab work to another location for analysis, the tiered lab benefit will apply.
• What happens if I visit an urgent care clinic and they perform lab work?
  
  
  If you are on the Incentive or Choice Fund plans, then the labs will count toward your plan deductible and coinsurance. If you are on the Copay plan, the lab will be covered under the $40 urgent care copay. This is assuming that the urgent care clinic processed the lab work and billed for it. If the urgent care clinic sends the lab work to another location for analysis, the tiered lab benefit will apply.
• My doctor performed a urinalysis in her office to see if I had a urinary tract infection. Will the medical plan pay this as a Tier 1 lab charge or as a Tier 2 lab charge?
  
  
  Lab work processed at your doctor's office will pay at the Tier 2 benefit level, which means you will pay 30 percent, unless the lab is a preventive screening. A preventive screening is a test done for a symptom-free or disease-free individual as part of the individual's well visit. Your plan will pay 100 percent for preventive screenings as long as you use a lab in the Cigna network. Please refer to the preventive health coverage flier for more information.
  
  Lab work drawn at an IU Health Arnett Clinic doctor's office will be covered at 100 percent, regardless of where it is processed, unless it's part of an urgent care or hospital visit.
• My doctor does not send lab work to a Tier 1 lab. What can I do?
  
  
  To use a Tier 1 lab, you will need to ask your doctor to do one of the following:

  • Write a lab order that you can take to your preferred Tier 1 lab when you go for testing OR
  • Fax a lab order to your preferred Tier 1 lab 

  The lab order will have the information the Tier 1 lab will need to process your lab work and send the results to your doctor. You will need to call your doctor to learn your lab results; the Tier 1 lab will not provide this information.
• A Tier 1 lab cannot do the lab service that I need. Will I have to pay for those lab charges?
  
  Yes, you will pay a coinsurance if you cannot use a Tier 1 lab. If you go to a Tier 2 lab, then you will pay 30 percent. If you go to a Tier 3 lab, then you will pay 50 percent.
• I am receiving anticoagulation therapy. I currently have my labs done at an anticoagulation clinic. What Tier 1 labs can provide this service?
  
  Typically, Tier 1 labs can provide this type of service. Contact the labs directly to verify that your location offers what you need. For lab contact and location information, go to the Purdue tiered lab benefit Web page, and then click the gold "Tier 1 labs" link near the top of the page.
• My doctor says that I need to have a "stat lab." What Tier 1 labs can provide this service?
  
  You can call the labs or visit their websites to see if stat lab services are available at the site. "Stat lab" means that the doctor needs the results immediately or urgently.

For Choice Fund with HSA plan participants

• I'm on the Choice Fund with HSA Plan. How will my lab claims be handled?
  
  
  If you are on the Choice Fund plan, all lab charges, except preventive, will apply toward your plan deductible and then be subject to the plan's coinsurance. The tiered lab benefit does not apply to the Choice Fund plan. However, you will save a significant amount of money if you use a Tier 1 lab because these facilities have agreed to process lab work at very cost-effective prices. 
  
  The Choice Fund with HSA plan will pay only preventive lab screenings at 100 percent. A preventive screening is a test done for a symptom-free or disease-free individual as part of the individual's well visit. Your plan will pay preventive screenings at 100 percent as long as you use a lab in the Cigna network. Please refer to the preventive health coverage flier for more information.