Employee Costs Summary
2013 Employee Costs Summary
View the 2012 Employee Costs Summary
*Important: Beginning in 2013, the Purdue Incentive and Purdue Copay plans no longer have an individual deductible and individual out-of-pocket maximum embedded within the family deductible and out-of-pocket maximum. If you cover one or more dependents, you will need to meet the full family deductible before benefits are paid on you or any of your covered family members. Likewise, you will need to reach the full family out-of-pocket maximum before you or any covered family members are in 100 percent coverage. This change brings coverage for the Purdue Incentive and Purdue Copay plans in line with coverage under the Purdue Choice Fund plan.
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Purdue Choice Fund
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Purdue Incentive Plan
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Purdue Copay Plan
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| Plan Feature | CIGNA Network | Out-of-Network | CIGNA Network | Out-of-Network | CIGNA Network | Out-of-Network |
| Purdue Health Savings Account Contribution | Annual Contribution (prorated): $650 employee only $1,300 family (employee + one or more dependents) |
N/A
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N/A
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| Annual Deductible |
$1,400 |
2,800 $5,600 |
$500 * $1,000 |
$1,000 * $2,000 |
Inpatient and outpatient services only $400 employee only * $800 family |
$800 employee only * $1,600 family |
| Annual Out-of-Pocket Maximum (includes deductible) |
$3,400 employee only $6,800 family (employee + one or more dependents) |
$6,800 $13,600 |
$2,400 * $4,800 |
$4,800 * $9,600 |
Inpatient and outpatient services only $1,500 employee only * $3,000 family |
$4,000 * $8,000 |
| Preventive Care | 0%, no limit | 50% after deductible | 0%, no limit | 40% after deductible | 0%, no limit | 40% after deductible |
| Contraceptives | 0% for generic, FDA approved Rx and other covered services per plan details. | |||||
| Breastfeeding Equipment +Supplies | 0% with limits | 50% after deductible | 0% with limits | 40% after deductible |
0% with limits
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40% after deductible |
| Primary Care Physician Office Visit | 20% after deductible | 50% after deductible | $20, no deductible | 40% after deductible |
$20 per visit,
no deductible |
40% after deductible |
| Specialist Office Visit | 20% after deductible | 50% after deductible | 20% after deductible | 40% after deductible |
$35 per visit,
no deductible |
40% after deductible |
| Lab (at physician's office, out patient facility and inpatient) | 20% after deductible | 50% after deductible | Tier 1 lab: 0%, no deductible Tier 2 lab: 30%, no deductible |
Tier 3 lab: 50%, no deductible |
Tier 1 lab: 0%, no deductible Tier 2 lab: 30%, no deductible |
Tier 3 lab: 50%, no deductible |
| Emergency Room | 20% after deductible | 20% after deductible |
20% after deductible | 20% after deductible |
$200 per visit, no deductible |
$200 per visit, no deductible |
| Urgent Care | 20% after deductible | 20% after deductible |
20% after deductible | 20% after deductible |
$40 per visit, no deductible |
$40 per visit, no deductible |
| Ambulance | 20% after deductible | 20% after deductible |
20% after deductible | 20% after deductible |
No charge | No charge |
| Hospital & Outpatient | 20% after deductible | 50% after deductible | 20% after deductible | 40% after deductible | 20% after deductible | 40% after deductible |
Mental Health/Substance Abuse |
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| Inpatient | 20% after deductible | 50% after deductible | 20% after deductible | 40% after deductible | 20% after deductible | 40% after deductible |
| Office Visit | 20% after deductible | 50% after deductible | $20, per visit | 40% after deductible | $20 per visit | 40% after deductible |
| Outpatient | 20% after deductible | 50% after deductible | 20% after deductible | 40% after deductible | 20% after deductible | 40% after deductible |
| Outpatient Group Physician office Therapy Mental Physician office |
20% after deductible | 50% after deductible | 20% after deductible | 40% after deductible | 20% after deductible | 40% after deductible |
| Intensive Outpatient Physician office |
20% after deductible | 50% after deductible | 20% after deductible | 40% after deductible | 20% after deductible | 40% after deductible |
| If participant purchases brand-name drug when generic is available, participant pays coinsurance for generic, plus difference in cost between brand names and generic | ||||||
| Prescription Drugs | Subject to Choice Fund annual deductible stated above (except for generic and brand preventive drugs that do not require deductible to be met), then: Retail: Generic/preventive: 0%
Generic/non-preventive: 25% Preferred brand: 35% Non-preferred brand: 55% Home Delivery (mail order): Generic/preventive: 0%,
Generic/non-preventive: 15% Preferred brand: 25% Non-preferred brand: 45% Rx costs apply to the same Out-of-Pocket Maximum stated above for Purdue Choice Fund |
No deductible Retail: Generic: 25%
Preferred brand: 35% Non-preferred brand: 55% Home Delivery (mail order): Generic: 15%
Preferred brand: 25% Non-preferred brand: 45% Rx Out-of-Pocket Maximum: $1,300 per participant |
No deductible Retail: Generic: 25%
Preferred brand: 35% Non-preferred brand: 55% Home Delivery (mail order): Generic: 15%
Preferred brand: 25% Non-preferred brand: 45% Rx Out-of-Pocket Maximum: $1,300 per participant |
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