Employee Costs Summary
2013 Employee Costs Summary
View the 2012 Employee Costs Summary
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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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