2012 Employee Costs Summary
View the 2013 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 | $1,300 employee only $2,600 family (employee + one or more dependents) |
$2,600 individual $5,200 family |
$500 individual $1,000 family |
$1,000 individual $2,000 family |
Inpatient and outpatient services only $250 individual $500 family |
$500 individual $1,000 family |
| Annual Out-of-Pocket Maximum (includes deductible) |
$3,300 employee only $6,600 family (employee + one or more dependents) |
$6,600 family $13,200 family |
$2,200 individual $4,400 family |
$4,000 individual $8,000 family |
Inpatient and outpatient services only $1,200 individual $2,400 family |
$4,000 individual $8,000 family |
| Preventive Care | 0%, no limit | 50% after deductible | 0%, no limit | 40% after deductible | 0%, no limit | No coverage |
| Primary Care Physician Office Visit | 20% after deductible | 50% after deductible | 20%, no deductible | 40% after deductible |
$15 per visit,
no deductible |
30% after deductible |
| Specialist Office Visit | 20% after deductible | 50% after deductible | 20% after deductible | 40% after deductible |
$30 per visit,
no deductible |
30% after deductible |
| Lab (at independent lab or physician's office) | 20% after deductible | 50% after deductible | Preferred lab: 0%, no deductible Non-preferred lab: 30%, no deductible |
50%, no deductible | Preferred lab: 0%, no deductible Non-preferred lab: 30%, no deductible |
50%, no deductible |
| Emergency Room | 20% after deductible | 20% after deductible (if not true emergency, then 50% after deductible) |
20% after deductible | 20% after deductible (if not true emergency, then 40% after deductible) |
$200 per visit, no deductible |
$200 per visit (if not true emergency, then 30% after deductible) |
| Urgent Care | 20% after deductible | 20% after deductible (if not true emergency, then 50% after deductible) |
20% after deductible | 20% after deductible (if not true emergency, then 40% after deductible) |
$40 per visit, no deductible |
$40 per visit (if not true emergency, then 30% after deductible) |
| Ambulance | 20% after deductible | 20% after deductible (if not true emergency, then 50% after deductible) |
20% after deductible | 20% after deductible (if not true emergency, then 40% after deductible) |
No charge | No charge (if not true emergency, then 30% after deductible) |
| Hospital & Outpatient | 20% after deductible | 50% after deductible | 20% after deductible | 40% after deductible | 20% after deductible | 30% after deductible |
| Mental Health/Substance Abuse | ||||||
| Inpatient | 20% after deductible | 50% after deductible | 20%, after deductible | 40% after deductible | 20%, after deductible | 30% after deductible |
| Office Visit | 20% after deductible | 50% after deductible | 20%, no deductible | 40% after deductible | $10 per visit | 30% after deductible |
| Outpatient | 20% after deductible | 50% after deductible | 20%, after deductible | 40% after deductible | $10 per visit | 30% after deductible |
| Outpatient Group Therapy Mental |
20% after deductible | 50% after deductible | 20%, after deductible | 40% after deductible | $10 per visit | 30% after deductible |
| Intensive Outpatient |
20% after deductible | 50% after deductible | 20%, after deductible | 40% after deductible | $10 per visit | 30% after deductible |
| Prescription Drugs | Coverage provided by Medco Health Solutions, Inc. Subject to Choice Fund annual deductible stated above (except for preventive prescription drugs), then: Retail: Generic: preventive 0%;
non-preventive 20% Preferred brand: 30% Non-preferred brand: 50% Mail Order: Generic: preventive 0%,
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 |
Coverage provided by Medco Health Solutions, Inc. No deductible Retail: Generic: 20%
Preferred brand: 30% Non-preferred brand: 50% Mail Order: Generic: 15%
Preferred brand: 25% Non-preferred brand: 45% Rx Out-of-Pocket Maximum: $1,300 person/$2,600 family |
Coverage provided by Medco Health Solutions, Inc. No deductible Retail: Generic: 20%
Preferred brand: 30% Non-preferred brand: 50% Mail Order: Generic: 15%
Preferred brand: 25% Non-preferred brand: 45% Rx Out-of-Pocket Maximum: $1,300 person/$2,600 family |
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