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Employee Costs Summary

2013 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.

 

Purdue Choice Fund
Purdue Incentive Plan
Purdue Copay Plan
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
N/A
Annual Deductible

$1,400
employee only

$2,800
family (employee + one or more dependents)

2,800
employee
only

$5,600
family

$500
employee only

* $1,000
family

$1,000
employee only

* $2,000
family

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
employee
only

$13,600
family

$2,400
employee only

* $4,800
family

$4,800
employee only

* $9,600
family

Inpatient and outpatient services only
$1,500
employee only
 
* $3,000
family

$4,000
employee only 

* $8,000
family

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
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
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