Medical Plan Highlights

• Active employees may participate in a high deductible plan with Health Savings Account (HSA) through PNC Bank.
• Medical benefits are provided by Anthem
• Enrollment is allowed only as a new hire, through qualifying events, or open enrollment
• Coverage is continuous unless actively changed
• Preventive medical care is covered at 100%

Preventive Services List

• Preventive drugs covered outside of the deductible, at coinsurance level

Preventive Drug List

2-Step Enrollment

There are two steps to enroll in the High Deductible Plan with Health Savings Account:

1. Complete the Medical/Dental/Vision enrollment form

- HSA/HDHP option

- HRA/HDHP option (if you have other insurance coverage, including Medicare, Medicaid, spouse plan, flexible spending, etc.)

2. Complete the Salary Reduction Agreement form (optional)
- if you intend to contribute your own money to your HSA.

- HRA participants cannot contribute their own money.

Anthem Member Services: Call Anthem if you have any issues regarding your coverage at: 833-820-8990

Anthem.com
Website registration is required

• Track HSA and claims
• Download Explanations of Benefits
• Pay bills out of your HSA
• Verify coverage for prescription drugs
• In-network provider look-up
• Manage plan ID cards
• Find a doctor

Anthem Portal Guide

Specialty Pharmacy

Mail Order

• Mail Service Order Form

Find a Doctor

Go Green! Anthem offers electronic statements for you to save on fees. A $1.50 charge will appear on your HSA if you continue with paper HSA statements. To "go green",

• Log into your Anthem.com account
• Click on “My Plan” on the top left and choose Spending Accounts
• Click on the “Manage your account” link, which will open a new window or tab
• Click on the settings icon in the top right; look for the option to “Go Green”

Health Savings Account (HSA)

Tax-exempt contributions to an HSA remain exempt if you use them (and their earnings) to pay for qualifying Medical expenses.

Certain restrictions exist for participation in an HSA:

• Must be enrolled in a high deductible health plan.
• Must not have any other insurance coverage.
• Dependents with other coverage may impact the amount you can save.

AUI will make a $500/$1000 employer contribution to the HSA for participating HDHP employees. New Hires will receive a pro-rated contribution.

Eligible HSA Expenses

Sample Anthem HSA/HRA Card

For those who have HSA accounts through HSA Bank:

Accessing your HSA Bank Account without MyCigna

Health Reimbursement Account (HRA)

Individuals who are not eligible for an HSA due to other medical coverage (Medicare, Medicaid, spouse insurance, flexible spending accounts, etc.) may receive the employer contribution given to HSAs through an HRA.

HRAs only have balances if an employer contribution is made to employee HSA accounts. For 2019, there is a $500/$1000 AUI contribution to the HRA.

LiveHealth Online - Telehealth Services

• Private video visit with board-certified doctor or licensed therapist
• Virtual visit costs as little as regular office visit or at most $49
• Sign up ahead of time for faster service when needed!

24/7/365 Nurse Line Available

• Registered Nurses available to answer questions at any time. Telephone number is on the back of your Anthem ID card

Anthem BlueCard Global Core

If you are traveling abroad and need services:

• Anthem will cover your claim as in-network if it is considered a "true emergency" (heart attack, bone break, seizure, etc.).
• You will have to pay at the time of service and submit the claim later. Claim forms are available on this page, or from Anthem.com
• Non-emergency services can be handled through LiveHealth Online.

Condition Care Assistance

Complex Care

• Assistance for coordinating care with complex health conditions. ComplexCare nurses will work with you and your doctors to create a customized plan to help you.

Case Management

• For those who experience hospital stays or serious health conditions, a case manager can help you answer questions, coordinate with doctors, educate you on your benefits, and provide you with guidance. For more information, please call 877-332-8193

Anthem Special Offers!

Did you know Anthem offers special discounts on things like vision and hearing products, or health and fitness services? To view the discounts offered, log into your Anthem.com portal. Click on Care, Discounts.

How much does it cost?

Current Year Medical Premiums

What is covered?

Summary Plan Description (SPD) *coming soon

Click the SPD to see what your Anthem plan pays.

Legal Plan Document

AUI Comprehensive Medical Plan Document.

Legal document outlining who can be covered and how the plan works.

Claim and Pre-Authorization Forms

Medical Claim Form
Medical Claim Form for out-of network claims, not for use with prescriptions.

IngenioRx Drug Claim Form
Use this form to file claims.

Rx Pre-Authorization Form
Use this form to receive pre-authorization drugs.

"Summary of Coverage and Benefits" document

The Patient Protection and Affordable Care Act (PPACA) requires the AUI Comprehensive Medical Insurance Plan to provide a “Summary of Coverage and Benefits” to plan participants prior to the close of annual open enrollment.

These documents were produced by Anthem and follow specific federal guidelines. Please note that these are only summaries and do not outline the comprehensive details of your plan. For complete coverage details you should refer to the Summary Plan Description for your plan as posted on this site.