Ivy Tech Community College
Limited Medical Insurance Plans
PLAN INFORMATION
Ivy Tech Community College currently offers two limited medical
insurance plans to adjunct faculty members who do not also have a fulltime appointment with Ivy Tech, or part-time (less than 60%) hourly or
administrative employees who are not eligible for the full-time Ivy Tech
benefit plan. Eligible employees may purchase one of the plans to
cover you, your spouse and eligible dependent children.
The two limited medical insurance plans offered include:
 Basic Medical Plan
 Enhanced Medical Plan
PLAN SUMMARY COMPARISON
Maximum Per
Occurrence or Sickness
Deductible
(per illness or injury)
Prescription Drug
Benefit
BASIC PLAN
ENHANCED PLAN
$2,500
$5,000
$200
$150
At pharmacy, there is a
point of sale discount.
After paying for
prescription, receipt
should be sent to
American Sentinel for
50% reimbursement
$20.00
At pharmacy, there is a
point of sale discount.
After paying for
prescription, receipt
should be sent to
American Sentinel for
50% reimbursement
$15.00
60% after deductible
80% after deductible
$400 per day
$500 per day
60%
80%
Plan comparison at a glance
Office Visit Copay
Hospital Care
Physician Services
Lab/X-ray/Diagnostic
Care
Surgery
Other Covered Medical
Services
Additional Inpatient
Benefit
Emergency
Room/Ambulance
BASIC MEDICAL PLAN SUMMARY
MultiPlan Network
Office Visit Benefit
$20 co-pay
Rx Benefit (name brands and generics)
Covered at 50% up to
$750 per Calendar Year
Hospital Care (inpatient and outpatient)
60% after per occurrence deductible
Physician Services
60% after per occurrence deductible
Additional In-patient Benefit
$400 Per Day
30 Days Per Calendar Year
Lab/X-ray/Diagnostic Care
60% up to $750 per occurrence
BASIC MEDICAL PLAN SUMMARY (continued)
MultiPlan Network
Emergency Room/Ambulance
Covered at 60%
($350 per visit Emergency Room Deductible – waived if due to an accident or results in
hospital admission)
Surgery (inpatient and outpatient)
60% after per occurrence deductible
Other Covered Medical Services
(home health, hospice, physical therapy)
60% after per occurrence deductible
Deductible Per Accident or Sickness
$200
Maximum Benefit Per Accident/Sickness
$2,500 Per Occurrence
ENHANCED MEDICAL PLAN SUMMARY
MultiPlan Network
Office Visit Benefit
$15 co-pay
Rx Benefit (name brands and generics)
Covered at 50% up to
$1,000 per Calendar Year
Hospital Care (inpatient and outpatient)
80% after per occurrence deductible
Physician Services
80% after per occurrence deductible
Additional In-patient Benefit
$500 Per Day
30 Days Per Calendar Year
Lab/X-ray/Diagnostic Care
80% up to $1,000 per occurrence
ENHANCED MEDICAL PLAN SUMMARY (cont.)
MultiPlan Network
Emergency Room/Ambulance
Covered at 80%
($350 per visit Emergency Room Deductible – waived if due to an accident or results in
hospital admission)
Surgery (inpatient and outpatient)
80% after per occurrence deductible
Other Covered Medical Services
(home health, hospice, physical therapy)
80% after per occurrence deductible
Deductible Per Accident or Sickness
$150
Maximum Benefit Per Accident/Sickness
$5,000 Per Occurrence
COVERAGE BASICS






90% of claims incurred are between $1 and $3,500
Both plans cover all State Mandates
$10,000 Accidental Death Coverage
No Medical Underwriting – Guarantee Issue
Vision Discount Program – National Vision Administrators
Prescription Benefits Available
• Express Scripts is the discount prescription vendor on both
plans.
 Pre-existing condition clause does not apply to Pregnancy
 Plan policies are underwritten by American Sentinel Insurance Co.
 $100 Wellness Benefit Included
PREMIUM INFORMATION
Employee Only
Employee + 1
Family
Monthly Premiums
Basic Plan
Enhanced Plan
$111.24 per month
$180.12 per month
$213.20 per month
$355.30 per month
$313.14 per month
$511.46 per month
Premiums are direct billed to the employee. Payments can be made
through debit card, credit card or ACH Debit monthly.
FREQUENTLY ASKED QUESTIONS
Why are there dollar limits on this plan?
The American Sentinel Plan was not designed to replace a
traditional health insurance plan, only to offer affordable
coverage to individuals who otherwise wouldn’t be able to buy
coverage.
Can an employee be turned down for coverage?
No, an eligible person cannot be turned down.
Can dependents be covered?
Yes. Due to changes with Health Care Reform, dependents
can now be covered to age 26, if the dependent is not eligible
for another employer-sponsored health plan.
FREQUENTLY ASKED QUESTIONS (continued)
Is there a pre-existing condition clause?
Yes, a pre-existing condition is an injury or illness for which you have received medical
advice, treatment, or incurred expenses within 6 months prior to your enrollment date. Preexisting conditions are covered after 12 continuous months from your enrollment date or
after 6 continuous months of receiving no treatment and incurring no expenses for the
condition. These periods may be reduced by any creditable coverage that you may have
had with a previous employer-sponsored or individual insurance plan. No pre-existing
limitation will be applied to pregnancy. Lastly, due to changes with Health Care Reform, the
pre-existing clause will not apply to any enrollee that is under the age of 19.
Who do I contact with questions?
Contact American Sentinel customer service at 1-800-692-7338 or you can email questions
to [email protected]
ENROLLMENT INFORMATION
To Enroll in one of the Plans:
 Complete the Enrollment Packet. Packets are located in the
Employee Services and Faculty Tabs of Campus Connect.
You may also obtain an Enrollment Packet from your Regional
Human Resources Department.
 Once the Enrollment Packet is complete, submit the completed
forms to your Regional Human Resources Department within
31 days from your date of hire.
 Coverage becomes effective on the first day of the month
following your completion and return to your Regional Human
Resources Department of the appropriate paperwork, and the
Regional Human Resources Department’s verification of
eligibility. Employees must have an active assignment on the
effective date of coverage.
CHANGE & TERMINATION INFORMATION
To make changes to your Plan:
 Complete the Change Form located in the Employee
Services tab on Campus Connect under College Benefits
Website via Adjunct Faculty/Part-Time Employees Forms &
Resources link. You may also obtain an Change Form from
your Regional Human Resources Department.
 Once the Change Form is complete, submit the completed
form to your Regional Human Resources Department.
To Terminate your Plan:
 To cancel your coverage please notify Christine Butler by
sending an email to [email protected]
 Your coverage will end at the end of the month coverage is
canceled.
UPCOMING OPEN ENROLLMENT PERIOD
 An Open Enrollment period will
be conducted September 2012.
OPEN ENROLLMENT  Effective date of coverage for
the Open Enrollment period will
be October 1, 2012.
 Check with your local Human
Resources Department for
information on meeting dates
and times.
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Ivy Tech Community College Limited Medical Insurance Plans