How do HealthSync Tiers work?

Tier 1 HealthSync providers offer quality care at the most affordable rates

Medical expenses can be a significant part of your annual spending budget. That’s why the State of Indiana’s medical plans give you a way to manage your healthcare dollars without sacrificing quality of care.

Tier 1 HealthSync is a network of providers who offer quality care at the lowest rates available. And these providers are available with all three of our medical plans: CDHP 1, CDHP 2 and the Traditional PPO Plan. In fact, all three medical plans give you a choice of three provider networks:

• Tier 1 HealthSync
• Tier 2 In-network
• Out-of-network

The same services are covered in each network tier. However, you’ll have lower out-of-pocket expenses when you choose Tier 1 HealthSync — the lowest deductible, coinsurance and out-of-pocket maximums.

• Helpful tip: Go to the State Personnel Department’s Benefits website to learn more about how deductibles and out-of-pocket maximums apply.

Find a HealthSync provider

To find a Tier 1 HealthSync provider, go to anthem.com and click on the Find Care tab. Be sure to log in or create an account if you don’t already have one. When you search for a provider, the Anthem system will automatically show the tier for each provider.

How Tier 1 HealthSync works

This is an example of how Mia, a state employee, uses HealthSync throughout the year to manage her costs:

• Tier 1 HealthSync visit: Mia visits a Tier 1 provider for a non-preventive service and pays $100, which is applied toward both her Tier 1 and Tier 2 deductibles.
• Tier 2 In-network visit: Next, she sees a Tier 2 provider, which costs $200 — again applied toward both her Tier 1 and Tier 2 deductibles.
• Additional visits: Mia sees Tier 1 or Tier 2 providers. Her expenses — including labs, prescriptions and X-rays — apply toward both Tier 1 and Tier 2 deductibles.
• Tier 1 deductible met: Now Mia only pays 10% when she visits a Tier 1 provider. The 10% Mia pays counts toward her Tier 1 and Tier 2 out-of-pocket maximums.
• Tier 1 out-of-pocket maximum met: This means she no longer pays anything when she sees a Tier 1 provider. Since in-network pharmacies are Tier 1 providers, her prescription costs will also be covered in full.
• Impact on Tier 2 out-of-pocket maximum: Mia has not yet met her Tier 2 out-of-pocket maximum, so she still pays 30% for any claims with a Tier 2 provider. If Mia meets the Tier 2 out of-pocket maximum, then she’ll pay $0 for any additional care received from Tier 2 providers.