HDHP Option PPO
The High-Deductible Health Plan (HDHP) Option comes with a health savings account (HSA). An HSA is a savings account that you can only use for qualified health care expenses. If you are not eligible for an HSA, let us know and we can set up a health reimbursement arrangement (HRA) for you. The funds in your HSA belong to you. You can keep them year after year, watch them grow, and take them with you if you change jobs or retire. There's no “use it or lose it” restriction, and eligible contributions to your HSA are tax-free.
With this option, the reward dollars earned in your health incentive account (HIA) will be added to your HSA. You may use the HSA funds to pay for your coinsurance, pharmacy copayments, and deductible. Subscribers can earn up to $75 in their HIA every plan year, while enrolled employees and their spouses can earn up to $150. Your earned HIA dollars will be deposited into your HSA in addition to the premium pass-through amount. Please make sure to add the amount funded from your HIA in your annual maximum contribution.
| Annual deductible |
| Self Only |
$2000 |
| Self Plus One/Self Plus Family |
$4000 |
| Cost share after deductible |
| Coinsurance (member pays) |
15% |
| Preventive care |
Member pays nothing |
| Provider services |
| PCP office visit |
15% after the deductible is met |
| Specialist office visit |
15% after the deductible is met |
| Virtual urgent care visit |
15% after the deductible is met |
| Urgent care visit |
15% after the deductible is met |
| Emergency room visit |
15% after the deductible is met |
| Prescription drug copayments – after deductible is met |
30-day supply |
90-day supply (mail order only) |
| Tier 1 Preferred Generic |
$20 |
$40 |
| Tier 2 Preferred Brand and Generic |
$50 |
$100 |
| Tier 3 Nonpreferred Brand and Generic |
$100 |
$200 |
| Tier 4 Specialty prescription drug |
50% of the discounted cost of the drug (max $250) |
N/A |
| Tier 5 preventive medications (per ACA) |
$0 |
$0 |
| Tier 6 oral chemotherapy (brand and generic) |
20% after deductible |
N/A |
| Safe Harbor preventive medications – 30 days |
$20, deductible does not apply |
Please note that with the HDHP Option PPO, prescriptions from out-of-network providers will not be covered by UPMC Health Plan.
High-Deductible Health Plan (HDHP) Summary of Coverage and Benefits
Reasons to Choose the High-Deductible Health Plan (HDHP) Option
2024 Safe Harbor Drug List
Plan Cost Scenario—HDHP Option PPO (Self Only)
Let's look at how you can use your health savings account (HSA) with debit card. For this example, let's assume you've chosen the Self Only option.
Your deductible is $2,000. You and your employer contribute $900 to your HSA, and there's $75 in your health incentive account because you completed several healthy activities. You have a medically necessary procedure that costs $1,250. You can use the $975 in your HSA to help pay for this expense, then pay the remaining $275 out-of-pocket. This will leave you with $750 remaining on your deductible.
With the HDHP Option PPO, prescription drug expenses are subject to the deductible. This means you will pay the full discounted rate for your prescriptions until you meet the deductible. In this example, your HSA funds will help pay these expenses. After you meet the deductible, only copayments will apply to prescriptions.
If your out-of-pocket is met, your coverage will pay 100 percent of your eligible medical expenses, including prescriptions.