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HDHP

The HDHP (High Deductible Health Plan) 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 a health reimbursement arrangement (HRA) will be set up for you. The funds in your HSA belong to you. You keep them year after year, watch them grow, and take them with you when you change jobs or retire. There's no “use it or lose it” restriction. And eligible contributions to your HSA are tax-free.

It's important to know that with an HSA, your health incentive account (HIA) funds can only be used after you meet your deductible. It's your choice whether you use money in your HSA to pay for medical costs before reaching that point. You pay all medical expenses until you reach your deductible. Once your deductible is met, your available HIA funds are automatically applied to out-of-pocket expenses. If you do not have HIA funds to use, you may use your HSA funds for out-of-pocket expenses, if available.

Plan Details

Individual

Annual Deductible (aggregate)
$2,000

Annual premium pass-through
$900 per year/$75 per month

Annual out-of-pocket maximum*
$6,000

Cost share after deductible
In-network: 15%
Out-of-network: 40%

Preventive care
In-network: Member pays nothing
Out-of-network: Member pays 40% or not covered

Family

Annual Deductible (aggregate)
$4,000

Annual premium pass-through
$1,800 per year/$150 per month

Annual out-of-pocket maximum*
$12,000

Cost share after deductible
In-network: 15%
Out-of-network: 40%

Preventive care
In-network: Member pays nothing
Out-of-network: Member pays 40% or not covered

*Deductible, coinsurance, and prescription drug copayments accumulate to the annual out-of-pocket maximum.

HDHP RX copayments after the deductible is met

In-network

Generic retail copayment – 30 days
$20 after deductible is met

Preferred brand and generic retail copayment – 30 days
$50 after deductible is met

Non-Preferred brand and generic retail copayment – 30 days
$100 after deductible is met

Specialty prescription drug copayment – 30 days
50% of the discounted cost of the drug up to a maximum of $250, after the deductible is met

Safe Harbor preventive Medications – 30 days
$20 copayment, deductible does not apply

Out-of-network

Generic retail copayment – 30 days
Not covered

Preferred brand and generic retail copayment – 30 days
Not covered

Non-Preferred brand and generic retail copayment – 30 days
Not covered

Specialty prescription drug copayment – 30 days
Not covered

Safe Harbor preventive Medications – 30 days
Not covered

Subscribers can earn up to $250 in their health incentive account every plan year, while enrolled employees and spouses can earn up to $500. The reward dollars you earn carry over from year to year. You can use these reward dollars to pay for pharmacy copayments and coinsurance once your plan deductible is met. And remember, all qualified medical expenses can be paid using your tax-free dollars from your HSA.

High Deductible Health Plan (HDHP) Summary of Coverage and Benefits

Plan Cost Scenario – HDHP Option (Self Only)

Let's take a look at how you can use your health savings account (HSA) and health incentive account (HIA) to help pay for medical expenses during your plan year. 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 $250 in your health incentive account after you completed several healthy activities. Then you have a medically necessary procedure that costs $2,250. You can use the $900 in your HSA to help pay for this expense, then pay the next $1,100 out of pocket. This gets you to your $2,000 deductible, and the final $250 can come from your HIA.

With the HDHP option, prescription drug expenses are subject to the deductible. This means you will pay the full discounted rate for your prescriptions until you have met the deductible. In this example, your HSA funds will help pay these expenses. After the deductible is met, only copayments apply to prescriptions.

If you use up your health incentive account funds, you are only responsible for copayments and 15 percent coinsurance until you reach your out-of-pocket maximum, which is the most you'll have to pay in one plan year. At that point HealthyU pays 100 percent of your eligible medical expenses, including prescriptions.

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It is important to know that when you enroll in this plan, services are provided through UPMC Health Plan's participating providers as described in UPMC Health Plan's federal brochure — but the continued participation of any one doctor, hospital, or other provider cannot be guaranteed.

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