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Plan Overview — 2019 HDHP Option

The 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 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.

With the HDHP Option you have:

  • Preventive care covered at 100 percent with no deductible applied.
  • A deductible of $2,000 for Self Only and $4,000 for Self Plus One and Self and Family.
  • HSA funding by UPMC Health Plan of $75.00 per month for Self Only enrollment and $150.00 for Self Plus One and Self and Family enrollment. If you are not eligible for an HSA, let us know and we'll establish an HRA for you.
  • Fifteen percent coinsurance for participating providers after your reach your deductible for services other than preventive care until your out-of-pocket maximum is reached.
  • An out-of-pocket maximum of $6,000 for Self Only and $12,000 for Self Plus One and Self and Family (in-network) or $8,000 for Self Only and $16,000 for Self Plus One and Self and Family (out-of-network).

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.

Health Savings Accounts (HSAs)

You are eligible for a HSA if you are enrolled in an HDHP, not covered by any other health plan that is not a HDHP (including a spouse’s health plan, but does not include specific injury insurance and accident, disability, dental care, vision care, or long-term coverage), not enrolled in Medicare, not received VA or Indian Health Services (IHS) benefits within the last three months, not covered by your own or your spouse's flexible spending accounts, and are not claimed as a dependent on someone else’s tax return. In 2019, for each month you are eligible for an HSA premium pass through, we will contribute to your HSA $75 per month for a Self Only enrollment or $150 per month for a Self Plus One or Self and Family enrollment. In addition to our monthly contribution, you have the option to make additional tax-free contributions to your HSA, so long as total contributions do not exceed the limit established by law, which is $3,500 for an individual and $$7,000 for a family. You can use funds in your HSA to help pay your coinsurance, copayments, and other qualified expenses. You own your HSA, so the funds can go with you if you change plans or employment. The Plan will establish an HSA for you with Healthcare Bank, a division of Bell State Bank & Trust, this HDHP’s fiduciary (an administrator, trustee, or custodian as defined by federal tax code and approved by the IRS.) HSA features include:

  • Your HSA is administered by UPMC Benefit Management Services.
  • Your contributions to the HSA are tax deductible.
  • Your HSA earns tax-free interest.
  • You can make tax-free withdrawals for qualified medical expenses for you, your spouse and dependents (see IRS publication 502 for a complete list of eligible expenses).
  • Your unused HSA funds and interest accumulate from year to year.
  • It’s portable - the HSA is owned by you and is yours to keep, even when you leave federal employment or retire.
  • When you need it, funds up to the actual HSA balance are available.
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HealthyU Checklist - HDHP

To get the most from your HealthyU plan, remember to do the following:

  • Open a health savings account (HSA).
  • Because the HDHP offers a lower monthly premium, you may want to deposit the money you save on your monthly premium into your HSA account.
  • For those enrolled in Self Plus One and Self and Family coverage, your adult family members over the age of 18 should also register and create their own MyHealth OnLine accounts.
  • Complete the MyHealth Questionnaire within the first 90 days of the new plan year (or within 90 days of your coverage effective date, if later). This will customize your MyHealth OnLine experience and you earn reward dollars in your health incentive account (HIA) for completing this activity.
  • Begin completing healthy activities to earn reward dollars. Track your reward dollars and monitor your HIA balance on MyHealth OnLine. Log in and view the Spending Accounts tab under the Spending and Claims menu.
  • Earn your maximum reward dollars to get the most value from your plan…up to $250 for Self Only coverage or $500 for Self Plus One and Self and Family coverage.
  • Take advantage of all of the programs offered through UPMC Health Plan to improve and maintain your health!

Remember that any unused reward dollars in your health incentive account carry over to the following plan year up to two times your annual deductible. And with the HDHP Option, the funds in your health savings account also carry over from the previous year.

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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.

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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Using MyHealth OnLine – HDHP Option

MyHealth OnLine is where you can go every day for practical tips, tools, and strategies for better health. You can also find a doctor, view your medical history, and get information on your health plan benefits. The site keeps all your health information, all in one place. At MyHealth OnLine, you can:

  • Earn and track your reward dollars, so you know exactly how much you have in your account to spend on health care. (Remember, with HealthyU, you earn reward dollars when you do healthy activities throughout the year.)
  • Enjoy discounts and savings. Through MyHealth Community, you'll receive discounts at health-related businesses such as gyms, spas, salons, health food stores, sporting goods stores, and more.
  • Manage your health care information. Access your doctor's contact information, plan benefits, research prescription and treatment options savings information, and view your spending summary and claims. You can even order a new member ID card if you lose it.
  • Get connected to your health. Chat online with a Health Care Concierge or health coach, read blogs from health experts, get advice on medical screenings and healthy activities, and set personal goals for managing your health.

Don't forget to complete your MyHealth Questionnaire! Not only will you earn reward dollars, but your answers will generate a simple summary of your current health status and customize MyHealth OnLine with activities that can benefit you most.

Getting started is easy

  • Create your MyHealth OnLine account. Create one here. It’s quick and easy. And once you’ve signed up, you’ll have secure, 24/7 access to your health information. You'll need the number on your member ID card for this. Once you’ve created your account, you can simply enter your user name into the login field located in the top right corner of this page. Then click the "Log in" button to access MyHealth OnLine.
  • Choose your PCP. Find one here. We all get sick. Sometimes it’s a minor illness. Sometimes it’s more serious. That’s why it’s important to have your own primary care physician, or PCP. Your PCP’s goal is to keep you healthy as well as treat you when you are sick or injured. Your PCP knows you and your health history. He or she is the best person to treat you and direct your care.

    Call a Health Care Concierge at 1-877-648-9641 if you need help finding a PCP near you.
  • Take your MyHealth Questionnaire. When you log in to your MyHealth OnLine account click on Better Health and Wellness Then click on Resources for Healthier Living. Go to Browse by Resource Type And finally Online Activities. In just 20 minutes or less, you can get a completely confidential overview of your health and a personalized plan to help you feel your best.

All enrolled employees, spouses, and children over 18 years old can register and complete their own MyHealth Questionnaire for reward dollars.

HealthyU Checklist Plan Cost Scenarios Using MyHealth OnLine Your Plan Options Plan Overview HealthyU Checklist Plan Cost Scenarios
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Attention

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.

Continue to upmchealthplan.com