You're in the driver’s seat when it comes to managing your medical care and finances. A HDHP is the only plan with a Health Savings Account (HSA) funded by your own tax-free dollars and any employer contributions. The HSA helps you pay your deductible and other healthcare expenses. HDHPs have higher annual deductibles and out-of-pocket maximum limits than other PPO plans. You can visit any provider, but if you stay in-network, you’ll be able to save more of your HSA dollars for future healthcare needs.
With a HDHP, the annual deductible must be met before plan benefits are paid for services, other than in-network preventative care services, which are 100% covered. Once your annual out-of-pocket expenses for covered services from in-network providers, including deductibles, copayments, and coinsurance, reaches the pre-determined out-of-pocket limit, the plan pays 100% of the allowable amount for the remainder of the calendar year. You are required to meet your medical annual deductible for both medical expenses and prescription drugs before the plan's coinsurance cost sharing begins. This means you pay the full cost of your medication until you reach your deductible, not a co-pay.
Another key difference between the HDHP and PPOs/EPOs is that under a HDHP, the deductible is aggregate, not embedded. Lastly, note that the HDHP has a separate deductible for in-network services and out-of-network services, so it is advised you try and stay in-network as much as possible.
Effective January 1, 2024, the HDHP will coordinate with Blue Shield medical plan for your pharmacy benefit.