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High Deductible Health Plan (HDHP)

Note:  not available to all employee groups

Overview

The High Deductible Health Plan or HDHP features a lower monthly premium and an integrated deductible for both medical and pharmacy costs.

When a High Deductible Health Plan is paired with a Health Savings Account (HSA), you can set aside tax-free money for current-year health care expenses and build savings for the future.

UC’s HDHP will utilize the Humana network of providers.

How It Works

  • A High Deductible Health Plan gives you solid health care coverage and greater control over health care spending:
  • No copayments - When you have medical and prescription costs, they apply to your deductible.
  • Preventive services coverage - Many preventive services are covered 100 percent before you meet the deductible.
  • Specified out-of-pocket maximum - The plan has a built-in cap on annual health care expenses; your deductible applies to the maximum.
  • Opportunity to open a Health Savings Account (HSA). Save tax-free money to pay deductible or coinsurance; you, your employer, or both can contribute to an HSA.
  • Lower premiums – UC’s High Deductible Health Plan will have a lower premium than the Point of Service (POS) plan.

You’ll have the freedom to see any health care provider, including specialists, without a referral. You’ll save money if you use Humana in-network providers, since their services are available at negotiated rates. This is especially important since, instead of a copay, you will be paying the full cost of a doctor’s visit or service until you satisfy your deductible. Once you meet the in-network deductible, you will pay a lower co-insurance percentage when you use an in-network provider.


Annual Deductible

The UC HDHP/HSA Plan meets the IRS guidelines for a high deductible health plan and qualifies for the Health Savings Account. You can use the funds that accumulate in your HSA to pay eligible medical, dental and vision expenses incurred by you, your spouse and dependents you claim on your income tax return.  You are responsible for meeting the deductible before the plan pays any eligible expenses.

Annual Deductible In-Network Out-of-Network
Individual (Employee Only) Coverage $1500 $3000
Family Coverage (any coverage level other than Employee Only) $3000 $6000

Important Note:  While you may cover a child up to age 26 (or 28 in some cases) or a Domestic Partner on the HDHP, qualified medical expenses are those incurred by you, your spouse and all dependents you claim on your tax return.  Expenses for domestic partners and adult children may not be reimbursable from the Health Savings Account – unless they are claimed as your tax dependents.  Refer to IRS Publication 969 for more details.

Co-insurance

Co-insurance is defined as the expense that an insured person is required to pay after the deductible is met. Once the deductible has been satisfied, the plan provides coverage for eligible expenses through co-insurance. The highest levels of coverage under the plan are available by utilizing the Humana network of providers.

If you utilize network providers, the plan pays for 90% of eligible expenses and you are responsible for the remaining 10% until you reach the co-insurance (or out of pocket maximum). If you do not use network providers, the plan pays for 70% of eligible expenses and you are responsible for the remaining 30%.

The same co-insurance level (90% in-network and 70% out-of-network) applies to the HDHP and Point of Service Plans beginning in 2014.

Annual Out-of-Pocket Maximum

Like the Point of Service Plan, the HDHP/HSA Plan also provides financial protection for you and your family in the event of a catastrophic illness or injury through the annual out-of-pocket maximum. 

If your share of in-network expenses (deductible and co-insurance paid by you) during the calendar reaches $3,000 for employee only coverage and $6,000 for all other levels of coverage, all remaining eligible expenses are covered by the plan at 100%, including ER visits and prescription drugs.

Annual Out-of-Pocket Maximum
In-Network
Out-of-Network
Individual (Employee Only) Coverage $3000* $6000*
Family Coverage (any coverage level other than Employee Only) $6000* $12,000*

*includes expenses paid towards the deductible

Prescription Drug Coverage

Humana will continue as the plan’s pharmacy benefit manager for 2014. You may fill prescriptions at either a retail pharmacy or by using RightSource mail order service. You are not required to use RightSource for purchase of maintenance medications.

With the HDHP/HSA Plan, you must pay all out-of-pocket expenses for prescription drugs until you meet your annual deductible. You can use your HSA funds to pay for prescription drugs. After you meet the deductible, you will pay the applicable co-insurance amount until you reach the co-insurance maximum.

Read more about the Health Savings Account.