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COMPARE YOUR MEDICAL OPTIONS


 

HSA Value & HSA Advantage Copay Value & Copay Advantage

PROVIDER CHOICE

You may use in-network or out-of-network providers. The Plan pays a higher level of benefits when you receive care from in-network providers.

PREVENTIVE CARE

Eligible in-network preventive care is covered at 100% with no deductible. Certain generic cholesterol and blood pressure medications are free. Diabetes supplies and insulin listed on the CVS formulary are 100% covered.

HEALTH SAVINGS ACCOUNT (HSA)

You may contribute tax-free dollars to an HSA to save and pay for eligible health care expenses — now or in the future.

With these options, you are not eligible to contribute to an HSA.

HEALTH CARE FLEXIBLE SPENDING ACCOUNT (FSA)

You may contribute to a limited-use Health Care FSA.

You may contribute to a full-use Health Care FSA.

ANNUAL DEDUCTIBLE

The annual deductible is the amount you pay before the Plan begins to pay for covered services. Prescription drug costs apply toward your annual deductible.

The annual deductible is the amount you pay before the Plan begins to pay for covered services. Prescription drug costs have a copay and therefore do NOT apply toward your annual deductible.

COINSURANCE OR COPAY

Once you meet the annual deductible, you pay coinsurance (a percentage of the cost) for covered services until you reach your individual out-of-pocket maximum.

Likewise, each covered dependent pays coinsurance until he/she reaches his/her individual out-of-pocket maximum or the combined family out-of-pocket maximum is met, whichever occurs first.

For certain covered services (e.g., doctor’s office visits), you pay a copay (a flat-dollar amount) regardless of whether you’ve met your annual deductible.

The deductible and coinsurance still apply for certain diagnostic and treatment services performed in a doctor’s office or hospital/outpatient setting.

Copays DO NOT apply toward the annual deductible but do apply toward the out-of-pocket maximum.

ANNUAL OUT-OF-POCKET MAXIMUM

The annual out-of-pocket maximum is the most you will pay in a Plan year for covered and allowed health care expenses (including the deductible and copays/coinsurance but NOT premiums) before the Plan pays 100% of covered in-network services. The same is true for each of your covered dependents. (You could pay more if you go out-of-network because out-of-network services are capped at an “allowed amount.” The Plan pays 100% of the allowed amount, but you are responsible for paying anything over that allowed amount.


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