1. If you have HDHP coverage, you can put up to $3,450 into the HSA, tax-free, in 2018. That total is $6,850 if you cover at least one other family member on your HDHP.
2. This means that any telehealth visit can be covered with no cost sharing or limited cost sharing prior to the HDHP deductible. For example, if an employer charges a $25 copay for telehealth visits for its PPO medical option, this same cost sharing could now be applied to the HDHP regardless of whether the HDHP deductible is satisfied.
3. With an HDHP, the policyholder pays out of pocketfor everything other than preventive care (and if allowed by the insurer, COVID-19 costs) until the deductible is met. HDHPs have annually-set guidelines for allowable deductibles and out-of-pocket costs. For 2020, HSA contribution limitsare $3,550 for an individual and $7,100 for a family.

What’s considered a High Deductible Health Plan? Under the tax law, HDHPs must set a minimum deductible and a limit, or maximum, on out-of-pocket costs. For calendar year 2021, these amounts for HDHPs are: Minimum deductible (The amount you pay for health care items and services before your plan starts to pay).

​To better understand the coverage provided under the HDHP, it's important to know these key terms.

Deductible

The deductible is a specified annual dollar amount you must pay for covered medical services before the plan begins to pay benefits. The HDHP has a much higher deductible than the PPO and EPO medical options available through the Board of Pensions.

• HDHP deductibles are flat amounts, as shown on the Key Provisions chart.
• If you enroll any family members, you are responsible for paying the entire family deductible before the plan pays benefits for care that is not preventive. There is no individual deductible amount that applies when one or more eligible family members are enrolled in the HDHP.
• You can reduce your deductibles by completing Call to Health, a well-being initiative that focuses on the four dimensions of wholeness: spiritual, health, financial, and vocational.
• Under the HDHP, the deductible applies to all your covered medical expenses — including doctor's office visits (in-person or virtual) and prescription drugs — except for
• preventive care, which is covered 100 percent when network providers are used; and
• certain preventive prescription drugs (see the Preventive Drug List), for which you pay a flat-dollar copay (see Copay below).
• When you enroll in the HDHP, you may set up and contribute to a health savings account (HSA), and use your HSA funds to pay for your deductible and other eligible medical expenses. Your employer may offer an HSA in which you can participate, or you may set up an HSA on your own.

Copay

A copay is a flat dollar amount that you pay upfront for certain services when using network providers.

• Under the HDHP, you pay a copay for certain preventive prescription drugs.
• The copay amount is based on whether the drug is a generic or formulary brand. Read more details.

Coinsurance

Coinsurance (previously referred to as a copayment) is the percentage of the cost for covered services that you pay after meeting the deductible:

• Your coinsurance for network medical services is 20 percent.
• Your coinsurance is 30 percent for non-preventive generic and formulary prescription drugs.
• The HDHP does not cover out-of-network care or non-formulary prescription drugs.

Total maximum out-of-pocket

The total maximum out-of-pocket is the most you will pay in a year in the form of deductibles, copays, and coinsurance. If your covered out-of-pocket expenses reach the total maximum out-of-pocket amount, the plan will pay 100 percent of allowable costs for the rest of the year.

• The HDHP individual and family total maximum out-of-pocket amounts are shown on the Key Provisions chart.
• Unlike the deductible, if any one covered family member's expenses reach the Member-only total maximum out-of-pocket amount before the family total maximum out-of-pocket is reached, the plan will pay 100 percent of covered expenses for that family member for the rest of the year.
• Expenses that count toward the HDHP total maximum out-of-pocket include your deductibles, coinsurance, and preventive prescription drug copays.

Hdhp Plans And Prescription Coverage

Copay Vs Hdhp

Copays for High Deductible Health Plans (HDHPs) work a little different from other types of plans. Typically with HDHPs, employees must meet their deductible before the carrier will pay for any services other than preventative care.

Hdhp Vs Copay

This means that if you have an HDHP with a $3,000 deductible and a $20 copay for primary care, you may have to meet the entire deductible before the copay will apply. This is why HDHPs are often paired with HSAs - the pretax contributions help offset the $3,000 deductible amount that you'll pay out-of-pocket before your copay can apply.