Except for preventive care (see question 4), instead of paying a flat $25 (PPO) or $40 (EPO) copay for each primary care network office visit, if you’re enrolled in the HDHP, you are responsible for the entire cost of the visit, and any treatment received, until your out-of-pocket costs reach the annual deductible amount. Although you are responsible for the entire cost of your care until you pay the deductible, the amount you pay is the discounted Blue Cross Blue Shield network rate. You can offset your out-of-pocket costs by using funds in a health savings account (HSA) to pay for eligible healthcare expenses, including the deductible. See questions 8 and 9 for information about the HSA.

In most cases, network providers will submit the claim for payment and wait for it to be processed before billing you. (Depending on the type of service, the provider may be able to give an estimate of your financial responsibility before care is received. You can also use the Care Finder tool on myqhealthpcusa.org to check costs.) You can then choose to pay any balance due using available HSA funds or pay the balance out of pocket allowing the HSA to grow to use for future healthcare expenses.

Important: The HDHP does not cover care received from out-of-network providers except for emergency services.

The annual deductible for 2023 is $3,000 if enrolled for Employee coverage and $6,000 if covering any eligible family members. Deductible amounts for 2023 will be reduced by 25 percent (to $2,250 and $4,500) if you are enrolled in 2022 medical coverage and complete Call to Health Level 1 (1,000 points including required challenges) by November 11, 2022.

The deductible under the HDHP works differently than the PPO and EPO deductibles. Under the HDHP, the entire family deductible must be satisfied 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. This means that if you enroll your spouse and/or eligible child(ren), you must meet the entire $6,000 family deductible before the HDHP begins to pay for services other than preventive care. The family deductible amount for 2023 can be reduced by 25 percent if you are enrolled in 2022 medical coverage and complete Call to Health Level 1 (1,000 points including required challenges) by November 11, 2022. In addition, you can use available HSA funds to help pay for the deductible.

Yes. The deductible does not apply to preventive care that is on the plan’s Preventive Schedule, which is covered 100 percent, or to the list of specified preventive drugs. You pay a flat dollar copay, based on whether the drug is a generic or a formulary brand-name when using one of these preventive drugs. The preventive drug list, available on pensions.org, includes select prescription drugs that are highly effective in preventing or managing chronic conditions, such as diabetes and high blood pressure.

The HDHP includes an annual cap — called the total maximum out-of-pocket — on the amount you will pay in a year in the form of deductibles, copays, and coinsurance. If your 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 maximum amounts for 2023 are $5,000 if enrolled for Employee coverage and $10,000 if covering any eligible family members. These amounts are less than the limits for out-of-pocket expenses set by the Affordable Care Act.

Unlike the HDHP deductible (see question 3), if any one covered family member’s expenses reach the employee out-of-pocket maximum before the family out-of-pocket maximum is reached, the plan will pay 100 percent of allowable charges for that family member for the rest of the year.

The HDHP uses the same Blue Cross Blue Shield (BCBS) national network as the PPO and EPO. The BCBS network is the largest in the country with the deepest discounts and the greatest choice of providers, hospitals, and facilities in all 50 states. For more information, visit pensions.org/medical and click Locating network providers.

Services from out-of-network providers are not covered.

You pay a copay (a flat dollar amount) with no deductible when using drugs on the plan’s preventive drug list. Most other generic and formulary prescription drugs are covered at 70 percent after your out-of-pocket expenses reach the annual deductible amount. In other words, after meeting the annual deductible, you pay 30 percent of the drug cost, up to a per-prescription maximum, until you reach the annual total out-of-pocket maximum (see question 5).

To see the copay and/or coinsurance and maximum amounts that apply for each type of covered drug, visit pensions.org/medical and click Prescription drug benefits under See Also.

A health savings account (HSA) is a tax-advantaged savings account that can be used to pay for current and future healthcare expenses. To contribute to an HSA, you must be enrolled in the HDHP. Generally, you contribute to an HSA on a pretax basis through payroll deduction. Contributions are exempt from federal income and FICA (Social Security and Medicare) taxes. HSAs feature what is considered a triple tax advantage: contributions are made pretax, any investment growth is tax-free (or tax-deferred), and distributions for eligible healthcare expenses are tax-free.*

* HSAs are never taxed at a federal income tax level when used for qualified healthcare expenses. Most states recognize HSA funds as tax-free. Consult a tax adviser regarding specific state rules.

If you enroll in the HDHP, you generally may make HSA contributions through pretax payroll deductions, up to annual limits set by the IRS. The annual contribution limits for 2023 are $3,850 if enrolled for Employee coverage and $7,750 if covering any family members. If you will be age 55 or older during 2023, you may make additional catch-up contributions of up to $1,000 for 2023. Employers have the option to make HSA contributions on their employee’s behalf. Both your contributions and any made by your employer count toward the IRS limit.

Advantages of enrolling in the HDHP include:

• lower cost of coverage than the PPO and EPO;
• access to a tax-advantaged health savings account (HSA); and
• greater control over your healthcare spending.

Employers may choose to offer HSAs through the Board of Pensions and Further, a leading HSA administrator. HSAs also provide advantages if you are enrolled in the HDHP:

• Unused funds in the account roll over from year to year — allowing the balance to grow over time.
• The HSA earns interest and funds can be invested, for increased tax-free earning potential, when the account balance reaches $1,000.
• HSAs are fully portable (you can keep the account when changing employers) and can be used in retirement to pay for qualified healthcare expenses, including Medicare premiums (but not subscription charges for the Medicare Supplement Plan offered through the Board of Pensions).

Employer contributions are not taxable to the employee and employee contributions are deducted from their pay on a pre-tax basis. Both employee and employer contributions count toward the annual IRS limit ($3,850 member only; $7,750 family).