With a high deductible health plan (HDHP), your deductible is higher and your premium is lower. Instead of paying copays when you visit the doctor or have a medical service performed, you pay the cost in full—that is, until you meet your deductible. Check out the Glossary of Terms for definitions of deductibles, copays, coinsurance and out-of-pocket maximums.
An HDHP does not mean less care or less coverage. It means that you pay only for the care you use—without prepaying for care that you may not use like in a PPO plan.
- Preventive services are covered at 100% by the plan, and your deductible does not apply.
- All services—including office visits and the full cost of prescription drugs—are subject to the deductible. This means you pay 100% of all costs until you have satisfied the deductible.
- If you have family coverage, the family deductible must be satisfied before any individual receives benefits.
- After your deductible is satisfied, you begin sharing expenses with the plan – that’s coinsurance. You pay a small percentage of the expenses and any copays after your deductible is met. The plan begins paying the larger portion of your covered expenses. (In the Ascension Network, your coinsurance is 0%.)
- After you satisfy the deductible, there are copays for emergency room and urgent care center visits and prescription drugs. These copays apply until you reach the out-of-pocket maximum.
- After you reach the out-of-pocket maximum, the Plan pays 100% of covered expenses for the rest of the calendar year. If you have family coverage (any dependents), the family deductible must be met (by one person or by all family members together) before the plan begins to pay a share of the covered expenses. In other words, coinsurance does not begin for any covered member’s expenses until the entire deductible is met for all covered members of the family.
Paying for Your Expenses: Health Savings Account (HSA)
If you choose a High Deductible Health Plan, described above, and do not participate in another health plan, you can set aside money in a Health Savings Account.
The Health Savings Account is designed to help you pay for your medical expenses, particularly to help toward your deductible and cost sharing expenses. The HSA can also be used to pay for other qualified health expenses such as dental and vision expenses. Both you and your health ministry may make contributions to the HSA. (The contribution limits are set each year by the IRS and may change.) You can use the money in your HSA to pay for qualified expenses now or you can keep the money in your account and use it to pay for future expenses.
HSA: Tax-Advantaged Health Accounts for HDHP Plans
SmartHealth’s High Deductible Health Plans (HDHP) include a Health Savings Account (HSA).The HSA allows for both employer contributions and associate contributions that you can use for medical, prescription drug, dental or vision expenses. You never lose the contributions if you don’t use them.
Important to know:
- If you are enrolled in Medicare, are covered by TriCare, are covered by another plan (which is not a high deductible plan) or you are claimed as a dependent on another person’s coverage, you may not open a new HSA or contribute to an existing HSA.
- In order to receive employer HSA contributions, you MUST open an HSA account and you MUST contribute at least $26 per year. Shortly after you enroll in a SmartHealth HDHP, you’ll receive an HSA welcome kit in the mail. You’ll need to complete and return the signed forms within 10 days of receiving your materials to comply with federal regulations.
- If you do not open an HSA account, you may choose to contribute to the Health Care FSA. However, you may not be able to receive employer contributions.
|Available with SmartHealth plans||HDHP||PPO or HDHP|
|Who owns the account||Associate||Ascension|
|Who funds the account||Ascension and Associate||Associate|
|Limits||*$3,400 individual coverage |
*$6,750 family coverage
|Ascension Contributions|| $500 for individual coverage plus up to $400 in wellness rewards |
$1,000 for family coverage plus up to $400 in wellness rewards
|Fund availability||As contributed each pay period||Annual amount available immediately|
|Carry-over limits||No limit on carry-over of unused funds||Limit of $500 annual carry-over of unused funds|
(available after termination of employment)
|Yes||Yes, if you elect COBRA continuation|
*Limits are combined annual limits of both employee and employer contributions to all HSA plans. This includes any amount contributed by Ascension to the HSA.
Aim for the Best Care at the Lowest Cost
You do not select a network or a doctor when you enroll. You choose a network when you need care, and you receive the level of coverage provided through that network. Each SmartHealth option offers you access to these providers:
Ascension network of physicians and facilities. You will benefit from the lowest-cost care when you use Ascension network providers. Because we are a health care provider, our medical plans are able to offer a higher level of coverage for most types of services than other employer’s plans. To assure you are able to take the greatest advantage of our plans’ savings, select a primary care physician for yourself and each of your covered family members from the Ascension Network. To view the physician directory, go to mysmarthealth.org.
A national network of providers. The benefits coverage available when you receive care from a provider in our medical plan’s National Network is designed to be comparable to other employer’s in-network coverage. The national network of providers is there to provide coverage when:
- you choose a provider who is not in the Ascension Network or
- when the care you need requires a provider who is not available in the Ascension Network.
To find a physician or facility in the national network, visit the website listed on your medical plan ID card.
Out-of-network providers. If you choose to use a provider who is not contracted with the Ascension network or the national network of providers, then you will pay at least half the expenses for the care you receive out-of-network up to the out-of-pocket maximum. However, out-of-network coverage is available in all medical plans.