The UC HSP is one part medical plan and one part health savings account that can add up to benefits for you.
In exchange for lower monthly premiums, you’re responsible for more up-front costs when you get care—some (or possibly all) of which you can pay for using a Health Savings Account (HSA) that UC funds specifically for paying medical, dental and vision costs. Here’s an overview of the plan:
- No-cost in-network preventive care for you and all enrolled family members through Anthem Blue Cross Prudent Buyer (PPO) providers. There’s no deductible or out-of-pocket cost for screenings and lab tests recommended by Anthem based on your age and gender.
- The Health Savings Account (administered by HealthEquity) is a personal savings account that you can use for health care. UC and you can both contribute tax-free* money to the account, and you can change your own contributions at any time.
- Each year you’re enrolled in the plan, UC will contribute to your account: $500 for individual coverage or $1,000 for family coverage. UC makes the full contribution to your account in January of each year. (Contributions for new hires are prorated according to this schedule.)
- Any unused money in your account rolls over for you to use in future years.
- You pay a calendar-year deductible ($1,350 individual coverage/$2,700 family coverage) before the plan begins to share in the cost of covered services, including pharmacy costs.
- If you enroll in family coverage, you must meet the family deductible before the plan will pay benefits for any covered family member.
- Once the annual deductible is met, the plan pays 80% of the cost of most covered services, including prescription drugs, and you pay 20%. The percentage you pay is called coinsurance.
- In-network expenses count toward meeting the out-of-network deductible, but out-of-network expenses do not count toward meeting the in-network deductible.
- You’re protected for the worst-case scenario. The health care protects your physical health. The out-of-pocket maximum protects your finances by limiting your financial liability for covered expenses.
- After you meet the out-of-pocket maximum amount ($4,000 for individual coverage/$6,400 for family—which includes the deductible), Anthem pays 100% for most covered services, including prescription drugs, for the remainder of the year. If you’re enrolled in family coverage, you must meet the family out-of-pocket maximum before Anthem will pay 100% of expenses.
- In-network expenses count toward meeting the out-of-network out-of-pocket maximum, but out-of-network expenses do not count toward meeting the in-network out-of-pocket maximum.
- Choose from a broad range of providers—including UC doctors and facilities—in the Anthem Prudent Buyer (PPO) network of over 60,000 providers. You can self-refer to most specialists. You’re covered across the state and around the world.
- Out-of-network care is also covered, but at a higher out-of-pocket cost to you.
- The out-of-network calendar-year deductible is higher than your in-network deductible. However, in-network expenses count toward meeting the out-of-network deductible. (Out-of-network expenses do not count toward the in-network deductible.)
- Coinsurance costs (the percentage you pay for covered health services after you meet the out-of-network deductible) are higher than what you’d pay with in-network providers.
- You pay charges above the plan allowed amount, in addition to any coinsurance.
- In most cases, you will need to pay in full at the time of service. You—not the provider—are responsible for submitting out-of-network claims to Anthem Blue Cross.
- If you see an out-of-network provider, you may receive a bill for the difference between the amount the plan reimburses for covered services—the allowable amount—and what an out-of-network provider chooses to charge. This is known as balance billing.
*Currently, for residents of California and New Jersey, HSA contributions and earnings are not excluded from state income tax. For more information, please consult your tax adviser.