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How You Pay for Care

UC puts money in your HSA

Self-
coverage:
$500

Family
coverage:
$1,000

You can add your own tax-free1 contributions to the HSA.

  • Self-coverage: Up to $2,950, or $3,950 if you are 55 or older
  • Family coverage: Up to $5,900, or $6,900 if you are 55 or older

You see the doctor

In-network preventive care is covered at 100%.

Your provider sends a claim to Anthem.

If you haven't met your deductible

You pay 100% of the cost,2 up to the deductible.

  • Self-coverage
    In-network: $1,350
    Out-of-network: $2,500
  • Family coverage
    In-network: $2,700
    Out-of-network: $5,000

Your provider might request payment at the time of service or send you a bill after your visit. This amount counts toward your individual deductible.

If you have met your deductible

Your insurance kicks in. You generally pay:

  • In-network
    20% of the cost2
  • Out-of-network
    40% of the cost2, 3

Your provider may request payment at the time of service or may send you a bill after your visit. This amount counts toward your out-of-pocket maximum.

The percentage you pay is called coinsurance.

Pay this amount with your HSA debit card, through the HealthEquity website or mobile app, or pay out of pocket and request reimbursement from HealthEquity.

You'll pay less when you use in-network providers.

Anthem will send you an Explanation of Benefits (EOB) showing the full amount and confirming the amount you're responsible for paying.4

You fill a prescription

If you haven't met your deductible

You pay 100% of the cost,2 up to the $1,350 or $2,700 deductible.

If you have met your deductible

Your insurance kicks in. You generally pay 20% of the cost in-network and 40% of the cost out-of-network.

Pay this amount with your HSA debit card or out of pocket.

You're protected by the out-of-pocket maximum

Essentially, it's a year-long safety net for the worst-case scenario. Once you reach the maximum, the plan pays 100% of Covered Services for the rest of the calendar year.

  • In-network
    Self-coverage: $4,000
    Family coverage: $6,4005
  • Out-of-network
    Self-coverage: $8,050
    Family coverage: $16,0005

Out-of-pocket maximum includes the deductible.

 

1 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.
2 Based on Anthem’s allowed amount for the service.
3 In-network expenses count toward meeting the in- and out-of-network deductible. Out-of-network expenses count only toward the out-of-network deductible.
4 If the EOB shows you owe a different amount than what the provider collected at the time of service or billed you, call Anthem Health Guide.
5 For family coverage, the full family out-of-pocket maximum must be met before the enrollee or covered dependents can receive 100% benefits for covered services. Out-of-network expenses do not count toward meeting the in-network out-of-pocket maximum.