With the HDHP plan, you are responsible for meeting an annual deductible and coinsurance for most covered services, except for primary care office visits and preventive services.
- Annual deductible: The amount you pay before your plan starts to pay.
- Coinsurance: The percentage you pay for health services, after your deductible, when
- your insurance plan begins to pay.
Before you meet your deductible: When you receive covered services from network doctors, you are responsible for paying the allowed charges. Allowed charges are the most your plan will pay for a covered service until you meet the deductible.
After you meet your deductible: EmblemHealth pays allowable charges minus your coinsurance.
You are protected by an annual catastrophic maximum. A catastrophic maximum is the amount of out-of-pocket costs you pay for health care expenses when you have a catastrophic illness (like cancer, heart attack, or stroke) before your plan pays.
After you meet the following copay, coinsurance, and deductible amounts in any enrollment year, you do not have to pay any more for covered services from network providers:
- $6,750 per person enrollment
- $13,500 per self plus one enrollment
- 13,500 per self and family enrollment
Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA)
With the EmblemHealth HDHP plan, you can enroll in either a health savings account (HSA) or a health reimbursement arrangement (HRA). Both offer:
- Coverage for costly medical services.
- Greater control over how you use your health care benefits.
Health savings account: An HSA is a tax-free fund that can be used to pay for certain medical and/or pharmacy expenses.
The contributions you make to an HSA are not subject to federal income tax. However, this money must be used to pay for certain medical expenses. Any money you don’t use in a plan year can be rolled over to be used for future medical costs.
Health reimbursement arrangement: When you participate in an HRA, your employer will credit you for the following health-related costs that are not otherwise covered by the plan:
- Copays
- Coinsurance
- Deductibles
- Prescription drugs
- Other medical services
The credited amounts you get from your employer will be kept in an HSA that you can use toward future medical costs.
To find out how to enroll in either an HRA or an HAS, contact Luke Pathiyil at: (646) 447-6173 or e-mail LPathiyil@EmblemHealth.com
