This plan exclusively covers you for in-network doctors and facilities. Except in the case of an emergency, you’ll pay the full price for any out-of-network care. To help with your share of costs, this plan comes with a Health Savings Account (HSA) that you can contribute to.
|EPO 2000 WITH HSA PLAN HIGHLIGHTS|
|Provider Network||Extensive national network of contracted providers.|
|Primary Care Physician (PCP) to manage care||Not required|
|Referrals needed to see a specialist||Not required|
|Calendar Year Deductible||$2,000 per individual/$4,000 per family1|
|Health Savings Account (HSA)||Yes. You can contribute pre-tax dollars to an HSA through HealthEquity. IRS limits for 2019 are $3,500 (employee only) and $7,000 (family). You can contribute an additional $1,000 if you are age 55 or older in 2019. Learn more|
|Coinsurance (You Pay) After Meeting Deductible||20%|
|Calendar Year Out-of-Pocket Maximum||$6,000 per individual/$12,000 per family|
|Preventive Care||Covered in full (calendar year deductible waived)|
|Office Visit (You Pay)||20%2|
Network pharmacy: specified preventive drugs—100% covered3; generic—$10 copay2; brand formulary—$25 copay2; brand non-formulary—$40 copay2
|Pharmacy Mail Services
(up to 90-day supply)
Network pharmacy: specified preventive drugs—100% covered3; generic—$20 copay2; brand formulary—$50 copay2; brand non-formulary—$80 copay2
- The family deductible must be met before any person receives benefits.
- After calendar year deductible.
- Calendar year deductible waived.
- As specified in drug list.