EPO 2000 with HSA

///EPO 2000 with HSA
EPO 2000 with HSA2019-06-13T22:10:39+00:00

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.

Employee Cost $$
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
Hospitalization 20%2
Pharmacy Retail
(30-day supply)
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
  1. The family deductible must be met before any person receives benefits.
  2. After calendar year deductible.
  3. Calendar year deductible waived.
  4. As specified in drug list.