HDHP with HSA

The HDHP with an HSA provides employees the freedom to manage the cost of their care while offering a large network of providers, which includes out-of-network services at a reduced benefit level. This plan also has the option of opening an HSA that you can fund with pretax dollars to help pay for health expenses.

An HSA is a personal savings account you can use to pay for qualified out-of-pocket medical expenses — now or in the future. Once you are enrolled in the HSA, you will receive a debit card to help manage your HSA reimbursements. Your HSA can also be used for your expenses and those of your spouse and dependents, even if they are not covered by the HDHP medical plan.

View eligible expenses: https://www.optumbank.com/all-products/medical-expenses.html

In-Network Preventive Care

To emphasize the importance of wellness, eligible preventive care expenses are covered at 100%, if you receive care from in-network providers.

View List of Preventive Services

Deductible

You pay for your medical and prescription costs until you meet your annual deductible. This deductible is higher compared to other medical plans but offset by HSA contributions you make.

Coinsurance

Once the deductible is met, you and the plan share any further health care costs until you meet the out-of-pocket maximum.

Out-of-Pocket Maximum

The plan limits the total amount you’ll pay each year. Once you meet your out-of-pocket maximum, the plan pays 100% of your eligible, in-network expenses for the remainder of the year.

HDHP With HSA
Valleywise Health Network
In-Network
(UHC Choice Plus)
Out-of-Network*
Plan Year Deductible (PYD)
Individual
$2,700
$2,700
$6,000
Family
$5,400
$5,400
$12,000
Plan Year Out-of-Pocket Maximum (Includes plan deductible and copays)
Individual
$2,700
$3,600
$10,000
Family
$5,400
$7,200
$20,000
Office Visits
Preventive Services**
100%
Covered at 100%
Not Covered
Primary Care Physician Office Visit
Covered at 100% after PYD
10% after PYD
50% after PYD
Specialist Physician Office Visit
Covered at 100% after PYD
10% after PYD
50% after PYD
7th Avenue Walk-in Clinic
Covered at 100% after PYD
10% after PYD
50% after PYD
Urgent Care Visit
Covered at 100% after PYD
10% after PYD
50% after PYD
Emergency Room Visit
Covered at 100% after PYD
Covered at 100% after PYD
Covered at 100% after PYD
Physician Services
In / Outpatient Physician Services
DMG Physician Services
Covered at 100% after PYD
10% after PYD
50% after PYD
Inpatient Hospital Services - Excludes all Physician Charges
Room & Board
Covered at 100% after PYD
10% after PYD
50% after PYD
Outpatient Facility Services - Excludes all Physician Charges
Operating, Recovery & Procedure Rooms Treatment Room; Anesthesia
Covered at 100% after PYD
10% after PYD
50% after PYD
Physical, Occupational, Speech, and Respiratory Therapy (60-visit maximum for all combined services)
Covered at 100% after PYD
10% after PYD
50% after PYD
Additional Details
Lab and Radiology/X-ray
Covered at 100% after PYD
10% after PYD
50% after PYD
Advanced Radiological Imaging
Covered at 100% after PYD
10% after PYD
50% after PYD
Primary Care Physician Recommended
No
No
No

* Out-of-Network provider charges are subject to Reasonable & Customary (R&C) plan limits, which may be less than the provider’s actual charge. Members are fully responsible for all charges above R&C limits.
** Claims must be coded by the provider as routine, preventive care. Copays will not be waived for diagnostic services rendered.
*** Only covered if authorization received through UMR Care Management. Dialysis covered in-network only.

Eligibility to Open an HSA

You are only eligible to open an HSA if you elect the HDHP with HSA medical plan and are you are not covered by any other health plan, including Medicare or Tricare.

IRS Rules to Know:

Eligible expenses are tax-free.

You can use your HSA to pay for eligible health care expenses tax-free. When used for things like deductibles, copays, prescriptions, and covered medical, dental, or vision care services, the money is not taxed.

Not compatible with Medicare.

HSAs are not compatible with Medicare. You cannot contribute after you elect Medicare, but any accumulated funds in your account are still available to use.

Non-eligible expenses are penalized.

Using your HSA for non-health care expenses will cost you. You will be taxed, plus there is a 20% penalty if you are under age 65. After age 65, the 20% penalty does not apply, but the expenses are still taxable.

There is a contribution limit.

It is your responsibility to monitor your HSA account balance to ensure you do not exceed the IRS combined maximum for the calendar year. Any excess contributions are subject to standard income tax rates plus 6% excise tax. Catch-up contributions of $1,000 per tax year over the limit are allowed if you are age 55-65 and not enrolled in Medicare.

2019 Contribution Limits
HDHP With HSA Coverage LevelIRS Annual Maximum ContributionAdditional Contribution Age 55-65
Individual$3,500$1,000
Family (filing jointly)$7,000$1,000

Accessing Your Funds

Optum Bank, who UMR uses as their trusted HSA bank partner, will automatically open your HSA for you. Watch your mail after you enroll for a welcome kit with important account information. You can access your HSA, including all balance and transaction activity online.

Changing Your HSA Contribution

You are allowed to change your contribution once per month, with the change becoming effective on the first Valleywise Health pay period following the change request. All requests must be emailed to benefits.mailbox@mihs.org and be received no later than the Monday prior to the pay date.

Your HSA is Always Yours – No Matter What!

One of the best features of an HSA is that any money left in your HSA account at the end of the year rolls over so you can use it next year or sometime in the future. And if you leave the company or retire, your HSA goes with you!