If you are enrolled or considering enrolling in the High Deductible Health Plan with Health Reimbursement Account (HDHP-HRA), the following should provide you with a summary of the plan along with some helpful tips on how the plan works.
Plan Features and Highlights
* family coverage = employee + spouse, employee + child(ren), and employee + family
The plan requires an upfront annual deductible of $2,000 for individual coverage and $4,000 for family coverage. Once the annual deductible is met, all services are covered in full, with the exception of Rx prescriptions which always require a co-payment under this plan.
Although there is a $4,000 annual family deductible, there is a per member cap of $2,000. For example, if a covered member of your family meets his/her $2,000 deductible (individual cap), then his/her deductible type services will be covered in full for the remainder of the year. Then, other covered family members are subject to meeting the remaining $2,000 deductible. Once the full $4,000 deductible is met, all deductible type services for all covered family members are covered in full.
Services subject to the Annual Deductible
All services, except for routine preventive visits and Rx prescriptions, are subject to the annual deductible. Once the annual deductible is met, all services except for Rx prescriptions co-payments are covered in full for the remainder of the calendar year.
The HDHP-HRA plan is part of BCBS of Massachusetts national PPO provider network which includes more than 90% of all practicing physicians and hospitals across the United States (not limited to Massachusetts or New England). You receive the highest level of benefits under your health care plan when you obtain covered services from in-network providers. To find a preferred provider in the PPO network, visit the BCBS website at www.bluecrossma.com/findadoctor and select the 'Blue Care Elect (PPO/EPO)' network.
Under this plan, you can also receive covered services from non-preferred providers (out-of-network providers who are not part of the PPO network). After your plan deductible is met, you pay an additional 20% co-insurance for out-of-network services, up to the plan's annual out-of-pocket maximum. The Plan's annual out-of-pocket maximum is either $5,000 or $10,000 depending on coverage level for individual or family. This annual maximum includes the annual deductible.
Health Reimbursement Account (HRA)
A Health Reimbursement Account (HRA) is automatically provided and funded by WHOI to cover the first 50% of the annual deductible. So, for an employee enrolled in individual coverage, the HRA will pay for up to the first $1,000 spent on deductible services and up to the first $2,000 for family coverage. Once the HRA is exhausted, you are responsible for the remainder of the annual deductible.
NOTE: The HRA is pro-rated for any mid-year enrollments into the HDHP plan. For example, an employee who enrolls in the HDHP-HRA plan in March will receive 10/12ths of the annual HRA amount.
For more detailed information about the WHOI-funded Health Reimbursement Account, please visit the HR/Benefits website under the 2015 Medical Plan Changes webpage at: http://www.whoi.edu/HR/page.do?pid=123516
How will I pay for my medical expenses under the HDHP-HRA plan?
Annual routine preventive services are covered in full with no office visit co-payment or deductible charges.
Rx prescription drugs require a co-payment only and are not subject to the deductible. Co-payments are based on the drug tier level (e.g., $15/$30/$50)
For services that are subject to the deductible, you should not pay anything at the point of service and follow these instructions:
At the Pharmacy: