High Deductible Health Plan - Plan Features and Highlights:
The plan requires an upfront Annual Deductible of either $2,000 for individual coverage or $4,000 for family coverage (family coverage includes individual plus one or more family members). Once the annual deductible is met, most services are covered in full, except for office visits which require a $15 co-payment.
Although there is a $4,000 deductible for family coverage, there is a per member cap of $2,000. For example, if a covered member of your family meets his/her $2,000 deductible for the year, 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.
Annual routine preventive visits and Rx co-payments are NOT part of the deductible or out-of-pocket maximum. These co-payments are always required by the member and should be paid at the time of service.
If you use out-of-network coverage, you are also subject to an Annual Out-of-Pocket Maximum of either $5,000 or $10,000 depending on coverage level. This annual maximum includes the annual deductible.
Remember, the HDHP is part of the PPO National Network which includes more than 90% of all practicing physicians and hospitals in the United States (not limited to Massachusetts like the HMO plans).
Health Reimbursement Account
A Health Reimbursement Account (HRA) is automatically provided and funded by WHOI to cover the first 50% of the annual deductible upfront. So, an employee enrolled in individual coverage is eligible to receive reimbursement for the first $1,000 spent on deductible services. For family coverage, reimbursement would be on the first $2,000 spent on deductible services. Once the HRA is exhausted, you are responsible for the remainder of the annual deductible.
How will I pay for my medical expenses under the HDHP?
- Effective January 1, 2011, under the Patient Protection and Affordable Care Act, annual routine preventive care services are covered in full with no office visit co-payment or deductible charges.
- For services that are subject to the deductible, you should not pay anything at the point of service and follow these instructions:
* Some providers may request to collect the $15 office visit co-payment at the point of service as part of their routine office practice procedures. If paid, please just be sure this amount is applied to and deducted from the provider bill.
How will I receive my HRA reimbursement?
- Once BCBS processes your claim, they will automatically submit a file to Benefit Strategies
- Benefit Strategies (our third party HRA claims administrator), will check your HRA account to verify funds are available
- If HRA funds are available, Benefit Strategies will automatically disperse payment from the HRA account and a check will be mailed to you (you can also setup for direct deposit if you choose)
For additional information on how the HRA claims process works, refer to the HRA Claims Process and FAQ's sheet provided by Benefit Strategies, the third-party company who administers the HRA claims.
And, don't forget to sign up for the BCBS Member Self-Service for online access to view your personal claims data. The link is provided below under 'related links.'
BCBS Member Services:
Benefit Strategies (for HRA questions):
Link to BCBS Member Self-Service page:
Link to Benefit Strategies login page for accessing your HRA and/or FSA account: