PPO Savings Plan
The PPO Savings Plan is a Qualified High-Deductible Health Plan (QHDHP). It has a lower payroll contribution but a higher deductible than the PPO Blue Plan.
Following are some features of the PPO Savings Plan:
- Medical coverage is the same as for the PPO Blue Plan
- Physician network is the same as for the PPO Blue Plan
- Drug formulary is the same as for the PPO Blue Plan
- In-network preventive care is covered at 100% with no deductible or coinsurance
- Includes a Health Savings Account (HSA) that allows subscribers to use pre-tax funds to pay for future and current health care expenses
Understanding the Plan
Deductibles, Coinsurance and Coinsurance Out-Of Pocket Limits
With the PPO Savings Plan, all medical services, including prescription drug costs, count toward the deductible. Once the deductible has been satisfied for the calendar year, the plan begins to pay claims at 90%, and the subscriber is responsible for paying the remaining 10% of any medical expenses for that year. This 10% cost-sharing component is called coinsurance.
The subscriber continues to pay 10% of the discounted amount for all medical claims until a coinsurance out-of-pocket maximum is met. After that, any remaining claims for that year are covered at 100%.
Note that the subscriber's deductible and coinsurance amounts are based on Highmark’s discounted price (sometimes called the allowed amount) rather than on the provider's charge.
Coverage Tiers: Individual, Family
PPo Savings Plan subscribers may select from two coverage tiers: Individual or Family.
For the PPO Savings plan, the Family deductible applies when more than one person is covered on the plan. Under the Family plan, the entire family deductible must be satisfied, by one or any combination of the family members, before the plan begins to pay claims at 90%.
The Individual deductible applies only when one person is covered on the plan.
Prescription Drug Coverage
All prescription drug claims count toward satisfying the deductible and out-of-pocket maximums for the plan.
For specific information about the PPO Savings Plan prescription drug coverage and costs, please see Prescription Coverage--PPO Savings.
Paying for Out-of-Pocket Medical Expenses
With the PPO Savings Plan, there is generally no payment due at the time of service; however, the subscriber will receive a bill from his/her provider. The subscriber may then choose to pay the bill from a Health Savings Account (HSA) or from other personal accounts. If the bill is paid from a Health Savings account, the subscriber may use the Highmark HSA debit card, or may pay the provider directly through the claims portal on the Highmark website.
With the HSA, there is no requirement to substantiate funds; however, it is recommended that for tax purposes, subscribers keep a record of their payments.
See Health Savings Account for more information about employer contributions to the HSA, maximum allowable annual contributions to the HSA, and how this type of account may be used to pay for medical expenses throughout the life span.
Understanding Medical Costs
Understanding the costs of medical services, procedures, equipment and prescription drugs can greatly assist subscribers in how they select providers and use medical care. PPO Blue members are provided with several ways to view the costs associated with their claims:
- The Highmark website outlines the costs associated with each claim. To locate this information, select the Claims tab on the subscriber's Home page of the Highmark website.
- An Explanation of Benefits (EOB) form will be sent to the subscriber each time a medical claim is submitted. The EOB outlines the providers's charge, the member discounted rate, the amount paid by the plan, and the costs that are the responsibility of the subscriber.
Subscribers who do not wish to receive paper copies may opt to receive them only through the Highmark website.
- The Care Cost Estimator Tool on the Highmark website allows plan members to view pricing of various services and procedures for providers in their geographic area.
For additional assistance with questions regarding the PPO Savings Plan or the Health Savings Account, please contact Highmark Blue Shield directly at 800-914-4384.
Eligibility Limitations for the PPO Savings Plan with the Health Savings Account (HSA)
While all full-time, benefits-eligible employees are eligible, the EMPLOYEE:
- CANNOT be enrolled in Medicare or be collecting Social Security benefits. It is recommended that employees who are returning from retirement consult with their financial advisor regarding implications of dis-enrolling from Medicare in order to be eligible for the HSA, as they will not be able to collect Social Security benefits unless they are enrolled in Medicare. Once an individual dis-enrolls from Medicare, that person is able to contribute to the HSA.
- CANNOT be enrolled in another health plan
- CANNOT have a balance in a HEALTH CARE Flexible Spending Account
- CANNOT have a J1 Visa; J1 Visa holders are eligible for the PPO Blue plan only
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