In order to comply with current Health Savings Account (HSA) regulations, certain benefit coverage under the High Deductible Health Plan is now subject to individual and family deductibles which were not applied in past years before benefits were paid. The changes include, but are not limited to:
- Charges for prescription eyeglasses and contacts
- Certain mental health and substance abuse charges
- Skilled nursing services
- Certain durable medical equipment charges
This plan provides a $300 wellness benefit per covered individual per calendar year. The deductible amount does not apply. Claims for eligible charges are paid at 80% if incurred at a PPO provider or 70% if incurred at a non-PPO provider.
Because Plan Option 3 is an HSA-compliant high deductible health plan, IRS regulations require that drug costs are subject to the medical deductible for individuals and families. This means that the total cost (less any applicable discounts) of a prescription must be paid at the time it is filled by the retail or mail pharmacy until the $2400 individual/$4000 family medical deductible is satisfied in a plan year. Once the medical deductible is satisfied, the co-pay feature of the prescription drug plan becomes effective and the major portion of drug costs are once again paid by the plan. |
For complete details on this plan option, you may view or download the High Deductible Plan Document below:
Should you have any questions regarding this plan option, please feel free to contact the Benefit Plans Office by e-mail to bpo@sab.wels.net or by calling toll-free at 1-800-487-8322.
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