| High Deductible Health Plan (HDHP) with Health Savings Account (HSA) | Preferred Provider Organization (PPO) |
| High Deductibles | Lower Deductibles |
| High out-of-pocket maximums | Lower out-of-pocket maximums |
| Lower monthly premiums | Higher monthly premiums |
| Eligible to contribute to an HSA. Click HERE to learn more! | Can’t contribute to an HSA |
How the PPO Buy-up and Core Plans work:
Annual Deductible: For non-preventive care there is an annual deductible that must be met. Preventive care is covered at 100% by the plan.
Copays: Are the flat dollar amount you pay each time you receive certain covered health services and apply to your out of pocket max.
Out-of-Pocket Maximum: This is the most that you will have to pay for covered services in a plan year. All medical and prescription drug deductibles, co-payments and coinsurance apply toward the out-of-pocket maximum. Once you meet the out-of-pocket maximum then the plan pays 100% of your eligible expenses, including the cost of all office visits and prescription drugs, for the remainder of the year.
Visit myuhc.com to find a provider, register for tele-medicine, manage usage and much more! Additional UHC resources are also listed on the wellness tab.
How the High Deductible Health Plan works:
Annual Deductible: For non-preventive care there is an annual deductible that must be met and includes all medical and pharmacy expenses. Preventive care is covered at 100% by the plan.
Pharmacy Copays are only applied after the deductible has been met.
Out-of-Pocket Maximum: This is the most that you will have to pay for covered services in a plan year. All medical and prescription drug deductibles, co-payments and coinsurance apply toward the out-of-pocket maximum. Once you meet the out-of-pocket maximum then the plan pays 100% of your eligible expenses, including the cost of all office visits and prescription drugs, for the remainder of the year.
The Essential Pharmacy Drug List can be found HERE
Visit myuhc.com to find a provider, register for tele-medicine, manage usage and much more! Additional UHC resources are also listed on the wellness tab.
PPO Buy Up Plan
Click HERE to find the Buy Up & Core Summary of Benefits & Coverage document.
Click HERE to find the Buy Up with HRA Summary of Benefits & Coverage document.
Click HERE to find the Core with HRA Summary of Benefits & Coverage document.
Click HERE to find the HDHP HSA Summary of Benefits & Coverage document.
|
BENEFITS |
$500 Buy Up PPO |
$1,500 Core PPO |
$5,000 HSA |
|
Total Plan Deductible (Single/Family) |
$5,000/$10,000 |
$5,000/$10,000 |
$5,000/$10,000 |
|
Employee Plan Deductible (Single/Family) |
Patient pays first $500/$1,000 |
Patient pays first $1,500/$3,000 |
Patient pays first $5,000/$10,000 |
|
Employer HRA Single Family |
Employer pays $4,500 (501 to $5,000) $9,000 ($1,001 to $10,000) |
Employer pays $3,500 ($1,501 to $5,000) $7,000 (3,001 to $10,000) |
$5,000/$10,000 |
|
Coinsurance |
30% |
30% |
20% |
|
Out-of-Pocket Maximum (Single/Family) |
$7,950/$15,900 |
$7,950/$15,900 |
$6,750/$13,600 |
|
Office Visit (PCP/Specialist) |
$0 Copay/$70 Copay |
$0 Copay/$70 Copay |
20% after Deductible |
|
Inpatient Hospital Services |
30% after Deductible |
30% after Deductible |
20% after Deductible |
|
Outpatient Surgical Services |
30% after Deductible |
30% after Deductible |
20% after Deductible |
|
Emergency Room Services |
$250 Copay |
$250 Copay |
20% after Deductible |
|
Urgent Care |
$50 Copay |
$50 Copay |
20% after Deductible |
|
Deductible Retail Rx Mail Order Rx |
N/A $10/$65/$125/$250 $25/$162.5/$312.50/$625 (2.5x retail) |
N/A $10/$65/$125/$250 $25/$162.5/$312.50/$625 (2.5x retail) |
Integrated, Medical Deductible applies first then: $10/$65/$125/$250 $25/$162.5/$312.50/$625 (2.5x retail) |
Health Reimbursement Account (HRA)
A health reimbursement arrangement (or HRA) is a benefits plan that reimburses you for eligible expenses to help offset costs not covered by your group health plan.
What makes an HRA different from a Health Savings Account or a Flexible Spending Account is that an HRA is entirely funded by your employer. Because of this, your involvement in an HRA does not count against your taxable income.
After your employer contributes funds to your HRA, you can start spending those funds on eligible expenses, set by your employer’s plan design.
Unused amounts cannot be cashed out. Your employer may have a rollover amount, where a portion of the funds can be carried over to the next year’s plan.
Your HRA is administered through WEX.
Click HERE for more information on how the HRA works!
For any questions or assistance you may need, WEX’s participant services team is available to you Monday through Friday from 6 am to 9 pm Central time.
You have a variety of options to contact WEX. You can use the live chat feature by logging into your online account, get support on our website at www.wexinc.com, or call to speak to a participant services representative.
Live Chat: from your online account, select Need Help? in the bottom right corner, which will open a virtual assistant window, then follow prompts.
Support on Website: To access the form, follow the below steps:
- Navigate to www.wexinc.com > Support > Contact customer service team > Contact WEX benefits.
- Select the following
- Type of Inquiry: Customer Service
- I am a: Employee/Participant
- Select “WEX Benefits Support Center”.
- Complete the form.
- A successful submission message will appear indicating that we’ll be in touch.
- The employee/participant will receive an email response with additional details or resolution to their inquiry.
Form URL: https://wexhealthinc.my.site.com/WEXbenefitscontactus/s/
For anything you’ve paid out of pocket, you can also submit claims to be reimbursed by using the WEX mobile app – simply login, select File a Claim and use the easy to follow steps. You can even take a picture of your explanation of benefits or itemized receipt right from your mobile phone!
And of course you can submit a claim thru you online account by following similar steps and uploading your documentation or by submitting the Claim form.
All claims are processed within 2 business days. You can choose to be reimbursed through direct deposit right to your bank account or have a check mailed to you. Direct deposit is provided free of charge and is a quick and easy way to get your reimbursement!
