High Deductible Health Plans
Understanding Your HDHP
You Pay Everything
When your plan year begins, you will pay all your medical costs until you reach a fixed amount, called a deductible. Many preventive visits and screenings are covered at no cost.
Insurance Pays Some
After your deductible is met, insurance pays some of the bill, except a percentage called coinsurance.
You Pay Some
You pay the coinsurance amount until you meet your out-of-pocket maximum.
Insurance Pays Everything
If you meet your out-of-pocket maximum, the insurance company pays for all covered medical services in full. Your out-of-pocket maximum is made up of the deductible and coinsurance amounts you paid. Now, all you continue to pay is your monthly premium.
Feel confident with helpful tools and resources
Find out if an HDHP is right for you. Estimate your health savings account contribution.
Your Member Account
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Frequently Asked Questions
HDHPs offer a lower premium with a higher annual deductible. With an HDHP, you pay the full cost for services until your annual deductible is met for services other than in-network preventive care services, which are covered 100%.
After you meet your deductible you may only be responsible for a small percentage of the costs called a co-insurance. Each plan is a little different, so you’ll want to be familiar with the terms of your plan.
HDHPs also have an out-of-pocket maximum to limit the maximum possible annual out-of-pocket expenses you pay for covered services.
Your HDHP will cover many of the same services that more traditional plans cover. You will still have coverage to see a primary care doctor or specialist, go to an urgent care or hospital, and for prescriptions. HDHPs don’t provide less coverage; it’s just the way you pay for those services that is different.
Your HDHP can often be paired with a reimbursement account such as an Health Savings Account (HSA), Flexible Spending Account (FSA), or Health Reimbursement Account (HRA) to help you save for future qualified health care expenses.
Ask your employer what reimbursement account options they offer.
|Health spending account comparison||HSA||HRA||FSA|
|You own the account||Available||Not Available||Not Available|
|Your employer owns the account||Not Available||Available||Available|
|You must have a high deductible health plan||Available||Not Available||Not Available|
|Only your employer can put money in||Not Available||Available||Not Available|
|You and your employer can put money in||Available||Not Available||Available|
|You can invest the money in the account||Available||Not Available||Not Available|
|Must report account when you do your taxes||Available||Not Available||Not Available|
The type of spending account that is offered by employers varies, but you might be able to open an HSA directly through your bank if your employer doesn’t offer one. It’s best to ask a financial advisor if this option will work for you.
An HSA allows you to save and pay for qualified expenses on a pre-tax basis, and the balance grows tax-free when you use it to pay for qualified medical expenses. Before opening your own HSA, check to see if your employer offers one.
Many commonly covered expenses, include:
Drug addiction therapy
Drugs (prescription) Eyeglasses Fees paid to health institute prescribed by a doctor
Hearing aids and batteries Hospital bills
Laser eye surgery Metabolism test
Neurologist Nurse (including board and meals)
Operating room costs Ophthalmologist
Orthopedic shoes Orthopedist
Postnatal treatments Licensed practical nurse for medical services Prescription medicines Psychiatrist
Spinal fluid test
Therapy equipment Vaccines
For a list of qualified medical expenses, visit IRS.gov
Note: Coverage of all services is subject to the terms of your HDHP
You will pay in full for health care until you meet your annual deductible. Some doctors may have you pay for the visit upfront or request a portion and they will bill the balance. After your appointment, your doctor will submit a claim to Excellus BCBSUnivera Healthcare. The amount you owe will be available on your Explanation of Benefits (EOB) and your provider will bill you for any balances due after your claim processes.
- Check to see if your doctor participates with your plan: Did you know Excellus BlueCross BlueShield Univera Healthcare negotiates discounts with local doctors, specialists, and preferred providers to help you save on services? Use our Find a Doctor tool to search for providers that participate with your plan.
- Estimate Medical Costs: Excellus BCBS Univera Healthcare has an Estimate Medical Costs tool that can help you plan, compare costs and budget for care. This can help to inform you and help you with dialogues with your care provider. Take a Tour
- Take advantage of Free Preventive Care: You can take advantage of free preventive care that is covered, including many immunizations and screenings (e.g. annual routine checkups, well child exams, mammograms, diabetes type 2 screening, and more).
- Talk to Your Doctor: Your doctor’s mission is to keep you healthy. They may be able to recommend lower-cost alternative procedures or payment plans that could work with your budget.
- Timing is Everything: You may also choose to schedule covered elective procedures after your deductible is met as it may mean less out of pocket cost. We don’t recommend putting off healthcare that is necessary, but it may be helpful to track your spending against your annual deductible and to consider any cost benefit based on timing of a visit or procedure.
- If your plan includes prescription coverage, many prescriptions are still subject to a deductible. Generic medications often work the same way as their name brand alternative, but for less money. Ask your doctor if there's a generic or if he or she has any samples or coupons to give you. Your pharmacist may also have a recommendation.
- You will pay out of pocket for prescription medications until you meet your annual deductible; afterwards, you will pay according to your plan coverage.
Many providers will wait until your claim is processed by Excellus BCBSUnivera Healthcare before billing you, but some doctors will require full or partial payment at the time of service. If a partial payment is collected when you visit the doctor, you will be billed for the balance once the claim is processed by Excellus BCBSUnivera Healthcare. Any payments made by us will be applied toward your bill. If you pay for a service in full and we also make a payment, the provider would be responsible to reimburse you any overpaid amounts.
You will pay out-of-pocket for healthcare until you meet your annual deductible and out-of-pocket max. Your out-of-pocket maximum amount is the most you’ll spend on healthcare in a year, aside from premium. Once you’ve reached your out-of-pocket maximum, the insurance company starts paying your covered claims in full when services are rendered by our participating providers.
We track what you’ve spent towards your deductible and out-of-pocket maximum for you in your online member account. When you sign up for a member account with Excellus BCBS sign up for a member account with Univera Healthcare, you can track your spending online or by using our mobile app. Your account will show you exactly how much we’ve counted toward your deductible and how much is left for you to pay.
Yes, absolutely! Your online member account gives you access to:
- Track your spending, deductibles and out-of-pocket amounts
- View claims and monthly health statements
- View benefits and coverage
- Find a Doctor that participates with your plan
- Estimate Medical Costs
Many HDHP members set up a reimbursement account to help pay for their medical expenses. If you don’t have money in a reimbursement account, you should ask your doctor or hospital about setting up a payment plan. Most doctors and hospital systems will work with you to find a payment plan that will work for your budget.
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