Download Coinsurance - North Memorial

HSA Seminar
PreferredOne HSA Plan
®
2013
What is an HSA Health Plan?
High Deductible Health Plan + Health Savings Account
Health Savings Accounts (HSAs) are used in conjunction
with a qualified High Deductible Health Plan (HDHP)
 Use pre-tax dollars from your HSA to pay the
deductible and coinsurance.
 First dollar coverage for preventive care
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High Deductible Health Plan
Out-of-Pocket Maximum: The maximum amount
you pay out of your pocket for covered services,
including the deductible and coinsurance.
Coinsurance: The percentage of the total cost you
must pay for a given service after you have met your
plan’s deductible.
Copay: A predetermined dollar amount that you must
pay for certain services and products.
Deductible: The amount you must pay out of your
pocket in a plan year before receiving any coverage
by the plan.
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100% Plan paid
for covered services
Out-of-Pocket
Individual $3,500
Family $8,000
Coinsurance
Tier 1: 100%
Tier 2: 80%
Coinsurance
&
Tier 1: 100%
Prescription Drug
Tier 2: 80%
Copayments
Deductible
Individual $1,2500
Family $3,00
Deductible
Individual $1,250
Family $3,000
Preventive care - 100%
100% Plan Paid: Once you reach your out-ofpocket maximum, the plan pays 100% of covered
services for the remainder of the plan year.
SM
In-Network HSA Plan Benefits
 Deductible - $1,250 single/$3,000 family
 Coinsurance
 North Tier 1 Providers – 100% coverage
after you reach the deductible amount is met.
 Tier 2 Providers – 80% coverage after you reach the deductible
amount is met.
 Prescription Drugs
• North Memorial Pharmacy
 Generic: $15 copayment after deductible amount is met.
 Formulary $30 copayment after deductible amount is met.
 Non-formulary 50% after deductible amount is met,
$30 minimum, $200 maximum.
 Out-of-Pocket Maximum - $3,500 single/$8,000 family
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Health Savings Account
SM
$
$
$
Out-of-Pocket
Individual $3,500
Family $8,000
Coinsurance
Tier 1: 100%
Tier 2: 80%
Coinsurance
&
Tier 1: 100%
Prescription Drug
Tier 2: 80%
Copayments
Deductible
Individual $1,2500
Deductible
Family
$3,00
Individual $1,250
Family $3,000
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Preventive care - 100%
100% Plan paid
for covered services
Twin Cities Metro Area
763.847.4477
Outside the Metro Area
1.800.997.1750
Customer Service Hours:
7:00 a.m. – 7:00 p.m., CST
PreferredOne.com/NM
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