This consumer-driven health plan covers you when you use doctors and hospitals in or out of our nationwide network. You can get care outside of our network, but your payments will be higher. The plan also includes a health reimbursement Arrangement (HRA) funded by SHBP. You can use your HRA to pay your eligible medical bills and annual deductible.
$125 Extra Benefit
You and your spouse can each earn up to $125 extra for your Health Reimbursement Arrangement by taking the Health
Assessment and getting an annual exam. Unused funds from your spending account are rolled over to use in the next plan year.
| Benefit/Service | Network / Non-network |
|---|---|
| Deductible | |
| Employee | $1,100 / same |
| Employee + 1 | $1,900 / same |
| Employee + Children | $1,900 / same |
| Family | $2,750 / same |
| Out-of-pocket maximum | |
| Employee | $2,500 |
| Employee + 1 | $4,100 |
| Employee + Children | $4,100 |
| Family | $5,700 |
| Annual HRA Contribution | |
| Employee | $500 |
| Employee + 1 | $1,000 |
| Employee + Children | $1,000 |
| Family | $1,500 |
| Lifetime maximum benefit | $ 2 million |
| Office / Doctor visit | 85%; subj to ded / 60%; subj to ded |
| Specialist visit | 85%; subj to ded / 60%; subj to ded |
| Urgent care visit | 85%; subj to ded / 60%; subj to ded |
| Emergency room | 85%; subj to ded / 85%; subj to ded |
| Ambulance | 85%; subj to ded / 85%; subj to ded |
| Outpatient surgery | 85%; subj to ded / 60%; subj to ded |
| Hospital stay | 85%; subj to ded / 60%; subj to ded |
| Maternity Care/Office Visit | 85%; subj to ded / 60%; subj to ded |
| Well-child visits | 100% |
| Mammogram | 100% |
| Annual adult physical | 100% |