HDHP

The HDHP, a qualified high deductible health plan, is the lowest-cost medical coverage option available through the Board of Pensions. A higher quality version of the typical HDHP available in the commercial market, it would be considered a bronze plan in the Health Insurance Marketplace. The HDHP option includes 100 percent coverage for network preventive care and a low flat-dollar copay for certain preventive drugs.

Provider network and deductible

HDHP participants have access to the same Blue Cross Blue Shield physicians, hospitals, and other healthcare providers as PPO and EPO participants, and no referrals are needed for care. The HDHP does not cover out-of-network care; however, 97 percent of current Medical Plan members receive their care from network providers, making the HDHP a viable option for many employers at a lower cost than the PPO and EPO.

The HDHP has a higher annual deductible than the PPO and EPO; however, because it is a qualified high deductible plan, members are eligible to enroll in a health savings account. The Board of Pensions urges employers selecting the HDHP to also offer a health savings account to help employees pay for eligible out-of-pocket expenses and offset the higher annual deductible.

HDHP participants, along with PPO and EPO participants, also can reduce their deductibles by participating in Call to Health.

Coverage details

Here are key details about HDHP coverage:

• Members pay out of pocket for all covered services — including doctor's office visits — up to the annual deductible amount of $3,000 ($6,000 if covering any eligible family members) except for
• preventive medical services (plan pays 100 percent); and
• certain preventive drugs (member pays a low flat-dollar copay).
• After the annual deductible is met, the member and the plan share the cost of care through percentage-based coinsurance:
• Members pay 20 percent (plan pays 80 percent) for covered services, such as doctor's office or urgent care center visits, telemedicine consultations, in- and outpatient hospital services, surgery, and emergency room visits.
• Members pay 30 percent (plan pays 70 percent), up to a maximum dollar amount per drug, for covered nonpreventive prescription drugs.
• Once the annual total maximum out-of-pocket amount of $5,000 ($10,000 for family coverage) is reached, the plan pays 100 percent of allowable charges for the rest of the calendar year. 
• Members who set up and contribute to an HSA can use HSA funds to pay for the deductible, required coinsurance, and other eligible out-of-pocket expenses.

Read more details about costs to HDHP participants.

Value-added features

All three medical options (PPO, EPO, and HDHP) include these unique features, which provide exceptional value and promote well-being and wholeness.

• Generous preventive care benefits
• Pharmacy benefits
• Call to Health
• Teladoc
• Employee Assistance Plan
• Centers of Excellence
• Livongo for Diabetes Program

Personalized support through care navigation

All three medical options also include care navigation, provided in partnership with Quantum Health. Care navigation guides members and their covered family members to high-quality care and helps them make the most of their medical benefits. It enhances the value of medical benefits through the Board of Pensions — at no additional cost to the member or employer.

Eligibility to participate

Employers may choose to offer the HDHP to employees who are regularly scheduled to work at least 20 hours a week. There is no work-hour requirement for ministers in self-employed validated service to participate in this coverage option.