HDHP Premium and Standard Plans

The Premium and Standard High-Deductible Health Plans (HDHPs), available through Aetna and UnitedHealthcare (UHC), cover the same medical services and use the same provider networks as the PPO plans. With both HDHPs you pay a higher deductible but less out of your paycheck in premiums. And you have access to a special account—a health savings account (HSA)—that gives you control over how you spend your health care dollars.

These plans may be different than what you’re used to. You should take some time to learn how they work so you can plan for your health care costs throughout the year. Having a complete understanding of the HDHP could mean extra money in your pocket.

What's so great about the HDHPs?
How the HDHPs work
HDHPs at a glance
What happens when you see a doctor?

What’s so great about the HDHPs?

  • Free preventive care for things like annual checkups, immunizations, and age-appropriate screenings.
  • You can use the same doctors and hospitals that you can use in the PPO plans.
  • Save money on taxes, now and in the future, by putting money in your HSA.
  • You’re covered if you ever have a catastrophic medical event with the out-of-pocket maximum, just like in a PPO plan.
  • The HDHPs are the least expensive medical plans, so you’ll pay less out of every paycheck in premiums.
  • You get free money from Salesforce in your HSA, if you enroll in the Premium HDHP.

How the HDHPs work

  1. Free in-network preventive care for you and your covered dependents. It’s covered 100% when you see in-network providers. You pay only the copay amount for preventive prescription drugs, without having to first meet the deductible. See the full list of preventive medications.
  2. Pay for non-preventive medical care and prescription drugs at the full discounted cost until you meet your deductible. If you cover more than one person, you need to meet the family deductible before the plan starts to pay for your medical and prescription drug costs. Find out more about how prescription drug coverage works under the HDHPs.
  3. After you meet your deductible, you and the plan share any further medical costs through coinsurance, and you pay a flat copay for prescription drugs. You’ll pay less for care when it’s received from in-network providers. If you cover more than one person, you need to meet the family deductible before coinsurance applies.
  4. You’re protected against really large bills. Once your medical and pharmacy expenses hit the out-of-pocket maximum, the plan pays 100% of the costs until the end of the plan year.
  5. Use your HSA to pay for medical expenses now or save for expenses in the future. For more information about the HSA, review the Health Savings Account page.

HDHPs at a glance

  HDHP Standard Plan HDHP Premium Plan
  In-network Out-of-network* In-network Out-of-network*
Your annual deductible $1,750/individual
$3,500/family
$3,500/individual
$7,000/family
$1,500/individual
$3,000/family
$3,000/individual
$6,000/family
Salesforce HSA contribution $0 $750/individual
$1,500/family
Your deductible after Salesforce contribution $1,750/individual
$3,500/family
$3,500/individual
$7,000/family
$750/individual
$1,500/family
$2,250/individual
$4,500/family
Coinsurance– percent you pay after deductible 10% 30% 10% 30%
Annual out-of-pocket maximum $3,000/individual
$6,000/family
$6,000/individual
$12,000/family
$3,000/individual
$6,000/family
$6,000/individual
$12,000/family
What you pay for a doctor’s office visit (including specialists) 10% after deductible 30% after deductible 10% after deductible 30% after deductible
What you pay for ER care 10% after deductible 30% after deductible 10% after deductible 30% after deductible
Your monthly cost EE only: $0
EE + spouse/domestic partner: $68
EE + children: $60
EE + family: $117
EE only: $47
EE + spouse/domestic partner: $135
EE + children: $120
EE + family: $234

* Out-of-network provider payments are based on reasonable and customary fees.

A note about how deductibles and out-of-pocket maximums work in the HDHPs

  • If you enroll in individual coverage, you must meet the individual deductible before Aetna/UHC shares in the cost of non-preventive care. Remember, you pay the full discounted cost for services until you meet the deductible!
  • If you enroll in family coverage, you and your dependents must meet the family deductible before Aetna/UHC shares in the cost of non-preventive care.
  • The same rules apply to the out-of-pocket maximum.

The main differences in the two plans are the monthly costs, deductibles, out-of-pocket maximums, and HSA employer contributions. While the HDHP Standard plan offers a premium-free, employee-only plan option, with significantly lower premiums for dependent level coverage, the HDHP Premium plan features free money from Salesforce in your HSA.

What happens when you see a doctor?

So when, and how, do you pay for care? Follow these steps:

  1. Present your Aetna or UHC medical ID card at the time you receive care. When you see an in-network doctor, you won’t need to pay anything at the time of your visit.
  2. After your visit, your doctor will send a bill to Aetna or UHC.
  3. You’ll receive an Explanation of Benefits (EOB) from Aetna or UHC showing what the plan paid and the exact amount you owe. Carefully review your EOB to make sure all services received are listed and coded correctly.
  4. Check out the amount you’re responsible for on your EOB—that’s what you’ll owe the doctor when you receive the actual bill. You can use your HSA to pay your doctor if you have money in your account.

Remember:

  • In-network preventive care is covered at 100%. During your checkup, if you receive treatment or screenings for a condition for which you’ve already been diagnosed—for example, a bone scan for diagnosed osteoporosis—that service is not considered preventive care and the deductible and coinsurance will apply.
  • For all other care and prescriptions, you pay the full discounted cost until you meet the deductible, which you can pay using funds from your HSA, or out of your pocket if you’d like to save your HSA money for future medical expenses. Then, the plan starts sharing the cost.

Need more help understanding your HDHP?

Health Advocate can help. A Personal Health Advocate is available to help you quickly and easily resolve any benefits or claims questions. Contact Health Advocate today at 1-866-695-8622 or go online