How Do HDHP Plans Work?Employers can elect the type of HDHP offered to employees. An HDHP can allow for only in-network coverage, similar to an HMO, or allow for out-of-network coverage, similar to a POS or PPO plan. If a plan has in-network benefits only, members cannot go outside of the network once the deductible is met. For a plan that allows both in- and out-of-network benefits, members will usually receive better benefits by staying in-network. All in- and out-of-network benefits offered through the HDHP plan, including prescription drug coverage if offered, must apply towards the deductible.
Many, but not all, HDHP plans will actually cover preventive and primary care physician visits for a low copayment, though this is not necessary. HDHP plans are not meant to cover the initial health care costs such as preventive, specialist and laboratory visits. Instead they are meant to cover catastrophic events such as chronic illnesses or extended hospital visits. Plan policy holders are expected to pay medical office and facility payments till the deductible is met. Once members reach the out-of-pocket maximum, all medical services are covered at no costs.
What is the HDHP Deductible and Out-of-Pocket Maximum?HDHP plan members have higher deductibles costs for their health care coverage, as the plan name suggests. The deductible is the amount of money a plan member must spend from his/her pocket before coverage kicks in. At least part of this deductible amount is covered by the HSA or HRA. As part of the legislation, there are minimum deductible limits set each year and adjusted for inflation, for a plan to qualify as an HDHP.
- Deductible Minimum
2008 - $1,100; 2009 - $1,150
2008 - $2,200; 2009 - $2,300
The annual out-of-pocket maximum is the maximum amount of money the member pays before medical services are provided at no cost. The annual out-of-pocket maximum includes deductibles and coinsurance payments. Not included in the out-of-pocket maximum are lifetime maximum benefits, usual, customary and reasonable (UCR) amounts, existing benefit limits and pre-certification requirements. Like the HDHP deductible minimum, the out-of-pocket maximum is adjusted each year for inflation.
- Out-of-Pocket Maximum
2008 - $5,600; 2009 - $5,800
2008 - $11,200; 2009 - $11,600