It has a health savings account (HSA) and the cost sharing is different. The CDHP has lower premiums and higher deductibles.
- Instead of paying copays, you will pay the full cost of the discounted network rates for services until the deductible is met. Then you pay a portion of the discounted network cost (a 20 or 30 percent coinsurance) until the annual out-of-pocket maximum is reached for in-network providers. The CDHP covers 100 percent of in-network costs after that.
- Instead of paying pharmacy copays, you pay the full negotiated cost of the prescription drugs up to the plan’s combined medical/pharmacy annual deductible, and then pay the coinsurance until the annual out-of-pocket maximum is reached. The plan covers 100 percent of in-network costs after that. There is not a separate pharmacy deductible or out-of-pocket maximum.
For certain 90-day chronic maintenance drugs (e.g., hypertension, high cholesterol, diabetes, depression, asthma/COPD, coronary artery disease, congestive heart failure), when you choose to fill these kinds of medications in a 90 day supply through Mail Order or a participating Retail-90 network pharmacy, you pay a lower (10 or 20 percent) coinsurance and do not have to meet your deductible first.
There is no individual deductible with family coverage. All deductibles are combined in the family deductible. When it is met, even if it is reached by just one family member, coinsurance rates will be charged until your out-of-pocket maximum is reached. Keep in mind, though, that the entire family deductible amount must be met before any insurance coverage kicks in and you will begin paying coinsurance.
Local government and local educations employees: The Limited PPO has a $100 per plan member pharmacy deductible that must be met each year before the Limited PPO plan begins paying anything toward your prescription drugs. After that, your applicable copayments will apply. The CDHP does not have a separate pharmacy deductible or out-of-pocket maximum.