HDHP Medical Plan
What you need to know
You have two High-Deductible Health Plan (HDHP) options: the HDHP with Health Savings Account (HSA), or the HDHP with Healthcare Reimbursement Account (HRA). Both plans are administered by Anthem Blue Cross and Blue Shield. You can select the HDHP with HRA only if you have Medicare or TRICARE. With both plans, you pay the full cost of care until you meet your annual deductible. Your HSA or HRA can help you cover those costs.
How the Plans Work
Your medical plan is designed to help keep you and your family healthy. Used in tandem with your other benefits—including dental and vision coverage, and services offered through the integrated employee assistance and work/life program—it’s also here to support you when you need care.
You may choose to waive medical coverage if you’re covered by another plan or your spouse is a YNHHS employee.
Under both HDHP plans:
- Your coverage is identical.
- You pay nothing for preventive care—including some preventive tests and prescription medications—when you use network providers.
- You pay the full cost of care until you meet your annual deductible, after which the plan begins to share costs with you.
- You pay discounted rates when you use providers and facilities in the Yale New Haven Health System and Anthem PPO network.
- You have mental health and substance abuse benefits.
- Special rules apply when you or your covered dependents are covered by more than one plan.
- There’s a combined annual deductible for medical and prescription services. Until the deductible is met, your eligible medical and prescription drug costs are applied against the deductible.
The difference between the plans? The account that comes with them—the HSA or HRA.
Health Savings Account
When you enroll for the HDHP with HSA, you will receive a welcome packet from HSA Bank, our HSA administrator. Follow the instructions to open your account.
After you meet your deductible, you can use your HSA to cover any coinsurance.
- For 2021, you can contribute up to $3,600 in your HSA if you have individual coverage and $7,200 if you’re covering others, too. And if you’re 55 or older, you can contribute an additional catch-up contribution of $1,000. Keep in mind your employer’s contribution, if any, when making your election. Total contributions to your account cannot exceed these IRS maximums.
- Your HSA contributions reduce your taxable income.
- Any unused funds roll over year after year, earning interest along the way.
- The money in your HSA is yours to use forever on qualified health expenses—even if you change employers or health plans, or retire.
- Once your balance reaches $1,000, you have the opportunity to invest it for potential growth.
Note: You also have the option of opening your HSA at a financial institution of your choice. However, unlike an account opened with HSA Bank, you will not be able to fund your HSA through direct payroll contributions, nor will you receive your employer’s contribution.
Healthcare Reimbursement Account
- As you receive services throughout the year, you pay out of pocket for expenses like coinsurance, copays, and other services, and then get reimbursed from your HRA up to the amount of your existing balance.
- Once you’ve met your annual deductible, you may pay coinsurance for the care you receive; the plan will cover the rest.
- You can use the HRA only while you are enrolled in this plan. You cannot take the money with you if you change plans or employers.
- You cannot contribute to your HRA.
How much you pay depends on the provider or facility you choose:
YNHHS Facilities
When you use the following YNHHS facilities, you’ll pay coinsurance after you’ve met your annual deductible, and you’ll generally pay less for covered services:
- Bridgeport Hospital
- Greenwich Hospital
- Lawrence + Memorial Hospital
- Northeast Medical Group
- Westerly Hospital
- Yale New Haven Care Continuum (Grimes Center)
- Yale New Haven Hospital
- Use the links below to search for a YNHHS facility that provides these services:
Anthem PPO Providers
- You’ll need to meet your annual deductible ($2,000 individual/$4,000 family) before the plan begins to share the cost of your care.
- After you meet your deductible, you’ll pay 20% coinsurance for care until you reach your annual out-of-pocket maximum.
- Once you meet your annual out-of-pocket maximum, the plan will pay 100% of covered expenses through that calendar year.
To find a provider in the Anthem Century Preferred Network, visit the Anthem website or call 888-266-2896. Or download the Anthem Sydney app to find health care services, resources, and important contacts. Learn more about Sydney [PDF].
Out-of-Network Providers
When you use a provider or facility that is not in the Anthem Century Preferred Network:
- You’ll pay the most for care.
- Anthem will pay a maximum allowable amount (MAA).
- You will be responsible for costs up to your annual deductible, coinsurance, and any difference between the MAA and the amount billed by the provider.
- You’ll need to file a claim for the care to be covered. Payments will be made directly to the provider unless you submit a bill showing you’ve paid it already. Get a claim form and instructions.
What You Pay for Care
Below is a summary of how certain services are covered. For a more complete list and any limitations, visit HRConnect to view the summary plan description (SPD), which will be available on January 1, 2021.
Your Annual Deductible & Out-of-Pocket Maximum
Annual Deductible*
YNHHS Facility
Family: $4,000
Anthem PPO Provider
Family: $4,000
Out-of-Network Provider
Family: $4,000
Out-of-Pocket Maximum
YNHHS Facility
Family: $6,000
Anthem PPO Provider
Family: $6,000
Out-of-Network Provider
Family: $8,000
Member Coinsurance After Deductible
YNHHS Facility
Anthem PPO Provider
Out-of-Network Provider
Office Visits and Physician Services
Preventive Care Exams
YNHHS Facility
Anthem PPO Provider
Out-of-Network Provider
Office Visits
YNHHS Facility
Anthem PPO Provider
Out-of-Network Provider
Ancillary Services
Diagnostic Services Performed in Hospital (Lab, x-ray, MRI, PET, CAT scan, nuclear cardiology)
YNHHS Facility
Anthem PPO Provider
Out-of-Network Provider
Diagnostic Services Performed in Office (Lab, x-ray, MRI, PET, CAT scan, nuclear cardiology)
YNHHS Facility
Anthem PPO Provider
Out-of-Network Provider
Rehabilitation Therapy Performed in Hospital[1] (Physical, speech, occupational, chiropractic, cardiac rehab)
YNHHS Facility
Anthem PPO Provider
Out-of-Network Provider
Outpatient Rehabilitation Therapy Performed in Office[2] (Physical, speech, occupational, chiropractic, cardiac rehab)
YNHHS Facility
Anthem PPO Provider
Out-of-Network Provider
[2] Physical, speech, and occupational therapy visits are limited to a combined total of 60 visits per member per calendar year. For physical therapy and occupational therapy, prior authorization is required after the first visit. Chiropractic services are limited to 12 visits per member per calendar year.
Urgent & Emergency Care & Telehealth
Emergency Care (Emergency room; copay waived if admitted)
YNHHS Facility/Provider
Anthem PPO Provider
Out-of-Network Provider
Urgent Care (Walk-in and urgent care centers)
YNHHS Facility/Provider
Anthem PPO Provider
Out-of-Network Provider
Ambulance Services (Hospital-owned)
YNHHS Facility/Provider
Anthem PPO Provider
Out-of-Network Provider
Ambulance Services (Not hospital-owned)
YNHHS Facility/Provider
Anthem PPO Provider
Out-of-Network Provider
Telehealth
YNHHS Facility/Provider
Anthem PPO Provider
Out-of-Network Provider
Inpatient and Outpatient Care
Outpatient Surgery Performed in Hospital Ambulatory Care Center
YNHHS Facility
Anthem PPO Provider
Out-of-Network Provider
Inpatient Surgery
YNHHS Facility
Anthem PPO Provider
Out-of-Network Provider
Outpatient Mental Health/Substance Abuse Services Performed in Office
YNHHS Facility
Anthem PPO Provider
Out-of-Network Provider
Inpatient Mental Health/Substance Abuse Services
YNHHS Facility
Anthem PPO Provider
Out-of-Network Provider
Skilled Nursing Facility[1]
YNHHS Facility
Anthem PPO Provider
Out-of-Network Provider
Durable Medical Equipment[2]
YNHHS Facility
Anthem PPO Provider
Out-of-Network Provider
[1] Skilled nursing facility services are limited to 100 days per calendar year.
[2] You must use a participating provider to be covered for durable medical equipment and prosthetic devices.
To see employee premium contributions for the medical plan, visit the enrollment site.
When to Connect with Anthem
For a medical stay and/or service preauthorization, call 800-238-2227 (in Connecticut) or 800-248-2227 (out of state). For behavioral health or substance abuse stays, call 800-934-0331.
- Inpatient stays in a hospital, skilled nursing facility, hospice facility, subacute care or acute rehabilitation facility, or a behavioral health or substance abuse treatment center (CALL at least 24 hours before the start of your stay)
- High-cost diagnostic imaging services prescribed by an out-of-network provider
- Organ/tissue transplants, including evaluation, donor search, organ procurement/tissue harvest, or transplant
For admissions following emergency or urgent care, you, your representative, or your doctor must call Anthem within 48 hours of admission.
If you do not precertify for the services above:
- Benefits for inpatient stays will be reduced by $200.
- Benefits for doctor fees will be reduced by 25%.
You can also connect with Anthem to:
- Find a provider in the Anthem Century Preferred Network
- Resolve insurance claim and billing issues
- Ask questions about preventive and/or diagnostic care
- Get general health information
Connect with…
HRConnect
Monday–Friday,
7:30 a.m. to 5 p.m. ET
844-543-2147
203-200-3838 (fax)
Website
Anthem Blue Cross & Blue Shield
844-963-0447
Website
COBRA
bswift
866-365-2413
Website
Health Savings Account (HSA)
HSA Bank
800-357-6246
866-357-6232 (Spanish)
Website
Telehealth
OnDemand
833-483-5363
Website
LiveHealth Online
888-548-3432
Website