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

What You Pay for Care

When to Connect with Anthem

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 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
The Health Savings Account (HSA) is a special account that you contribute to on a pretax basis through payroll deductions. Your employer contributes to it, too. You can use the money in your HSA to cover your health care expenses until you reach your annual deductible and the plan begins to share those costs with you. The HSA is not available to you if you are currently enrolled in Medicare or TRICARE.

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
The Healthcare Reimbursement Account (HRA)is a special account to which your employer contributes to help you cover the cost of your health care expenses. You can use these funds to cover your costs as you reach your annual deductible. The HRA is available only to employees enrolled in Medicare or TRICARE.

  • 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:
Anthem PPO Providers
When you choose to receive care from an Anthem Century Preferred Network provider:

  • 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:

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 Cost

Annual Deductible*
Anthem PPO Provider
Individual: $2,000
Family: $4,000
Out-of-Network Provider
Individual: $2,000
Family: $4,000
Out-of-Pocket Maximum
Anthem PPO Provider
Individual: $3,000
Family: $6,000
Out-of-Network Provider
Individual: $4,000
Family: $8,000
Member Coinsurance After Deductible
Anthem PPO Provider
0% after deductible
Out-of-Network Provider
30% after deductible
* The $2,000 individual annual deductible only applies to “employee only” coverage. If you cover any one else under this plan, your annual deductible is $4,000.

Office Visits and Physician Services

Preventive Care Exams
Anthem PPO Provider
0%, deductible waived
Out-of-Network Provider
30% after deductible
Office Visits
Anthem PPO Provider
0% after deductible
Out-of-Network Provider
30% after deductible

Ancillary Services

Diagnostic Services (Lab, x-ray, MRI, PET, CAT scan, nuclear cardiology)
Anthem PPO Provider
0% after deductible
Out-of-Network Provider
30% after deductible
Rehabilitation Therapy (physical, speech, occupational, chiropractic, cardiac rehab)[1]
Anthem PPO Provider
0% after deductible
Out-of-Network Provider
30% after deductible
[1] 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)
Anthem PPO Provider
$100 copay after deductible
Out-of-Network Provider
$200 copay after deductible
Urgent Care
Anthem PPO Provider
0% after deductible
Out-of-Network Provider
30% after deductible
Ambulance Services
Anthem PPO Provider
0% after deductible
Out-of-Network Provider
30% after deductible
Telehealth
Anthem PPO Providers: LiveHealth Online and YNHHS OnDemand
Anthem PPO Provider
$49 after deductible
Out-of-Network Provider
N/A

Inpatient and Outpatient Care

Outpatient Surgery Performed in Hospital Ambulatory Care Center[1]
Anthem PPO Provider
0% after deductible
Out-of-Network Provider
30% after deductible
Inpatient Surgery (Semi-private room and board)[2]
Anthem PPO Provider
0% after deductible
Out-of-Network Provider
30% after deductible
Outpatient Mental Health/Substance Abuse Services Performed in Office[3]
Anthem PPO Provider
0% after deductible
Out-of-Network Provider
30% after deductible
Inpatient Mental Health/Substance Abuse Services[4]
Anthem PPO Provider
0% after deductible
Out-of-Network Provider
30% after deductible
Skilled Nursing Facility[5]
Anthem PPO Provider
0% after deductible
Out-of-Network Provider
30% after deductible
Durable Medical Equipment[6]
Anthem PPO Provider
0% after deductible
Out-of-Network Provider
30% after deductible

[1] Hospital or surgical center facility charges only.

[2] Room and board, lab work, medical supplies, and other hospital ancillary services.

[3] The Employee and Family Resources (EFR) program provides up to six (6) confidential counseling sessions at no cost to you.

[4] Inpatient rehabilitative services are limited to 100 days per member per year.

[5] Skilled nursing facility services are limited to 100 days per calendar year.

[6] You must use a participating provider to be covered for durable medical equipment and prosthetic devices.

For additional details about covered services, visit HRConnect to view the summary plan description (SPD).

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.

Before receiving any of the following services, you must call Anthem for preauthorization. Otherwise, your benefits will be reduced.

  • 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

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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

Find a doctor
YNHHS Physician Referral
888-461-0106

COBRA
bswift
866-365-2413
Website

Health Savings Account (HSA)
HSA Bank
800-357-6246
Website

Telehealth
OnDemand
833-483-5363
Website

LiveHealth Online
888-548-3432
Website

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