HDHP

​The HDHP, a qualified high deductible health plan, is the lowest-cost medical option of the available medical options.

nurse in doctor's office

The HDHP covers care received from network providers but does not cover out-of-network care. The Board urges employers to offer a health savings account (HSA) when selecting the HDHP.

Key features of the HDHP include the following:

  • Members pay out of pocket for all covered services — including doctor's office visits — up to the annual deductible amount of $3,000 ($6,000 if covering any eligible family members) except for
  • After the annual deductible is met, the member and the plan share the cost of care through percentage-based copayments:
    • Members pay 20 percent (plan pays 80 percent) for covered services, such as doctor's office or urgent care center visits, telemedicine consultations, in- and outpatient hospital services, surgery, and emergency room visits.
    • Members pay 30 percent (plan pays 70 percent), up to a maximum dollar amount per drug, for covered non-preventive prescription drugs.
  • Once the annual copayment out-of-pocket maximum of $6,750 ($13,500 for family coverage) is reached, the plan pays 100 percent of allowable charges for the rest of the calendar year.
  • Members who set up and contribute to an HSA can use HSA funds to pay for the deductible, required copayments, and other eligible out-of-pocket expenses.

Eligibility

Employers may choose to offer the HDHP to ministers of the Word and Sacrament and employees who are regularly scheduled to work at least 20 hours a week. There is no work-hour requirement for ministers in self-employed validated service to participate in the HDHP.

The HDHP is not available to those in Pastor's Participation.

Cost of coverage

For medical coverage under menu options, employers may offer either the PPO, the EPO, or the HDHP, any two options, or all three. The employer must contribute at least 50 percent of the cost of Member-only coverage in the lowest-cost option offered — regardless of which option or coverage level the employee elects.

Employees enrolled in menu options may be required to pay

  • the balance of the cost for Member-only coverage; and/or
  • up to 100 percent of the incremental cost of coverage for their eligible family members.

Medical Plan coverage

Employees enrolled in the HDHP have access to the Blue Cross Blue Shield (BCBS) network of physicians, hospitals, and other healthcare providers. The HDHP requires use of network physicians and hospitals to access

  • preventive care benefits;
  • hospital and medical/surgical coverage;
  • behavioral health benefits; and
  • prescription drug coverage.

The HDHP also provides resources to improve well-being.

Services provided by out-of-network providers are not covered.

Health savings account

The HSA is a tax-advantaged, individual account that can be used to pay for qualified healthcare expenses. Employees who enroll in the HDHP medical coverage option may be eligible to set up and contribute to an HSA.

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Preventive care

For those enrolled in the Medical Plan, the preventive care benefit covers 100 percent of the plan allowance for eligible preventive screenings and immunizations with a network provider and is not subject to a deductible.

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Prescription drug benefits

Prescription drug benefits are automatically included with all medical options. Benefits are administered by OptumRx, which offers a national network of participating pharmacies, including a mail-order pharmacy, and maintains a formulary of preferred prescription medications.

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