When you enroll in the high deductible health plan (HDHP), you must use the plan’s national network of physicians, hospitals, and other healthcare providers to receive benefits. The HDHP does not cover care received from out-of-network providers except for emergency services.
To better understand the coverage provided under the HDHP, it's important to know these key terms.
The deductible is a specified annual dollar amount you must pay for covered medical services before the plan begins to pay benefits. The HDHP has a much higher deductible than the PPO and EPO medical options available through the Board of Pensions.
A copay is a flat dollar amount that you pay upfront for certain services when using network providers.
A copayment is the percentage of the cost for covered services that you pay after meeting the deductible:
The total maximum out-of-pocket is a set annual dollar amount you pay for covered medical services and prescription drugs, after which the plan pays 100 percent of covered expenses for the rest of the year.