Health Insurance

South Williamsport Area School District offers health insurance coverage to eligible employees through Highmark Blue Cross Blue Shield (http://www.highmarkbcbs.com).

Below are Summary of Benefits and Coverage for our various plans:

PPO-C: Summary of Benefits and Coverage effective 7/1/17

CDHP-1: Summary of Benefits and Coverage effective 7/1/17

How does CDHP-1 work?

Under CDHP-1, there is a deductible that must be met. After the deductible is met, you pay a coinsurance (for medical bills) or a copay (for prescriptions) until you reach the maximum out of pocket expense.

2017/18 Deductible Max Out of Pocket
Individual $1,300 $2,000
Family $2,600 $4,000

The Max Out of Pocket includes the deductible amount, so after you meet the deductible, you will only incur an additional $700 for individuals or $1,400 for families.  The limits listed above run from July 1 – June 30.  It is based on date of service, not the date the claim was submitted.

The amount that is used to calculate the deductible and coinsurance is the Member Discounted Rate.  For example, a provider might submit a charge of $52; however, they have an agreement with Highmark BCBS that it will only cost $35.  $35 is the amount that would be used to calculate the deductible or coinsurance.

Under the Affordable Care Act, all preventative care must be paid by insurance.  You should not be charged for preventative services.

Since there are no longer copays, how much do I pay?

When you go to the service provider (e.g. doctor/hospital), you should pay nothing upfront.  The service provider submits the claim to the insurance company.  The insurance company processes the claim and informs the service provider how much you owe.  The service provider sends you a bill.  You can pay your bill using funds in your HSA. The easiest way to pay the bill is to list your HSA debit card information on the bill.  You can also upload your receipt to the Discovery Benefits website and they will send a check directly to the service provider.  If you don’t have enough funds in your HSA, I suggest writing a check to the HSA and then having the HSA pay the bill.  You will then be able to claim the amount as a HSA contribution on your tax return in order to save on taxes.

When you go to the pharmacy, you must pay your bill immediately.  If you haven’t met your deductible, you will be charged the actual cost of the prescription.  If you have met your deductible, you will be charged a copay.  The easiest way to pay is to use your HSA debit card.  If you forgot your HSA debit card, you will have to pay out of pocket.  You can then submit your receipt to Discovery Benefits and they will reimburse you with funds from your HSA.

How do I keep my expenses down?

The point of a high deductible plan is to make informed decisions about your healthcare.  When is the last time that you asked if the prescriptions you are on are still necessary?  Have you asked if there is an effective generic equivalent?  Have you considered using mail order prescriptions for routine drugs? Getting 3 months of prescriptions in bulk is generally cheaper than going to the pharmacy 3 times.  If your doctor ordered an MRI, did you automatically head to the hospital instead of shopping around?  The hospital is typically 2 – 3 times the cost of a local radiology center.  You can compare costs or find doctors on www.highmarkbcbs.com.

How do I track my deductible, max out of pocket, and HSA balance?

To track your deductible and max out of pocket, use the Highmark BCBS website (www.highmarkbcbs.com).  This will list all claims for both medical and prescriptions.

To track the balance in your HSA, use the Discovery Benefits website (www.discoverybenefits.com).  You can use your HSA funds for dental (including braces) and vision expenses, but these expenses do not count toward your deductible or max out of pocket limits.

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