Summary of Coverage
The Priority Health HDHP-HMO and HDHP-POS medical plan is a high-deductible health plan (HDHP) that is partnered with a health savings account (HSA) bank account.
With this plan, you will be responsible for all non-preventive care expenses until you reach the deductible, with the exception of any applicable prescriptions under our chronic conditions rider.
After you meet the deductible, co-insurance will begin to cover the majority of the cost of care. There may also be additional co-payments for services as well. You will pay co-insurance and co-payments until the out-of-pocket limit is reached.
If participants reach the out-of-pocket limit, the plan will pay 100 percent for covered services and/or prescriptions.
To be eligible to enroll in the HDHP-POS plan, per IRS regulations, you must not have any other health insurance coverage unless the second health insurance coverage is also a high-deductible health plan. For example, if you elect this plan, you may not be covered by an HMO, which is not considered a high deductible health plan elsewhere, or Medicare/Medicaid.
You may notice that the HDHP-POS and the HDHP-HMO have the exact same plan design. Not sure what the difference between these two plans is? The difference is the ability to go out of the provider network for non-emergent care. With the HDHP-POS plan, you can go out of the Corewell Health, Priority Health, and Cigna (if living out-of-state) networks. There are exceptions to the HMO or HDHP-HMO for out-of-state dependents, so having dependents out-of-state does not mean you would need to enroll in this plan. Most team members who chose this HDHP-POS plan want the flexibility to see providers that are not a part of the network.
One of the greatest benefits to your enrollment in one of the Corewell Health HDHP medical plans through Priority Health is access to a health savings account (HSA). This bank account is only available to those enrolled in a qualified high-deductible health plan (HDHP). Corewell Health provides an annual contribution to this account for you to use toward your medical costs.
*No more than $9,200 per person under family
**For details regarding providers and services for your plan, refer to you benefit guide.
***Annual Corewell Health employer HSA contribution is deposited into the HSA account each paycheck (approx. $19.23 per pay for single and $28.75 per pay for all other coverage tiers until the maximum has been reached).
Tier 2 services that apply to the deductible will credit both Tier 1 and Tier 2 deductibles. Only Tier 1 services will credit Tier 1 deductibles. Tier 1 and Tier 2 out-of-pocket maximums track in combination. On the HDHP-POS plan Tier 3 does not apply to Tier 1 or Tier 2. The HDHP-HMO plan provides a similar network as the HMO plan and does not include coverage for out of network providers.
How your plan pays for care:
You Pay:
Provider bills until you reach the deductible.
- In the HDHP-POS and HDHP-HMO plans, the individual deductible only applies to team member-only coverage. Covered families must meet the family deductible.
- Tier 2 services that apply to the deductible will credit both Tier 1 and Tier 2 deductibles. Only Tier 1 services will credit Tier 1 deductibles. Tier 1 and Tier 2 out-of-pocket maximums track in combination.
You + The Plan Pay:
- Once you have paid the deductible, the plan will share the cost of the remaining expenses through co-insurance and copays, until you have reached the out-of-pocket limit.
- The out-of-pocket limit is the limit of all of your costs for the year. Deductibles, co-insurance and copays all apply to the out-of-pocket limit.
- Costs are higher outside of Tier 1 providers: your share of the bill, the deductible, and the out-of-pocket maximum all increase in the Tier 2 network.
The Plan Pays:
- Most costs above the out-of-pocket limit. The plan covers 100% of eligible costs (such as coinsurance) for the rest of the year.
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