Plan Design Summary

The Access HDHP plan design provides the same freedom of choice for doctors or hospitals across the country (nationwide coverage) as the Access Plan. The difference is that the Access HDHP plan has a higher deductible and higher out-of-pocket limits. In exchange for increased cost sharing, this plan offers a lower monthly premium cost than the Access Plan and is paired with a required Health Savings Account (HSA) to help pay your out-of-pocket costs. If you enroll in the Access HDHP plan, you must also enroll in the HSA administered by TASC. Not everyone is eligible for this plan design. See Eligibility below for more information.

  • Uniform Dental benefits may be added for a minimal cost.
  • You can compare the Access HDHP plan design to the other plan designs to determine if it will meet your medical needs.

Important to know:

The Access HDHP plan does not pay any health care costs, including prescriptions, until the annual deductible has been met (with the exception of preventive services and prescriptions mandated by the Patient Protection and Affordable Care Act). After the annual deductible has been met, you will be responsible for office visit copays and applicable coinsurance on non-office visit services, up to the annual out-of-pocket limit.

Use the HDHP Questionnaire to see if this may be the right plan design option for you.

Eligibility

You are eligible for the Access HDHP if you meet the following requirements:

If you enroll in the Access HDHP, you must also enroll in the HSA. Therefore, you must be eligible for both plans.

Note: Employees who are eligible for the Graduate Assistant benefit package ARE NOT eligible for the Access HDHP plan design.

Provider Network

WEA Trust administers the Access Plan. You may see any doctor or provider of your choice. However, you will receive a higher level of benefits (and pay less out-of-pocket) if you use a preferred or in-network provider.

To see if your doctor or hospital is a preferred or in-network provider, go to: https://www.weatruststatehealthplan.com/service-areas/access-medicare-plus-smp and look at the information under “IYC Access Plan”.

Coverage

In-Network Coverage

Uniform Benefits

Uniform Benefits refers to the schedule of benefits that are provided by WEA Trust for the Access HDHP plan’s in-network benefits. The purpose of Uniform Benefits is to help contain the rising cost of health insurance and simplify your selection of a health plan. Because all health plans (insurance carriers) administer the same schedule of benefits, you can decide which plan to select on the basis of:

  • Cost
  • Quality and member satisfaction
  • Access to specific physicians or other health care providers
  • Referral policies

Uniform Benefits does not mean that all plans will treat all illnesses in an identical manner. Treatment will vary depending on the needs of the patient, the providers involved and the managed care policies and procedures of each health plan.

Preventive Care

In general, routine preventive and wellness medical services received in-network will be covered at 100%, even if you have not met the deductible. Here is a list of preventive care services, as identified by the Patient Protection and Affordable Care Act.

Non-preventive Care

For non-preventive care received in-network, you must meet the in-network annual deductible before the plan will provide Uniform Benefits coverage. This means that you will be responsible for paying the total costs of all medically necessary services until you meet the deductible, including prescriptions. Once you meet the deductible, Uniform Benefits will take effect and you will pay either an office visit copay or coinsurance on other medically necessary care until you reach the annual out-of-pocket limit.

In-Network Deductible: $1,500 Single/ $3,000 Family

The Access HDHP plan design has a non-embedded deductible. This means that if you have Family coverage, the full family deductible must be met before services are covered for any individual. This deductible includes both medical services and prescription drug benefits and applies to the annual out-of-pocket limit.

Once your deductible has been met, you will pay:

  • $15 copay for office visits
  • $25 copay for specialty office visits (includes specialty providers, urgent care, vision exam)
  • $75 copay for emergency room visits (waived, if admitted). Deductible and coinsurance applies to services beyond the copay.
  • 10% coinsurance on most services except for office visits
In-Network Out-of-Pocket Limit: $2,500 Single/ $5,000 Family

The annual out-of-pocket limit for the Access HDHP plan includes both medical and prescription drug expenses. Once you reach your annual out-of-pocket limit, the plan pays 100% of most covered benefits for the rest of the year.

Out-of-Network Coverage

The table below outlines the schedule of benefits that is administered by WEA Trust for services received out-of-network.

Access HDHP Out-of-Network (Your Costs)
Deductible $2,000 Individual/ $4,000 Family (combined medical & Rx)
Office Visit Copay After deductible: 30% coinsurance
Specialty Office Visit Copay After deductible: 30% coinsurance
Coinsurance After deductible: 30% coinsurance
Out-of-Pocket Limit $3,800 Individual/ $7,600 Family (combined medical & Rx)
Preventive Care Subject to the deductible, copays and/or coinsurance

To see a detailed list of covered benefits, see the Certificate of Coverage pdf .

Pharmacy Benefits

Prescription drug coverage is included in the Access HDHP plan at no additional cost and is provided by Navitus Health Solutions. Under the Access HDHP plan, you will be responsible for paying the total costs of prescriptions until you meet the deductible.

After you meet the deductible, you will be required to pay either a copay or coinsurance when you buy prescription drugs which is determined by the level of the drug. All covered prescription drugs (Rx) fall into one of four cost-sharing levels, including Level 1 for most generic drugs and Levels 2, 3 and 4 for most brand-name drugs.

To determine what you would pay for prescription drugs, see the Comparison of Pharmacy Benefits.

Uniform Dental Benefits

Uniform Dental provides coverage for diagnostic, preventive and restorative services (such as fillings). It does not include coverage for major dental services such as crowns, root canals or implants. Uniform Dental benefits are administered by Delta Dental of Wisconsin and may be added on to your health insurance coverage for a minimal cost.

Click here to learn more about Uniform Dental benefits.

Premiums

For State Group Health Insurance premiums, see the Premiums page.

Forms & Resources

For all State Group Health Insurance forms and resources, click here.


last updated: 12/01/2017

 

Every effort has been made to ensure this information is current and correct. This page does not guarantee enrollment or the ability to make changes to your benefits.