University of Cincinnati Medical Plan Summary and Comparison Non AAUP - Effective January 1- December 31, 2022
HSA/HDHP The HSA/HDHP has a non-embedded deductible . If you elect to cover dependents, all family member’s expenses are “pooled together” to reach the family deductible. Once the family deductible is met, the plan will pay 80% of each family member’s covered expenses until the annual out-of-pocket maximum is reached. The individual deductible does NOT apply when family members are covered. The HSA/HDHP plan also has a non-embedded out-of-pocket which means if you, the subscriber, are the only person covered by this plan, only the “individual” amounts apply to you. If you also cover dependents (other family members under the plan), the “family” amounts apply. The “family” out-of- pocket amounts can be satisfied by one family member or a combination of family members. Once the family out-of-pocket is met, it is considered met for all family members. The network and out-of-network pocket maximums are separate and cannot be combined. If you are a newly benefits eligible employee after January 1 and choose the HDHP/HSA, your UC HSA contributions will be pro-rated based on your HDHP/HSA start date benefits start date. If you choose to contribute to the HSA during your first year of coverage, it is your responsibility to ensure you do not exceed the HSA contribution amount allowed by the IRS. When determining how much you want to contribute, be sure to include the pro-rated UC-contribution amount in addition to your own. Please consult a tax advisor or refer to www.irs.gov. PPO The PPO has an embedded deductible . If you elect to cover dependents, both the individual and family deductible amounts apply. The family deductible amounts can be satisfied by any combination of family members, but you could satisfy your own individual deductible before the family deductible is met. Once you meet your individual deductible, the plan will pay 80% of your eligible expenses. This may occur before another family member reaches his/her deductible. Once the family deductible is met, all family member’s eligible expenses will be paid at 80% until the family out-of-pocket maximum is met. The PPO plan has an embedded out-of-pocket which means if you, the subscriber, are the only person covered by this plan, only the “individual” amounts apply to you. If you also cover dependents (other family members) under this plan, both the “individual” and “family” amounts apply. The “family” out-of- pocket amounts can be satisfied by any combination of family members, but you could satisfy your own “individual” out-of-pocket amount before the “family” amount is met. You will never have to satisfy more than your own “individual” out-of-pocket amount. If you meet your “individual” amount, other family members’ claims will still accumulate towards their own “individual” out-of-pocket and the overall “family” amounts. This continues until your other family members meet their own “individual” out-of- pocket or the entire “family” out-of-pocket is met. The network and out-of-network out-of-pocket maximums are separate and cannot be combined. Note: Medical out-of-pocket does not apply to the pharmacy out-of- pocket. The pharmacy out-of-pocket for an individual is $8,700 per person per calendar year. The combined family maximum out-of- pocket (medical and pharmacy) is $17,400 per family per calendar year. The network and out-of-network out-of-pocket maximums are separate and cannot be combined. Explanations above based on network services.
Page 7 of 7 Rev. 10/2021
Made with FlippingBook Online newsletter maker