High Deductible Health Plan
Perfect for individuals or families who want to open a Health Savings Account (HSA).
High-Deductible Health Plan Overview
In-Network Deductible
|
Individual |
Family |
|---|---|
|
$2,250 or $3,750 |
$4,500 or $7,500 |
In-Network Out-of-Pocket Max
|
Individual |
Family |
|---|---|
|
$4,500 or $5,625 |
$9,000 or $11,250 |
Lifetime Benefit Max
|
Individual |
Family |
|---|---|
|
Unlimited |
Unlimited |
Overview
Calendar Year Deductible1
|
In-Network |
Out-of-Network |
|
|---|---|---|
|
Option 1: Individual |
$2,250 |
$2,250 |
|
Option 2: Individual |
$3,750 |
$3,750 |
|
Option 1: Family |
$4,500 |
$4,500 |
|
Option 2: Family |
$7,500 |
$7,500 |
Out-Of-Pocket Maximum (OOP)2
|
In-Network |
Out-of-Network |
|
|---|---|---|
|
$4,500 |
for $2,250 deductible |
Unlimited |
|
$5,625 |
for $3,750 deductible |
Unlimited |
|
$9,000 |
for $4,500 deductible |
Unlimited |
|
$11,250 |
for $7,500 deductible |
Unlimited |
Lifetime Benefit Maximum
|
In-Network |
Out-of-Network |
|
|---|---|---|
|
Lifetime Benefit Maximum |
Unlimited |
Unlimited |
1Deductible per calendar year.
2Once the OOP maximum is met, benefits are provided at 100% for a member for the remainder of the calendar year. This applies to in-network provider services only.
Services
Coinsurance
|
In-Network (Plan Pays) |
Out-Of-Network (Plan Pays) |
|
|---|---|---|
|
Coinsurance |
80% of eligible charges |
60% of eligible charges |
|
HDHP plan members are responsible for 100% of current Teladoc copay per visit until calendar year deductible (CYD) is met. No charge after CYD is met. |
No coverage |
Preventative Care Benefits
|
In-Network (Plan Pays) |
Out-Of-Network (Plan Pays) |
|
|---|---|---|
|
80% |
Not Covered |
|
|
80% |
Not Covered |
|
|
80% |
60% |
|
|
80% |
60% |
|
|
80% |
60% |
|
|
80% |
60% |
Prescription Drug Coverage
|
Unlimited calendar year maximum |
|---|
1 Benefits are available, subject to deductible and coinsurance, for a member under the age of 7 (on plan deductibles $3,000 and $5,000) for physical examinations and appropriate immunizations/vaccinations when services are rendered by an in-network provider. Exams not used during the time periods below do not carry over to the next time period.
- Physical Examination Guidelines
- Under age 1: 4 exams from birth to the child’s first birthday
- Age 1: 2 exams from the child’s first birthday to the child’s second birthday
- Age 2 – 6: 1 exam per year (determined by the child’s birthday)
2 Benefits will be available, subject to deductible and coinsurance, for one routine OB/GYN exam per calendar year. Services must be rendered by an in-network physician’s office and billed by the in-network provider. Related pathology, including pap smear, which is provided as a part of the routine OB/GYN exam, will be covered when the services are rendered by an in-network physician’s office and billed by the in-network provider. Related pathology that the physician sends to an independent laboratory will be subject to deductible and coinsurance. No benefit is available for routine OB/GYN exams provided by an out-of-network provider.
3 Benefits will be provided for 1 routine colonoscopy every 4 years for members age 50 and over when provided by an in-network or out-of-network provider, subject to the deductible and coinsurance.
4 Benefits will be provided, subject to deductible and coinsurance, for 1 routine PSA per calendar year when services are rendered by an independent laboratory or other outpatient setting.
5 Benefits will be provided, subject to deductible and coinsurance, for the interpretation of 1 routine pap smear per calendar year when services are rendered by an independent laboratory or other outpatient setting.
6 Benefits will be provided, subject to deductible and coinsurance, for routine mammography screening provided such examinations are conducted upon the recommendation of the member’s physician. One baseline routine mammogram will be allowed for members between the ages of 35-39. One routine mammogram will be allowed annually for members age 40 and above.
Maternity Benefits
Maternity Benefits will be available after a member’s coverage on a 2-person, 3-person or family contract has been in effect for nine consecutive months. Individual coverage has NO maternity benefits.
Pre-Existing Condition Waiting Period
Benefits will not be provided for any pre-existing condition until a member has completed a waiting period of at least 12 months. A pre-existing condition is defined in the contract as “An illness, injury, pregnancy or any other medical condition which existed at any time preceding the effective date of coverage under this contract for which: Medical advice or treatment was recommended by, or received from, a provider of health care services; or symptoms existed which would cause an ordinarily prudent person to seek diagnosis, care or treatment.” The pre-existing condition waiting period will apply to all members listed on the contract.
We use the UHC Choice Plus network. That means if you choose an in-network provider, your costs stay lower thanks to pre-negotiated rates with UnitedHealthcare. If you visit an out-of-network provider, you’ll likely face higher costs and may be responsible for amounts beyond what your plan covers.
Want to make sure you’re getting the most value? Check your provider’s network status before scheduling care.
Health Savings Account Eligible!
Have A Farm Bureau Health Plans Rep Contact You For More Information
Individual & Family Plans
Farm Bureau Health Plans utilizes the UHC Choice Plus Network which is UnitedHealthcare’s largest provider network in Tennessee.