High Deductible Health Plan
Perfect for individuals or families who want to open a Health Savings Account (HSA).
We offer a range of High Deductible Health Plan (HDHP) choices for individuals or families in need of health coverage with an HSA option.
Our HDHPs meet all federal requirements necessary to open a Health Savings Account. Farm Bureau Health Plans utilizes the UnitedHealthcare Choice Plus Network. Please keep in mind that in-network payments are based on negotiated fees. If an out-of-network provider is used, the member's liability will increase significantly. Get more information on Health Savings Accounts by clicking here.
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High-Deductible Health Plan Overview
CALENDAR YEAR DEDUCTIBLE
In-Network |
Out-of-Network |
|
CALENDAR YEAR DEDUCTIBLE 01(Unless otherwise indicated, all benefits are subject to the deductible)(In-network and out-of-network deductibles are separate and do not combine) |
|
|
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
In-Network |
Out-Of-Network |
|
Out of Pocket Maximum (OOP) 02 |
|
|
$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 |
FOOTNOTES
- Deductible per calendar year.
- Once 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.
COINSURANCE
In-Network (plan pays) |
Out-Of-Network (plan pays) |
|
Coinsurance |
80% of eligible charges |
60% of eligible charges |
TeladocSee Teladoc page for additional details. |
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 |
Teladoc Expert Medical ServicesSee Teladoc Expert Medical Services page for additional details. |
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 |
PREVENTIVE CARE BENEFITS
In-Network (plan pays) |
Out-Of-Network (plan pays) |
|
Well Child Services 01 |
80% |
Not Covered |
Annual OB/GYN Exam 02 |
80% |
Not Covered |
Routine Colonoscopy 03 |
80% |
60% |
Annual Routine PSA 04 |
80% |
60% |
Annual Routine Pap Smear 05 |
80% |
60% |
Mammogram 06 |
80% |
60% |
PRESCRIPTION DRUG COVERAGE
Unlimited calendar year maximum per member
- Generic or Brand | Farm Bureau Health Plans will reimburse 80% of the maximum allowable charge, after CYD.
- Home Delivery service is also available
- Broad Formulary
- Members may use pharmacy of choice for brand name and/or generic prescriptions; specialty drugs are provided through Optum Specialty Pharmacy.
FOOTNOTES
- 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)
- 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.
- 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.
- 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.
- 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.
- 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 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.
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 does not apply to members under the age of 19 covered on a Family plan.
Provider Network
Farm Bureau Health Plans utilizes the UHC Choice Plus Network which is UnitedHealthcare's largest provider network in Tennessee.
Download Schedule of Benefits
This schedule is intended to help you compare coverage benefits and is a summary only.
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