Coverage and Benefits

Coverage and Benefits

Coverage and Benefits

Example Highlights of a Typical HSA Plans Benefits

PRACTITIONER SERVICES

In Network Out of Network
Office Visits $30-PCP/$50-Specialist 40% after deductible
Preventive Care (HealthCare.gov)
Preventive Care Q&A (AETNA)
100% for one routine physical per calendar year
Refer to two adjacent links for description
Surgery 20% after deductible 40% after deductible
Radiology/Laboratory 20% after deductible 40% after deductible
Maternity 20% after deductible 40% after deductible
photo-female-doctor-xray

HOSPITAL SERVICES

In Network Out of Network
Inpatient Care
(semi-private room or intensive care unit)
20% after deductible 40% after deductible
Hospital Outpatient Care 20% after deductible 40% after deductible
Emergency Room 20% after deductible 40% after deductible
Pre-Admission Testing 20% after deductible 40% after deductible
Extended Care / Rehabilitation 20% after deductible 40% after deductible
Requires Pre-approval
Hospice Care 20% after deductible 40% after deductible
Requires Pre-approval.
photo-female-surgeon

OTHER SERVICES

In Network Out of Network
Mental Illness and Substance Abuse
Inpatient
20% after deductible 40% after deductible
Requires pre-approval
Mental Illness and Substance Abuse
Outpatient
20% after deductible 40% after deductible
Durable Medical Equipment / Supplies 50% after deductible 50% after deductible
Prescription Drugs 40% after deductible 40% after deductible
photo-female-blood-pressure