Deductibles and Levels of Coverage
The HDHP option provides four levels of coverage:
Level 1 includes 100% coverage for preventive care, such as annual physicals and screenings based on age and gender. These services are provided at no cost to you when you use an in-network provider. Preventive care sets the foundation for all of your health care, and is the first step to staying healthy. Preventive care generally does not include services that are intended to treat an existing illness, injury, or condition.
However, in situations where it is unreasonable or impractical to perform another procedure to treat the condition, any treatment that is incidental or ancillary to a preventive care service or screening is also considered preventive care. Under current federal tax guidance, the following services are considered preventive care:
- Periodic health evaluations, such as annual physicals;
- Well-child care;
- Child and adult immunizations; and
- Screening services for a variety of conditions including cancer and heart disease.
The deductible will be waived for certain preventive drugs. Those preventive drugs include various types of vitamins (geriatric, pediatric, and prenatal), cholesterol lowering agents, agents for osteoporosis, and diabetes therapies. View the CVS/Caremark HDHP Preventive Therapy Drug List (PDF).
$1,600 Individual, $3,200 Family
The next level is the annual deductible. Your annual deductible is the amount you need to pay before your medical and prescription drug plan pays for benefits. One or more family members combined must meet the entire deductible that applies for family coverage before the Plan begins paying non-preventive care beneﬁts, including prescription drug beneﬁts. The HDHP has a combined deductible for medical and prescription drugs. With the exception of some preventive care medications, prescription drugs are not covered until the annual deductible is met. Tip: You can use your HSA to help offset the cost of the deductible and other eligible out-of-pocket expenses.
10% for In-Network Once the Deductible is Met
After the annual deductible is met, coinsurance begins. Coinsurance means you and the Plan share the cost of eligible expenses. The Plan pays a percentage of your expenses — 90% for in-network services — and you will pay the remaining 10%. If you use out-of-network providers, your coinsurance goes up to 30%. It’s important to remember that not only is your cost lower when you use an in-network provider, due to network discounts, NYU’s cost is also lower. In-network providers have agreed to charge lower rates so both you and NYU pay less.
$3,000 Individual, $6,000 Family for In-Network; and $5,000 Individual, $10,000 Family for Out-of-Network
Once you reach the out-of-pocket maximum, the Plan pays 100% of covered medical expenses for the rest of that calendar year.