For more information visit HCA - Health Savings Account

What is a consumer-directed health plan (CDHP)?

A CDHP is a high-deductible health plan (HDHP), with a health savings account (HSA).  CDHPs offer lower premiums, a higher medical deductible, and a higher medical out-of-pocket limit than most traditional health plans.

Other features include:

• If you cover yourself and one or more family members, you must pay the entire family medical deductible before the CDHP begins paying benefits.
• Your prescription-drug costs count toward the annual medical deductible and out-of-pocket maximum.
• Preventive care services are covered at 100 percent with no medical deductible.

See benefits and coverage by plan for CDHP coverage details.

What is a health savings account (HSA)?

An HSA is a tax-exempt account anyone can deposit funds into on your behalf. You can deduct any amount you contribute from your taxable income, giving you a tax savings.

You can use your HSA to pay for IRS qualified out-of-pocket medical expenses (like deductibles, copays, and coinsurance), including some expenses and services that your health plans may not cover. You can spend HSA funds on qualified expenses for your spouse or other tax dependents, even if they aren't covered on your plan. In addition, your HSA balance can grow over the years, earn interest, and build savings that you can use to pay for health care as needed and/or pay for Medicare Part B premiums.

Am I eligible?

The PEBB Program offers consumer-directed health plans (CDHPs) with health savings accounts (HSAs) to eligible members through Kaiser Permanente WA (formerly Group Health, Kaiser Permanente NW*, and Uniform Medical Plan. When you enroll in a CDHP, you are automatically enrolled in an HSA. The plans' HSA trustee is HealthEquity, Inc.

*Kaiser Foundation Health Plan of the Northwest, with plans offered in Clark and Cowlitz counties in WA, and the Portland, OR area.

You must meet certain eligibility requirements to enroll in a CDHP/HSA. If you (the subscriber) are not eligible for a CDHP/HSA and enroll, you may be liable for tax penalties.

You are not eligible to enroll in a CDHP with an HSA if:

• You are enrolled in Medicare Part A or Part B or Medicaid (called Apple Health in Washington).
• You are enrolled in another comprehensive medical plan—for example, on a spouse’s or state-registered domestic partner’s plan.
• You or your spouse or state-registered domestic partner is enrolled in a Voluntary Employees’ Beneficiary Association Medical Expense Plan (VEBA MEP) account, unless you convert it to limited HRA coverage.
• You have TRICARE.
• You enrolled in a Medical Flexible Spending Arrangement (FSA) or Health Reimbursement Arrangement (HRA). This also applies if your spouse has a Medical FSA, even if you are not covering your spouse on your CDHP. This does not apply if the Medical FSA or HRA is a limited purpose account, or for a post deductible Medical FSA.
• You are claimed as a dependent on someone else’s tax return.

Other exclusions apply. Check IRS Publication 969—Health Savings Accounts and Other Tax-Favored Health Plans at www.irs.gov, contact your tax advisor, or call HealthEquity toll-free at 1-877-873-8823 to verify whether you qualify. See The Complete HSA Guidebook for full details.

Medical plan types

The PEBB Program offers three types of medical plans:

Managed-care plans

Managed care plans may require you to select a primary care provider (PCP) within its network to fulfill or coordinate all of your health needs. The plan may not pay benefits if you see a non-contracted provider.

Preferred provider organization health plans

PPO’s allow you to self-refer to any approved provider type in most cases, but usually provide a higher level of coverage if the provider contracts with the plan.

Consumer-directed health plans (CDHPs)

CDHPs let you use a health savings account (HSA) to help pay for out-of-pocket medical expenses tax free, have a lower monthly premium than most other plans, and a higher deductible and a higher out-of-pocket limit. See Health plans with health savings accounts (HSAs).

Medical plan options

You may choose from the plans listed below. Your options are limited to the plans available in your county. Remember, if you cover eligible dependents, everyone must enroll in the same medical plan.

Managed-care plans

• Kaiser Permanente WA Classic (formerly Group Health Classic)
• Kaiser Permanente WA Value (formerly Group Health Value)

Preferred-provider plans

• UMP Classic, administered by Regence BlueShield
• UMP Plus, administered by Regence BlueShield

Consumer-directed health plans (CDHPs)

• Kaiser Permanente WA CDHP (formerly Group Health CDHP)
• UMP CDHP, administered by Regence BlueShield

Visit the PEBB plan sites for more information: Kaiser Permanente WA (formerly Group Health) plans, or Uniform Medical Plan (UMP) plans.

To add or remove a dependent from your health insurance, you must complete a new Employee Enrollment Change Form and return it to the Benefits Office. Be sure to complete the form in its entirety - this will replace all previous forms. Usually this must be done within 30 days of the qualifying event.

Medical Plan Summaries

Kaiser Permanente WA

• Kaiser Permanente WA Classic (2019)
• Kaiser Permanente WA CDHP (2019)
• Kaiser Permanente WA SoundChoice (2019)
• Kaiser Permanente WA Value (2019)

Uniform Medical Plans

• UMP Classic (2019)
• UMP Consumer-Directed Health Plan (UMP CDHP) (2019)
• UMP Plus—Puget Sound High Value Network (PSHVN) (2019)
• UMP Plus—UW Medicine Accountable Care Network (UW Medicine ACN) (2019)

Medical Plan Certificates of Coverage
The certificates of coverage (COCs), also called benefits booklets, are produced by the health plans to provide detailed information about plan benefits and what is and is not covered.

Kaiser Permanente WA

• Kaiser Permanente WA Classic (2019)
• Kaiser Permanente WA CDHP (2019)
• Kaiser Permanente WA SoundChoice (2019)
• Kaiser Permanente WA Value (2019)

Uniform Medical Plans

• UMP Classic (2019)
• UMP Consumer-Directed Health Plan (UMP CDHP) (2019)
• UMP Plus—Puget Sound High Value Network (PSHVN) (2019)
• UMP Plus—UW Medicine Accountable Care Network (UW Medicine ACN) (2019)

Deductibles

All medical plans require you to pay an annual deductible before the plan pays for covered services. UMP Classic also has a separate annual deductible for some prescription drugs. Preventive care and certain other services are exempt from the medical plans’ deductibles. This means you do not have to pay your deductible before the plan pays for the service.

Coinsurance or copays

Some plans require you to pay a fixed amount, called a copay. Other plans require you to pay a percentage of an allowed fee (called a coinsurance) when you receive care.

Out-of-pocket limit

The annual out-of-pocket limit is the most you pay in a calendar year for covered benefits. UMP Classic has a separate out-of-pocket limit for prescription drugs. Once you have paid this amount, the plans pay 100 percent of allowed charges for most covered benefits for the rest of the calendar year. Certain charges incurred during the year (such as your annual deductible, copays, and coinsurance) count toward your out-of-pocket limit. There are a few costs that do not apply toward your out-of-pocket limit:

• Monthly premiums and applicable surcharges.
• Charges above what the plan pays for a benefit.
• Charges above the plan’s allowed amount paid to a provider.
• Charges for services or treatments the plan doesn’t cover.
• Coinsurance for non-network providers.
• Prescription-drug deductible and prescription-drug coinsurance (UMP Classic only).

Monthly Premiums

Medical Premiums for 2018

How to make changes

You must submit the  Employee Enrollment/Change form to the benefits office during the annual open enrollment or when a special open enrollment event occurs, within the PEBB Program’s timelines.

To make a change during annual open enrollment:
The benefits office must receive the Employee Enrollment/Change form between November 1-30. You may also make some changes using My Account. See the chart of changes you can make during the annual open enrollment.

To make a change when a special open enrollment event occurs:
Events that create a special enrollment include. The benefits office must receive the Employee Enrollment/Change form no later than 60 days after the event that created the special open enrollment.

Changes you can make any time

You can make some changes during the year without a special open enrollment event.

• Change your name and/or address. Use the Employee Enrollment/Change form.
• Remove dependent(s) from coverage due to loss of eligibility (required). Your personnel, payroll, or benefits office must receive a complete Employee Enrollment/Change form no later than 60 days after the event.
• Start, stop, or change your contribution to your health savings account (HSA). Use the Employee Authorization for Payroll Deduction to Health Savings Account form.
• Change your HSA beneficiary information. Use the Health Savings Account Beneficiary Designation form.