High Deductible Health Plans (HDHPs) usually have lower monthly premiums than plans with lower deductibles. By using the untaxed funds in your state-sponsored Health Savings Account (HSA) to pay for expenses before you reach your deductible, you reduce your overall healthcare costs.

Expense Types

There are three types of expenses associated with an HDHP:

  • Deductible – You pay all costs until you reach your deductible.
    • You can pay for services with your HSA or other funds.
    • Your preventive care is covered 100% when you use an in-network doctor (as required by federal law). 
    • The deductible includes prescription drugs and applies to the out-of-pocket limit (OOPL).
    • If you are enrolled in a family plan, the entire family deductible must be met before coverage begins.
  • Coinsurance - You and your plan share the cost of services.
    • Once the deductible is met, your plan will pay a percentage of costs and you will pay the remaining percentage (percentage varies by plan).
    • You can pay your coinsurance share using your HSA or other funds.
  • Out-of-Pocket Limit – The most you’ll have to pay during the plan year.
    • When your deductible and coinsurance payments reach this limit, you are done paying for the year.
    • The plan will pay 100% of expenses for the rest of the year.
    • This limit protects you in the event of a major medical event.

Pharmacy Benefits

The plan will not pay for most medical or prescription costs until the annual deductible is met. Some preventative prescription drugs, including some contraceptive prescription drugs, and maintenance medications are covered at 100% before the deductible. To find the costs of your drugs, go to ETF's Find the Cost of Your Drugs website. 

Payment for Services

When you have a health event, present your insurance card to your doctor. Your doctor will send a claim to your health plan to provide discount information. You will receive a statement for payment.

To pay for eligible medical expenses:

  • You can use your HSA payment card or pay out of pocket.
  • If you choose to pay out of pocket, you can either choose to reimburse yourself or keep the funds in your HSA to grow your savings.

Be sure to keep all receipts and pertinent documentation to prove your HSA was used for eligible medical expenses. For more information about eligible medical expenses, see the medical expense eligibility tool.