Our HSA plan benefi ts vary considerably from our Optimum
and Value plans. Here are the key benefit features:
Preventive care (In-Plan benefit) – The HSA
Plan waives the deductible for preventive care services
when these services are received from a participating personal
physician/provider. The deductible also is waived for annual
gynecological exams and mammograms. You pay a $20 office
visit copayment when you see a participating provider. The
deductible is not waived for other
participating personal physician/provider orspecialist office
visits.
Participating personal physician/provider office visits
for illness or injury (In-Plan benefit)– You
pay a $20 copayment after meeting your annual deductible
amount.
Specialist office visits for illness or injury,
hospital, surgery, x-ray, laboratory and other covered services
from participating providers and health care facilities
(In-Plan benefi t) – You pay a 20 percent coinsurance
after meeting your annual deductible amount.
Prescription drugs – The deductible is not
waived for the prescription drug benefit for the HSA
Plan. Once you meet your annual deductible, you pay a 50
percent coinsurance for all drugs, both generic and brand-name
for up to a 30 day supply. Unlike the Optimum and Value
plans, there is no calendar year limit for how much the
plan will pay for prescription drug coverage. You must use
one of our participating pharmacies (except in emergency
situations) for buying your prescription drugs. You get
to choose from over 20,000 pharmacies nationwide, including
most major chain pharmacies as well as many local independent
pharmacies. You also can use our participating mail order
pharmacy, Walgreens Healthcare Plus, for certain maintenance
medications and purchase up to a 90-day supply.
LifeWise
HSA Plans
