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The Vanguard Group

Medical plan: HDHP

Last updated: 31 Mar 2014  BenefitsMailbox, Ext. 34BEN or 800-407-8576
 

How it works

The High-Deductible Health Plan (HDHP) has a deductible and an account to help you offset that deductible. That account, referred to as a health savings account (HSA), receives a contribution from Vanguard and can receive pre-tax contributions from you as well. An HSA is yours to keep, even if you leave Vanguard.

After your deductible is reached, you'll pay a portion of the expenses through coinsurance until you reach the out-of-pocket maximum. Here are the details of the plan.

High-Deductible Health Plan
Deductible $1,500 individual
$3,000 family
HSA contribution $600 individual
$1,200 family
Coinsurance 20% in network
40% out-of-network
Out-of-pocket maximum $3,500 individual
$7,000 family

Prescription drug coverage is automatically included with this plan. Please note: This plan is slightly different from the Aetna HealthFund in regards to prescription coverage, in that nonpreventive prescription drug costs will count toward the deductible and out-of-pocket totals for the HDHP.

More about the HDHP

  • Preventive care: All in-network preventive care services (e.g., physicals and immunizations) are covered at 100% with no coinsurance or deductible. Review the plan's summary of coverage for full list. Preventive care expenses from out-of-network providers are also covered—subject to a deductible, coinsurance, and "reasonable and customary" (R&C) limitations. You can also use the prescription drug plan for coverage for preventive drugs that help with specific chronic conditions such as asthma.
  • Nonpreventive care: Nonpreventive medical services and prescription drugs are subject to the deductible and coinsurance. You'll pay these expenses with your own funds, but you can use your HSA to reimburse yourself for out-of-pocket expenses, such as the deductible and coinsurance. If you've exhausted your HSA, you'll pay the balance from your own funds. When you've met the deductible, nonpreventive expenses are covered by the plan at 80% in-network and 60% out-of-network.
  • Prescription drugs: Nonpreventive prescription drugs will count toward the deductible and out-of-pocket totals. Note: This plan is slightly different from the Aetna HealthFund in regard to prescription coverage, in that prescription costs do not count toward the deductible for the Aetna HealthFund.

Have family coverage?

For family coverage, nonpreventive care and nonpreventive prescription drugs used by each person apply fully toward the $3,000 family deductible.

Note: This differs from the Aetna HealthFund, as the HDHP has no "individual deductible" for family coverage.

Two examples of the family deductible

  • Example 1: You're enrolled in the HDHP. Your deductible is $3,000, and Vanguard's HSA contribution is $1,200.

If you go to various in-network providers and incur $2,000 in nonpreventive medical expenses, you'll pay $2,000 out-of-pocket. If you choose, you may access the funds in your Health Savings Account (HSA) to reimburse you for this expense.

  Plan pays You pay
Deductible: $3,000 $0 $2,000
Total amounts $0 $2,000

The total amount you've spent out-of-pocket so far is $2,000.*

Then, if your spouse also goes to various in-network providers and incurs $2,200 in nonpreventive expenses ($1,200 in medical and $1,000 for prescriptions), you must pay the remaining amount toward the deductible ($1,000) plus 20% of the $1,200 balance ($240). Therefore, the family's total out-of-pocket expense is $3,240. (In-network preventive care is always covered at 100%.)

  Plan pays You pay
Amount remaining of deductible: $1,000 $0 $1,000
Amount remaining after deductible: $1,200 $960 (80% coinsurance) $240 (20% coinsurance)**
Total amounts $960 $1,240

The total amount you've spent out-of-pocket so far is $3,240* ($3,000 deductible plus $240 coinsurance).

  • Example 2: You're enrolled in the HDHP. Your deductible is $3,000, and Vanguard's HSA contribution is $1,200.

If you visit various in-network providers and incur $4,000 in nonpreventive medical and prescription expenses, you'll pay $3,000 toward the deductible plus 20% of the remaining $1,000 ($200). The family's total out-of-pocket expense is $3,200. Any future nonpreventive expenses incurred by any member of the family are subject to coinsurance. (In-network preventive care is always covered at 100%.)

  Plan pays You pay
Deductible: $3,000 $0 $3,000
Amount remaining after deductible: $1,000 $800 (80% coinsurance) $200 (20% coinsurance)**
Total amounts $800 $3,200

The total amount you've spent out-of-pocket so far is $3,200* ($3,000 deductible plus $200 coinsurance).

Out-of-pocket maximum

You are protected if you have large expenses by the out-of-pocket maximum. If you reach the annual out-of-pocket maximum (in-network or out-of-network: $3,500 per individual, $7,000 family), your expenses are paid 100% for in-network services and 100% of R&C costs for out-of-network services for the rest of the plan year. Nonpreventive prescription drugs count toward the out-of-pocket maximum in this plan.

Example of the out-of-pocket maximum

You're enrolled in the HDHP and you have family coverage. Your deductible is $3,000, and Vanguard's HSA contribution is $1,200.

If you visit various in-network providers and incur $4,000 in nonpreventive medical and prescription expenses, you'll pay $3,000 toward the deductible plus 20% of the remaining $1,000 ($200).

  Plan pays You pay
Deductible: $3,000 $0 $3,000
Amount remaining after deductible: $1,000 $800 (80% coinsurance) $200 (20% coinsurance)**
Total amounts $800 $3,200

The total amount you've spent out-of-pocket is $3,200* ($3,000 deductible plus $200 coinsurance).

Then, your spouse has an inpatient hospital stay resulting in a $30,000 health care bill. You have already met the family deductible, so this expense is subject to coinsurance up to the out-of-pocket maximum of $7,000. You have already met $3,200 of your $7,000 out-of-pocket maximum, so you will only be billed $3,800 for the hospitalization charge.

  Plan pays You pay
Amount remaining of deductible: $0 $0 $0
Amount of service: $30,000 $26,200 (80% coinsurance) $3,800 (20% coinsurance up to the out-of-pocket maximum)**
Total amounts $26,200 $3,800

The total amount you've spent out-of-pocket is $7,000* ($3,000 deductible plus $4,000 coinsurance).

*You will first be billed for these services from your provider. If you choose to reimburse yourself for these costs, you must request a distribution from your HSA provider.

**If you elected a health care flexible spending account (FSA), you could pay this amount from the FSA. Refer to the healthcare FSA: Q&A for details.