Medical Plans

Services

Network

Non-Network

Services

Network

Non-Network

Preventive Services

Network
MCHCP pays 100%

Non-Network
40% coinsurance

MCHCP pays 100%

40% coinsurance

Deductible
Individual
Family

Network
Individual: $1,650
Family: $3,300

Non-Network
Individual: $3,300
Family: $6,600

$1,650
$3,300

$3,300
$6,600

Medical OOP Maximum
Individual
Family

Network
Individual: $4,950
Family: $9,900*

Non-Network
Individual: $9,900
Family: $19,800

$4,950
$9,900*

$9,900
$19,800

Prescription OOP Maximum

Combined with medical

Virtual Care through Sydney Health

Network
MCHCP pays 100%

Non-Network
Network Benefit

MCHCP pays 100%

Network Benefit

All coinsurance and copayment amounts listed below are AFTER the deductible has been met, if a deductible applies.

Medical Services

Network
20% coinsurance

Non-Network
40% coinsurance

20% coinsurance

40% coinsurance

Urgent Care

Network
20% coinsurance

Non-Network
Network Benefit

20% coinsurance

Network Benefit

Emergency Room

Network
20% coinsurance

Non-Network
Network Benefit

20% coinsurance

Network Benefit

Prescription Drugs**

Network
Generic: 10% coinsurance up to $50
Preferred: 20% coinsurance up to $100
Non-Preferred: 40% coinsurance up to $200

Non-Network
Generic: 40% coinsurance
Preferred: 40% coinsurance
Non-Preferred: 50% coinsurance

Generic: 10% coinsurance up to $50
Preferred: 20% coinsurance up to $100
Non-Preferred: 40% coinsurance up to $200

Generic: 40% coinsurance
Preferred: 40% coinsurance
Non-Preferred: 50% coinsurance

* Any individual family member need only incur a maximum of eight thousand seven hundred dollars ($8,700) before the plan begins paying one hundred percent (100%) of covered charges for that individual.

** Reduced coinsurance/copayments for certain diabetic medications and supplies. See Diabetes Support Services for more information.

Contribution rules for HSAs are complex. Members should consult a tax advisor about individual circumstances and the maximum annual contribution. MCHCP does not provide individual tax advice.

Key Advantages
How it Works
Eligibility

Key Advantages

The HSA offers several key advantages:

Control: HSA funds accumulate to pay for IRS-qualified medical expenses, such as doctor and chiropractor fees, dental treatments, hospital bills, prescriptions and more. You decide how to spend it based on your health care needs and budget. Plus, HSA funds roll over from year to year, there is no "use-it-or-lose-it" policy.
Flexibility: You can deposit (as long as you remain eligible) or withdraw money any time. There is a yearly maximum amount for how much you can put in your account.
Portability: You own the HSA funds and may keep them — even if you later change health plans, leave your job or retire.
Tax Savings: There are triple tax savings with an HSA

You can put away money for qualified medical expenses* before taxes are taken out. This means you set aside income-tax-free dollars in an HSA to pay for qualified medical expenses.
Savings in your HSA grow tax-free.
You pay no taxes when you use HSA funds to pay for qualified medical expenses*.

*A complete list of qualified expenses can be found on the IRS website. HSA funds may also be used toward the qualified medical expenses of the subscriber's spouse and eligible dependents (as defined by the IRS).

How it Works

How the HSA Plan Works:

Active employee opens an HSA through bank of their choice. The bank will send a debit card, along with detailed information about the account.
Members may contribute to their HSA at any time. Members are encouraged to fund their account up to the annual limit set by the IRS (see Annual Contribution Limits).
Members may monitor their account through their bank’s website and/or monthly activity statements.
When visiting any health care provider or pharmacy, the member may pay for their expenses using the HSA funds. No claim forms are required.
There are no copayments with the HSA Plan. Members will pay all of their medical and prescription expenses until the annual deductible is met. The HSA may be used at any time for qualified expenses, as long as sufficient funds are available in the account.
Once the deductible is met, members will pay coinsurance on covered expenses until their out-of-pocket maximum is reached. At that time, the plan will begin paying 100% of covered services and prescriptions (see Family Coverage below).

Family Coverage

If two or more family members are covered in the HSA Plan, the family deductible must be met before the member begins paying applicable coinsurance. One covered family member's expenses may meet the entire family deductible.

Eligibility

To participate in an HSA Plan, subscribers cannot:

Be claimed as a dependent on someone else's tax return.
Be enrolled in another medical plan, including Medicare and TRICARE.

If the subscriber is an active employee and Medicare eligible, they must defer Medicare Part A and Part B to contribute to the HSA.
If the subscriber is retired and they or a covered dependent will be Medicare primary in the plan year, they cannot enroll in the HSA Plan.
Exception: A member may be enrolled in another qualified high deductible health plan, dental and/or vision plan.

Be a retiree with a Medicare-eligible dependent.
Have a health care flexible spending account (FSA) [excludes premium-only, Dental/Vision Health Care and dependent care portions] or a health reimbursement account (HRA).
Have received medical benefits from the Department of Veterans Affairs (VA) at any time during the previous three (3) months, unless the medical benefits received consist solely of disregarded coverage or preventive care.

Additional Information

See Prescription Drug Plan for information on the prescription drug coverage and coinsurance/copayments.

HSA Plan

Public Entity Members

Services

Network

Non-Network

Services

Network

Non-Network

Key Advantages

How it Works

Eligibility

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