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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

Combined with medical

Combined with medical

LiveHealth® Online

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
Specialty: 20% coinsurance up to $100

Non-Network
Generic: 40% coinsurance
Preferred: 40% coinsurance
Non-Preferred: 50% coinsurance
Specialty: No coverage

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

Generic: 40% coinsurance
Preferred: 40% coinsurance
Non-Preferred: 50% coinsurance
Specialty: No coverage

* 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

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 plans, leave your job or retire.
  • Tax Savings: There are triple tax savings with an HSA
    1. 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.
    2. Savings in your HSA grow tax-free.
    3. You pay no taxes when you use HSA funds to pay for qualified medical expenses*.
  • MCHCP Contribution: MCHCP will contribute to the HSAs of active employees — $300 for individual coverage and $600 for family coverage. New employees or subscribers who elect coverage during a special enrollment period with an effective date after January 1 will receive a prorated contribution.

*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:

  1. MCHCP partners with Central Bank to provide your Health Savings Account (HSA). MCHCP will open an HSA for you in HSA Central, a division of Central Bank. Once MCHCP opens your account, you will receive a welcome email from HSA Central with detailed information on how to access your account. Your HSA Central Debit Mastercard® will arrive in the mail within 10 to 15 business days.
  2. Members may contribute to their HSA at any time. MCHCP will make an annual contribution to each active employee’s HSA. Members are also encouraged to fund their account up to the annual limit set by the IRS (see Annual Contribution Limits). Active employees may contribute through voluntary payroll deductions. Retirees may contribute by making deposits directly.
  3. Members may monitor their account through HSA Central’s website and/or monthly activity statements.
  4. When visiting any health care provider or pharmacy, the member may pay for their expenses using the HSA funds. No claim forms are required.
  5. 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.
  6. 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 tab).

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.

Two married active state employees who cover children may combine medical deductibles by participating in a Family Roll Up.

The maximum annual MCHCP contribution for married state employees who cover children when both are enrolled in the HSA Plan is $600. Each spouse will receive $300 into their individual health savings account.

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.
    • Exception: A member may be enrolled in another qualified high deductible health plan, dental and/or vision plan.
  • 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


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