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HDHP
HSA-eligible High Deductible Health Plan with the lowest premiums and an employer HSA contribution.
Plan details
Availability
All eligible employees
HSA Eligible
Yes
FSA Eligible
Limited Use FSA only
Premium contributions
HDHP : Full-Time
| Coverage Tier | Premium | Non-Tobacco | Tobacco |
|---|---|---|---|
| Employee Only | Bi-weekly | $64.67 | $87.75 |
| Weekly | $32.33 | $43.87 | |
| Employee + Spouse | Bi-weekly | $142.28 | $165.36 |
| Weekly | $71.14 | $82.68 | |
| Employee + Child(ren) | Bi-weekly | $119.65 | $142.73 |
| Weekly | $59.83 | $71.37 | |
| Employee + Family | Bi-weekly | $206.95 | $230.03 |
| Weekly | $103.48 | $115.02 |
HDHP : Part-Time
| Coverage Tier | Premium | Non-Tobacco | Tobacco |
|---|---|---|---|
| Employee Only | Bi-weekly | $64.67 | $87.75 |
| Weekly | $32.33 | $43.87 | |
| Employee + Spouse | Bi-weekly | $275.99 | $299.07 |
| Weekly | $138.00 | $149.53 | |
| Employee + Child(ren) | Bi-weekly | $232.08 | $255.15 |
| Weekly | $116.04 | $127.58 | |
| Employee + Family | Bi-weekly | $401.43 | $424.51 |
| Weekly | $200.72 | $212.25 |
Deductible and Out-of-Pocket
| Detail | In-Network | Out-of-Network |
|---|---|---|
| Deductible (Individual) | $3,400 | $6,000 |
| Deductible (Family) | $6,000 | $12,000 |
| Coinsurance (plan pays) | 100% after deductible | 50% after deductible |
| Out-of-Pocket Max (Individual) | $4,000 | $8,000 |
| Out-of-Pocket Max (Family) | $8,000 | $16,000 |
What you pay per visit
| Service | In-Network | Out-of-Network |
|---|---|---|
| Preventive Care | 100% | 50% after deductible |
| Primary Care Visit | 100% after deductible | 50% after deductible |
| Specialist Visit | 100% after deductible | 50% after deductible |
| Diagnostic Care | 100% after deductible | 50% after deductible |
| Urgent Care | 100% after deductible | 50% after deductible |
| Emergency Room | 100% after deductible | 100% after deductible |
Pharmacy benefits
| Tier | RETAIL (30-DAY) IN-NETWORK | RETAIL (30-DAY) OUT-OF-NETWORK | Mail order (90-day) |
|---|---|---|---|
| Generic | $10 copay* | 50%* | $25 copay* |
| Preferred | $35 copay* | 50%* | $87.50 copay* |
| Non-Preferred | $60 copay* | 50%* | $150 copay* |
*After deductible. Mail order is not available out-of-network.
Plan Notes
- HSA-eligible plan. TAS Energy provides an HSA employer contribution: $400 (Employee), $600 (Employee + Spouse or Child(ren)), $800 (Family), $400 (Part-Time), deposited annually.
HDHP plan contacts
BCBS of TX
BCBS of TX (Prime Therapeutics) — Pharmacy