High-Deductible Health Plan for RWJBH BHealthy Care
The High-Deductible Health Plan (HDHP) gives you the flexibility to spend your health care dollars as you choose.
High Deductible Health Plan (HDHP) members must meet a deductible before the plan begins covering services. Preventive services, such as wellness exams, prenatal care and cancer screenings are covered at 100% when the providers are in-network, whether you have met your deductible or not. Coverage for all other services, including prescription drugs, does not begin until you have met your deductible. The HDHP provides both in–network and out-of-network coverage.
- In-Network Tier: Covers services provided by physicians and facilities that participate in the Horizon Direct Access® Network and the national BlueCard® network outside of New Jersey, including RWJBarnabas Health facilities and providers. Using providers in this tier provides you with the lowest out-of-pocket costs.
- Out-of-Network Tier: Covers services provided by physicians and facilities that do not participate in either the Horizon Direct Access network or the national BlueCard network.
If you elect to participate in the HDHP, you may be eligible to set aside pre-tax money into a Health Savings Account (HSA) to help pay for eligible expenses and offset your deductible or coinsurance amounts. The HSA belongs to you. That means that you can keep the account even if you change employers, and the balance rolls over from year to year. Remaining funds can also be used to fund health coverage in retirement.
Deductible
| In-Network | Out-of-Network | |
|---|---|---|
| Individual | $1,400 | $2,200 |
| Family | $2,200 | $4,400 |
Member Coinsurance
| In-Network | Out-of-Network | |
|---|---|---|
| Your payment | You pay 20% after deductible | You pay 40% after deductible |
Out-of-Pocket Maximum
Once any one individual meets the individual out-of-pocket maximum, their expenses are covered at 100%, all other family members must collectively meet the family out-of-pocket maximum.
| Individual | $7,050 |
| Family | $14,100 |
Preventive Care Services
| Service | In-Network | Out-of-Network |
|---|---|---|
| Routine Adult Physical Exams 1 per calendar year |
No charge | Not covered |
| Immunizations | No charge | Not covered |
| Routine Child Exams | No charge | Not covered |
| Routine GYN Exam | No charge | Not covered |
| Routine Mammogram | No charge | Not covered |
| Prostate Exam | No charge | Not covered |
Office/Virtual Visits
| Service | In-Network | Out-of-Network |
|---|---|---|
| Primary Care Physician (PCP) | You pay 20% after deductible | You pay 40% after deductible |
| Specialist | You pay 20% after deductible | You pay 40% after deductible |
TeleMed
$59 copay
Routine Eye Exam
| Service | In-Network | Out-of-Network |
|---|---|---|
| One exam per 12 months for all ages | You pay 20% after deductible | You pay 40% after deductible |
Diagnostic Lab and X-Ray
| Service | In-Network | Out-of-Network |
|---|---|---|
| Lab | You pay 20% after deductible | You pay 40% after deductible |
| X-Ray | You pay 20% after deductible | You pay 40% after deductible |
Emergency Room Treatment
| In-Network | Out-of-Network | |
|---|---|---|
| Your payment | You pay 20% after deductible | You pay 20% after deductible |
Hospital Care/Surgery
Precertification is required.
| Service | In-Network | Out-of-Network |
|---|---|---|
| Inpatient | You pay 20% after deductible | You pay 40% after deductible |
| Outpatient | You pay 20% after deductible | You pay 40% after deductible |
Mental Health & Substance Use
Precertification is required.
| Service | In-Network | Out-of-Network |
|---|---|---|
| Inpatient | You pay 20% after deductible | You pay 40% after deductible |
| Outpatient | You pay 20% after deductible | You pay 40% after deductible |
