ALERT! Prescription drug costs do count toward your deductible. You pay the entire cost of your drugs, even those covered by the plan, until you have met your entire deductible.
A deductible is a fixed dollar amount you pay each calendar year before the plan begins paying most benefits. For this plan, the deductible for a single person on an account is $1,400; for more than one person on an account, $2,800; see "How Does the Deductible Work With More Than One Person?" below. You pay your providers until you meet your deductible for the year, then the plan begins to pay benefits for your care. See below for services that are exempt from the deductible.
What Doesn’t Count Toward My Deductible?
The following out-of-pocket expenses do not count toward your deductible:
- Services you pay for that aren’t covered by the plan.
- Charges for services exceeding benefit maximums. For example, the maximum for vision hardware is $150 every two calendar years; charges over $150 do not count toward your deductible.
- Charges for services beyond benefit limits. For example, the annual benefit limit for acupuncture is 16 visits. Costs for more than 16 visits are not covered by the plan and do not count toward your deductible.
- Out-of-network provider charges that exceed the allowed amount, including non-network pharmacies.
- The ancillary charge* for brand-name drugs that have a generic equivalent.
TIP: You can spend from your HSA for noncovered services as long as they are qualified medical expenses.
Which Services Are Exempt From the Deductible?
You don’t have to pay toward the deductible for these services before the plan pays:
TIP: All services not listed above are subject to the deductible. This means that you must pay the first $1,400 or $2,800 of covered services before the plan begins to pay.
How Does the Deductible Work With More Than One Person?
- If you cover only yourself, your deductible is $1,400; you must pay this amount for covered services not exempt from the deductible (including covered drugs) before the plan begins to pay for your care.
- If you cover yourself and at least one other person, your deductible is $2,800. You must meet this amount of covered services for all covered persons combined before the plan pays for any services, including drugs (other than those exempt from the deductible).
ALERT! If you receive services with a benefit limit (such as chiropractic, massage therapy, or physical therapy) before meeting your deductible, those visits will count toward the benefit limit. For example, if you pay out of pocket for a chiropractor visit because you haven’t met your deductible, that visit will count toward the maximum of 10 visits per calendar year. See definition of “Limited Benefit” for more information. Note: If a dependent has other coverage primary, visits paid by the primary plan also count toward UMP CDHP benefit limits.
*The ancillary charge no longer applies effective January 1, 2014. After that date, you’ll pay the
normal coinsurance for nonpreferred brand-name drugs that have a generic equivalent.