High-deductible Health Plan (HDHP) FAQs
High-deductible health plans (HDHPs) have higher deductibles and lower monthly premiums compared to traditional plans. If your plan has a high deductible, you’ll pay the full cost for health services you use until the deductible is met. After the deductible is met, the plan begins to pay for some (or all) of your costs. With an HDHP, you may have higher costs when you use health care, but you’ll pay less for insurance on a monthly basis. In addition, HDHPs can be paired with an HSA or HRA. These accounts allow you to save for current and future health expenses.
How do I access health care with an HDHP?
In many ways, your HDHP with MVP Health Care works like a traditional health plan. If you need health care, you will visit a provider in your network and present your MVP ID card. The difference is that you will be paying out-of-pocket for any health care services you access until you meet your annual deductible. If you choose to see and out-of-network provider, your benefits are provided at the out-of-network level, with higher out-of-pocket costs. Once you’ve met your deductible, you will return to a more traditional payment structure—with simple co-pays or co-insurance, according to the terms of your plan.
Note: Most preventive health services, like regular check-ups and health screenings, are covered in full, not subject to a deductible.
When I access health care, how will I know how much I have to pay?
You will receive an Explanation of Benefits (EOB) from MVP in the mail 3-4 business days after the claim has been processed. The EOB shows MVP’s negotiated rate for the services you accessed and the amount you are responsible for paying. The EOB may look like a bill, but it is not. Your health care provider will send you a bill for the amount shown on the EOB, and you can pay according to the terms required by the provider (check, credit card, etc.).
Note: If your health plan includes prescription benefits, you will pay at the pharmacy when you pick up your medication.
What if the heath care provider requires me to pay at the time of my visit?
While most providers will wait until your EOB is processed before sending you a bill, some providers may require full or partial payment at the time of your visit. Any amount you pay will ultimately count toward the bill generated by the provider. If you overpay for the service, the provider should reimburse you for the amount you overpaid.
How do prescriptions work with an HDHP?
If your health plan includes prescription benefits, you will present your MVP ID card to your pharmacist, just like you would with a traditional health plan. However, many prescription medications are generally subject to a deductible. So you will pay the full cost of prescriptions out-of-pocket until you meet your annual deductible. Once you’ve met your deductible, you will begin paying co-payments or co-insurance for covered medications, according to the terms of your plan. In either case, you will be required to pay when you pick up your medication. Consult your plan materials or ask your employer for more details.
How can I keep track of my deductible throughout the year?
The best way to stay informed about your deductible, as well as other account-related information is to access your MVP online account.
Sign in to view your benefit information, claims status, referrals/prior authorizations and track your progress toward your plan’s deductible.
Note: It’s important to know where you are in relation to your deductible before you visit the doctor.
How can I use the funds in my health reimbursement arrangement (HRA) or health savings account (HSA) to pay for my medical expenses?
Ask your employer if you have access to one of these spending accounts and for details about how you can use the funds to pay for qualified out-of-pocket medical expenses.