High Deductible Summary
In combination with Miami's High Deductible Health Plan (HDHP), a Health Savings Account (HSA) is a way to pay for qualified healthcare expenses with a tax-free bank account. You will receive a debit MasterCard that can be used to access your HSA funds.
See HDHP Plan Summary Information as a PDF
| Service | Network Tier 1⇒ Member Pays |
Network Tier 2⇒ Member Pays |
Out-of-Network Benefits Member Pays** |
|---|---|---|---|
|
Calendar Year Deductible |
$2,000 single $4,000 family |
$5,000 individual $10,000 Family |
|
| Medical Out-of-Pocket Maximum For other than single coverage, family out-of-pocket maximum applies. |
$3,250 single $6,500 family |
$6,350 individual $12,700 family |
|
| Preventive Care (wellness exams, cancer screenings, immunizations) |
$0 | $0 | 50% after deductible |
| Office Visits (primary care physician) |
10% after deductible | 20% after deductible | 50% after deductible |
| Behavioral Health | 10% after deductible | 20% after deductible | 50% after deductible |
| Specialist/Allergist | 10% after deductible | 20% after deductible | 50% after deductible |
| Physician Services (outside of office) |
10% after deductible | 20% after deductible | 50% after deductible |
| Diagnostic X-Rays and Lab Work | 10% after deductible | 20% after deductible | 50% after deductible |
| Advanced Imaging (such as MRI, CAT, PET) |
10% after deductible | 20% after deductible | 50% after deductible |
| Hospital Emergency Room Services (True) | 10% after deductible | 10% after deductible | 10% after deductible |
| Urgent Care Facility | 10% after deductible | 20% after deductible | 20% after deductible |
| Speech Therapy (limit 30 visits per year) |
10% after deductible | 20% after deductible | 50% after deductible |
| Physical and Occupational Therapy (limit 60 visits per year) |
10% after deductible | 20% after deductible | 50% after deductible |
| Acupuncture (limit 20 visits per year) |
10% after deductible | 20% after deductible | 50% after deductible |
| Chiropractic Services (limit 20 visits per year) |
10% after deductible | 20% after deductible | 50% after deductible |
| Pharmacy-Retail | 20% after deductible | 50% after deductible | |
| Pharmacy-Specialty Drugs | 20% after deductible 30-day supply only |
50% after deductible | |
| Pharmacy-Mail Order | 20% after deductible | Not covered | |
When using a tier 1 or tier 2 free-standing lab or imaging center, you will pay $0 after in-network deductible.
*$0 after medical out-of-pocket maximum has been met.
**Out-of-network providers may balance bill you for charges in excess of the Usual, Customary, and Reasonable (UCR) fee. You will be responsible for charges in excess of the maximum UCR fee in addition to any applicable deductible, coinsurance or co-payment. Additionally, any amount you pay the provider in excess of the maximum UCR fee will not apply to your out-of-network deductible or out-of-pocket maximum.