This document provides an overview of high deductible health plans (HDHPs). It explains that HDHPs have high deductibles that must be paid before insurance coverage begins, as well as high out-of-pocket maximums. However, HDHPs also have lower monthly premiums than other plans. They can be used with health savings accounts to pay for medical expenses with pre-tax dollars. The document provides details on using HDHPs with different insurance networks and covers topics like preventative care coverage and spending HSA funds.

1. High Deductible
Health Plans
A guide for understanding health insurance

2. We know…
…considering a high deductible health
plan (HDHP) can seem intimidating.
Especially when you first look at the plan
details and see…
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3. H I G H D E D U C T I B L E S
It’s in the name…and that means you’ll have to
come out of pocket to pay for health care
before your health insurance begins to pay.
H I G H O U T O F P O C K E T M A X
Once you hit your deductible, you’ll still be on
the hook for a coinsurance share and copay
costs until you reach this amount.
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4. so benefits
do exist
By the end of this presentation, you
should have an idea of whether or not an
HDHP could make sense for your needs.
L O W E R M O N T H LY P R E M I U M S
Now we’re getting somewhere. These plans
usually cost less per month than other low
or zero deductible plans.
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5. With a
Catastrophic
Health Plan
These plans may come with high
deductibles, but like all Affordable Care
Act plans, you’re covered if something
major happens that you can’t predict.
If you’re healthy, active, and generally
tend to have low health care needs.
This plan could help you save money,
but keep you covered when the
unexpected happens.

6. Free Preventative Care
You’re fully covered for preventative care
such as physicals, immunizations,
screenings, and basic birth control &
contraceptives.
A little goes a
long way
Health Savings Accounts
Only high deductible plans can be paired
with these tax-advantaged savings
accounts to be used on eligible medical
expenses.
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7. HDHPs in and out of
different networks
Learn how to use high deductible plans on
PPO, EPO, or HMO networks.
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8. PPOs and EPOs
Preferred and Exclusive Orgs.
These networks are generally wide and flexible
networks of doctors, facilities, and labs where you
can get in-network and out-of-network health care.
HMO
Health Maintenance Org.
These networks, like Kaiser, require you to choose
a primary care physician who will manage your care
and refer you to specialists, and usually don’t offer
out of network coverage.
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9. PPOs and EPOs
Separate In & Out Deductibles
Your HDHP will have a larger and separate
deductible for any care you get out-of-network,
so be sure to stay in-network as often as
possible.
Have a doctor you love?
If you’re considering an HDHP for the first time
and have a doctor you love, it’s a good idea to
check your carrier network to ensure they are
covered in your network.
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10. Out of Network
Emergency is
covered
For all network types, the Affordable Care Act
requires emergency medical care to be covered
with the same benefit as in-network. This also
means that an out of network ER visit will also
count toward your in-network deductible.
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11. Embedded
Deductibles
As you look at your summary of benefits, you’ll notice that
the deductible and out-of-pocket max are greater when
you need family coverage.
But some HDHPs can also come with an embedded
deductible, which allows a single member of your family to
reach a slightly smaller deductible rather than wait for the
family deductible to be reached.
H D H P S C O U L D A L S O I N C L U D E
W H E N O N E P E R S O N H A S H I G H N E E D S
You’ll pay out of pocket up to the embedded
deductible rather than the full family deductible
allowing coinsurance and copays to begin sooner.
P I C K I N G U P T H E S L A C K
The rest of the family will need to spend whatever
remains up to the regular deductible before
insurance begins to kick in for their separate needs.
R E A D T H E F I N E P R I N T
Not all HDHPs come with an embedded deductible,
so be sure to read your plan documents to check if
this applies to your plan.
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12. Health Savings Accounts
O N L Y H I G H D E D U C T I B L E P L A N S C A N P A I R W I T H
With the money you save in lower
premium costs with an HDHP, you can
contribute money to a tax-advantaged
HSA for when you’ll inevitably need to
spend money on your health care.
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13. Like retirement accounts, you can
contribute money via pre-tax payroll
contributions and the money grows tax-
free over time. Unlike a 401k though, you
may spend money from your account at
any time, tax-free, to pay for eligible
health care expense.
Just like IRAs, there are annual limits to
how much you can contribute to your
HSA each year.
IT’S A HEALTH
CARE 401K
WITH CONTRIBUTION
LIMITS
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14. Unlike Flex Spending Accounts where
you lose the money if you don’t use it.
You own it
If you leave your company. You also
keep any money you don’t spend
since the money rolls over annually.
You keep it
Any capital gains you make from
investing your HSA funds are also tax-
free. Each HSA vendor has different
rules so be sure to ask if there are fees
and minimum balance requirements.
You can invest it
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AND NUMEROUS
BENEFITS

15. You can spend HSA money tax-free for
Qualified Medical Expenses (see a list of
examples in the FAQ). Spend your HSA
money on your:
• Prescriptions
• Coinsurance
• Copays
You can’t spend HSA money on
insurance premiums.
SPENDING HSA MONEY
HDHPs and HSAs
encourage us to use
our health care wisely
to save costs and
make better decisions.
But there are keys to
savvy spending.
MINIMIZE
WORRY
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16. USE GENERIC
DRUGS
USE FREE
PREVENTATIVE CARE
Talk to your doctor and ask questions about
costs, necessity, side effects, and anything else.
This can help you spot potential out-of-network
costs or help you negotiate better prices.
ACT LIKE A HEALTH
CARE CUSTOMER
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17. Your HSA money, like regular bank accounts, can be spent with a linked
debit card or check. You can also deposit cash if you use an HSA vendor
with a close location. If you have an account, you may also spend money
from another account and reimburse yourself with money from your HSA
later.
How do I add to & spend money from my HSA?
If you spent money with a non-HSA account, you can reimburse that
account with a transfer of funds from your HSA. You can transfer funds
with a cash withdrawal, check or account-to-account transfer. You can also
retroactively reimburse yourself if you paid for a medical expense but didn’t
have money in the account at the time.
How do reimbursements work?
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18. You can contribute funds the moment your account is open for a
plan year until the day your taxes are due. For most people, that
would be April 15.
When can I contribute and when can I spend?
Nope, HSAs are use-it-or-save-it accounts. You can choose to
spend it on out-of-pocket medical expenses “on your own” and
save the money in your account for major expenses in the
future, allowing the roll over to grow your overall balance.
Do I have to spend my HSA money?
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19. Same as with a Flex Spending Account, these are medical
services that work towards treating physical or mental illnesses
or diseases.
What counts as a Qualified Medical Expense?
• acupuncture
• ambulance
• artificial limb
• body scan
• braille books and
magazines
• breast reconstruction
surgery
• chiropractor
• contact lenses
• dental treatment
• diagnostic devices
• disabled dependent care
expenses
• doctor visits
• drug addiction
• drugs
• eye exam
• eyeglasses
• eye surgery
• guide dog or other service
animal
• hearing aids
• home care
• hospital services
• nursing services
• organ donors
• oxygen
• physical therapy
• psychiatric care
• smoking cessation
• therapy
• transplants
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20. Our dedicated Customer Success Team at
Lumity is available to answer questions you
have 24/7.
Lumity Dashboard Help Desk Ticket Support
Email: support@lumity.com
Phone: 1 (844) 258-6489
Monday – Friday 8 am – 6pm PT
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Have
Questions?