All the Medical Trust plans provide care through a network of doctors, dentists, hospitals, pharmacies, laboratories, and other providers.
We offer the following types of medical plans for seminarians:
- Preferred Provider Organization (PPO) Plan
- Consumer-Directed Health Plan/Health Savings Account (CDHP/HSA)
All of our plans include preventive care, prescription coverage, as well as vision and hearing benefits.
PPO members can receive services from any provider — inside or outside of the plan’s network — without coordinating their care through a primary care physician. However, the plan pays greater benefits for care received from a network provider or facility. PPO members are responsible for ensuring that the services and care they receive are covered by the plan. They are often responsible for submitting their own claims for out-of-network care.
A CDHP/HSA member’s coverage consists of two parts:
- A traditional health plan that promotes preventive care and protects members against catastrophic healthcare expenses (Consumer-Directed Health Plan) and
- A tax-advantaged savings/reimbursement account (Health Savings Account) that allows members to take control of their day-to-day healthcare costs.2
With the exception of certain types of preventive care, the benefits from a Consumer-Directed Health Plan begin after the member meets the annual deductible.3 Contributions to a Health Savings Account help members build savings for current and future medical expenses that fall within the deductible of the health plan. A list of qualified medical expenses that may be paid with funds held in the HSAs can be found at the IRS website.
How the CDHP works
The Consumer-Directed Health Plan works much like a PPO. Members can receive services from any provider, and they do not have to coordinate their care through a PCP. While the CDHP covers services in and out-of-network (like the PPO), the CDHP provides very strong financial incentives for members to use network providers.4 Under these plans, certain preventive care services are not subject to the deductible and require no cost share if provided by network providers.
How the HSA works
The Health Savings Account is funded by the employee and/or employer, with a “tax-favored” status. Members can open an HSA only if they are enrolled in a qualified High Deductible Health Plan. When they incur medical expenses, they can choose to pay with either HSA funds or out-of-pocket. If HSA funds are not used, the balance continues to grow with tax-free earnings and is available for future medical expenses.
Funds deposited in an HSA belong to the member until they are spent. Unused dollars may earn interest tax-free, with certain restrictions. If members change employers or retire, they can take their HSA with them. Withdrawals from an HSA are tax-free, as long as they are used to pay for qualified medical expenses. Distributions from an HSA that are not used for qualified medical expenses will be assessed a penalty of 20 percent. For tax reporting, it is important for members to retain records of these expenses.
Health Savings Accounts and High Deductible Health Plans
1In general, members and/or their spouses are not eligible for the CDHP/HSA option if they have any other health coverage that would apply to services covered by the CDHP/HSA, such as coverage through a spouse's employer. Participation in a flexible spending account (FSA) may also limit a member’s ability to obtain coverage under the CDHP/HSA option.
3The CDHP deductible is a combination of medical and pharmacy deductible requirements. Therefore, to begin receiving benefits from the CDHP medical and prescription drug plans, members must meet one combined deductible.