Consumer-Driven Health Benefit Plans
Consumer-driven health care describes health benefit plans made to help members:
- Become more informed and careful about their health care choices.
- Take control over their health and health care purchases. These benefit plans are listed on the health care ID card and on eligibilityLink.
These plans include:
- A member responsibility, which is the amount members pay from their own pockets for their deductibles, copayments and coinsurance, up to the out-of-pocket maximum.
- An account that helps members pay their out-of-pocket costs on a pre-tax basis. The account can either be a health savings account (HSA) or a health reimbursement account (HRA).
- Health coverage that pays benefits after members meet the deductible and that pays 100% of network preventive care services.
- Resources that give information about network care providers, cost of services and options for getting health care.
HRAs and HSAs are similar in many ways:
- They are both a type of medical savings account.
- The medical benefit includes a deductible. Members typically use their HSA or HRA to pay out-of-pocket expenses until they meet the deductible. The benefit plans include an out-of-pocket maximum and, once met, they pay 100 percent of covered services, including pharmacy.
- They cover routine, preventive care under the basic medical benefit. These services are not subject to the deductible.
HRAs and HSAs differ in that:
- Employers most often fund HRAs.
- Employees most often fund HSAs.
- With HSAs, if members do not have sufficient funds in their account, or choose to save those funds for a later date, they pay any remaining cost share out-of-pocket. The HSA belongs to the account holder even if they change employers. The Internal Revenue Service allows annual deposits that can equal the benefit plan’s deductible.