Consumer-driven health benefit plans - Chapter 3, 2022 UnitedHealthcare Administrative Guide

Consumer-driven health benefit plans are 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 ID card and by checking eligibility and benefits in the UnitedHealthcare Provider Portal.

These plans include 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).

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 or after they meet the deductible. The benefit plans include an out-of-pocket maximum and, once met, they pay 100% 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.