Choosing a Plan: PPO Plus vs PPO Plus HSA

We know plan selection can be a scary process, but it doesn't have to be. We got you! Here are the primary differences between our two plan types: PPO Plus & PPO Plus HSA.  

You'll notice both plan types are PPO Plus, which means that all Sana plans provide coverage for both in and out-of-network providers. If you want to see an out-of-network provider, learn more about how to do that here: Flex Care Options

Let’s break it down! 

How PPO Plus Plans (C, B, E, P, S) Work

If a covered service is not preventive or eligible for a copay, it will be subject to the plan’s deductible. This means the member will pay out of pocket for the service until the deductible is reached. Once the deductible is met, the member is responsible for the coinsurance amount until the out-of-pocket max is reached. At that point, the plan pays for 100% of covered expenses.

It’s important to know:

PPO Plus Plans (C, B, E, P, S) 

Our PPO Plus plans offer excellent coverage from day one. You’ll pay higher monthly premiums than you would with our H plans but have the peace of mind that most of your visits and medications will cost just a small copay (see Plan Matrix below). Furthermore, you’ll have 100% free access to all of our Care Partners

Choosing between PPO Plus Plans

  • Premium and Superior (P & S) plans are ideal if you prefer a copay structure for common healthcare services & Rx drugs, and a lower coinsurance and out-of-pocket-maximum (OOPM)
    • These plans are best suited for members with more frequent or high-cost healthcare needs because there are fewer out-of-pocket expenses once the deductible is met.
    • Coinsurance: the percentage of costs of a covered health care service a member pays after they’ve paid their deductible
      • Members will pay less for services subject to their deductible and coinsurance on the S and P plans (ex, diagnostic care, hospitalizations, surgery, etc.)
        • The S plan has a 10% post-deductible member coinsurance 
        • The P plan has a 20% post-deductible member coinsurance
  • Essential, Basic, and Core (E, B, C) plans are ideal if you prefer a copay structure for common healthcare services & Rx drugs, but don’t mind a higher coinsurance and out-of-pocket-maximum (OOPM)
    • These plans are best suited for members who don’t plan to meet their deductible, as the post-deductible coinsurance and OOPMs are higher 
    • Coinsurance: the percentage of costs of a covered health care service a member pays after they’ve paid their deductible
      • Members will pay more for services subject to their deductible and coinsurance on the E, B, and C plans (ex, diagnostic care, hospitalizations, surgery, etc.)
        • The E plan has a 30% post-deductible member coinsurance
        • The B plan has a 40% post-deductible member coinsurance
        • The C plan has a 50% post-deductible member coinsurance 

 

How a PPO Plus HSA Plan Works

Members pay all medical costs, including non-preventive prescriptions, out of pocket until the deductible is met. At that point, the plan pays for 100% of covered expenses.

It’s important to know:

PPO Plus HSA (H) Plans

PPO Plus HSA plans have lower premiums and higher deductibles than most of our PPO Plus plans. Members covered by a PPO Plus HSA plan can contribute to a Health Savings Account (HSA) each month to cover medical expenses. Before selecting this plan, check with your employer to see if they pay into employee HSA accounts

  • An H plan may be right for a member who doesn’t anticipate care needs outside of preventive care and preventive medications, and doesn’t mind the risk of paying total price for visits until the deductible is met.
  • If you visit a doctor regularly, have a major procedure coming up, take specialty medications, or tend to spend a lot of money on healthcare, you may not be interested in a PPO Plus HSA plan

 

Plan Matrix
Overview of Plan Types

Have questions? We've got you covered.

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