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.
The biggest difference isn't just how you pay for care — it's also how you access care.
- PPO Plus: More flexibility to find and access providers on your own, with copays available for many common services.
- PPO Plus HSA: An HSA-compatible option with lower premiums and a higher deductible.
- Sana First Health Plan (SFHP): A lower-cost plan option that uses a guided-care model, with Sana Care as the starting point for most care. Sana First plans are designed to cost approximately 15% less in premiums than comparable Sana PPO plans, while giving members additional support navigating their care.
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 are not HSA-compatible
- Services that qualify as preventive care & preventive medications are 100% covered by all Sana plans
- If a member has dependents on their Sana plan, the deductibles & OOPMs are embedded
- Sana Care is a $0 copay
PPO Plus Plan Coverage
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).
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
-
Members will pay less for services subject to their deductible and coinsurance on the S and P plans (ex, diagnostic care, hospitalizations, surgery, etc.)
✅ 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
-
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.)
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 plans are HSA-compatible
- Sana does not administer HSAs
- Please refer to our HSA Help Center article for more information
- Services that qualify as preventive care & preventive medications are 100% covered by all Sana plans
- If a member has dependents on their Sana plan, the deductibles & OOPMs are embedded
- Sana Care is a $0 copay
PPO Plus HSA (H) Plan Coverage
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 the 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.
How the Sana First Health Plan (SFHP) Works
The Sana First Health Plan is designed to offer a lower-cost plan option while giving members more guidance when they need care.
Sana First plans are designed to have premiums approximately 15% lower than comparable Sana PPO plans. The biggest difference is how members access most care.
With Sana First, Sana Care is your starting point for most care.
Here's how the guided-care process works:
- Start with Sana Care. Tell your Care Team about your health concern.
- Your Care Team evaluates your care needs. If your needs can be handled through Sana Care, your Care Team can continue helping you virtually.
- Connect with Care Navigation. If you need in-person care, Care Navigation will identify a shortlist of appropriate provider options based on your medical needs, location, quality, availability, and cost.
- Choose the provider that works for you. You're still in control of where you receive care from the options provided.
- Sana sends the referral. Sana will send the required referral documentation to your selected provider so you can move forward with scheduling your care.
Sana First is not an HMO or EPO with a fixed provider directory. Care Navigation can help connect you with Sana direct-contract providers, HealthSmart providers, or non-contracted providers who can bill Sana directly.
Referral Requirements
For most in-person care, Sana First members must have a Sana Care referral before receiving care.
If you receive care that requires a referral without first completing the Sana Care referral process, the claim will be denied and you'll be responsible for 100% of the cost.
You do not need to start with Sana Care for:
- Emergency Room care
- Urgent Care
- OB/GYN care
- Pediatric primary and preventive care
Pediatric specialty care is coordinated directly through Care Navigation rather than starting with a Sana Care virtual provider.
Have questions? We've got you covered.
- Log in to view account details.
- Search FAQs in our Help Center.
- Connect with Customer Support directly through the chat icon on most Sana pages or call us at (833) 726-2123 Monday through Friday, 7 AM to 7 PM Central.