Southwest Care Center Open Enrollment Runs from Nov. 11th through Nov. 25th, 2024
Medical
Benefits
You have two health plan options which will allow you to personalize your coverage to fit your and your family's needs. For full plan details, navigate to the Benefit Plan Documents Folder located here.
Fast find links:
COVERAGE, DEDUCTIBLES & OUT OF POCKET/ANNUAL MAXIMUMS BY PLAN
PREMIUMS AND CONTRIBUTIONS BY EMPLOYEE AND EMPLOYER
Vantage High Deductible Health Plan (HDHP) With Health Savings Account (HSA)
An HDHP is a medical plan that combines traditional medical coverage along with a tax-advantaged way to save for future medical expenses with significantly lower premiums than the Preferred Provider Plan (PPO). The HDHP with HSA gives you flexibility and discretion over how you use your health care dollars today. While premiums are lower than the other plan option, it does come with higher annual deductibles and out-of-pocket expense.
High Deductible Health Plans (HDHP) highlights:
​
-
Lower Premiums: HDHPs have lower monthly premiums compared to traditional health plans, which can result in immediate savings.
-
Health Savings Account (HSA) Election in the HDHP plan automatically includes an HSA, where you can save money tax-free for qualified medical expenses. Contributions to an HSA can reduce your taxable income. Additionally, SCC contributes to your HSA each pay period which helps offset the out-of-pocket expenses you may pay with this plan.
-
Cost Control: HDHPs encourage more mindful healthcare spending, as you'll be more aware of costs due to higher out-of-pocket expenses before reaching your deductible.
-
Preventive Care Coverage: HDHPs cover preventive services (like vaccinations and annual check-ups) at no cost, even before you meet your deductible.
-
Once you reach the deductible, the plan kicks in to share the cost of care. When you meet the out-of-pocket maximum, the plan covers you 100%-same as the other plan.​
​
This plan is a great option for team members and families who are generally healthy and have lower annual healthcare expenses.
​
Health Savings Account (HSA) To Accompany Your High Deductible Health Plan
The High Deductible Health Plan comes with a complementary Health Savings Account (HSA) which is a powerful tool for managing healthcare costs while providing tax benefits and healthcare savings opportunities. Important: Those with Medicaid or Medicare may enroll in the HDHP but are restricted by federal/state program rules from participating in a Health Savings Plan (HSA).
Health Savings Account (HSA) highlights:
​
-
Tax Advantages: Contributions to an HSA are tax-deductible, reducing your taxable income. Additionally, interest and investment earnings grow tax-free, and withdrawals for qualified medical expenses are also tax-free. Self-contribution is voluntary not required. Below are a few important notices related to contributions:
-
Maximum annual contribution to an HSA in 2025 is $4,300 for an employee only coverage. Note that is amount includes the employer contribution of $2,000 leaving the employee able to contribute max. $2,300 annually.​
-
Maximum annual contribution to an HSA in 2025 for plans that cover spouse and/or dependents is $8,550. Note that this amount includes the employer contribution of $3,000 leaving the employee able to contribute max. $5,550.
-
​For those 55 and older, by the end of the calendar year, there is an additional catch-up contribution of $1,000.
-
The IRS regulates how HSAs are handled. Please review details specific to your circumstance by accessing the IRS Publication 969.
-
​Flexibility in Spending: HSAs can be used to pay for a wide range of qualified medical expenses, including deductibles, copayments, and certain over-the-counter medications.​
-
Rollover of Funds: Unlike Flexible Spending Accounts (FSAs), unused funds in an HSA roll over from year to year, allowing you to save for future medical expenses.
-
Portability: HSAs are owned by the individual, so they remain with you even if you change jobs or health plans.
-
Long-Term Savings: HSAs can serve as a tool for saving for healthcare costs in retirement, as funds can be used tax-free for qualified expenses after age 65.
-
Investment Opportunities: Many HSAs allow you to invest your funds in stocks, bonds, or mutual funds, potentially increasing your savings over time.
-
Lower Premiums: HSAs are typically paired with High-Deductible Health Plans (HDHPs), which often have lower premiums compared to traditional plans.
-
Employer Contributions: SCC contributes a generous amount to your HSA each paycheck. See the HDHP Premium Table above for details.
-
Easy to Access Savings: Plan participants receive a debit card through Health Equity. You may pay for eligible expenses just like you would be using your personal debit card.
Preferred Provider Plan (PPO)
The PPO plan gives you the freedom to seek care from the provider of your choice. However, you will maximize your benefits and reduce your out-of-pocket costs if you choose a provider who participates in the Presbyterian PPO network. If you choose the PPO plan, you will have to pay a co-pay (a fixed dollar amount) each time you visit a provider. The PPO plan has higher premiums and higher deductibles than an HDHP medical plan and does not come with a complementary Health Savings Account (HSA) nor an employer contribution contribution.
Preferred Provider Plan (PPO) highlights:
​
-
Flexibility in Provider Choice: Members can see any doctor or specialist, but they will pay less if they use providers within the PPO network.
-
No Referral Required: You don’t need a referral to see a specialist, making it easier to access specialized care.
-
Higher Costs for Out-of-Network Care: While you can see out-of-network providers, doing so usually results in higher out-of-pocket costs.
-
Preventive Care Coverage: Preventive services, like annual check-ups and vaccinations, are at no extra cost when using in-network providers.
-
Deductibles and Copayments: Members pay a deductible before insurance kicks in but not for many visits and services which only require a co-payment.
-
Out-of-Pocket Maximums: PPO plans have a cap on the total amount you'll pay out-of-pocket in a year, providing some financial protection.
-
Variety of Services Covered: Many PPO plans cover a broad range of services, including hospital stays, surgeries, and mental health care.
-
Prescription Drug Coverage: Unlike the HDHP, the PPO includes a formulary for prescription medications, often with different tiers offering set co-pays.
​
This plan is a great option for team members and families who are seeking flexibility and choice in their healthcare, a known cost associated with visits and other services through established co-pays, and who may have higher healthcare utilization needs throughout the year such as treatment for chronic conditions.
​