Plan basics

Plan types, services areas and networks

We offer four types of individual plans:

  • Full network HMO
  • HMO choice, which includes Henry Ford Choice and Genesys Choice
  • PPO
  • Catastrophic, which is offered as a PPO or HMO

When weighing health plan costs, we want you to be aware of costs you need to look beyond your premium. They include:

  • Copays
  • Coinsurance
  • Deductibles

Let's break it down:

  • Copay

    This is a set amount you pay each time you visit your doctor, get health care services, medications or health care supplies. The amount depends on the type of service it is and what your specific plan covers.

    Often, copays don’t count toward your deductible. You’ll still pay copays after you’ve met your deductible, until you reach your out-of-pocket limit. In some cases, your deductible must be met before copays start.

  • Deductible

    This is the amount you owe for covered health care or prescription drugs before your plan starts to pay for them. There are individual deductible amounts and family deductible amounts. If you go out-of-network for your care, your deductible will be much higher. Your deductible resets each benefit period, which is most often a calendar year.

  • Coinsurance

    The percentage of charges for certain covered health care that you pay after your deductible has been met.

  • Out-of-pocket limit

    The most you’ll pay for care during a benefit period – most often a calendar year – before HAP starts to pay 100 percent of your care.

    All copays, coinsurance and deductibles count toward your out-of-pocket limit.

    Deductibles by plan type

    All HAP plans have individual deductibles and family deductibles, but family deductibles can work differently based on the type of plan you have.

    Embedded

    For family coverage, there are two different deductibles: one for each family member and one for the family as a whole.

    • Deductible for each family member: When a family member meets their individual deductible limit, HAP will start paying the whole amount for covered care for that family member.
    • Family deductible: When the family collectively meets the family deductible, health care for the whole family is covered – even if some family members haven’t met their individual deductibles.
    Aggregate

    There are no individual deductibles. All family members work together to meet the family deductible.

    The deductible can be met by a single family member or a combination of family members. Once it’s met, health care for the whole family is covered.

    Aggregate with a cap

    This works like the aggregate deductible, except each family member has a limit on what they can add to the family deductible.

You can purchase one of these plans during open enrollment or during a special enrollment period, or SEP.

Learn more about SEPs.

You may also be able to get financial assistance, also know as a subsidy, to help pay for your premium.

See if you're eligible for a subsidy.

Health savings account

We offer health plans that can be paired with a health savings account. These plans have higher deductibles. An HSA is simply a bank account for health care expenses. Ours comes with a helpful debit card for easy access to your account. You can use your HSA card to pay for doctor visits, hospital stays, copays, eyeglasses, prescriptions and more.

Some benefits of using an HSA:

  • Contributions are made with pretax money
  • The interest you earn on your money isn’t taxed
  • The money rolls over each year
  • The money goes with you, even if you change health plans or retire

 

Qualified health plans, essential health benefits and plan levels

Qualified health plans

Qualified health plans, known as QHPs, are Affordable Care Act-compliant plans that cover essential health benefits and follow established limits on out-of-pocket costs.

Essential health benefits

Essential health benefits, or EHBs are health care services that must be covered by all qualified health plans. EHBs include the following:

  • Ambulatory patient services
  • Emergency care
  • Hospitalization
  • Maternity and newborn care
  • Mental health and addiction services, as well as behavioral health care
  • Prescription drugs
  • Rehabilitative and habilitative care and devices like speech therapy or hearing aids
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including dental and vision care

Plan levels

Health plans are grouped into categories called metal tiers. They're designed to help you compare health plans with similar coverage. HAP offers silver, bronze and Catastrophic tiers. Each tier shows how you and your plan share costs, The amount you pay for covered services, medications and medical supplies is called cost sharing. The different metal tiers are based on the percentage of health care costs the plan covers. Bronze usually have the lowest monthly premiums and highest out-of-pocket costs - copays, deductibles and coinsurance - while Silver plans usually have higher monthly premiums and lower out-of-pocket costs.

Catastrophic Plans offer coverage for higher-cost services such as hospitalization. This type of plan is available to individuals who are under 30 or who receive a hardship exemption from the government.

 

Ready to take the next step?

Need help? Call (855) 948-4427 to speak with a knowledgeable, certified representative.

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    (855) 948-4427

  • HMO Plans

    (800) 759-3436

  • PPO Plans

    (800) 944-9399