Consumer-Directed Health Plans FAQs

A consumer-driven health plan (CDHP) combines a PPO health plan with a spending account, which can be funded by the employer, the employee or both. Consumer-driven plans give employees more control over how they spend their health care dollars and give them access to online resources to make more informed health care decisions.

Our CDHP includes four major components:

1. Preventive care and wellness visits are paid in full for in-network services—nothing is deducted from the spending account and members don’t need to meet the deductible to enjoy these benefits.
2. Spending account funds are used to pay for covered health care expenses. Money spent from this account counts toward the deductible.
3. PPO benefits begin after members meet the deductible. Members have the freedom to see any doctor without a referral.
4. Online resources help members increase their awareness and knowledge of health issues and help them keep track of their Health Care Account and health care expenses.

A Health Care Account is an employer-funded account used by employees to pay for health care expenses. Charges for covered medical care services are first paid from this account. Money spent from the Health Care Account is also applied toward the deductible. Unspent funds roll over from year to year. If the employee leaves the plan, funds return to the employer.

A Health Savings Account can be established with funds from the employer, the employee or both. Employees can use these funds to pay for covered medical care services and money spent from this account also counts toward the deductible. The employee owns the account and funds remain with the employee if he/she leaves the plan.

A traditional plan generally pays a percentage of the charges for covered medical expenses only after members satisfy a plan deductible or copay. With a spending account, preventive care and wellness services received in network are paid in full before the deductible is met.

Employers can choose to set aside a specific amount of money for employees each benefit year in a Health Care Account, and/or employees can establish a Health Savings Account, which can be funded by the employer, the employee or both. These account funds pay for other covered health care expenses that are also applied to the deductible. Employees pay the remaining deductible amount and then PPO benefits begin.

Unused funds roll over year to year, as long as the employee remains in the plan. If the employee leaves the plan, funds return to the employer. HSA funds roll over year to year and are portable and remain with the employee even if he/she leaves the plan.

If an employee uses all of the funds in their Health Care Account, the employee is responsible for any remaining balance of the deductible before PPO benefits begin.

If there is a remaining balance in the employee’s Health Care Account at the end of the benefit year, it automatically rolls over to the next year and is added to the annual contribution made by the employer. The total balance remains available to the employee as long as he/she participates in the plan; however, to limit your company’s financial liability, the amount that can accumulate in this account can be capped.

If an employee chooses another plan or leaves the company without continuing the coverage (e.g., under COBRA), the balance in the Health Care Account returns to the employer.

HSA funds are portable and remain with the employee even if they leave the plan.

HSA funds are portable and remain with the employee even if he/she leaves the plan.

Our CDHP empowers and engages members to become more active in managing their health and health care costs—potentially saving you money over time. The integrated consumer-driven plan provides a seamless approach to claims processing—automatically paying claims from the Health Care Account or the PPO benefit plan. Employer groups pay as they go. Company funds claims only as they are paid from the Health Care Account, so unused account balances remain part of the company’s cash flow.