Question: How does a participant pay for a medical expense? Explain the process.
Answer: It apparently involves four steps, as follows.
- A participant has a health event, visits a pharmacy, or doctor for treatment.
- The participant is responsible for the full cost of his or her health care expenses until the deductible is met. The participant can choose to pay for the medical expense with available funds from their HSA or pay another way and let the HSA grow.
- Once the deductible is met, the plan coverage begins and the participant and the plan pay co-insurance.
- The participant is protected with an out-of-pocket limit. After that limit is reached, the plan pays 100% of covered expenses.
Clearly in this case, the dollar amount of your annual deductible is key to understanding your new effective annual medical costs.
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