How It Works

This is an open access plan that does not require you to choose a primary care physician. You may choose the physician of your choice. However, to receive your maximum benefit, you should select an in-network doctor from participating Florida Blue, Blue Options (Network Blue) providers found at www.floridablue.com.

Plan Details Include:

• Your School District continues to provide employee only medical coverage at no premium cost to you
• Your School District continues to offset a portion of the dependent coverage cost
• Employees have the freedom to choose an in-network or out-of-network service provider at the time of service
• For coverage other than employee only, the family deductible must be met before coinsurance or copayments are applicable
• Your School District contributes $678.52 to your Health Savings Account. Per IRS Regulations, the maximum 2024 HSA contribution is $4,150 for single and $8,300 for family. This maximum includes the $678.52 contributed by DCPS

Note: If you are ineligible to participate in an HSA, you may elect a High Deductible Health Plan and contribute to a Medical FSA.

HSA Funds may be used based on what’s available in the account.

HSA Funds are not use it or lose it. Employees who contribute their own money to the HSA must make that election again at the enrollment session.

Changes to your HSA contribution amount may be made once per month. Contact the DCPS Employee Benefits Department if a request to change is desired.

For Medicare Part D coverage, the prescription drug coverage offered by the High Deductible Health Plan is considered Non-Creditable.

High Deductible Health Plan (HDHP) and Health Savings Account (HSA)

The HDHP is a health insurance plan with lower premiums and higher deductibles than a traditional health plan. It gives you greater control over how you spend your healthcare dollars. This plan blends the best features of a preferred provider organization (PPO) with a tax-advantaged Health Savings Account (HSA) that you can use to pay eligible medical expenses.

Plan benefits

The HDHP allows you to use in-network and out-of-network providers. It is always more cost effective to use in-network doctors, facilities, and other providers. 

Here is how the plan works in-network: 

• You are not required to select a primary care provider (PCP) or get referrals for in-network specialists. 
• You pay 100% of the negotiated, discounted fee for all in-network services and prescription drugs until you reach the annual deductible.
• Once you meet the deductible, the plan pays:
  • 75% of the negotiated, discounted fees for covered in-network, in-patient services, outpatient and ER services
  • 80% of the negotiated, discounted fees for all other covered in-network services except for prescription drugs (see below).
• Your deductible and coinsurance, including prescription drugs, applies to your out-of-pocket maximum. 
• After you reach your out-of-pocket maximum, all covered services, including prescriptions, are paid at 100% by the health plan.

Here is how the plan works out-of-network: 

• You pay 100% of the eligible fees for all out-of-network services until your out-of-network deductible is met. You may be balance billed. 

Note: You will be responsible for all ineligible charges. You will be balance billed for any service that is not covered by Florida Blue. Ineligible charges do not count towards the deductible and they do not count towards the out-of-pocket maximum.

• Once you meet the out-of-network deductible, the plan pays 50% of the allowed amount for covered out-of-network services. 
• Your deductible and coinsurance applies to your out-of-pocket maximum. 
• After you reach your out-of-pocket maximum, all covered services are paid to 100% of the allowed amount.

Health Savings Account 

A Health Savings Account (HSA) is an interest-bearing spending and savings account that you use to pay for eligible healthcare expenses using tax-free dollars. You must be enrolled in the High Deductible Health Plan (HDHP) to contribute to the HSA.

Qualifying for an HSA

In order to open an HSA, you must be “HSA Eligible.” IRS guidelines say that an HSA Eligible Individual is anyone who:

• Is covered by an HSA-qualified High Deductible Health Plan (HDHP). 
• Cannot be claimed as a dependent by another person.
• Isn’t covered by some sort of additional, non-HDHP insurance program. 
• Is under age 65 and not entitled to Medicare.

Annual HSA contributions

The IRS sets limits for how much you can contribute to an HSA in each calendar year. These limits, established by the federal government and subject to change, are tied to the rate of inflation. Over-contributing to your HSA leads to a tax penalty on excessive funds. 

The 2024 plan year contribution limit is $4,150 for single and $8,300 for family.
Payer Provision Rule: no individual can pay more than $9,450 on the individual plan. 

Catch-up contributions

HSA owners age 55 and older can make additional contributions to their HSA called “catch-up contributions.” For 2024, the allowed catch-up contribution is $1,000. 

Important facts about High Deductible Health Plans (HDHP) with HSA

The law stipulates that in order to have a Health Savings Account (HSA) you must participate in a qualified High Deductible Health Plan (HDHP). However, if any of the following situations pertain to you, you can participate in the HDHP but NOT the HSA.

• If you enrolled in Medicare or Medicaid, you cannot open an HSA.
• If you have Tricare, you cannot have an HSA because Tricare does not offer an HDHP.
• If you are receiving medical care from the Veteran’s Administration for a non-service related disability, you cannot have an HSA.
• Flexible Spending Accounts (FSA) which cover all medically necessary expenses make you ineligible for an HSA.
• Employees may not contribute to an HSA until their FSA account is empty.
• If a spouse participates in a private healthcare plan, Medicare, Medicaid, or Tricare, this will make you ineligible for a HSA if you are also covered.
• If you no longer have an HSA qualified HDHP, you cannot contribute to your HSA, but you can maintain and spend the already deposited funds as stipulated by law.

Use it or save it

Your HSA is your personal account, and you can choose how you want to use it. You can choose to use the funds as you need them for medical care, or pay for medical expenses with other non-HSA funds. You may save the funds for upcoming expenses.

Banking or custodial fees

A $2.50 monthly custodial fee will be applied to the member’s HSA account. A $5.00 monthly fee will be applied if you are no longer enrolled in an employer sponsored HDHP, but continue to maintain your PayFlex HSA.

HDHP Plan Bi-Weekly Contribution Rates