High Deductible Health Plans (HDHP)

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High Deductible Health Plans (HDHP) Overview

High Deductible Health Plans (HDHP) Overview

Our High Deductible EPO and PPO give you the freedom to see providers within the network without a referral. Members with a High Deductible PPO may also visit non-participating providers at an out-of-network benefits level.

Our High Deductible EPO and PPO plans include:

  • No primary care physician or referrals required
  • No charge for many preventive health care services including annual physicals and screenings provided in-network
  • The choice to see a non-participating provider (PPO only)
  • Access to a national network of more than half a million providers
  • Worldwide coverage for emergency care

How it Works

A high deductible PPO plan from CDPHP Universal Benefits, Inc. (CDPHP) gives you the freedom to visit CDPHP doctors without a referral and see non-participating doctors if you choose. It all depends on your needs, your wants, and your budget – you make the call.  

FAQs

Q. What should I do if I have an emergency when I’m out of the area?

A. If you have an emergency outside the CDPHP service area, go to the nearest hospital emergency room. CDPHP will cover the hospital emergency room bill in full — minus your copayment or deductible and coinsurance.

Take Control

How It Works

A high deductible plan means that you pay for most health care expenses up to a certain dollar amount before the insurance policy begins to cover them. Only expenses for covered benefits count toward the deductible.

A few things to remember:

  • Amounts paid toward copayments or coinsurance do not count toward satisfaction of the deductible.
  • Only expenses for benefits covered under the plan count toward the deductible.
  • The family deductible applies to all plans that are not individual coverage. If you have a family deductible, no member of your family may receive insurance coverage for services unless the entire family deductible has been satisfied either by an individual or by a combination of covered family members.
  • Because it is so important that you keep track of your deductible, we suggest that you retain all receipts for health expenses, including any copayment or coinsurance amounts. These will enable you to document payments that should be credited to your deductible or maximum.

HDHP Plan Tools

HDHP Plan Tools

Here are some tools that might be helpful to you if you have a high-deductible plan.

Tip Sheets - Find tips to help you understand everything in your plan from receiving care, to what you need to do for prior authorization.

Handbooks - Download these complete guides to your HDHP coverage and all of the services available to you in these flexible plans.

Secure Online Site Access for Members
Get answers to many of your questions, check your claims, update your address, order new ID cards, and more – all online, 24/7.

Find-A-Doc and Find-A-Doc Mobile
Search for an in-network or out-of-network provider.

Forms
Find any forms you may need to complete for care with your HDHP plan.

Is Your Prescription Covered? 
Use a helpful drug search tool to find information on coverage, pricing, and prescription details.

HDHP FAQs

HDHP FAQs

Get answers to the most common questions about High Deductible plans.

Q. What should I do if I have an emergency when I’m out of the area?

A. A medical emergency is defined as a sudden illness or injury so severe that the average person would believe that immediate medical attention is needed to avoid serious health damage or bodily harm.

If you have an emergency outside the CDPHP service area, go to the nearest hospital emergency room. CDPHP will cover the hospital emergency room bill in full — minus your copayment or deductible and coinsurance. If the situation is urgent but not an emergency, such as a sore throat, sprain, or infection, contact the CDPHP Resource Coordination Department at 1-800-274-2332 for advice in obtaining the care you need.

Q. How do I access my out-of-network benefits?

A. With your high deductible PPO plan you have coverage for care from non-participating providers but you should understand that your costs will be higher than seeking care within the network. Please refer to the benefit materials provided to you at the time of enrollment for specifics on your out-of-pocket costs. These vary according to the plan purchased by your employer group.

Q. How do I submit a claim?

A. If you’ve received a covered service and the provider of medical services requested that you pay the charge at the time of service, send a completely itemized bill to our office so that you receive the maximum available benefits. That bill should include:

  • Provider’s name, address, telephone number, and tax ID number
  • Date of service
  • Name of each procedure/procedure code, including the name of any drugs
  • Charge for each procedure
  • Diagnosis
  • Receipt for any payment made
  • Member’s name and ID number

Please send claim to: Capital District Physicians’ Health Plan, Inc., P.O. Box 66602, Albany, NY 12206-6602.

Note: this same process applies to claims for care you received out of the country.

Q. Can I order my prescription drugs by mail?

A. Yes. The CDPHP Mail Order Prescription service is available to members who have a prescription drug rider and who take maintenance medication.