HDHP + HSA
View 2021 Enable Midstream Benefit Rates
The High-Deductible Health Plan (HDHP) paired with a Health Savings Account (HSA) option provides medical coverage for you today and lets you save tax-free dollars for future medical expenses – even into retirement.
Enable Midstream jump-starts your savings by contributing money to your HSA. Enable will contribute $500 if you select Employee Only coverage or $1,000 for all other tiers. You can contribute tax-free dollars as well, up to $3,600 for an individual or $7,200 for a family. In any year that you are age 55 or older, you may contribute up to an additional $1,000. (These are 2021 limits and limits may change at any time, see irs.gov for more information) Fidelity handles the administration of your HSA.
If you are not eligible for an HSA, you may choose to add an FSA (Flexible Spending Account) to your HDHP instead.
Here are a few highlights of the HDHP + HSA Plan.
- Portability: If you should leave Enable Midstream, you may take your HSA with you.
- Lower taxes: You can save for your medical future as well as cut your tax bill. Your contributions are tax-free.
- Build your savings: Any money left in your HSA account at the end of the year rolls over to the next year.
Generally, you are not eligible to open or contribute to an HSA if you are covered under a health plan that is not a high deductible health plan. You may not be eligible to open or contribute to an HSA if:
- You are married and your spouse has non-HDHP coverage that covers you.
- You are enrolled in Medicare or Tricare coverage.
- You are eligible for Veterans Affairs medical benefits and have received medical benefits from the Veterans Affairs during the previous three months.
- You are covered by a general purpose health Flexible Spending Account (general purpose health FSA) or health reimbursement arrangement, including coverage though your spouse, that pays or reimburses medical expenses before you meet your HSA-eligible health plan’s deductible.
Please consult with your tax advisor if you have further questions.
How the Plan Works
When you need medical care, you can use your available HSA dollars or pay out of pocket. Once you've met your deductible, your HDHP benefits begin. Check out the Deductible in Action for a real life example. You'll pay just 10 percent for your in-network covered services. You'll also pay copays for prescription drugs. If you reach your out-of-pocket maximum, you won't pay anything for covered services for the rest of the year.
2021 Summary of Benefits & Coverage – Individual
2021 Summary of Benefits & Coverage – Individual + Family
2020 Summary of Benefits & Coverage – Individual
2020 Summary of Benefits & Coverage – Individual + Family
HDHP Paired with HSA Plan Details
| Plan Detail | In-Network* | Out-of-Network* |
|---|---|---|
|
Contributions to Your Health Savings Account or Flexible Spending Account |
$500 Employee only $1,000 All other coverage levels
|
|
|
Deductible |
$1,500 Employee only |
$3,000 Employee only |
|
Coinsurance |
Plan pays 90% You pay 10% |
Plan pays 70% |
|
Out-of-Pocket Maximum |
$4,000 Individual $8,000 Family |
$8,000 Individual $16,000 Family |
|
Preventive Care |
Covered at 100% |
30% after deductible |
|
Primary Care Office Visit |
10% after deductible
|
30% after deductible |
|
Specialist office visit |
10% after deductible |
30% after deductible |
|
Urgent Care |
10% after deductible |
30% after deductible |
|
Emergency Room |
10% after deductible |
You meet your deductible, then pay 30% coinsurance. 10% coinsurance when emergency room is used for true emergency care. |
|
Hospitalization |
10% after deductible |
30% after deductible |
|
MDLIVE |
$44 per visit until you meet your deductible, then 10% |
N/A |
|
MDLIVE - Behavioral Health |
$85-$175 per visit depending on the services received until you meet your deductible, then 10% |
N/A |
| Prescription Drugs | You meet your deductible, then pay applicable copays or coinsurance | |
|
Pharmacy-filled Generic |
$10 copay after deductible |
30% after deductible |
|
Pharmacy-filled Preferred |
$25 copay after deductible |
30% after deductible |
|
Pharmacy-filled Non-Preferred |
$45 copay after deductible |
30% after deductible |
| Mail-ordered/Smart90 Generic (90-day supply) |
20% after deductible |
N/A |
|
Mail-ordered/Smart90 Preferred |
20% after deductible |
N/A |
|
Mail-ordered/Smart90 Non-Preferred |
20% after deductible |
N/A |
* In-network and out-of-network deductibles are separate. Only in-network services apply toward your in-network deductible, and only out-of-network services apply to your out-of-network deductible.
** Family coverage includes employee + spouse, employee + child(ren), and employee + family.
HDHP and PPO Plan Comparison
| Plan Detail | HDHP | PPO |
|---|---|---|
|
|
In-Network |
In-Network |
|
Deductible* |
$1,500 Employee only $3,000 Family** |
$750 Individual $1,500 Family** |
|
Enable Contribution HSA or FSA |
$500 Employee Only $1,000 Family** |
N/A |
|
Coinsurance (after deductible) |
Plan pays 90% You pay 10% |
Plan pays 80% Plan pays 20% |
|
Out-of-Pocket Maximum |
$4,000 Individual $8,000 Family** |
$3,000 Individual $7,500 Family** |
|
Preventive Care |
Covered at 100% |
Covered at 100% |
|
Primary Care Office Visit |
10% after deductible |
$25 copay |
|
Specialist office visit |
10% after deductible |
$40 copay |
|
Urgent Care |
10% after deductible |
$75 copay |
|
Emergency Room |
10% after deductible |
20% after deductible plus a $250 copay. If admitted to the hospital, the $250 copay is waived |
|
Hospitalization |
10% after deductible |
20% after deductible |
|
MDLIVE |
$44 per visit until you meet your deductible, then 10% |
$10 copay |
|
MDLIVE - Behavioral health |
$85-$175 per visit depending on the services received until you meet your deductible, then 10% |
$10 copay |
|
Pharmacy-filled Generic (34-day supply) |
$10 copay after deductible |
$10 copay |
|
Pharmacy-filled Preferred/Formulary (34-day supply) |
$25 copay after deductible |
$35 copay |
|
Pharmacy-filled Non-Preferred/Formulary (34-day supply) |
$45 copay after deductible |
$60 copay |
|
Mail-ordered/Smart90 Generic (90-day supply) |
20% after deductible |
$20 copay |
|
Mail-ordered/Smart90 Preferred/Formulary (90-day supply) |
20% after deductible |
$70 copay |
|
Mail-ordered/Smart90 Non-Preffered/Non-Formulary (90-day supply) |
20% after deductible |
$120 copay |
*In-network and out-of-network deductibles are seperate. Only in-network services apply toward your in-network deductible, and only out-of-network servcies apply to your out-of-network deductible
**Family coverage includes employee + spouse, employee + child(ren), and employee + family
For detailed plan information, visit the Plan Documents page on the HUB. You may also request a copy of the plan document by contacting the HR Service Center at 844-687-4748 (844-OUR-HR4U) or HR@enablemidstream.com.