FBHP Silver S01CPH (HSA-Qualified)

FBHP Silver S01CPH (HSA-Qualified)



About the Plan

The Silver HSA-eligible plan provides mid-level costs, deductibles and out-of-pocket maximums with the option of paying for coverage from your Health Savings Account.

Farm Bureau Health Plans uses UnitedHealthcare Choice Plus Network. Please keep in mind that in-network payments are based on negotiated fees. If an out-of-network provider is used the member's liability will increase significantly. 

Not everyone is eligible for an HSA. Click here for more information about HSA’s, visit  or contact Health Equity at 866-346-5800.

Please use this prescription drug list to identify the drugs covered by Farm Bureau Health Plans ACA-compliant plans. Use this as a guide to help manage the overall cost of prescription drug benefits.

Resources
Provider Network
Prescription Drug List
Summary Of Benefits and Coverage

Effective January 1, 2017 In-Network Out-of-Network
Calendar Year Deductible (Individual) $2,600 $5,200
Calendar Year Deductible (Family) $5,200 $10,400
Out-of-Pocket (Individual) $4,700 $14,100
Out-of-Pocket (Family) $9,400 $28,200

Effective January 1, 2017 In-Network Out-of-Network
Coinsurance (except as otherwise listed) 20% (Plan pays 80%) 50% (Plan pays 50%)
Primary Care Visit to treat an injury or illness 20% coinsurance after deductible. 50% coinsurance after deductible plus amounts over the allowed amount 
Specialist visit

20% coinsurance after deductible

50% coinsurance after deductible plus amounts over the allowed amount

Other practitioner office visit

20% coinsurance after deductible

50% coinsurance after deductible plus amounts over the allowed amount

Preventive care/screening/immunization

No Charge

50% coinsurance after deductible plus amounts over the allowed amount

Preventative Benefits 0% (Plan pays 100%) 50% after deductible (Plan pays 50%)
Inpatient (After Deductible) 20% (Plans pays 80%)  50%  (Plan pays 50%)
Other Covered Services (After Deductible) 20% (Plans pays 80%)  50%  (Plan pays 50%)
Routine Dental Pediatric dental check-up: 
No charge
Pediatric dental check-up: 
50% coinsurance after deductible plus amounts over the allowed amount
Routine Vision Pediatric eye exam:
No charge
Pediatric eye exam:
No charge
Prescription Drug Coverage Generic:
$3 copay after deductible

Preferred brand: 
$35 copay after deductible

Non-preferred brand: 
$150 copay after deductible

Generic and Preferred specialty
$300 copay after deductible

Non-preferred specialty
$350 copay after deductible
Generic: 
50% coinsurance after deductible, plus amounts over allowed amount

Preferred brand: 
50% coinsurance after deductible, plus amounts over allowed amount

Non-preferred brand: 
50% coinsurance after deductible, plus amounts over allowed amount
Emergency Room Services 20% coinsurance after deductible 20% coinsurance after deductible

Ready to Enroll?

Farm Bureau Health Plans is proud to offer quality coverage at an affordable cost.

Medicare Supplements Insured by TRH Health Insurance Company, Columbia, TN.
TRHH-POST-POLA-FL14-174; TRHH-POST-POLB-FL14-175; TRHH-POST-POLC-FL14-176; TRHH-POST-POLD-FL14-177; 
TRHH-POST-POLF-FL14-178; TRHH-POST-POLG-FL14-179; TRHH-POST-POLM-FL14-180; TRHH-POST-POLAN-FL14-181
Not connected with or endorsed by the U.S. or state government. This is a solicitation of insurance. A representative of TRH Health Insurance Company may contact you. Benefits not provided for expenses incurred while coverage under the policy is not in force, expenses payable by Medicare, non- Medicare eligible expenses or any Medicare deductible or copayment/coinsurance or other expenses not covered under the policy.

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