High Deductible Health Plan (HSA-Qualified)

High Deductible Health Plan (HSA-Qualified)

About the Plan
Looking for Health Savings Account (HSA) qualified plan? Farm Bureau Health Plans offers a range of High Deductible Health Plans (HDHP) which meet all federal requirements necessary to open a HSA.

Farm Bureau Health Plans uses UnitedHealthcare ChoicePlus 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.
 
Resources
Provider Network
Schedule of Benefits

  In Network Out of Network

Calendar Year Deductible1

(Unless otherwise indicated, all benefits are subject to the deductible) (In-network and out-of-network deductibles are separate and do not combine)

$1,500 for individual
$2,500 for individual
$3,000 for family
$5,000 for 2-person/3-person/family

$1,500 for individual
$2,500 for individual
$3,000 for family
$5,000 for 2-person/3-person/family

Out of Pocket Maximum(OOP)2

$3,000 for $1,500 deductible
$3,750 for $2,500 deductible
$6,000 for $3,000 deductible
$7,500 for $5,000 deductible

Unlimited

Lifetime Benefit Maximum

Unlimited

Unlimited

Footnotes

  1. Deductible per calendar year.
  2. Once the OOP maximum is met, benefits are provided at 100% for a member for the remainder of the calendar year. This applies to in-network provider services only.

  In Network Out of Network

Coinsurance

20% of eligible charges (plan pays 80% of eligible charges) 40% of eligible charges (plan pays 60% of eligible charges)

Preventive Care Benefits

Well Child Services3 20% Not Covered
Annual OB/GYN Exam4 20% Not Covered
Routine Colonoscopy5 20% 40%
Annual Routine PSA6 20% 40%
Annual Routine Pap Smear7 20% 40%
Mammogram8 20% 40%

Prescription Drug Coverage
Unlimited calendar year maximum per member

  • Generic | Farm Bureau Health Plans will reimburse 80% of the maximum allowable charge, after deductible, when purchased at an in-network pharmacy
  • Brand Name| Farm Bureau Health Plans will reimburse 80% of the maximum allowable charge, after deductible, when purchased at an in-network pharmacy
  • Home Delivery service is also available

Footnotes

  1. Benefits are available, subject to deductible and coinsurance, for a member under the age of 7 (on plan deductibles $3,000 and $5,000) for physical examinations and appropriate immunizations/vaccinations when services are rendered by an in-network provider. Exams not used during the time periods below do not carry over to the next time period.

    Physical Examination Guidelines:

    Physical Examination Guidelines:
    Age Number of exams
    Under age 1 4 exams from birth to the child’s first birthday
    Age 1 2 exams from the child’s first birthday to the child’s second birthday
    Age 2 through 6 1 exam per year (determined by the child’s birthday)
  2. Benefits will be available for one routine OB/GYN exam per calendar year. Services must be rendered by an in-network physician’s office and billed by the in-network provider. Related pathology, including pap smear, which is provided as a part of the routine OB/GYN exam, will be covered when the services are rendered by an in-network physician’s office and billed by the in-network provider. Related pathology that the physician sends to an independent laboratory will be subject to deductible and coinsurance. No benefit is available for routine OB/GYN exams provided by an out-of-network provider.
  3. Benefits will be provided for 1 routine colonoscopy every 4 years for members age 50 and over when provided by an in-network or out-of-network provider, subject to the deductible and coinsurance.
  4. Benefits will be provided, subject to deductible and coinsurance, for 1 routine PSA per calendar year when services are rendered by an independent laboratory or other outpatient setting.
  5. Benefits will be provided for the interpretation of 1 routine pap smear per calendar year when services are rendered by an independent laboratory or other outpatient setting.
  6. Benefits will be provided, subject to deductible and coinsurance, for routine mammography screening provided such examinations are conducted upon the recommendation of the member’s physician. One baseline routine mammogram will be allowed for members between the ages of 35-39. One routine mammogram will be allowed annually for members age 40 and above.

Maternity Benefits will be available after a member’s coverage on a 2-person, 3-person or family contract has been in effect for nine consecutive months. Individual coverage has NO maternity benefits.

Benefits will not be provided for any pre-existing condition until a member has completed a waiting period of at least 12 months. A pre-existing condition is defined in the contract as “An illness, injury, pregnancy or any other medical condition which existed at any time preceding the effective date of coverage under this contract for which: Medical advice or treatment was recommended by, or received from, a provider of health care services; or symptoms existed which would cause an ordinarily prudent person to seek diagnosis, care or treatment.” The pre-existing condition waiting period does not apply to members under the age of 19.

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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