Group Medical Benefits

At TPS Group Medical, we understand that choosing the right health plan for you and your family can be overwhelming. That's why we offer High Deductible Health Plans (HDHPs) that combine traditional medical coverage with a Health Savings Account (HSA) or a Health Reimbursement Arrangement (HRA) to help you save for future medical expenses while providing flexibility and discretion over how you use your healthcare dollars today.

HDHPs have higher annual deductibles and out-of-pocket maximum limits than other types of health plans. With an HDHP, the annual deductible must be met before plan benefits are paid for services other than in-network preventive care services, which are fully covered. HDHPs also protect you against catastrophic out-of-pocket expenses for covered services. Once your annual out-of-pocket expenses for covered services from in-network providers, including deductibles, copayments, and coinsurance, reaches the pre-determined catastrophic limit, the plan pays 100% of the allowable amount for the remainder of the calendar year. This means that you won't incur additional out-of-pocket medical expenses for in-network care, including doctor visit co-payments and prescriptions which are excluded from some traditional plan's catastrophic limits.

One of the key benefits of our HDHPs is the HSA. An HSA allows you to pay for current health expenses and save for future qualified medical expenses on a pre-tax basis. Funds deposited into an HSA are not taxed, the balance in the HSA and interest grows tax-free, and that amount is available on a tax-free basis to pay your qualified medical expenses, including your copays, coinsurance, and deductible. When you enroll in an HDHP, the health plan determines whether you are eligible for an HSA or an HRA based on the information you provide.

To be eligible for an HSA, you must be enrolled in an HDHP and not covered by another health plan (including a spouse's health plan, but not including specific injury insurance and accident, disability, dental care, vision care, or long-term care coverage).

You must also not be enrolled in Medicare, not in receipt of VA or Indian Health Service (IHS) medical benefits within the last three months, not covered by your own or your spouse's flexible spending account (FSA), and not claimed as a dependent on someone else's tax return.

With an HDHP and an HSA, you can make additional voluntary tax-deductible contributions into your HSA, up to an allowable amount determined by IRS rules. Your HSA dollars earn tax-free interest. When you need preventive care, your plan will provide it without cost to you, when you use participating plan providers. When you need non-preventive health care, you pay the full cost of that care with funds from your HSA or out-of-pocket, up to your plan's high deductible. Health plans negotiate discounts with providers who participate in their health plan network. It is a good idea to obtain your Explanation of Benefits (EoB) to obtain your cost share before paying your provider.

At TPS Group Medical, we believe that HDHPs with HSAs are an effective way to help you manage your healthcare costs while still providing access to quality care. Our experienced team is available to answer any questions you may have about our HDHP options and how they can benefit you and your family.