Advantage PPO Saver Overview
How Advantage PPO Saver Works
Not all health plans work the same way. This website will explain how the Advantage PPO Saver plan works, so be sure to read through it carefully to understand your plan.
You can also visit mytuftshealthplan.com, our secure members-only site, to learn the details of the specific plan your employer has chosen for you. And be sure to read your Benefit Document, available at mytuftshealthplan.com, to see a complete list of your specific plan’s covered and non-covered benefits.
Knowledge is power, and knowing how your plan works will give you the power to plan for and control your out-of-pocket costs.
The goal is more affordable healthcare.
Our goal at Tufts Health Plan is to enable every employer to offer affordable healthcare to their valuable employees. So we try to provide as many options as possible.
The Advantage PPO Saver plan is one such option, and it in turn offers options of its own. It is a high deductible health plan (HDHP) as defined by the Internal Revenue Service, and may be paired with a Health Savings Account (HSA) available through other institutions, including local banks. HSAs are accounts that can be used to pay medical expenses, while offering certain tax advantages. The IRS lists the benefits of an HSA as follows:
- You can claim a tax deduction for contributions you, or someone other than your employer, make to your HSA even if you do not itemize your deductions on Form 1040.
- Contributions to your HSA made by your employer (including contributions made through a cafeteria plan) may be excluded from your gross income.
- The contributions remain in your account until you use them.
- The interest or other earnings on the assets in the account are tax-free.
- Distributions may be tax-free if they are used to pay for qualified medical expenses.
- An HSA is “portable.” It stays with you if you change employers or leave the work force.
Please read IRS Publication 969 for more information.
Here’s how it works.
You enroll in an Advantage PPO Saver plan, then set up a Health Savings Account (HSA) at any financial institution that provides HSA services. You decide how much you’d like to contribute (up to maximum IRS limits), either one-time or on an ongoing basis. The account rolls over automatically every year, and you are eligible to contribute to the account as long as you are enrolled in an HDHP-compliant medical plan. And you can keep this account even if you change jobs.
You can learn more specific details about the Advantage PPO Saver medical plan by reading your Benefit Document. It’s hard to know what the future holds, but with the Advantage PPO Saver plan and an HSA, at least you’ll be a bit more prepared.
This information has been provided for informational purposes only. While we aim to ensure that content is current, accurate and complete, Tufts Health Plan makes no representations or warranties regarding its accuracy or completeness, and the information provided should not be construed as legal or tax advice or as a recommendation of any kind. Please consult your own tax advisor or legal counsel with respect to your individual circumstances and needs.
The Advantage PPO Saver plan incorporates a fee structure that does require some cost-sharing on your part. This cost-sharing is primarily in the form of two components: the deductible and the copay.
The deductible is the amount you must pay before your insurance kicks in. We’re speaking here only of the services that are subject to a deductible. Not everything you go to the doctor for is subject to the deductible. In other words, there are some things you can go to the doctor for that are covered right away, without your having to meet your deductible. These are generally preventive services, but they’re spelled out in greater detail in the second section of this Member Kit.
The deductible for your specific plan can vary. The amount is chosen by your employer, based on how much the entire plan costs them. We work closely with your employer to provide the best possible plan at the best possible cost for both employer and employee.
Here’s an example of how the deductible works. Let’s say your plan has a $1000 family deductible. You’re working in the yard, you have an accident, and you have to make a trip to the emergency room. Your maximum responsibility would be $1000. Now let’s say you or another family member have another accident in the same plan year. Your deductible of $1000 for the plan year has already been met, so you don't have to worry about any deductible amount.
Regardless of the status of your deductible, there are some services that may also require a copay. A copay is a fee that you pay as partial payment for certain services. For instance, a visit to the doctor’s office often requires a copay. That means you pay, for example, $20 out-of-pocket as your copay.
Whether or not your deductible has been met, if a copay is required for the type of medical service you want, you are responsible for the copay. Again, the best way to control out-of-pocket costs is to read this Member Kit so you understand what you are and what you are not responsible for.
And you can always find out exactly what your specific plan covers by reading your Benefit Document or accessing your secure member account at mytuftshealthplan.com.
There’s one more component of the Advantage PPO Saver plan’s fee structure that bears mentioning. It’s called coinsurance, and it applies primarily to durable medical equipment (such as a wheelchair or crutches), hearing aids, low-protein foods and prosthetics. If you require any of those items, you would share a percentage of the cost.
In some cases, coinsurance may also apply to other items. You can find the specifics of your plan, including the exact amount of your coinsurance, by reading your Benefit Document or by visiting mytuftshealthplan.com.