PennCare HDHP Insurance Plan – Eligibility: 0.5 FTE or greater – benefits become effective on the first day of the month on or after your date of hire
Group Number:
If you are covered under the PennCare PPO, you pay the least when you visit a PennCare provider, more when you visit an Independence Blue Cross (IBX) in-network provider, and the most when you visit an out-of-network provider. When you see a PennCare provider, you have no deductible and a lower out-of-pocket maximum, and you can receive preventive care, inpatient hospital care, and advanced radiology care at zero cost.
Note: Insurance plan year is July 1 – June 30
Section Links
What Does High Deductible Health Plan (HDHP) Mean?
In a HDHP, your medical and prescription drug expenses must exceed the amount of your deductible in order to receive reimbursement from the Plan. In other words, the Plan pays for all covered expenses incurred after you have met the annual deductible amount and out-of-pocket expense maximum limits for individual and/or family (depending on the elected coverage level).
Benefits of a Healthy Lifestyle
As a participant in the PennCare HDHO Plan, Preventive Care visits are covered 100%, at PennCare providers and IBX in-network providers, without having to meet your annual deductible
Note: To be considered “preventive care”, the claim must be coded as a wellness visit and the service must be performed by PennCare providers or IBX in-network providers. Preventive Care visits include annual checkups and screenings for each enrolled member of your family.
Am I Eligible to Participate in the PennCare HDHP Plan and/or HSA?
Who is Eligible… Employees enrolled in the PennCare HDHP who meet the following requirements:
- Do not have a Health Care FSA
- Are not enrolled in Medicare or TRICARE
- Are not claimed as a tax dependent of another individual
- Do not have medical coverage other than an HDHP, including coverage under their spouse’s or domestic partner’s plan
Quick Links:
Helpful Links
PennCare PPO Insurance Plan – Eligibility: 0.5 FTE or greater – benefits become effective on the first day of the month on or after your date of hire
Group Number:
With the PennCare PPO, the cost you pay depends on the provider network you choose and your coverage level. You may move between these networks throughout the year, and eligible expenses incurred in the PennCare and IBX networks can help satisfy the in-network deductible. If you see a provider outside the PennCare and IBX networks, you will have to meet the out-of-network deductible.
Note: Insurance plan year is July 1 – June 30
See below for some highlights of the PennCare PPO Health Insurance Plan:
- Lower deductible – Higher per-pay-check employee contribution.
- You pay a copay, which is a fixed dollar amount, for most in-network services.
- You pay a flat copay for Prescription drug costs and do not need to meet a deductible.
Embedded deductible — for employee + spouse/child(ren) and family coverage, after an individual meets his or her deductible, the plan will start paying benefits for that person.
Embedded out-of-pocket maximum — for employee + spouse/ child(ren) and family coverage, after an individual meets his or her individual limit on how much they have to pay in health care costs in a year, otherwise known as their out-of-pocket maximum, the PennCare PPO will start to cover 100% of their eligible medical expenses for the remainder of the plan year.
Benefits of a Healthy Lifestyle
Preventive Care is covered 100% without having to meet your annual deductible when participating in the PennCare PPO Plan.
Note: To be considered “preventive care”, the claim must be coded as a wellness visit and the service must be performed by PennCare providers or IBX in-network providers. Preventive Care visits include annual checkups and screenings for each enrolled member of your family.
Paying for Qualified Medical Expenses
Employees enrolling in the PennCare are eligible to enroll in a Health Care Flexible Spending Account (FSA) for out-of-pocket expenses associated with deductibles, co-payments, and co-insurance.
Quick Links:
Helpful Links
Medical Plans At A Glance & Employee Premiums
Medical Plans At A Glance
Employee Premiums
Penn Medicine OnDemand – Eligibility: Employees and Dependents (14+) enrolled in either the PennCare HDHP or PennCare PPO health plan
Penn Medicine Lancaster General Health offers a virtual health care service, known as Penn Medicine OnDemand, to employees and dependents 14+ currently enrolled in either the PennCare HDHP or PennCare PPO health plan.
OnDemand is offered to LG Select participants at no cost. OnDemand is offered to LG Consumer participants for $49 / visit until the deductible is met; following deductible satisfaction, a $20 copayment is required per visit.
This service provides virtual visits for minor illnesses and injuries, such as sore throat, pink eye, urinary tract infections, rashes and headache. The service, managed by a nurse practitioner, can be reached 24 hours a day, seven days a week by calling 717-544-2222. To facilitate a video visit, employees are encouraged to download the MyChart app, available at MyLGHealth.org, prior to calling.
Behavioral Health coverage for the medical plan is provided by Quest Behavioral Health.
Quest administers mental health and Substance Use benefits to employees and their family members. Quest provides mental health and Substance Use services that include inpatient, Partial Hospitalization, intensive Outpatient, and traditional Outpatient with licensed Providers.
Quest Care Managers are available 24 hours a day / 7 days a week for urgent or emergent concerns. Services are available for employees, their families, and Providers to assist in determining the appropriate level of care and what resources are available.
Quest Care Managers can assist with referrals to a wide range of services, provide guidance on how to access treatment, and determine what is needed for Authorization.
If you elect Medical Plan coverage under the available Penn Medicine Medical Plans, you are eligible to receive the Behavioral Health Benefits described under this summary plan description for the PennCare HDHP or PennCare PPO health plan.
Fertility Services
Fertility services including medication ($30,000 lifetime maximum) are only available through a PennCare Network provider, UPHS’s medical programs. This includes service providers from LG Hospital, WBH and Penn Fertility Care (includes HUP, PA Hospital, Penn Presby Medical Center and CHOP). Employees must be enrolled in a UPHS medical plan.
