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I am planning to open a 'Health Savings Account' account but I am not sure if my plan can be considered as HDHP . I would highly appreciate if someone can kindly have a look at my coverage information below and let me know if my plan qualifies as HDHP for 2017?

  1. Family Deductible (In-Network) : $3000
  2. Individual Out-of-Pocket Maximums (In-Network) : $3000
  3. Family Out-of-Pocket Maximums (In-Network) : $6000
  4. Family Deductible (Out-of-Network) : $3000
  5. Individual Out-of-Pocket Maximums (Out-of-Network) : $15000
  6. Family Out-of-Pocket Maximums (Out-of-Network) : $15000

I believe that my plan is not HDHP since the maximum out of pocket expense in my plan is $6000 against the OOP limit $13,100 mentioned on this link on IRS website.

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    The best way to determine for sure is to simply ask your insurance provider if your plan is an HSA-eligible HDHP. They should know.
    – Ben Miller
    Mar 31, 2017 at 8:49
  • Just ask HR - assuming this is through your employer.
    – Michael
    Mar 31, 2017 at 15:34

2 Answers 2

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In order to qualify as a "High Deductible Health Plan" HDHP, the plan must do both:

  • Have deductibles equal to or exceeding the IRS guidelines
  • Not pay benefits, other than preventive care, until the deductible is satisfied

Your plan may have a deductible in excess of the minimum required by the IRS but if the deductible is waived and you can see your primary doctor for an office visit copay or pick up a prescription for your Generic tier copay, that's not an HSA compatible HDHP. This important distinction is why carriers label HSA compatible plans specifically and why some seemingly "high deductible" plans do not have the HSA designation.

This is the important sentence from IRS Pub 969:

An HDHP may provide preventive care benefits without a deductible or with a deductible less than the minimum annual deductible. Preventive care includes, but isn’t limited to, the following.

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It would appear that you do indeed have an HDHP. The US government health care website specifies that the deductible must be

  • Greater than $1300 for an individual, and
  • Greater than $2600 for a family

The total OOP (which only applies to in-network coverage) must not exceed

  • $6550 for an individual, and
  • $13,100 for a family
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  • Hi, Thanks for pointing out the typo. I do satisfy the first criteria but what about total OOP (in network) limit. Mine is $6000 against the mentioned limit of $13100 ?
    – tek3
    Mar 30, 2017 at 23:31
  • It's a must-not-exceed limit. $6000 is less than $13,100, therefore it does not exceed.
    – Hari
    Mar 30, 2017 at 23:32
  • 'must-not-exceed' limit , in this context, might also mean maximum OOP amount plan need to have to be considered HDHP.
    – tek3
    Mar 30, 2017 at 23:43
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    This is interesting. PPOs can have higher deductibles than $2,600/family, but if you choose that plan it seems like you're not eligible for an HSA. Companies typically have a separate plan labeled HDHP, and I wonder how many people (myself included) don't realize that a PPO with >$2,600/family deductible is classified by the IRS as an HDHP.
    – BobbyScon
    Mar 31, 2017 at 1:44
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    @BobbyScon, because those plans are not HSA compatible because they will generally waive the deductible for a number of services. Primary office visit and prescription drugs are probably the more common services with waived deductibles on non-HSA-compatible plans, even if the SBC or plan summary indicates deductibles that meet or exceed the IRS guidelines.
    – quid
    Mar 31, 2017 at 6:11

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