Coverage and cost-sharing
TL;DR
Like other health plans, Yuzu requires the member to contribute to the cost of care through cost-sharing. Cost-sharing is complicated, but easiest to think about if you visualize this graph.
Stage 1: “Pre-deductible” Care
Only preventative care is covered before the member hits their deductible. Preventative care is healthcare that is an investment in keeping you healthy rather than a response to an illness or accident. This means the following services must be covered in-network:
This definition is standardized and set by the government and doesn’t vary much between plans. For a plan to be a high deductible health plan (HDHP) and permit an HSA, the IRS enforces that no other services (including emergency services) be covered pre-deductible.
Stage 2: Paying Out of Pocket up to Your Deductible
For costs not considered preventative care, your plan does not kick in until you hit your deductible. Yuzu has HSA integrations that make it easy to pay for this care from the contributions your employer set aside for you or that you contributed yourself.
Claims for covered services must still be submitted to Yuzu so that Yuzu can credit the spending towards your deductible. View your Summary Plan Document (SPD) or Summary of Benefits and Coverage (SBC) within the Yuzu member app for details about what is covered by Yuzu.
Stage 3: The Coinsurance Corridor
After you’ve hit your deductible, your plan starts to kick in and you are only required to pay the co-insurance percentage of the cost of care and your plan pays the rest. You may still use your HSA to pay for your coinsurance
Stage 4: After hitting the MOOP
After you’ve hit your Maximum Out of Pocket spending, your plan will pay entirely for covered benefits.
