Coverage and cost-sharing

494 words | 2 minute read


The Yuzu plan is an ACA and ERISA compliant plan designed to be comparable to Silver or Gold plans
Your plan is “full access”, meaning you have the freedom to choose any healthcare provider, though GoodRx Telehealth and HealthSmart are recommended as preferred options. See "Choosing Medical” for more details
Your plan has a deductible of $2,400 and a MOOP (”maximum out of pocket”) of $7,200. However, most employers choose to contribute to their employees’ HSAs to offset all or most of this potential OOP spend, resulting in a “Net $0 Deductible

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:

One annual checkup (aka “well-visit”) including blood work
Vaccines (except those only obtained for travel)
Birth control
Disease screenings (e.g. cancer screenings at qualified ages)

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.

The bottom line

With employer contributions to your HSA, most Yuzu members have a “Net $0 Deductible” plan, which is even better than a typical high-end plan in that you keep any money you don't spend each year via your HSA 🤑

Contact us

If you have any questions about any of your health benefits, please text or call us at ‪203-208-9898‬, or email us at We will respond to you ASAP, in most cases within minutes.