Health Account Plan and Health Account

The Health Account Plan (HAP) is available through Anthem and Kaiser, depending where you live. It offers targeted free preventive and primary care so you can be sure you’re getting the right care, right away:

The HAP also comes with the PG&E-funded Health Account to help you cover your health expenses.

Benefits under both Anthem and Kaiser are mostly the same, with a few exceptions. To compare Anthem and Kaiser benefits, log into your Mercer BenefitsCentral account and click on the Medical tab.

How the HAP and Health Account Work Together

The Health Account Plan (HAP) helps build a better you by offering some free preventive and primary care – so you can be sure you're getting the right care right away. Each calendar year, you have to pay 100% of your covered services until you meet the annual deductible. Then, the HAP will start to pay its share of benefits for covered expenses.

You can use the Health Account to pay for eligible health care expenses except premiums:

Important! You can use the Health Account to help pay for your dependents' eligible health care expenses only if they're enrolled in your medical plan.

If you earn maximum Health Account Credits, you'll have enough to pay the entire HAP deductible.

After the annual deductible has been satisfied you pay 10%–20% of most covered services and the plan pays the rest. That’s called coinsurance. But you only have to pay coinsurance up to a point because you are protected by the out of pocket maximum. You’ll never be responsible for paying more for covered expenses that the out of pocket maximums: $2,400 for single coverage $4,800 for family coverage. Your out-of-pocket maximum is equal to your deductible plus coinsurance payments.

What the Health Account reimburses

You can use your Health Account to pay for eligible out-of-pocket medical, prescription drug, mental health and substance abuse, dental and vision expenses. For details, visit the IRS website and view IRS Publication 502, Medical and Dental Expenses. Or review the Anthem list of eligible expenses or the Kaiser list of eligible expenses. You can’t use your Health Account to pay for health care premiums, gym memberships and most cosmetic procedures.

How many Health Account Credits you get each year

How many Health Account credits you’ll get—provided in full by PG&E—depends whether you have single or family coverage. You can earn more credits by taking a health screening, testing tobacco-free, or completing Provant’s tobacco cessation program.

Annual Health Account credits

If you enroll in the HAP Single coverage Family coverage
You automatically get: $500 $1,000
If you take an annual health screening: $250 $500
If you test tobacco-free or complete Provant’s telephonic tobacco cessation program: $250 $500
Yearly total: $1,000 $2,000
ROLLOVER CREDITS: Any Health Account credits you don’t use will roll over into next year’s account in January of the next year, giving you an even bigger balance to spend.

If you move from single to family coverage midyear, you’ll get the family level of credits.

Who qualifies for additional credits?

If your base rate of pay is lower than $27.75 as of January 1, 2019, you’ll get extra Health Account credits on January 1 of that year. If you get a raise later in the year, you can still keep the extra Health Account credits.

Annual Deductible

Each year, you're responsible for paying 100% of covered charges until you meet the annual deductible:

  • $1,000 for single coverage
  • No more than $2,000 for family coverage (maximum $1,000 per person)

Any HAP services that aren't subject to the annual deductible or that are free—like some preventive and primary care—don't apply to your deductible. Most medical, prescription drug, and mental health and substance abuse services do apply to the deductible. You can use the Health Account to pay those costs.

Out-of-Pocket Maximum

The annual out-of-pocket maximum works like a financial safety net by limiting how much you pay for eligible expenses each year. It includes amounts you pay toward the annual deductible — but it does not include any penalty charges, amounts in excess of the reasonable and customary amounts for out-of-network charges, or charges for services that aren’t covered.

If you earn the maximum amount of Health Account credits, it can pay for your entire medical deductible-which is a big part of your annual out of pocket maximum.

There are no pre-existing conditions exclusions or lifetime benefit maximums except for infertility services, which has a cap of $7,000.

TIP: If you’ve met your annual deductible or out-of-pocket maximum, you may want to get prescription refills or take care of upcoming doctor visits or treatments before January 1, when your deductible and out-of-pocket maximum resets to zero.

Annual Deductible Annual out-of-pocket maximum
$1,000 for single coverage $2,400 for single coverage
$1,000 per person and $2,000 total per family $4,800 per family
Remember: Deductible + Coinsurance = Out of pocket maximum

Single Coverage Example:

You have a life-saving operation that costs $25,000. You have single coverage, so your annual deductible is $1,000. You pay the first $1,000 (your deductible).

Then you pay 20% of the remaining charges (your coinsurance) until you’ve paid $1,400.

Your out-of-pocket maximum is $2,400 ($1,000 deductible + $1,400 coinsurance). In this example you paid $2,400 and the plan paid $22,600 for the surgery. If you have more expenses later in the year, the plan will pay 100% of allowed amounts for covered services for the rest of the year.