HDHP Plan
Ketjen offers two medical plan options through UnitedHealthcare for 2027.
HDHP Plan
Plan Details
- Carrier
- UnitedHealthcare
- Plan Type
- HDHP
- HSA Eligible
- Yes
- FSA Eligible
- Limited Purpose FSA
- HRA Eligible
- No
Premiums
Bi-Weekly premiums
| Coverage tier | Employee Contributions | Ketjen Contribution |
|---|---|---|
| Employee Only | $49.85 | $315.52 |
| Employee + Spouse | $123.69 | $716.64 |
| Employee + Child(ren) | $108.46 | $595.83 |
| Employee + Family | $186.46 | $993.66 |
Employee Only
- Employee Contributions
- $49.85
- Ketjen Contribution
- $315.52
Employee + Spouse
- Employee Contributions
- $123.69
- Ketjen Contribution
- $716.64
Employee + Child(ren)
- Employee Contributions
- $108.46
- Ketjen Contribution
- $595.83
Employee + Family
- Employee Contributions
- $186.46
- Ketjen Contribution
- $993.66
Employer Contributions
| Coverage tier | Employer Contribution |
|---|---|
| Employee | $750 |
| Family | $1,500 |
| Wellness Incentives Employee | $1,000 |
| Wellness Incentives Employee + Spouse or Partner | $2,000 |
Employee
- Employer Contribution
- $750
Family
- Employer Contribution
- $1,500
Wellness Incentives Employee
- Employer Contribution
- $1,000
Wellness Incentives Employee + Spouse or Partner
- Employer Contribution
- $2,000
Deductible and Out-of-Pocket Limits
| Feature | In-Network | Out-of-Network |
|---|---|---|
| Annual Deductible (Combined Medical / Rx) - Employee Only Coverage | $2,500 | $5,000 |
| Annual Deductible (Combined Medical / Rx) - Employee + Dependent Coverage' | $5,000 | $10,000 |
| Out-of-Pocket Max (Combined Medical / Rx)² - Employee Only Coverage | $5,000 | $10,000 |
| Out-of-Pocket Max (Combined Medical / Rx)² - Employee + Dependent Coverage' | $10,000 | $20,000 |
Annual Deductible (Combined Medical / Rx) - Employee Only Coverage
- In-Network
- $2,500
- Out-of-Network
- $5,000
Annual Deductible (Combined Medical / Rx) - Employee + Dependent Coverage'
- In-Network
- $5,000
- Out-of-Network
- $10,000
Out-of-Pocket Max (Combined Medical / Rx)² - Employee Only Coverage
- In-Network
- $5,000
- Out-of-Network
- $10,000
Out-of-Pocket Max (Combined Medical / Rx)² - Employee + Dependent Coverage'
- In-Network
- $10,000
- Out-of-Network
- $20,000
- ¹ Employee + Dependent Coverage includes Employee + Spouse, Employee + Child(ren), and Employee + Family
- ² Includes Deductible and Co-insurance.
Medical Services
| Services | In-Network | Out-of-Network |
|---|---|---|
| Preventive Care | No copay | Not covered |
| Primary physician office visit | 20% after ded. | 50% after ded. |
| Specialist office visit | 20% after ded. | 50% after ded. |
| Telehealth | 20% after ded. | 50% after ded. |
| Inpatient hospital services | 20% after ded. | 50% after ded. |
| Outpatient hospital services (lab, x-ray, diagnostic) | 20% after ded. | 50% after ded. |
| Advanced diagnostics | 20% after ded. | 50% after ded. |
| Urgent Care | 20% after ded. | 50% after ded. |
| Emergency room care | 20% after ded. | 20% after ded. |
| Other | In Vitro Fertilization Services; GLP-1 Medication | — |
Preventive Care
- In-Network
- No copay
- Out-of-Network
- Not covered
Primary physician office visit
- In-Network
- 20% after ded.
- Out-of-Network
- 50% after ded.
Specialist office visit
- In-Network
- 20% after ded.
- Out-of-Network
- 50% after ded.
Telehealth
- In-Network
- 20% after ded.
- Out-of-Network
- 50% after ded.
Inpatient hospital services
- In-Network
- 20% after ded.
- Out-of-Network
- 50% after ded.
Outpatient hospital services (lab, x-ray, diagnostic)
- In-Network
- 20% after ded.
- Out-of-Network
- 50% after ded.
Advanced diagnostics
- In-Network
- 20% after ded.
- Out-of-Network
- 50% after ded.
Urgent Care
- In-Network
- 20% after ded.
- Out-of-Network
- 50% after ded.
Emergency room care
- In-Network
- 20% after ded.
- Out-of-Network
- 20% after ded.
Other
- In-Network
- In Vitro Fertilization Services; GLP-1 Medication
- Out-of-Network
- —
Retail (30-day supply)
| Tier | In-Network | Out-of-Network |
|---|---|---|
| Generic | 20% after ded. | 50% after ded. |
| Brand preferred | 20% after ded. | 50% after ded. |
| Brand non-preferred | 20% after ded. | 50% after ded. |
Generic
- In-Network
- 20% after ded.
- Out-of-Network
- 50% after ded.
Brand preferred
- In-Network
- 20% after ded.
- Out-of-Network
- 50% after ded.
Brand non-preferred
- In-Network
- 20% after ded.
- Out-of-Network
- 50% after ded.
Mail order (90-day supply)
| Tier | In-Network | Out-of-Network |
|---|---|---|
| Generic | 20% after ded. | 50% after ded. |
| Brand preferred | 20% after ded. | 50% after ded. |
| Brand non-preferred | 20% after ded. | 50% after ded. |
Generic
- In-Network
- 20% after ded.
- Out-of-Network
- 50% after ded.
Brand preferred
- In-Network
- 20% after ded.
- Out-of-Network
- 50% after ded.
Brand non-preferred
- In-Network
- 20% after ded.
- Out-of-Network
- 50% after ded.
Plan Notes
- Provides a lower monthly premium, a tax-advantaged HSA, and a higher Ketjen contribution through HSA and wellness incentives.
- This is a summary of coverage, please refer to your summary plan description for the full scope of coverage. In-network services are based on negotiated charges. Out-of-network services are based on a percentage of Medicare charges.