2020 HRA Medical Plan
Empower HRA National One Open Access or SmartCare Plan
The Empower HRA Plans combines HealthPartners medical coverage with a reimbursement account you can use to pay for your qualifying out-of-pocket medical expenses. If you enroll in the Empower HRA Plan, an account will automatically be set up for you to use with HealthPartners. SPPS will deposit funds into your account based on the coverage level you choose. These funds will be available to you as of January 1 each plan year. Reimbursment for expenses are processed through the carrier, HealthPartners. Funds not used for eligible medical expenses in the current year may be rolled over for future medical expenses.
Single = $500
Single + 1 dependent = $750
Family = $1,000
- Preventive care services – such as annual routine physicals and well-child care, are covered at 100%.
- Saint Paul Public Schools contributes and deposits money into your HRA account each year, based on your coverage level to reimburse you for eligible medical expenses incurred by you and/or your covered dependents.
- Account contributions can only be made by SPPS. The IRS will not allow employees to contribute to the HRA account.
- Deposits that are not used for eligible medical expenses during the plan year may be rolled over into the following year for future medical expenses.
- You may not borrow against future deposits; only the money existing in your account at any given time is available for use.
- Funds in the HRA may be used to pay for pharmacy copays.
- Unused HRA balances are returned to SPPS upon employment separation.
- The account does not earn interest.
Empower HRA Plan Basics
- Your deductible is the annual amount you pay out of pocket for medical services before the plan begins paying. Coinsurance is the amount you and the plan share after the deductible is met and before you reach the out-of-pocket maximum. The out-of-pocket maximum is the annual “maximum” amount you pay for covered services.
- With the HRA, each covered person must meet a in-network annual deductible, or combined family deductible. After you meet the deductible, you pay 10% of the discounted costs until you reach the out-of-pocket maximum per person, or per family. After you meet your annual out-of-pocket maximum, the Plan pays 100% for in-network covered medical services.
- If you are enrolled in a HRA Medical Plan and change plans during Open Enrollment or with a Qualifying Status Change or terminate your employment with SPPS the funds in the HRA Account are forfeited at the end of the month from the change or termination.
The SmartCare plans offer a lower premium by utilizing a smaller alternative network compared to the open access network plans. You'll have access to three SmartCare Clinics for primary care and the HealthPartners and Park Nicollet providers and facilities for additional care. SmartCare clinics offer phone, video or in-person care visits and have expanded hours to provide you with additional flexibility to get the care you need when you need it.
The Open Access Plan allows memebers to access any provider in the network, including specialists, without a referral and receive in-network benefits. Members on this type of plan do not need to select a primary care clinic. While members do not need referrals to access providers in the Open Access network, some services may require a written order from the recommending physician.
For specific tier information, contact HealthPartners at 952.883.5000 or HealthPartners.com
Your deductible is the annual amount you pay for medical services before the plan begins paying. Your out-of-pocket maximum is the annual “maximum” amount you pay for covered services. With the HSA Medical, each covered person must meet the in-network annual deductible, or combined family deductible which is the same as the out-of-pocket maximum. After the per person or family deductible and out-of-pocket maximum is met, the Plan pays 100% for in-network covered medical and prescription drug services. See table above for plan deductible amounts.
- Every dollar that accumulates toward the annual “per person” deductible and out-of-pocket maximum also counts toward the family deductible and family out-of-pocket maximum.
- For covered prescription drugs, you pay the applicable copay. The copay counts towards your deductible and out-of-pocket maximum and you can use HRA funds for the copays.
- HRA funds are used to pay for covered medical expenses applied to your annual deductible and your share of coinsurance.
- Make sure you stay in-network. The out-of-network deductible and out-of-pocket maximum is higher and your costs are greater.
Paying for Prescription Drugs
If you enroll in the Empower HRA Plan:
- You will be responsible for paying prescription drug copays for any prescription drugs.
- Your prescription drug expenses will count towards your deductible and your out-of-pocket maximum.
- You may use the funds in your HRA to pay your prescription drug copays.