- What is a high-deductible health plan?
It is your insurance policy. The deductible represents the dollar amount of covered expenses that an individual must pay in a given plan year before any charges are paid by the health plan. In order to qualify for a Health Savings Account, the deductible must be $1,100 or higher for a single person, or $2,200 or more for a family.
Top
- What is a Health Savings Account (HSA)?
A Health Savings Account is a tax-advantaged savings account that you can establish in order to pay for your deductible, copays, coinsurance and any other IRS qualified medical expense. An HSA is established at a financial institution. You must be enrolled in a high-deductible health plan with an annual deductible of $1,100 for a single or more in order to establish a Health Savings Account (HSA). For HSA answers, please reference the HSA FAQs.
Top
- What applies toward my annual deductible?
All medically necessary services that are covered under your Patriot Healthcare plan, including prescription drugs that are covered under the plan and emergency room visits.
Top
- Do preventive services apply toward my deductible?
No. Preventive services are paid in full by Patriot Healthcare prior to meeting your deductible if they are performed at a Patriot100 provider. See your Patriot Signature Plan for more details.
Top
- What doctors and facilities are in Patriot Healthcare's network?
Physicians
All physicians who participate in the First Health Network in New Hampshire, Vermont, Maine and Massachusetts are Patriot100 Providers.
Facilities & Hospitals
Patriot100 Network
This includes a group of select facilities and hospitals. After a member meets their deductible, there will not be any coinsurance applied for medically necessary services performed at a Patriot100 Provider. Click here to view our Provider Directory.
Patriot80 Network
This includes First Health facilities and hospitals in NH, VT, MA and ME that are not Patriot100 Providers. After a member meets their combined medical and prescription drug deductible, they will pay 20% coinsurance for medically necessary services performed at a Patriot80 Provider, and Patriot will pay the remaining 80%. Click here to view our Provider Directory.
Top
- How will I know if my doctor is in the network?
Please call Member Support at 1.800.597.7728 and they will help you determine if your doctor is participating in the network. Or view our Provider Directory to locate a physician in the network.
Top
- What if my physician's office is located in a Patriot80 facility or hospital?
If your physician is a Patriot100 physician and you are going in for an office visit, then that is considered a Patriot100 provider and no coinsurance applies. If you are admitted to a Patriot80 facility or hospital for outpatient or inpatient medically necessary services, then coinsurance would apply to the facility charges only, not to the physician charges.
Top
- What if my physician refers me to a to a Patriot80 provider?
For any pre-scheduled services obtained at a non-Patriot 100 hospital, outpatient facility or lab, members are responsible for an additional 20% coinsurance once the deductible has been met. If these services are obtained at a Patriot 100 hospital, outpatient facility or lab, they will be covered 100% after the deductible has been met. This does not apply to emergency care. Any services obtained at the emergency room, regardless of what facility, will be covered by Patriot Healthcare once you have met your deductible and emergency room copay. If you are admitted, then the emergency room copay will be waived.
Top
- Once I have paid the maximum out of pocket amount for the year, does Patriot pay 100% of my medically necessary services that are covered under the plan even if it is at a Patriot80 provider?
YES.
Top
- What if I go to the emergency room at a non-Patriot 100 hospital and I'm admitted?
If you are admitted, you are responsible up to your deductible amount and then Patriot will cover the remaining costs for medically necessary services covered under the plan. As soon as you have stabilized and are released, if you decide to continue treatment at a Patriot80 or out-of-network facility, coinsurance will apply. However, if you choose a Patriot100 facility for your care after you are releases, you will be covered at 100% for medically necessary services covered under the plan.
Top
- What happens if I have to go to the Emergency room after I have met my deductible?
You will pay $150 emergency room copay and it does apply to the out of pocket maximum. This $150 is waived if you are admitted into the hospital.
Top
- How much will I pay for prescription drugs once my deductible is met?
Generic drugs are $10, Preferred drugs are $25 and non-preferred drugs are $40. Click here for more details on our prescription drug coverage.
Top
- What is an out-of-pocket maximum?
It is the maximum amount that you will be responsible for paying each calendar year toward the following:
- Your Deductible
- Copays for prescription drugs
- Coinsurance at Patriot80 providers
- Copays for emergency room care
For single coverage:
- Plan I / Plan II = $2,500
- Plan III = $5,000
For employee & spouse and employee and dependent(s):
- Plan I / Plan II = $5,000
- Plan III = $10,000
Top
- Are there exclusions to the maximum out of pocket?
Yes. If you receive services from out-of-network providers (Non- Patriot100 and Non-Patriot80), they do not apply to your out-of-pocket maximum. There is an annual benefit limit of $100,000 for out of network services.
Top
- Will I have to pay my deductible up front at the hospital/physicians office?
Be prepared to pay your deductible upfront. However, not all providers expect payment at the time of service. This will vary on a case by case basis depending on the provider.
Top
- What if I live in Massachusetts?
If your employer is based in New Hampshire and has enrolled in our plan, you are eligible. All physicians in the HCVM network in Massachusetts are Patriot100 providers. We have a select group of hospitals in Massachusetts that are in our Patriot100 network - Beth Israel Deaconess Medical Center, Brigham & Women's Hospital, Children's Hospital, Dana Farber Cancer Center, Lahey Clinic, Massachusetts General Hospital, Massachusetts Eye & Ear and New England Baptist Hospital.
Top
