High Deductible Summary

In combination with Miami's High Deductible Health Plan (HDHP), a Health Savings Account (HSA) is a way to pay for qualified healthcare expenses with a tax-free bank account. You will receive a debit MasterCard that can be used to access your HSA funds.

See the PPO plan summary.

Plan Summary Effective January 1, 2020

Service Network Tier 1⇒
Member Pays
Network Tier 2⇒
Member Pays
Out-of-Network Benefits
Member Pays**

Calendar Year Deductible
For other than single coverage, family deductible applies.

$2,000 single
$4,000 family
$5,000 individual
$10,000 Family
Medical Out-of-Pocket Maximum
For other than single coverage, family out-of-pocket maximum applies.
$3,000 single
$6,000 family
$6,350 individual
$12,700 family
Preventive Care
(wellness exams, cancer screenings, immunizations)
$0 $0 50% after deductible
Office Visits
(primary care physician)
10% after deductible 20% after deductible 50% after deductible
Behavioral Health 10% after deductible 20% after deductible 50% after deductible
Specialist/Allergist 10% after deductible 20% after deductible 50% after deductible
Physician Services
(outside of office)
10% after deductible 20% after deductible 50% after deductible
Diagnostic X-Rays and Lab Work 10% after deductible 20% after deductible 50% after deductible
Advanced Imaging 
(such as MRI, CAT, PET)
10% after deductible 20% after deductible 50% after deductible
Hospital Emergency Room Services (True) 10% after deductible 10% after deductible 10% after deductible
Urgent Care Facility 10% after deductible 20% after deductible 20% after deductible
Speech Therapy
(limit 30 visits per year)
10% after deductible 20% after deductible 50% after deductible
Physical and Occupational Therapy
(limit 60 visits per year)
10% after deductible 20% after deductible 50% after deductible
Acupuncture
(limit 20 visits per year)
10% after deductible 20% after deductible 50% after deductible
Chiropractic Services
(limit 20 visits per year)
10% after deductible 20% after deductible 50% after deductible
Pharmacy-Retail 20% after deductible  50% after deductible
Pharmacy-Specialty Drugs 20% after deductible
30-day supply only
50% after deductible
Pharmacy-Mail Order 20% after deductible  Not covered

When using a tier 1 or tier 2 free-standing lab or imaging center, you will pay $0 after in-network deductible.

*$0 after medical out-of-pocket maximum has been met.

**Out-of-network providers may balance bill you for charges in excess of the Usual, Customary, and Reasonable (UCR) fee. You will be responsible for charges in excess of the maximum UCR fee in addition to any applicable deductible, coinsurance or co-payment. Additionally, any amount you pay the provider in excess of the maximum UCR fee will not apply to your out-of-network deductible or out-of-pocket maximum.