HSA-Qualified
PPO High Deductible Health Plan
Provides you with an affordable plan that enables you to manage medical
expenses while providing potential tax advantages. Can use with a Health
Savings Account (HSA) or choose not to.
HSA’s allow you to set up an account to pay for medical care and build up
savings to pay for future medical expenses. Pre-tax contributions reduce
individual taxable income and qualified medical expense withdrawals are
tax-free.
- PPO High Deductible
In-Network deductible for single
coverage is $2,000 and family is $4,000. 100%
coinsurance after the deductible is met.
Out-of-Network deductible for
singe coverage is $5,000 and family is $10,000.
50% coinsurance After the deductible is met.
No deductible In-Network Care:
Preventive visits $20 copayment
Routine GYN/Pap (1 per benefit period) $20
co-Payment
Mammography 100% covered
Pediatric immunizations 100% covered
- The Bancorp Bank
Preferred relationship with Independence Blue
Cross includes:
- No application or account set-up
fees
- No monthly account maintenance fee
- Earn interest with first deposit
- Free, no-annual-fee Visa Debit
Card
- Toll-free 24/7 customer service
and online access
- Invest HSA funds through National
Financial Services
You also have the option to set up your account
through
Any HSA trustee or custodian.
Forms and Documents
Application
Enrollment/Change Form
Plan Summaries
PPO HDHP Benefit
Prescription Drug Benefit
Rates
PPO HDHP Rate Letter
The Bancorp Bank
Bancorp Bank Enrollment Instructions
Enrollment Form
Bancorp Bank Fee Structure
HSA Frequently Asked Questions