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