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Be a Smart Consumer

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Last updated date: 3/11/2024

Knowing more about your health benefits is the best way to use them wisely and save money.

Money-Saving Tips

Get the most from your health benefits with these tips on being well and making smart financial choices.

Use in-network providers.

They bill your insurance company directly at negotiated rates, saving you time and money. Make sure a service is covered by your insurance company before you receive care. Note: If you’re enrolling in an HMO plan (if available in your area), the plan only pays benefits for care received in network.

Keep up with preventive care.

It’s fully covered by all of our medical plans and can help detect and prevent potentially costly health issues. You pay nothing for annual physicals, recommended immunizations, routine cancer screenings, and more when you see in-network providers. 

Use tax-free money to pay for eligible health expenses.

Contributing to a Health Savings Account (HSA) and/or a Flexible Spending Account (FSA) is easy and saves you money. You can set aside pre-tax dollars from your paycheck to use for your out-of-pocket costs. Keep in mind that with an HSA, you can only spend contributions actually deposited into your account. With a Health Care or Limited Purpose FSA, you can only carry over up to $660 of unused FSA money to the next year; you will forfeit amounts above $660.

Shop smart for prescriptions.

Using generic alternatives will almost always save you money — and they’re just as effective as brand-name prescriptions. It’s also a good idea to compare prices at different pharmacies before deciding where to fill a prescription. For your ongoing prescriptions, use the home-delivery service to save money and time.

Take advantage of the Myriad Genetics Wellness Program. 

Our wellness program offers valuable resources to improve your health and prevent the need for costly care. The program aspires to create a sustainable culture of health, caring, and inclusivity where education and activities improve teammate wellbeing, engagement, and productivity.

Use your medical plan’s website.

Log in to your medical plan’s website to see how much of your deductible you’ve met, review claims, find in-network providers, use helpful cost-estimating tools, and more.

Choose the right place to get care.

Facilities charge different amounts for the same services. Use the guide below to help you save money and choose the most appropriate care for your situation.

Telehealth Doctor’s office Urgent care clinic Emergency room
Use it for
A non-emergency medical issue that can be diagnosed by phone or online A condition that can wait until the next day for medical attention A condition that needs immediate care but is not life- or limb-threatening A life-threatening or potentially crippling condition that needs immediate attention
Examples
  • Colds and allergies, flu/cough
  • Ear infections, pink eye
  • Behavioral health
  • Sore throat, fever
  • Routine exam, screening
  • Checkup, vaccine, prescription refill
  • Broken bone, severe sprain or strain
  • Cut requiring stitches
  • Anxiety attack
  • Sudden weakness, dizziness, or loss of consciousness
  • Uncontrollable bleeding
  • Chest pain, difficulty breathing
Cost
You pay: $   You pay: $   You pay: $$   You pay: $$$  
Find it
Learn more Call your regular doctor or search for an in-network provider on your medical plan’s website Search for urgent care clinics near you on your medical plan’s website Call 911 or search online for the nearest hospital

Terms to Know

Coinsurance

Coinsurance is how you and your medical plan share the cost of medical services after you meet the plan’s annual deductible. For example, if your deductible is $2,000 and your coinsurance is 20%, once your out-of-pocket expenses reach $2,000, your plan would start to pay 80% of your covered costs, leaving you responsible for the other 20%. Your provider will usually send you a bill for the 20% you owe after your claim has been processed by your health plan.

Limited Purpose Flexible Spending Account (FSA)

Because the IRS doesn’t allow you to contribute to both a Health Savings Account (HSA) and a Health Care FSA, a Limited Purpose FSA is offered to you if you enroll in a medical plan with an HSA. With a Limited Purpose FSA, you can pay for eligible dental and vision expenses with tax-free dollars. Since you don’t pay income tax on the money you put in an FSA, it’s like getting a discount on your bills! 

You contribute to your FSA through before-tax payroll deductions by selecting how much you want to contribute over the course of the plan year, with a proportionate amount of that annual contribution coming out of each paycheck. Your entire annual contribution to a Limited Purpose FSA is available to you from the beginning of the plan year.

FSAs have a “use it or lose it” rule, so estimate your contribution carefully. At the end of the year, you may forfeit any unused money. Depending on your account rules, you may be able to carry over your balance up to a certain amount, or you may be offered an extension to the year-end deadline. 

Consumer Directed Health Plan (CDHP)

A CDHP is a medical plan that puts you in charge of your spending through lower premiums, higher deductibles, and a tax-free Health Savings Account (HSA). You can see any provider, but you’ll generally pay less by staying in-network.

For nonpreventive medical and prescription expenses, you pay 100% of your costs until you meet the annual deductible, after which you and the plan share the cost of covered medical care and prescriptions through coinsurance. If your total deductible and coinsurance expenses reach the plan’s out-of-pocket maximum, you won’t have to pay anything further for the rest of the year. Keep in mind that in-network preventive care, like annual physicals and immunizations, is covered in full at no cost to you.

To help pay out-of-pocket expenses, you can contribute tax-free money from your paycheck to an HSA. The money in your HSA is always yours to keep and can be used now or in the future.

Copay

A copay is a fixed amount you pay for a covered health care service. For example, you might have a $30 copay when you go to the doctor’s office. Your copay is usually due at the time you receive the service and can vary based on the type of service you receive.

Deductible

A deductible is the amount of eligible expenses you must pay each year before your plan begins paying for covered services. For example, if your annual deductible is $2,000, you must pay for your nonpreventive expenses until your costs reach $2,000, after which the plan will start to pay a percentage of costs. 

Plans typically have different deductibles for individual coverage and family coverage. Depending on your plan, you might need to meet a separate deductible for each covered family member or one larger family deductible before coinsurance begins for anyone.

Your deductible does not apply to in-network preventive care, which is covered at no cost to you. Depending on your medical plan, the deductible may not apply to other services, too, such as doctor’s office visits and prescriptions.

Dependent Care Reimbursement Account (DCRA)

A Dependent Care Reimbursement Account allows you to pay for eligible dependent care expenses with tax-free dollars. Since you don’t pay income tax on money you put in an FSA, it’s like getting a discount on your child care or elder care costs! Eligible expenses for a Dependent Care Reimbursement Account include day care and summer camps for children under age 13, and day care for dependent elders. 

You contribute to your FSA through before-tax payroll deductions by selecting how much you want to contribute over the course of the plan year, with a proportionate amount of that annual contribution coming out of each paycheck. You can only use money actually deposited into your account.

Dependent Care Reimbursement Accounts have a “use it or lose it” rule, so typically, any unused money left in your account at year-end is forfeited.

Exclusive Provider Organization (EPO)

An EPO is a medical plan similar to an HMO. While only care you receive from in-network providers is covered, you typically aren’t required to select a primary care provider (PCP). EPOs often have a low or no deductible and low to moderate premium costs, with copays typically paid at the time of service for nonpreventive in-network medical care and prescriptions. 

Keep in mind that in-network preventive care, like annual physicals and immunizations, is covered in full at no cost to you. You’re also protected by an annual limit on costs — if you reach the out-of-pocket maximum, the plan pays 100% of any further covered expenses for the rest of the year.

Health Care Flexible Spending Account (FSA)

A Health Care FSA is an account you can use to pay for eligible health care expenses with tax-free dollars. Since you don’t pay income tax on the money you put in an FSA, it’s like getting a discount on your medical, dental, vision, and medication costs! Eligible expenses for a Health Care FSA include deductibles, coinsurance, and copays for medical, dental, and vision care, as well as many over-the-counter items like bandages, sunscreen, and feminine care products.

You contribute to your FSA through before-tax payroll deductions by selecting how much you want to contribute over the course of the plan year, with a proportionate amount of that annual contribution coming out of each paycheck. Your entire annual contribution to a Health Care FSA is available to you from the beginning of the plan year.

FSAs have a “use it or lose it” rule, so you may forfeit any unused money at the end of the year. Depending on your account rules, you may be able to carry over your balance up to a certain amount, or you may be offered an extension to the year-end deadline.

Health Maintenance Organization (HMO)

An HMO is a medical plan that provides coverage only when you receive care from providers within the HMO network. You’re required to select a primary care provider (PCP) who will coordinate your care to manage costs.

Generally, HMOs have a low or no deductible and low to moderate premium costs, with copays typically paid at the time of service for nonpreventive in-network medical care and prescriptions. Keep in mind that in-network preventive care, like annual physicals and immunizations, is covered in full at no cost to you.

You’re also protected by an annual limit on costs — if you reach the out-of-pocket maximum, the plan pays 100% of any further covered expenses for the rest of the year.

Health Savings Account (HSA)

A Health Savings Account, or HSA, is tax-free and only available to participants in a qualified high-deductible health plan. You contribute to your HSA through before-tax payroll contributions to pay for eligible medical expenses — including deductibles, coinsurance, and copays. All the money in your HSA rolls over each year and is always yours to keep. You can even invest the money in your HSA to build up savings you can put towards health expenses in retirement.

You can only use money actually deposited into your HSA. If you don’t have enough in your HSA at the time of your medical expense, you can pay another way and reimburse yourself from your HSA later.

Out-of-pocket maximum

An out-of-pocket maximum is the most money you would have to pay in a plan year for covered health care expenses. If your out-of-pocket expenses (such as your deductible, coinsurance, and copays) reach your plan’s out-of-pocket maximum, you won’t pay anything further for covered services for the rest of the year.

Preferred Provider Organization (PPO)

A PPO is a medical plan that generally has a lower deductible and higher premiums, which keeps your costs more predictable. You can see any provider, but you’ll generally pay less by staying in-network.

Typically, you pay a copay for nonpreventive doctor’s office visits and prescriptions. The cost of other medical services, like hospital stays, must be paid in full before meeting the plan’s annual deductible. Then, the plan will share the cost of these services through coinsurance.

You’re also protected by an annual limit on costs — if you reach the out-of-pocket maximum, the plan pays 100% of any further covered expenses for the rest of the year.

Premiums

Premiums are the money you contribute from your paycheck to pay your share of the cost of being enrolled in a health plan. Myriad Genetics also pays a large percentage of this cost. 

Your premium depends on the plan you choose and who you enroll. For example, a medical plan with a low deductible will have a higher premium than a plan with a higher deductible. And, you’ll pay a lower premium to enroll yourself, while a higher premium would apply when enrolling your spouse and kids.

Preventive care

Preventive care services include routine physicals, health screenings, routine blood work, and recommended immunizations. In-network preventive care is covered free of charge with all plans.

Qualified life event

A qualified life event is a change in your life that qualifies you to update your benefits enrollment before the next Open Enrollment. For example, if you get married in April and your Open Enrollment is typically in the fall, you wouldn’t need to wait until then to change your benefits. You could add your spouse to your coverage or drop your coverage and join your spouse’s plan within 30 days of your wedding. Only changes related to your life event are allowed.

Telehealth

Telehealth provides convenient, 24/7 access to board-certified doctors by phone or video, wherever you are. Telehealth appointments are typically less expensive than going to an urgent care center, with costs varying depending on your medical plan. In some cases, certain specialist visits are available through telehealth, such as psychiatry and dermatology.