Major Medical HSA 10000 Premier

HSA-eligible plan. Hospital services use reference-based pricing (reimbursement based on Medicare-published costs plus an additional percentage); excess charges do not count toward the deductible or out-of-pocket maximum. Prior authorization required for certain services (imaging, hospital stays, rehabilitation); a 25% payment reduction penalty applies when non-recommended providers are used for non-emergent services. Physical rehabilitation limited to 12 visits per year. Pharmacy benefits through EHIM. Amaze virtual mental health: spouse and children under 26 eligible even if not on the plan. Supplemental Critical Illness: 30-day waiting period applies; spouses receive 100% of the benefit, children 50%.