The HSA Medical Plan offers 100% coverage for in-network preventive care. For other health care services and prescription drugs, you must meet an annual deductible before benefits begin.
When you enroll in the HSA Medical Plan, a Health Savings Account (HSA) is automatically opened in your name with HealthEquity. Tenneco will make a contribution to your account, and you can elect to make your own pre-tax contributions as well, up to IRS limits.
In-Network vs. Out-of-Network Care
In-network providers have negotiated service rates with Credence BCBS. An out-of-network provider may charge more than Credence BCBS is willing to pay. Because of this, the out-of-network deductible is higher than the in-network deductible. Before receiving treatment, check with Credence BCBS to ensure a doctor, lab, hospital, specialist or other provider is in-network, how much care will cost and understand your health plan.
HSA Medical Plan: Key Features
The chart below summarizes how medical services are covered under the HSA Medical Plan.
| Plan Feature | In-Network | Out-of-Network |
|---|---|---|
|
Annual Deductible (aggregate)1 |
Individual: $1,500 |
Individual: $3,000 |
|
Annual Out-of-Pocket Maximum (aggregate)1 |
Individual: $3,750 |
Individual: $7,500 |
|
Preventive Care2 |
You pay nothing for plan-eligible preventive care; no deductible applies |
You pay 40%, after deductible |
|
Coinsurance |
You pay 20%, after deductible |
You pay 40%, after deductible |
|
Hospital Emergency Room Care |
You pay 20%, after deductible If claim is submitted with a non-emergency diagnosis, an additional $200 penalty will apply |
You pay 20%, after deductible If claim is submitted with a non-emergency diagnosis, you pay 40% after deductible |
- “Aggregate” means the deductible or out-of-pocket maximum must be met at the full family level for any coverage tier other than individual coverage.
- For specific preventive services, a list of covered immunizations, visit limitations and/or pre-certification requirements, refer to the Summary Plan Descriptions at TennecoPlanDocs.com or visit credenceblue.com.
