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PCA High & Low

Personal Care Accounts

The PCA High and PCA Low are both PPO plans that are consumer driven and designed for employees who want to be actively involved in their health care. The plans offer lower employee contributions in exchange for a higher annual deductible, coinsurance and out-of-pocket maximum. But what sets the PCA High PPO and PCA Low PPO apart from your other health plan options is that each year you receive a lump sum allowance to spend as you choose on health care. Additionally, unused amounts roll to the next year and are added to new amounts placed in these accounts by the university for your healthcare needs. You can accrue up to three times the annual university contribution for the plan you select.

 

 

How the PCA High PPO and PCA Low PPO Work

What is a PCA?

This option combines a PPO plan with a Personal Care Account, PCA for short. The PCA is like an “expense account” into which the university puts money. The amount of a PCA varies, depending on the plan you choose. If you use all of your PCA funds, you pay additional medical expenses until you meet your deductible. If you don’t use all the funds, you can carry them over to the next plan year.

 

 

Why you might want it

The PCA PPO plan gives you choice and flexibility in how you pay for health care:

  • Reduce your deductible with PCA funds. Some of the PCA funds you spend apply to your deductible, so you’re reducing the deductible with funds supplied by the university.
  • Carry over unused dollars. If you have funds left over at the end of the plan year, you can keep them for next year as long as you enroll in a Humana PCA PPO plan with the university. The maximum amount of the PCA account is three times the annual university contribution to that account.
  • No co-payments. When you go to a participating doctor’s office, just ask them to bill you after Humana has processed the claim and calculated your member discount. When the bill arrives, give the doctor’s office your HumanaAccess card number to pay the discounted fee directly from your PCA. If they don’t take Visa, pay the balance and then file for reimbursement from your PCA.

 

 

Using your account

On the first day of the plan year, you can start spending your PCA dollars on items approved by the university health plan. If you use all of your PCA funds, it’s your responsibility to pay for additional medical expenses until you meet your deductible for the year. Once you’ve met the deductible, you pay only the coinsurance percentage for covered services specified in your plan. With this kind of plan, your deductible is often higher than with other plans. However, your out-of-pocket costs are capped so you’re protected against any major, unexpected medical expenses that are covered by your plan.

 

Using your HumanaAccess card

Once your Humana coverage begins, you’ll receive a HumanaAccess card in the mail. You can use this card for PCA-eligible expenses wherever Visa cards are accepted, such as doctors’ offices and hospitals. Save receipts every time you use your PCA, since Humana may ask for expense verification as required by the IRS.

 

Carrying over unused dollars

If you don’t use all of your PCA funds, you can save them for next year, as long as you enroll in the same type of Humana plan with the same employer. Let’s say you choose a plan with a $1,000 PCA, and you use only $700 during the plan year. Humana will add the $300 balance to your PCA next year.

 

 

For a detailed list, consult : PCA High Summary of Benefits (PDF) or the PCA Low Summary of Benefits (PDF).

 

 

 

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