Blue Shield HDHP PPO — Overview
A High-Deductible Health Plan (HDHP) pairs lower premiums with a higher annual deductible. Preventive care is generally covered in full. You’ll pay the full cost of most non-preventive services until you meet the deductible, then cost-sharing applies.
Plan snapshot
$2,200 Employee / $4,400 Family
$4,600 Employee / $9,200 Family
10% in-network / 30% out-of-network
Uses the same provider network as the Traditional Blue Shield PPO.
What to know
- Lower premiums than a traditional PPO; you pay more when you use care until the deductible is met.
- Preventive care is typically covered in full before the deductible.
- 2026 HSA limits: $4,400 Employee / $8,750 Family (+$1,000 if 55+).
- Unlike a Flexible Spending Account, HSA balances roll over each year.
Is this a good fit?
- Good fit if: you expect low/moderate care, want lower premiums, and are comfortable budgeting for bigger bills.
- Think twice if: you have ongoing specialist visits/prescriptions or prefer predictable copays.
- Premiums are spread out; the deductible may be due at once when care occurs.
How HDHP compares to Traditional PPO
| Category | HDHP In-Network | HDHP Out-of-Network | PPO In-Network | PPO Out-of-Network |
|---|---|---|---|---|
| Deductible | $2,200 / $4,400 | $4,000 / $8,000 | $750 / $1,500 | $1,250 / $2,500 |
| Out-of-Pocket Max | $4,600 / $9,200 | $10,000 / $20,000 | $2,000 / $4,000 | $2,000 / $4,000 |
| Coinsurance | 10% | 30% | 10% | 30% |
| Office Visit | 10% after deductible | 30% after deductible | $30 copay | 30% coinsurance |
| Emergency | 10% after deductible | Same as in-network | $100 + 10% coinsurance | Same as in-network |
| Inpatient Hospital | 10% after deductible | 30% after deductible | 10% coinsurance | 30% coinsurance |
| Rx Retail | $15 Generic / $30 Brand* | 50% up to $250 | $10 Generic / $20 Brand | 50% up to $250 |
| Rx Mail | $30 Generic / $60 Brand* | 50% up to $250 | $20 Generic / $40 Brand | 50% up to $250 |
Note: If you enroll in an HSA, you cannot also participate in the City’s Health Care FSA.
Examples — pick a name
Sam — Rarely uses care
Employee-only; values lower premiums and saving for future costs.
- Key considerations:
- Has funds for unexpected expenses before the deductible is met?
- Comfortable choosing providers vs. a guided HMO model?
Evelyn — College kids, national access
Needs nationwide in-network access; weighing premiums vs. higher deductible and variable bills.
- Key considerations:
- Does the HDHP’s PPO network meet out-of-state needs?
- Would staying PPO + FSA align better?
Marcus — Ongoing care & prescriptions
Frequent specialist visits; may reach deductible quickly.
- Key considerations:
- Do regular visits/Rx make HDHP less cost-effective?
- Are larger periodic bills harder to budget than copays?
Gloria — Planning for retirement
Wants to build savings for future health costs; weighs near-term spend vs. long-term growth.
- Key considerations:
- How much can she save while covering current costs?
- Is bill variability acceptable during the savings period?
Unique HSA Benefits
Learn More about the HSA at HealthEquity
Explore official resources to go deeper on how HSAs work, what you can contribute, and the tax forms you may need.
HealthEquity resources
HealthEquity’s step-by-step learning hub covering HSA basics, eligible expenses, investing, and more.
Which IRS forms apply to HSAs (e.g., 5498-SA, 1099-SA) and how annual contribution limits work.
Tip: Keep your HealthEquity login handy so you can view contribution history, eligible expenses, and statements.