A Self-Directed Health Plan (SDHP) is a very flexible type of health insurance. An SDHP combines parts of PPO plans and Health Saving Accounts. It provides the user with the ability to choose whatever health care provider they want, whether they are inside or outside the managed care network.
An individual with a SDHP owns a savings account that contains funds intended to cover their health care costs. However, the individual with the account is not required to make contributions, although they can if they want to. The main contributor to the plan is the insurer.
The account is restocked every three months with approximately $500 for families or $250 for individuals. This money can be used to pay for preventative health care that is covered under the plan. Any money that is not used in the quarter can be rolled over to the next quarter, and any money that is not used in a year can be rolled over into the next year.
SDHPs focus much more on preventative health care than traditional types of managed health care plans. SDHPs have fairly low monthly premium costs, but have high deductibles. However visits for preventative health care don’t require a co-pay or deductible. Non-preventative visits require a co-pay and deductibles for non-preventative visits need to paid for the year in full before subsequent visits will be covered. Unused deductible amounts do not roll over.
SDHPs also provide accessed to health care professionals through a preferred provider network. Visits to network providers is optional and policy holders don’t need referrals to see specialists. However visits to specialists and non-network doctors does require a co-payment.
Most SDHPs cover a wide range of preventative health care, including:
- Regular checkups, routine physical exams and consultations
- Pre-natal and post-natal care
- Immunizations
- Cervical screening and mammograms for women
- Screening and diagnostic tests like x-rays
- Home Visits
- Some plans include prescription coverage
Emergency health care and in-patience hospital care like surgery are not covered under the preventative section of the insurance plan. For medical costs other than preventative health care, there will be a deductible that has to be paid before there is any insurance coverage.
SDHPs are well suited for families and individuals with low ongoing health care costs that include mostly preventative care costs like yearly check ups and routine physical exams. People who enjoy good health can usually minimize their health care costs quite a bit with a SDHP.
One advantage to an SDHP is any unused funds can be carried over on a quarterly as well as yearly basis. This means that unused funds can keep accumulating and then be available when expensive medical expenses come up.
For individuals with chronic health conditions like diabetes, a self directed health plan would not be suitable. Chronic illnesses usually require frequent visits to the doctor as well as other medical care, and these types of visits and care are not considered preventative health care.
