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With just a basic understanding of the bold words on these webpages, you’ll be able to decode the jargon and understand the differences between the health plans. The key terms and the 2-minute video below about premium credits, the amount of money your annual conference or employer puts toward the monthly cost of your benefits (aka premium), can help you see which medical/pharmacy, dental and vision plans might be best for your household.

At its core, HealthFlex, the health plan offered by Wespath, is about choice. You have lots of plans and features to choose from during Annual Election (AE), which is when you can make your plan selections to meet your expected health and financial needs for the upcoming year. Your premium credit helps offset the cost of your plans.


Regardless of which HealthFlex medical/pharmacy plan you choose, how you pay for expenses is fundamentally the same:


At the outset, you pay for all your health care expenses until you meet the deductible.1 After that, you pay part of your covered health care expenses and HealthFlex pays the remaining cost. That’s called co-insurance. HealthFlex also includes a safety net for covered medical, pharmacy and behavioral health expenses that’s known as an out-of-pocket (OOP) max. HealthFlex pays the bills in full after you reach your OOP max. Some plans have co-payments (aka co-pays), which are set dollar amounts you pay for health care services and expenses; these don’t count toward the deductible but they do count toward the OOP max.

With HealthFlex, you can choose between six different plans for medical, pharmacy and behavioral health needs. Three plans are paired with a Health Savings Account (HSA), two plans come with a Health Reimbursement Account (HRA) and one traditional plan that does not include a health account but has co-pays. You also can choose between up to three different dental plans and three vision plans.

Real World Examples

Click the examples below to see how these terms apply.

  • Example 1: Cost of Primary Care Physician (PCP) Visit

    For this example, the in-network primary care physician (PCP) has agreed with Blue Cross Blue Shield of Illinois or UnitedHealthcare to accept $80 (allowed amount). (In reality, a PCP’s billed or non-discounted rate is usually higher.) Until you meet your out-of-pocket max, an office visit to this PCP under each of the HealthFlex plans would cost you as follows:

    • B1000: You pay a $30 co-pay.


    In the other plans, you would pay the $80 bill until you meet your deductible. After that, co-insurance would apply to the $80 bill as follows:

    • C2000 and H1500: You pay 20% after deductible is met. 20% of $80 = $16
    • H2000: You pay 30% after deductible is met. 30% of $80 = $24
    • C3000: You pay 50% after deductible is met. 50% of $80 = $40
    • H3000: You pay 60% after deductible is met. 60% of $80 = $48

  • Example 2: Cost of Hospital Stay

    In this scenario, you have a three-day, non-surgical stay at an in-network hospital. The amount the hospital has agreed to accept for this stay is $15,000, even though the bill without insurance may be much higher. (The cost of a hospitalization varies widely based on the treatment received.) Typically, patients are billed at the end of the stay for hospital charges. Physician charges for care received while hospitalized are usually billed separately. For the sake of simplicity, let’s assume you not only met your deductible right before the hospital stay, but you equaled it, and you have no family members covered in HealthFlex (individual coverage).

    After the deductible is met, co-insurance applies to hospital bills with all HealthFlex plans. However, the amount you pay is capped at the annual out-of-pocket max for each plan. The OOP max for the B1000, C2000, C3000, H1500 and H2000 is $5,000 for individual coverage. The OOP max for the H3000 is $6,000 for individual coverage.

    Here’s how much of the hospital bill you will owe under each of the HealthFlex plans:

    • B1000, C2000, H1500: You pay 20% after deductible is met. 20% of $15,000 = $3,000
    • H2000: You pay 30% after deductible is met. 30% of $15,000 = $4,500. However, the out-of-pocket max is $5,000 and you have already met the $2,000 deductible. So, you will owe $3,000.
    • C3000: You pay 50% after deductible is met. 50% of $15,000 = $7,500. However, the out-of-pocket max is $5,000 and you have already met the $3,000 deductible. So, you will owe $2,000.
    • H3000: You pay 60% after deductible is met. 60% of $15,000 = $9,000. However, the out-of-pocket max is $6,000 and you have already met the $3,000 deductible. So, you will owe $3,000.

Additional Resources



1 There is no deductible to meet for pharmacy benefits with the HRA plans and the traditional plan. With those plans, HealthFlex always pays either a portion of the cost (co-insurance) or there’s a co-pay. Medications on the Preventive drug list are never subject to the deductible.

Annual Election Resources