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Qualified high deductible health plans

An IRS-qualified high deductible health plan, suitable for pairing with a tax-free health savings account (HSA).

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For groups of 1-50 employees

Most employees enrolled in a QHDHP are eligible to open a Health Savings Account (HSA), a type of savings account designed to pay qualified medical expenses. This HSA can be funded by a combination of employer and/or employee contributions -- both contribution types are tax deductible.

Funding options are flexible too. Employers can allow employees to elect to deposit money into an HSA via payroll deduction. The HSA funds can be used to pay for immediate or future health care expenses such as deductible, copays and coinsurance, or medical expenses that aren't covered by the plan. The list of qualified medical expenses that can be paid with an HSA is determined by the IRS and can be found in IRS Publication 502.

Employees can also let their HSA dollars accumulate. These funds earn interest, tax free. When money is needed to pay medical expenses, the withdrawals are also tax free. Highlights:

  • Lower premiums compared to many fully-insured medical plans.
  • Employer contributions are exempt from federal and FICA taxes.
  • Employees have the triple tax advantage:
    1. Contributions are made pre-tax
    2. Tax-free earnings and interest
    3. Payments for eligible expenses are not taxed.
  • Deductible is reached through combined medical and prescription costs, not separate deductibles.

While employers are free to choose any HSA administrator, or not offer one at all, Capital offers a low-cost, fully-integrated Health Savings Account, administered by HealthEquity.

 

D/$=Deductible applies first then a copay

2026 plans

Gold

Plan Deductible1 Coinsurance Out-of-pocket max PCP Specialist Emergency room
Gold QHDHP PPO 2000/0/10

$2,0002

 0% $7,500 D/$10 D/$20 D/$175

Silver

Plan Deductible1 Coinsurance Out-of-pocket max PCP Specialist Emergency room
Silver QHDHP PPO 2750/0/25

$2,7502

 0% $7,500 D/$25 D/$50 D/$350
Silver QHDHP Advance PPO 2750/0/155

C1 - $2,7502

C2 - $5,5002

C1 - 0%

C2 - 20%

 $7,500

C1 - D/$15

C2 - D/$30

C1 - D/$30

C2 - D/$45

 D/$350
Silver QHDHP Capital Advantage PPO 2750/0/154

C1 - $2,7502

C2 - $5,5002

C1 - 0%

C2 - 20%

 $7,500

C1 - D/$15

C2 - D/$30

C1 - D/$30

C2 - D/$45

 D/$350
Silver QHDHP Convenience PPO 2750/0/156

C1 - $2,7502

C2 - $5,5002

C1 - 0%

C2 - 20%

 $7,500

C1 - D/$15

C2 - D/$30

C1 - D/$30

C2 - D/$45

 D/$350
Silver QHDHP PPO 3500/0/25

$3,5002

 0% $7,500 D/$25 D/$50 D/$350
Silver QHDHP-E PPO 3750/0/25

$3,7503

 0% $7,500 D/$25 D/$50 D/$350
Silver QHDHP-E PPO 4500/0/10

$4,5003

 0% $7,500 D/$10 D/$20 D/$350
Silver QHDHP-E PPO 5300/0/15

$5,3003

 0% $7,400 D/$15 D/$30 D/$350

Bronze

Plan Deductible1 Coinsurance Out-of-pocket max PCP Specialist Emergency room
Bronze QHDHP-E PPO 6900/0/0

$6,9003

 0% $7,200 No charge after deductible No charge after deductible D/$300
Bronze QHDHP-E PPO 8000/0/0

$8,0003

 0% $8,300 No charge after deductible No charge after deductible D/$300

2025 plans

D/$=Deductible applies first then a copay

2025 plans

Gold

Plan Deductible1 Coinsurance Out-of-pocket max PCP Specialist Emergency room
Gold QHDHP PPO 2000/0/10

$2,0002

 0% $6,900 D/$10 D/$20 D/$175

Silver

Plan Deductible1 Coinsurance Out-of-pocket max PCP Specialist Emergency room
Silver QHDHP PPO 2750/0/25

$2,7502

 0% $6,900 D/$25 D/$50 D/$350
Silver QHDHP PPO 3500/0/25

$3,5002

 0% $6,900 D/$25 D/$50 D/$350
Silver QHDHP-E PPO 3750/0/25

$3,7503

 0% $6,900 D/$25 D/$50 D/$350
Silver QHDHP-E PPO 4500/0/10

$4,5003

 0% $6,900 D/$10 D/$20 D/$350
Silver QHDHP-E PPO 5300/0/15

$5,3003

 0% $6,500 D/$15 D/$30 D/$350

Bronze

Plan Deductible1 Coinsurance Out-of-pocket max PCP Specialist Emergency room
Bronze QHDHP-E PPO 6900/0/0

$6,9003

 0% $7,200 No charge after deductible No charge after deductible D/$300

1Deductible shown is for a single plan. Family deductible is two times the single deductible.

2The deductible on the family plan is non-embedded. If there is only one person enrolled on the plan, the Single deductible amount applies. If there are two or more members on the plan, the full Family deductible must be met before the plan begins to pay.

3 For all the plans designated as "QHDHP-E," the deductible on the family plan is embedded. If there is only one person enrolled on the plan, the Single deductible amount applies. If there are two or more members on the plan, any member on the plan is still only responsible for the Single deductible amount. Once the Family amount is met, no more deductible will be charged for that benefit period for any member on the contract.

4Capital Advantage plans are only available in Cumberland, Dauphin, Perry and York counties.

5Advance plans are only available in Adams, Berks, and Lancaster counties.

6Convenience plans are only available in Adams, Franklin, Lancaster, Lebanon, Lehigh, Northampton, and York counties.

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