Use the filter to find information for the coverage level you want:
- Employee Only
- Employee + One
- Employee + Family
| COVERAGE LEVEL | IN NETWORK | OUT OF NETWORK* |
| Employee Only |
| Your Biweekly Contribution | $40.22 | $40.22 |
| Deductible | $1,500 | $3,000 |
| Hess HSA Contribution | $500 | $500 |
| Your HSA Contribution | Up to $3,350 ($3,850 IRS limit minus Hess contribution) | Up to $3,350 ($3,850 IRS limit minus Hess contribution) |
| Out-of-Pocket Maximum | $2,750 | $5,000 |
| EMPLOYEE ONLY | | |
* Out-of-network expenses are limited to the eligible maximum allowed amount. You are responsible for paying any amount over the eligible maximum allowed amount charges in addition to your deductible and coinsurance.
| COVERAGE LEVEL | IN NETWORK | OUT OF NETWORK* |
| Employee + One |
| Your Biweekly Contribution | $80.43 | $80.43 |
| Deductible | $3,000 | $6,000 |
| Hess HSA Contribution | $1,000 | $1,000 |
| Your HSA Contribution | Up to $6,750 ($7,750 IRS limit minus Hess contribution) | Up to $6,750 ($7,750 IRS limit minus Hess contribution) |
| Out-of-Pocket Maximum | $5,500 | $10,000 |
| EMPLOYEE + ONE | | |
* Out-of-network expenses are limited to the eligible maximum allowed amount. You are responsible for paying any amount over the eligible maximum allowed amount charges in addition to your deductible and coinsurance.
| COVERAGE LEVEL | IN NETWORK | OUT OF NETWORK* |
| Employee + Family |
| Your Biweekly Contribution | $137.52 | $137.52 |
| Deductible | $3,000 | $6,000 |
| Hess HSA Contribution | $1,000 | $1,000 |
| Your HSA Contribution | Up to $6,750 ($7,750 IRS limit minus Hess contribution) | Up to $6,750 ($7,750 IRS limit minus Hess contribution) |
| Out-of-Pocket Maximum | $5,500 | $10,000 |
| EMPLOYEE + FAMILY | | |
* Out-of-network expenses are limited to the eligible maximum allowed amount. You are responsible for paying any amount over the eligible maximum allowed amount charges in addition to your deductible and coinsurance.