• What is BlueEdge?
• How is BlueEdge different from a traditional health plan?
• What is a Health Savings Account (HSA)?
• How does the employee use the funds in his/her HSA?
• What are qualified medical expenses?
• Can the employee use the HSA to pay for non-health-related expenses?
• What is the BlueEdge HSA Plan deductible?
• How does the BlueEdge HSA family deductible work?
• Does the employee have to pay for preventive medical services funds from the HSA?
• What covered services will the employee have to pay for out of his/her own pocket?
• Can the unused funds in the HSA be rolled over each year?
• For how long can the employee keep the HSA?
• How does the prescription drug plan work?
• What if I have questions about group plans?
BlueEdge is a consumer-driven health plan that works with a spending account option – a Health Savings Account (HSA) – that the employee and/or the employer may fund. BlueEdge gives the employee control over how to spend the health care dollars and includes four major components:
- HSA funds from the employee and/or the employer are used to pay for covered health care expenses. Money spent from this account, for covered services, counts toward the deductible.
- PPO benefits begin after the deductible is met. The employee has the freedom to see any doctor without a referral.
- Preventive care and wellness visits are covered – nothing is deducted from the spending account and the employee doesn't need to meet the deductible to enjoy these benefits.
- Online decision resources help increase awareness and knowledge of health issues and help the employee keep track of the HSA and health care expenses.
How is BlueEdge different from a traditional health plan?
Most traditional plans pay a percentage of the charges for covered medical expenses only after the employee satisfies a plan deductible or copayment. With BlueEdge, the preventive care and wellness services are covered without first meeting the deductible. The employee and/or the employer may also set aside a specific amount of money each benefit year in an HSA. The HSA funds pay for other covered health care expenses that are also applied to the deductible. The employee pays the remaining deductible amount and then PPO benefits begin. Any funds in a HSA is the employee's to keep, even if he/she change jobs or stop working.
What is a Health Savings Account (HSA)?*
An HSA is a tax-favored savings account that the employee uses with a high-deductible health insurance plan such as BlueEdge. The HSA can be established with funds from the employee, the employer, or both. The money in an HSA helps pay the deductible, as well as any other eligible medical expenses (including coinsurance), that may not be covered by the health plan after the deductible is met.
An HSA is similar to an individual retirement account (IRA) because it can be invested in a variety of investment vehicles while accumulating tax-free interest. However, the HSA funds are not taxed when withdrawn to pay for qualified medical expenses. The employee can make withdrawals from the HSA for nonmedical expenses, but it will be taxed as normal income and subject to a 10% penalty (if withdrawn before age 65).
At the end of each year, any unused funds in the HSA remain in the account and continue to earn interest tax-free.
HSA funds are portable, which means the employee owns the account. Even if he/she switches jobs, the funds stay with the employee.
For more basic information about HSAs, download and print out an HSA brochure (PDF) from the U.S. Department of the Treasury.
How does the employee use the funds in the HSA?
Using funds in the HSA is easy. Typically, the member will receive a debit card and/or checkbook from his/her financial institution. For example: When the member needs to visit the doctor and pay for a qualified medical expense, he/she uses the debit card or check to make the payment. The member will receive more information from the HSA administrator/bank.
What are qualified medical expenses?
HSAs can be used to pay for many types of medical expenses, even some which are often excluded on health insurance plans. These include:
- Health insurance plan deductibles, copayments, and coinsurance
- Prescription and over-the-counter drugs
- Dental services, including braces, bridges, and crowns
- Vision care, including glasses and lasik eye surgery
- Psychiatric and certain psychological treatments
- Long-term care services
- Medically related transportation and lodging
To obtain a current list of qualified medical expenses as determined by the IRS go to www.irs.gov.
Can the employee use the HSA to pay for non-health-related expenses?
The employee may withdraw money from the HSA for items other than qualified health expenses, however, that money may be subject to additional taxes or penalties. The employee can contact the HSA administrator/bank for more information.
What is the BlueEdge HSA Plan deductible?
Like most other PPO plans, BlueEdge includes an annual deductible. A deductible is a fixed amount the employee is required to pay before health care benefits begin. The HSA pays a portion of the deductible and the employee is responsible for paying the remaining part. Please note that certain expenses can be paid from the HSA, but may not qualify toward the deductible.
How does the BlueEdge HSA family deductible work?
The family deductible is an aggregate deductible, which means that the entire family deductible amount must be satisfied before benefits begin for any family member.
Does the employee have to pay for preventive medical services funds from the HSA?
No. Most preventive medical services (e.g., routine physical exams, age-based testing and vaccinations) are covered at 100 percent under BlueEdge when care is received from in-network doctors. The employee can check the group plan documents for specific coverage details.
What covered services will the employee have to pay for out of his/her own pocket?
There are three circumstances when the employee will have out-of-pocket expenses:
- The employee has used all of the HSA funds, but has not yet met the deductible. The employee is responsible for paying for health care services until he/she satisfies the deductible.
- The employee has met the deductible, so PPO benefits are available. If the plan includes coinsurance, the employee will be responsible for paying a percentage of the charges. There is an out-of-pocket maximum, so he/she won't pay more than this amount during the benefit year as long as he/she stays in network. The employee can check the plan documents for specific coverage details.
- Non-covered services, additional coinsurance (until the employee meets the higher out-of-pocket limit), and charges in excess of our allowed amount when the employee receives services out of network.
Can the unused funds in the HSA be rolled over each year?
Yes. The funds will accumulate without a maximum limit.
For how long can the employee keep the HSA?
The employee owns the HSA. He/she can take it from one job to the next or use it when retiring.
How does the prescription drug plan work?
BlueEdge HSA features a 25/50 percent prescription drug benefit.
The copayment for prescription drugs purchased through this drug plan is 25 percent of the covered charge for generic drugs and 50 percent of the covered charge for brand-name drugs. If the percentage of the covered charge falls between the minimum/maximum copayment, the employee will pay the actual percentage amount.
| Program | Percentage Employee Pays | Minimum Amount | Maximum Amount |
| Retail Pharmacy: Up to a 30-day supply or 180 units, whichever is less. | |||
| Generic drug | 25% | $20 | $75 |
| Brand-name drug | 50% | $40 | $125 |
| PrimeMail Pharmacy Mail-Order Service: Up to a 90-day supply or 540 units, whichever is less. | |||
| Generic drug | 25% | $40 | $150 |
| Brand-name drug | 50% | $80 | $250 |
| Prior-approved enteral nutritional products and special medical foods. | 50% | N/A – employee pays 50% | N/A – employee pays 50% |
The copayment will never exceed the maximum copayment listed. The copayments are applied to the medical plan annual out-of-pocket limit. The employee should have prescriptions filled at a participating pharmacy (see the Network Directory or search the Provider Finder®) or through the PrimeMail Pharmacy mail-order service. Coverage is always subject to the limitations of the health care plan. For some medications, prior approval, generic substitution, or quantity limits may apply. See the Prescription Drug Plan Rider for details, limitations, and exclusions.
The BCBSNM Drug List does not apply to the 25/50 Percent Prescription Drug Plan.
What if I have questions about group plans?
For more information about our plans for groups, please contact BCBSNM Customer Service toll-free at (800) 432-0750 or email us.
*HSAs have tax and legal ramifications. The information provided herein is for informational purposes only and is not intended as tax or legal advice. Consult a tax or legal professional for advice regarding HSAs.
Learn More About BlueEdge HSA for Groups:
Overview
Product Summary
Benefit Information
Spending Account and the Deductible
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