• What is BlueEdge?
• How is BlueEdge different from a traditional health plan?
• What is a Health Savings Account (HSA)?
• How do I use the funds in my HSA?
• What are qualified medical expenses?
• Can I use my HSA to pay for non-health-related expenses?
• What is the BlueEdge HSA Plan deductible?
• How does the BlueEdge HSA family deductible work?
• Do I have to pay for preventive medical services funds from my HSA?
• What covered services will I have to pay for out of my own pocket?
• Can the unused funds in my HSA be rolled over each year?
• For how long can I keep my HSA?
• How does the prescription drug plan work?
• What if I have questions about my benefits?
BlueEdge is a consumer-driven health plan that works with a spending account option – a Health Savings Account (HSA) – that you and/or your employer may fund. BlueEdge gives you control over how you spend your health care dollars and includes four major components:
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HSA funds from you and/or your employer are used to pay for covered health care expenses. Money spent from this account, for covered services, counts toward your deductible.
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PPO benefits begin after you meet the deductible. You have the freedom to see any doctor without a referral.
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Preventive care and wellness visits are covered – nothing is deducted from the spending account and you don't need to meet the deductible to enjoy these benefits.
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Online decision resources help increase your awareness and knowledge of health issues and help you keep track of your 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 you satisfy a plan deductible or copayment. With BlueEdge, your preventive care and wellness services are covered without first meeting the deductible. You and/or your employer may also set aside a specific amount of money for you each benefit year in an HSA. The HSA funds pay for other covered health care expenses that are also applied to your deductible. You pay the remaining deductible amount and then PPO benefits begin. Any funds in a HSA are yours to keep, even if you change jobs or stop working.
What is a Health Savings Account (HSA)?*
An HSA is a tax-favored savings account that you use with a high-deductible health insurance plan such as BlueEdge. The HSA can be established with funds from you, your 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 your health plan after you meet your deductible.
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, your HSA funds are not taxed when withdrawn to pay for qualified medical expenses. You can make withdrawals from your 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 your HSA remain in the account and continue to earn interest tax-free.
HSA funds are portable, which means you own the account. Even if you switch jobs, the funds stay with you.
For more basic information about HSAs, download and print out an HSA brochure (PDF) from the U.S. Department of the Treasury.
How do I use the funds in my HSA?
Using funds in your HSA is easy. Typically a financial institution will provide you with a debit card and/or a checkbook. For example: When you need to visit your doctor and pay for a qualified medical expense, use the debit card or check to make the payment. You will receive more information from your 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
Check with your tax advisor or go to www.irs.gov to obtain a current list of qualified medical expenses as determined by the IRS.
Can I use my HSA to pay for non-health-related expenses?
You may withdraw money from your HSA for items other than qualified health expenses, however, that money may be subject to additional taxes or penalties. Contact your 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 you are required to pay before health care benefits begin. The HSA pays a portion of the deductible and you are responsible for paying the remaining part. Please note that certain expenses can be paid from your HSA, but may not qualify toward your 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.
Do I have to pay for preventive medical services funds from my HSA?
No. Most preventive medical services (e.g., routine physical exams, age-based testing and vaccinations) are covered at 100 percent under BlueEdge when you receive care from in-network doctors. Check your group plan documents for specific coverage details.
What covered services will I have to pay for out of my own pocket?
There are three circumstances when you will have out-of-pocket expenses:
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You've used all your HSA funds, but have not yet met your deductible. You are responsible for paying for health care services until you satisfy the deductible.
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You've met your deductible, so PPO benefits are available. If your plan includes coinsurance, you will be responsible for paying a percentage of the charges. There is an out-of-pocket maximum, so you won't pay more than this amount during the benefit year as long as you stay in network. Check your plan documents for specific coverage details.
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Non-covered services, additional coinsurance (until you meet the higher out-of-pocket limit) and charges in excess of our allowed amount when you receive services out of network.
Can the unused funds in my HSA be rolled over each year?
Yes. Your funds will accumulate without a maximum limit.
For how long can I keep my HSA?
You own your HSA. You can take it from one job to the next. You can even use it when you retire.
How does the prescription drug plan work?
BlueEdge HSA features a 25/50 percent prescription drug benefit.
Your 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, you will pay the actual percentage amount.
| Program | Percentage You Pay | 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 – you pay 50% | N/A – you pay 50% |
Your copayment will never exceed the maximum copayment listed. Your copayments are applied to the medical plan annual out-of-pocket limit. Be sure to have your 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 your health care plan. For some medications, prior approval, generic substitution, or quantity limits may apply. See your 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 my benefits?
BCBSNM's customer service representatives are available to answer your questions 6 a.m. to 10 p.m. MT, Monday through Friday, and 8 a.m. to 5 p.m. MT on Saturdays and holidays. If you call after hours, you can leave a message and we will return your call by the next business day. Call the toll-free number printed on the back of your member ID card. Please have your ID card available when you call. You may also email your questions to BCBSNM Customer Service.
*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
Overview
Benefit Information
How BlueEdge HSA Works
Spending Account and the Deductible
Easy steps for setting up an HSA
