• What is BlueEdge?
• What is a high-deductible health plan (HDHP)?
• What is a Health Savings Account (HSA)?
• What are the advantages of an HSA?
• Do I have to set up an HSA before I start paying for my medical expenses?
• How do I set up an HSA?
• How do I contribute to my HSA?
• How much can I contribute to my 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 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?
• Can an HSA be used by individuals over age 65?
• How does the prescription drug plan work?
• What if I have questions about my benefits?
BlueEdge is a PPO plan that is qualified to be combined with a Health Savings Account (HSA) that you fund for health care expenses. BlueEdge gives you control over how you spend your health care dollars and includes four major components:
- HSA funds from you are used to pay for covered health care expenses. Money spent from this account, for covered services, counts toward your deductible.
- PPO benefits begin after you meet the deductible. You have the freedom to see any doctor without a referral.
- Preventive care and wellness visits are paid in full for in-network services – nothing is deducted from the HSA and you don't need to meet the deductible to enjoy these benefits.
- Online decision resources help increase your awareness and knowledge of health issues and help you keep track of your health care expenses.
What is a high-deductible health plan (HDHP)?
A high-deductible health plan features an annual deductible for individuals and families. Because the deductible is a higher dollar amount, monthly premiums are typically lower than they are for other health plans. HDHPs, like BlueEdge Individual HSA and BlueEdge 100 from Blue Cross and Blue Shield of New Mexico (BCBSNM), qualify to be used with a tax-advantaged health savings account (HSA).
What is a Health Savings Account (HSA)?*
An HSA is a tax-favored savings account that you set up with an HSA administrator/bank to use with a high-deductible health insurance plan such as BlueEdge. 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 
from the U.S. Department of the Treasury.**
What are the advantages of an HSA?
- Control: The money in your HSA belongs to you – you decide how to spend it based on your health care needs and budget. You can even use your HSA to pay the medical expenses of family members not covered by your high-deductible plan.
- Flexibility: You can deposit (until age 65) or withdraw your money any time without a tax penalty as long as you use the money for qualified medical expenses (there is a yearly maximum amount for contributions).
- You own it! Your HSA is yours for life. It's portable, so you can take it with you from one job to the next. You can even continue to make contributions and withdrawals. Even though you can't make contributions once you reach age 65, your HSA continues to earn tax-free interest – and you can still use your account to pay for health-related expenses tax-free!
- Tax Savings: An HSA lets you to put away money for medical expenses before taxes are taken out. This means that you can set aside income-tax-free dollars in an HSA to pay for your qualified medical expenses. While your HSA grows, it also accumulates interest on a tax-free basis. You pay no taxes or penalties when you use your HSA to pay for your qualified medical expenses. When you turn 65, the amount remaining in your HSA can serve as a retirement benefit by covering qualified medical costs such as deductibles and coinsurance.
Do I have to set up an HSA before I start paying for my medical expenses?
Yes, if you want to take full advantage of a high-deductible plan that qualifies for an HSA. First you enroll in the high-deductible insurance plan like BlueEdge Individual HSA from BCBSNM; next you open an HSA with a bank that offers HSAs; then you can begin paying your medical expenses from your health savings account.
To build savings for health-related expenses, you will need to pair your BlueEdge health plan with an HSA. You may choose any HSA financial administrator or set up a health savings account directly with a bank. There are national and local HSA administrators/banks that offer HSAs. To set up your HSA, we recommend you work with your broker or check with your own bank.
Other resources you can check for more information about HSAs and the financial institutions that offer them:
How do I contribute to my HSA?
You may contribute your own money to your account by making a lump sum contribution or by making periodic payments at any time (up to your plan's annual deductible). For more information about HSA contributions, contact your HSA administrator/bank or visit the U.S. Treasury Web site.**
How much can I contribute to my HSA?
Each year, individuals and families can contribute up to the amount of their plan's annual deductible or the IRS-specified contribution amount – whichever amount is lower. For more information about HSA contributions, visit the U.S. Treasury Web site.**
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 can ask for 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 deductible?
Like most other PPO plans, BlueEdge includes an annual deductible. A deductible is the amount of covered charges that you must pay in a calendar year before the Plan begins to pay its share of covered charges incurred by you during the rest of the same calendar year. 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 BlueEdge HSA (Basic, Enhanced, Premium Plans) family deductible is an aggregate deductible. The family deductible must be met before plan benefits begin for any covered family member. There is no individual deductible for a family member to meet. Once the deductible is met, you begin to pay coinsurance up to the out-of-pocket limit. Please note: One family member may satisfy the entire PPO deductible for the whole family.
With the BlueEdge 100 plan, each family member has an individual deductible amount within the family deductible. Once one family member satisfies the individual amount, he or she is eligible for benefits and does not have to wait until the family deductible has been satisfied. Once the family deductible is met, benefits begin for all covered members.
Do I have to pay for preventive medical services 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 health 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:
- 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.
- 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.
- 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.
Can a HSA be used by individuals over age 65?
Yes. Although individuals over age 65 cannot contribute to their HSA, they can continue to earn tax-free interest on the balance and can use their account to pay for health-related medical expenses tax-free.
How does the prescription drug plan work?
You have one of the prescription drug plans below. Please refer to your BCBSNM member ID card or your Benefit Information to confirm which plan you have.
Percent/Coinsurance Drug Plan
BlueEdge Individual HSA Plans (Basic, Enhanced, and Premier) feature 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 (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 Benefit Information for details, limitations, and exclusions.
The BCBSNM Drug List does not apply to the 25/50 Percent Prescription Drug Plan.
Drug Plan with Deductible
BlueEdge 100 High-Deductible Health Plans feature a deductible prescription drug benefit.
Your prescription drugs are subject to the medical plan deductible; once the deductible is met, the plan pays 100%.
| Program | Amount You Pay: | Amount the Plan Pays: |
| Retail Pharmacy: Up to a 30-day supply or 180 units, whichever is less | ||
| Generic and brand-name drugs | PPO deductible amount | 100% after deductible |
| PrimeMail Pharmacy Mail-Order Service: Up to a 90-day supply or 540 units, whichever is less. | ||
| Generic and brand-name drugs | PPO deductible amount | 100% after deductible |
What if I have questions about my benefits?
BCBSNM's customer service representatives are available to answer your questions 6 a.m. to 8 p.m. MT, Monday through Friday, and 8 a.m. to 5 p.m. MT on weekends and holidays (closed Thanksgiving and Christmas Day). 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.
Learn More About BlueEdge HSA Plans for Individuals:
Overview
Benefit Information
Easy steps to setting up your health plan and HSA
*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.
**We do our best to ensure that the information on the Web sites shown above is useful, but can't be responsible for the content of those sites or any information you may take from them (please read our legal disclaimer). When you click on a site link above, it will open in a new window so that you can explore that site without having to leave here. When you are through visiting the other site, you can close that window and return to the BCBSNM site.
