With the Blue Cross and Blue Shield of New Mexico (BCBSNM) HCA plan, an employer sets aside a specific amount of money for each employee each benefit year in a Health Care Account (HCA). The HCA can help the employees and their covered family members pay for qualified health care expenses.
Here's how the Health Care Account works:
- When an employee needs any covered medical care, the first dollars spent are automatically deducted from the account — they don't even need to file a claim.
- The money paid from the HCA account is applied toward each employee's annual plan deductible.
- Employees can keep track of their HCA balance on their Explanation of Benefits (EOBs) and online.
- If an employee uses use all of your HCA contribution, the employee is responsible for any remaining balance of the deductible before PPO coverage begins. The amount in the employee's HCA is applied toward meeting the deductible. Once the deductible is met, BlueEdge HCA benefits begin.
- Any remaining balance in an employee's account at the end of the benefit year automatically rolls over to the next year and is added to the annual employer contribution. The greater the balance, the less the employee has to pay out of pocket.
- If an employee has coverage for dependents, the family HCA can be used to pay for any covered services received by any family member covered under the plan.
- If an employee chooses another plan or leaves the company without continuing coverage (e.g., under COBRA), the balance in the HCA is returned to the employer.
BlueEdge has an annual deductible that must be satisfied before PPO benefits begin.
Here's how it works:
- The deductible amount, which is based on the particular benefit plan, is shared between the spending account contribution and the employee.
- The money used from the HCA is applied toward the deductible.
- Once all the money in the HCA is used, the employee needs to satisfy any remaining balance of the deductible before PPO benefits begin.
- If the employee's dependents are covered under the plan, the deductible works like most other BCBSNM's PPO programs. No family member has to satisfy more than the individual deductible before receiving PPO benefits, and the PPO benefits will be paid for the whole family once the family deductible is met. The deductible is not part of the out-of-pocket maximum