Blue Care Elect Saver (with Health Savings Account)
Blue Care Elect Saver
If you are enrolled or considering enrolling in the Blue Care Elect Saver plan, the following should provide you with a summary of the plan along with some helpful tips on how the plan works.
Plan Features and Highlights
- BCBS Plan Name: Blue Care Elect Saver
- WHOI pays 75% of the premium, employee pays 25%
- Annual Deductible: $1,500 for individual coverage, $3,000 for family coverage*
- WHOI contributes up to 50% of the deductible through biweekly contributions to your HSA
- Uses BCBS' national PPO network
- In-network and out-of-network coverage
- No Primary Care Physician required
- No referrals to Specialists required
- Employees can make voluntary contribution to HSA
- Employees can participate in new 'Limited Purpose' Healthcare Flexible Spending Account (LPFSA)
* family coverage = employee + spouse, employee + child(ren), and employee + family
The plan requires an upfront annual deductible of $1,500 for individual coverage and $3,000 for family coverage. Once the annual deductible is met, some services are covered in full. Some services, including but limited to prescriptions and specialist office visits, will continue to require a co-payment even after the deductible has been met.
The family deductible of $3,000 can be met by one member or any combination of members enrolled under the same family plan (no individual cap per member). Under a plan that includes the subscriber and eligible dependents, the entire amount of the family deductible must be met before benefits will be provided for any one member.
Services subject to the Annual Deductible
All services, except for routine preventive visits, are subject to the deductible. This includes Rx prescriptions under this plan.
This plan is part of BCBS of Massachusetts national PPO provider network which includes more than 90% of all practicing physicians and hospitals across the United States (not limited to Massachusetts or New England). You receive the highest level of benefits under your health care plan when you obtain covered services from in-network providers. To find a preferred provider in the PPO network, visit the BCBS website at www.bluecrossma.com/findadoctor and select the 'Blue Care Elect (PPO/EPO)' network.
Under this plan, you can also receive covered services from non-preferred providers (including providers who are not part of the PPO network). After your plan deductible is met, you pay an additional 20% co-insurance for out-of-network services, up to the plan's annual out-of-pocket maximum. The Plan's annual out-of-pocket maximum varies depending on coverage level for individual or family. This annual maximum includes the annual deductible.
Health Savings Account (HSA)
HSA: Employer Contributions
With the Blue Care Elect Saver plan, a Health Savings Account (HSA) will be offered and tied to that plan. The Institution will make a contribution to the employee's HSA equal to 50% of the annual deductible under this plan - this equates to up to $750 for employees enrolled in individual coverage and up to $1,500 for family coverage. The Institution will make this HSA contribution on a biweekly basis.
NOTE: The HSA is prorated for new hires and any mid-year enrollments.
HSA: Employee Contributions
In addition to the HSA contribution from WHOI, employees may also make their own voluntary pre-tax contributions to their HSA account. Unlike an FSA account, the IRS allows for contributions to an HSA at any time during the year, including mid-year changes. So for those employees who may be unsure during Open Enrollment, they have plenty of time during the year to make or change their HSA election.
HSA: Contribution Limits
Annual contributions to an HSA are limited by the IRS each year. This year, the maximum amount of HSA contributions for an employee enrolled in individual coverage is $3,500 and $6,900 for those enrolled in family coverage. Remember, family coverage includes employee + spouse and employee + child(ren) coverage. The limits take into account the combined employer and employee contributions.
The IRS also allows for an additional $1,000 annual contribution for employees age 55 or older.
HSA: Excess Contributions
In addition to the annual limits, the IRS also has specific rules for HSA contributions during the year in that they cannot exceed the amount of months that the employee is covered by a High Deductible Health Plan (HDHP). This would only impact someone who ends or enrolls in coverage in the Blue Care Elect Saver plan mid-year.
EXAMPLE: An employee under age 55 has individual coverage in the HDHP-HSA plan. The employee either ends employment or changes status and loses eligibility for coverage in April 2018. In this example, the IRS would only allow pro-rated HSA contributions for 4 months (Jan - April). Taking the annual individual contribution limit for 2018 of $3,500, this employee would only be allowed to have up to $1,166.67 in HSA contributions. Any contributions in excess of that amount would need to be distributed from the HSA account and would be considered as taxable income to the employee.
HSA: Age Restrictions
Per IRS regulations, employees age 65 or older can only participate in a Health Savings Account if they are not enrolled in Medicare. Employees in this age category who wish to enroll in the Blue Care Elect Saver plan should verify their Medicare enrollment status with the Social Security office.
HSA contributions (both employer and employee) are tax-free as long as they are used for eligible expenses. Eligible expenses are defined by the IRS under Code Section 213(d). For a detailed explanation and listing of eligible expenses, please review the IRS publication at: http://www.irs.gov/pub/irs-pdf/p502.pdf
HSA contributions are fully owned by the employee. Unused HSA dollars are not forfeited like an FSA, and are completely portable if you end employment with/or retire from the Institution.
How will I pay for my medical expenses under the Blue Care Elect Saver plan?
Annual routine preventive services are covered in full with no office visit co-payment or deductible charges.
Rx prescription drugs are subject to the deductible. Once the deductible is met, Rx co-payments apply based on the drug tier level. Once deductible has been met, certain prescriptions for Tier 1 Diabetes & Coronary Artery Disease (CAD) will have $0 copay.
For services that are subject to the deductible, you should not pay anything at the point of service and follow these instructions:
At the Doctor's Office:
- Go to the doctor and show your BCBS ID card
- Provider submits claim to BCBS
- BCBS processes the claim and determines the allowable/contracted charges
- BCBS sends a claims summary to the provider for appropriate billing and to the patient for their records
- Provider bills patient based on BCBS allowable charges
- BCBS sends claims information to Health Equity for online HSA claims administration
- Pay doctor your cost share from your HSA account with Health Equity (if funds are available), or pay out-of-pocket if you prefer to save your HSA money. NOTE: you may reimburse yourself later from your HSA once funds are available.
- Receive email notification from Health Equity of payment/reimbursement as well as monthly statement.
At the pharmacy:
- Go to pharmacy
- Show your BCBS ID card
- Pharmacy applies discount
- The pharmacy will determine your member cost share
- Pay pharmacy from your HSA funds by debit card (if funds are available), or pay out-of-pocket if you prefer to save your HSA money or if funds are not available. NOTE: You may reimburse yourself later from your HSA once funds are available.
- Claim is sent to BCBS to be applied to deductible
Last updated: April 30, 2018