BlueEdge^SM HSA and BlueEdge^SM Direct HCA
(2-150) Employees

 

BlueEdge HSA and BlueEdge Direct HCA are PPO plans that include a Spending Account to help employees pay for medical expenses and meet the annual deductible.

Spending Accounts

A Health Savings Account (HSA) is a tax-exempt account available to employees covered by a high-deductible health plan. Contributions, potential interest gains and distributions (when used for qualified medical expenses) are tax free. Deposits to the account can be made by the employee, the employer or both. Unspent funds in the account roll over year to year. The account is portable, which means it belongs to the employee even if he or she changes jobs, leaves the plan or retires.

A Health Care Account (HCA) is funded by the employer and helps members meet the deductible and pay for health care expenses. Members must pay their portion of the deductible each year before HCA funds can be used. PPO-eligible expenses count toward the deductible.

The chart below presents the different BlueEdge HSA and BlueEdge Direct HCA plan design options and includes a comparison of in-network versus out-of-network benefits.

Prescription drugs are covered at the medical coinsurance benefit noted in the chart below.

---

In-Network Benefits — 100% / 70% Coinsurance

Coinsurance	Deductible (Individual/Family)	Out-of-Pocket Max (Individual/Family)	Office Visit/ Emergency Room Benefit*
100%	$1,200 / 2,400	$2,400 / $4,800	Covered at 100% / 90%
100%	$1,500 / $3,000	$3,000 / $6,000	Covered at 100% / 90%
100%	$2,500 / $5,000	$2,500 / $5,000	Covered at 100% / 100%
100%	$2,500 / $5,000 Embedded	$2,500 / $5,000	Covered at 100% / 100%

Out-of-Network Benefits

Coinsurance	Deductible (Individual/Family)	Out-of-Pocket Max (Individual/Family)
70%	$2,400 / $4,800	$4,800 / $9,600
70%	$3,000 / $6,000	$6,000 / $12,000
70%	$5,000 / $10,000	$5,000 / $10,000
70%	$5,000 / $10,000 Embedded	$5,000 / $10,000

In-Network Benefits — 80% / 50% Coinsurance

Coinsurance	Deductible (Individual/Family)	Out-of-Pocket Max (Individual/Family)	Office Visit/ Emergency Room Benefit*
80%	$1,200 / $2,400	$2,400 / $4,800	Covered at 80% / 100%
80%	$1,500 / $3,000	$3,000 / $6,000	Covered at 80% / 90%
80%	$2,500 / $5,000	$5,000 / $10,000	Covered at 80% / 90%
80%	$2,500 / $5,000 Embedded	$5,000 / $10,000	Covered at 80% / 90%

Out-of-Network Benefits

Coinsurance	Deductible (Individual/Family)	Out-of-Pocket Max (Individual/Family)
50%	$2,400 / $4,800	$4,800 / $9,600
50%	$3,000 / $6,000	$6,000 / $12,000
50%	$5,000 / $10,000	$10,000 / $20,000
50%	$5,000 / $10,000 Embedded	$10,000 / $20,000

* The deductible must be met before the indicated benefits for office visit/emergency room applies.

---

Contact Us

Blue Cross and Blue Shield of Illinois
300 East Randolph Street
Chicago, Illinois 60601-5099
(800) 654-7385

Health Reimbursement Arrangements and Health Savings Accounts

Health Reimbursement Arrangements and Health Savings Accounts, including products under the BlueEdge product portfolio, have tax and legal ramifications. Blue Cross and Blue Shield of Illinois does not provide legal or tax advice, and nothing herein should be construed as legal or tax advice. These materials, and any tax-related statements in them, are not intended or written to be used, and cannot be used or relied on, for the purpose of avoiding tax penalties. Tax-related statements, if any, may have been written in connection with the promotion or marketing of the transaction(s) or matter(s) addressed by these materials. You should seek advice based on your particular circumstances from an independent tax advisor regarding the tax consequences of specific health insurance plans or products.