HMO PLAN DETAILS
NETWORK BLUE NEW ENGLAND DEDUCTIBLE WITH HRA
Only care received from doctors, hospitals, and other providers in our New England Network is covered. This plan’s service area includes Massachusetts, Rhode Island, Vermont, Connecticut, New Hampshire, and Maine.
HERE’S WHAT YOU SHOULD KNOW
About Your Care
Primary Care Provider is required
Referrals are needed to see specialists
About Your Coverage
In-network preventive care is
Only care received from doctors, hospitals, and other providers in our New England network is covered
About Your Costs
Higher cost per paycheck (compared with PPO plan)
Copay only needed for most medical services and purchasing prescriptions
Auto-enrolled into a Health Reimbursement Arrangement (HRA) with Blue Cross contributions (with option to enroll in a Health Care FSA) to help offset costs
HMO COSTS
Paycheck Contributions2 for Annualized Base Salary < $80K | Paycheck Contributions2 for Annualized Base Salary ≥ $80K | Deductible3 | Out-of-Pocket Maximum | |
---|---|---|---|---|
Individual | $50.49 | $71.24 | $1,250 | $3,000 |
Individual +1 | $100.49 | $141.93 | $2,500 | $6,000 |
Family | $146.60 | $208.12 | $2,500 | $6,000 |
Pharmacy3,4
Retail Pharmacy (1-Month Supply) | Mail Order Pharmacy (3-Month Supply) | |
---|---|---|
Tier 1 (generic) | $15 copay, no deductible | $30 copay, no deductible |
Tier 2 (brand) | $30 copay, no deductible | $60 copay, no deductible |
Tier 3 (non-preferred brand) | $50 copay, no deductible | $150 copay, no deductible |
How Payments Work with Our HMO Plan
In-network preventive care is 100% covered.1
Phase 1
You make copayments for some services right away. For others, you pay 100% of the cost until you reach your deductible.
Phase 2
Once you meet your deductible, you’ll then make copayments for prescriptions and most services with Blue Cross paying for the majority of the expenses — until you meet your out-of-pocket maximum.
Phase 3
When you reach the out-of-pocket maximum, Blue Cross will then pay 100% of any eligible, in-network expenses for the rest of the year.
NEED FAMILY COVERAGE?
Under this HMO plan, you and each member of your family work toward the deductible amount as individuals. Copayments begin for all family members when any combination of individual family member expenses meets the family deductible amount. See Phase 2.
Things to Consider
- Your PCP is your main source for health care services. If you see another doctor or specialist, you’ll need to get a referral from your PCP for the service to be covered by your plan. Please make sure to update your PCP ID number with Employee Services by phone or via email to avoid delay in payment of claims.
- This plan has a higher cost per paycheck but is offset by having a lower deductible and out-of-pocket maximum. It pairs with an HRA that can be used to pay for eligible medical and prescription drug expenses.
- You have the option of electing a health care FSA that can be used for eligible medical, prescription drug, dental, and vision expenses.
- If you elect a Health Care FSA for 2024, up to $610 of unused funds will roll over from your 2023 balance and be available to use in 2024. Dependent Care FSA dollars aren't eligible for the roll over.
Financial Accounts for HMO
Health Reimbursement Arrangement (HRA) |
Health Care FSA |
Dependent Care FSA |
|
---|---|---|---|
How is this funded? | Blue Cross automatically enrolls you into an HRA and contributes a set amount | You have the option to enroll, and can contribute personal funds up to the annual maximum | You have the option to enroll, and can contribute personal funds up to the annual maximum |
Contributions5 from Blue Cross |
Individual: $400 Individual +1: $800 Family: $1,000 |
None | None |
Contributions5 from You | Individual contributions not allowed | Currently $3,200, but may change pending any IRS adjustments | $5,000 per household or $2,500 if you’re married but filing separately |
Who Can I Use This Money for? | You, your spouse, any covered tax dependents enrolled in the plan5 | You, your spouse, your tax dependents (including children up to age 26) whether or not they’re enrolled in the plan5 | Your children under age 13, a disabled spouse or adult dependent — whether or not they’re enrolled in the plan6 |
What Can I Use This Money for? | All eligible6,7 medical and prescription drug expenses in the plan year8 | All eligible6,7 medical, prescription drug, dental, and vision expenses in the plan year8 | Childcare and adult day care expenses while you and your spouse work or attend school |
What Happens to My Account Balance at the End of the Year? | Your unused balance is forfeited and doesn’t roll over to the next year “Use it or lose it” | If you elect a Health Care FSA for 2024, up to $610 of your unused balance from 2023 will roll over | Your unused balance won't roll over |
What Happens to My Account if I Leave Blue Cross? | Your account is closed. You can file claims up to 90 days after your termination date for services received while you were working at Blue Cross |
Your account is closed. You can file claims up to 90 days after your termination date for services received while you were working at Blue Cross |
Your account is closed. You can file claims up to 90 days after your termination date for services received while you were working at Blue Cross |
1. Diagnostic tests and lab work aren't covered under preventive care.
2. Paycheck contribution amounts are for full-time associates. For part-time rates, download 2024 part-time rates.
3. The copay is waived for birth control (tier 1/generics only), smoking cessation drugs, and certain orally administered anti-cancer drugs.
4. These categories apply for most cases, but some medication tiers may vary.
5. Cannot be used for domestic partner expenses.
6. Eligible expenses include deductibles, co-insurance, and copayments where applicable.
7. Withdrawals for non-eligible expenses are subject to a tax penalty.
8. All expenses must be incurred in the plan year—January 1, 2024 to December 31, 2024. You can file claims for reimbursement through March 31, 2025.