Here's a Quick Overview of Our HMO Plan:
About Your Care
Primary Care Provider is required
About Your Coverage
In-network preventive care is
About Your Costs
Higher cost per paycheck (compared with PPO plan)
Auto-enrolled into an
|Paycheck Contributions2 for Annual Salary < $70K||Paycheck Contributions2 for Annual Salary ≥ $70K||Deductible3||Out-of-Pocket Maximum|
|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|
Certain medications that treat high blood pressure, heart conditions, high cholesterol, depression, diabetes, and respiratory conditions are covered at no cost once you meet your deductible. Click here for a complete list of medications.
How Payments Work with Our HMO Plan
Preventive care is 100% covered.1
You make copayments for some services right away. For others, you pay 100% of the cost until you reach your deductible.
Once you meet your deductible, you'll then make copayments for most services and prescriptions—with Blue Cross paying for the majority of the expenses—until you meet your out-of-pocket maximum.
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.
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 services and prescription drugs. The HRA doesn't cover dental or vision. You can open a health care FSA to help offset some of these costs. All of these expenses are also applied to the deductible.
- If you elect a Health Care or Dependent Care FSA for 2022, any unused funds will roll over from your 2021 balance.
Financial Accounts for HMO
|Health Reimbursement Arrangement
|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|
Individual +1: $800
|Contributions6 from You||Individual contributions not allowed||$2,750||$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 dependents enrolled in the plan6||You, your spouse, your tax dependents (including children up to age 26) whether or not they’re enrolled in the plan6||Your children up to age 12, and disabled adult dependents, whether or not they’re enrolled in the plan6|
|What Can I Use This Money for?||All eligible7,8 medical and prescription drug expenses in the plan year9||All eligible7,8 medical, prescription drug, dental, and vision expenses in the plan year9||Childcare expenses while you and your spouse work or attend school9|
|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 an FSA, your unused balance from 2021 will roll over to 2022. However, any unused balance in your FSA at the end of 2022 will not roll over.||If you elect an FSA, your unused balance from 2021 will roll over to 2022. However, any unused balance in your FSA at the end of 2022 will not 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 2022 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. Exclusive Smart90®' requires that associates on certain maintenance medications get a 90-day prescription from their doctor. Learn more at bluecrossma.org/90daymeds.
6. Cannot be used for domestic partner expenses.
7. Eligible expenses include deductibles, co-insurance, and copayments where applicable.
8. Withdrawals for non-eligible expenses are subject to a tax penalty.
9. All expenses must be incurred in the plan year—January 1, 2022 to December 31, 2022. You can file claims for reimbursement through March 31, 2023.