Ppo plan details
Blue care elect saver—choice
with hsa
We suggest you consider this plan if you live outside of New England. That’s because you’ll need access to a national network of providers.
HERE’S WHAT YOU SHOULD KNOW
About Your Care
No Primary Care Provider (PCP) required
No referrals needed
About Your Coverage
In-network preventive care is 100% covered1
More flexibility in choosing your doctors
About Your Costs
Lower cost per paycheck (compared with HMO plan)
Auto-enrolled into an Health Savings Account (HSA) with Blue Cross contributions and optional personal contributions (with option to enroll in a Limited Purpose FSA) to help offset costs
PPO Costs
Paycheck Contributions2 for Annualized Base Salary < $80K | Paycheck Contributions2 for Annualized Base Salary ≥ $80K | Deductible3 | Out-of-Pocket Maximum | |
---|---|---|---|---|
Individual | $31.03 | $47.86 | $1,600 | $5,000 |
Individual +1 | $61.67 | $95.27 | $3,200 | $10,000 |
Family | $89.71 | $139.70 | $3,200 | $10,000 |
Pharmacy4,5
Retail Pharmacy (1-Month Supply) |
Mail Order Pharmacy (3-Month Supply) |
|
---|---|---|
Tier 1 (generic) | Deductible, then $10 copay | Deductible, then $20 copay |
Tier 2 (brand) | Deductible, then $25 copay | Deductible, then $50 copay |
Tier 3 (non-preferred brand) | Deductible, then $45 copay | Deductible, then $135 copay |
How PPO Payments Work
In-network preventive care is 100% covered.1
Phase 1
You pay the cost of any care (including pharmacy expenses) beyond preventive services until you reach the deductible amount. With contributions from Blue Cross, your HSA will help you pay these costs.
Phase 2
Once your medical care expenses meet the deductible, you and Blue Cross share costs through co-insurance and/or copayments—with Blue Cross paying most 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.
Under this PPO plan, you and your family meet the family deductible as a group. No individual deductible applies. Once one or more family members meet the family deductible amount, co-insurance will kick in for everyone. See Phase 2.
THINGS TO CONSIDER
- Under this plan, the member is billed 100% of the charges until the deductible is met. Funds from your HSA, including the Blue Cross contributions, can be used to pay for the charges.
- This plan has a slightly higher deductible and out-of-pocket maximum, but these increases are offset by a lower cost per paycheck and by using your HSA for medical expenses.
- If you elect a Limited Purpose FSA for 2024, any unused funds up to $610 from your 2023 Limited Purpose or Health Care FSA will roll over and be available to use in 2024.
- Depending on your annual salary, Blue Cross HSA contributions may cover up to 75% of your deductible.
Financial Accounts for PPO
Health Savings Account (HSA) |
Limited Purpose FSA |
Dependent Care FSA |
|
---|---|---|---|
How is this funded? | Blue Cross automatically enrolls you into an HSA and contributes a set amount. You have the option to contribute additional personal funds. | 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. |
Contributions from Blue Cross for Annualized Base Salary < $80K |
Individual: $1,225 Individual +1: $2,450 Family: $2,450 Non-tax dependents, like domestic partners, aren’t eligible. |
None | None |
Contributions from Blue Cross for Annualized Base Salary ≥ $80K |
Individual: $850 Individual +1: $1,700 Family: $1,700 Non-tax dependents, like domestic partners, aren’t eligible. |
None | None |
Contributions from You for Annualized Base Salary < $80K | Individual: $2,925 Individual +1: $5,850 Family: $5,850 |
Currently $3,200, but may change pending any IRS adjustments | $5,000 per household or $2,500 if you’re married but filing separately |
Contributions from You for Annualized Base Salary ≥ $80K | Individual: $3,300 Individual +1: $6,600 Family: $6,600 |
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, your tax dependents (including children up to age 19 or age 24 if a full-time student) whether they're enrolled in the plan or not6 | You, your spouse, your tax dependents (including children up to age 26), whether they're enrolled in the plan or not6 | Your child 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 eligible7,8 medical, prescription drug, dental, and vision expenses that occur now9 or in the future | All eligible7 dental and vision expenses in the plan year10 | Childcare and adult day care expenses while you and your spouse work or attend school6 |
What Happens to My Account Balance at the End of the Year? | Your unused balance rolls over year to year and can grow tax free with interest or can be invested. | If you elect a Limited Purpose FSA for 2024, up to $610 of your unused balance from 2023 will roll over.7 | Your unused balance will not roll over. |
What Happens to My Account if I Leave Blue Cross? | The money is yours to keep and save for future expenses, even into retirement. | 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 part-time rates for 2024.
3. Under this plan, you’re responsible for the full cost of medical services, as well as any medication costs, until you reach your deductible.
4. The copay is waived for birth control (tier 1/generics only), smoking cessation drugs, and certain orally administered anti-cancer drugs.
5. These categories apply for most cases, but some medication tiers may vary.
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. “Now” refers to expenses incurred anytime this year.
10. All expenses must be incurred in the plan year—January 1, 2024 - December 31, 2024. File claims through March 31, 2025.