Medical Plan FAQ

Click on the question for more information about your healthcare plans.

• How does my HMO $500 Deductible plan work?

  What is a deductible?

  Your plan has a deductible, which means all the costs up to the deductible amount must be paid before this plan begins to pay for certain covered services you use. The annual deductible is $500 per member, capped at $1,000 per family. Watch this Annual Deductibles Explained video for how it works.

  When does the deductible apply?

  The deductible applies to these covered services: hospital admissions, outpatient surgery, diagnostic tests, imaging, short-term rehabilitation services (physical or speech therapy), and durable medical equipment.

  What happens when the deductible is met?

  Once the deductible is met for the calendar year, you pay nothing* for subsequent services in these categories. (*Rehabilitation Services continue to have a $30 copay and durable medical equipment has 20% coinsurance until you reach your annual out-of-pocket maximum.)

  You will continue to pay copays for office visits, prescription drugs, emergency room visits, and urgent care. These copays do NOT count toward the deductible.

  Where does the money come from to cover the deductible?

  You can contribute to a Medical FSA to pay your portion of the deductible with pre-tax dollars. Watch this Flexible Spending Account (FSA) video for how it works. (The FSA can be used for medical claims subject to the deductible, copays, coinsurance, and other qualified medical, dental and vision expenses.)

  Questions?

  Be sure to review the HMO Blue New England $500 Deductible Summary of Benefits and Coverage for plan details. Call Blue Cross Blue Shield member services at 888-456-1351.   The member service person will be able to see your coverage and answer your specific questions.

• How does my PPO $500 Deductible plan work?

  What is a deductible?

  Your plan now has a deductible, which means all the costs up to the deductible amount must be paid before this plan begins to pay for certain covered services you use. The annual deductible is $500 per member, capped at $1,000 per family. Watch this Annual Deductibles Explained video for how it works.

  When does the deductible apply?

  The deductible applies to these in-network covered services: hospital admissions, outpatient surgery, diagnostic tests, imaging, mental/behavioral health or substance use disorder inpatient services, and durable medical equipment. For most out-of-network services, the deductible applies first and then you are responsible for 20% coinsurance until you reach your out-of-pocket maximum for the year.

  What happens when the deductible is met?

  Once the deductible is met for the calendar year, you pay nothing* for subsequent services in these categories. (*Durable medical equipment has 20% coinsurance.)

  You will continue to pay copays for office visits, prescription drugs, emergency room visits, urgent care and rehabilitation services. These copays do NOT count toward the deductible.

  Where does the money come from to cover the deductible?

  You can contribute to a Medical FSA to pay your portion of the deductible with pre-tax dollars. Watch this Flexible Spending Account (FSA) video for how it works. (The FSA can be used for medical claims subject to the deductible, copays, coinsurance, and other qualified medical, dental and vision expenses.)

  Questions?

  Be sure to review the Blue Care Elect $500 Deductible Summary of Benefits and Coverage for plan details. Call Blue Cross Blue Shield member services at 888-456-1351.   The member service person will be able to see your coverage and answer your specific questions.

• What is the difference between a preventive and a diagnostic test and how does it work with my deductible?

  Preventive screenings fall under the recommended screening guidelines as outlined by the ACA typically because of your age and gender. As long as your provider bills the test as preventive, there is no cost for you.

  Diagnostic tests are performed to diagnose a condition as a result of symptoms or family history or to monitor an existing condition. These tests are subject to the health plan deductible.

  Here are some examples of how services may be billed as preventive or diagnostic:

  • Preventive: The doctor orders blood work for a 50-year-old male patient to screen for cholesterol levels during the annual exam.
    Diagnostic: A patient takes medication for high cholesterol. The doctor wants to monitor cholesterol levels and orders blood work two times a year. The tests are diagnostic because they are being done to monitor an existing condition.
  • Preventive: The doctor orders a mammogram for a 50-year-old female patient to screen for breast cancer as part of her annual exam.
    Diagnostic: A patient feels a small lump on her breast. The doctor orders a mammogram. The test is diagnostic because it is being done to diagnose breast cancer based on symptoms.
    

  Please see the Expanded Coverage for Preventive Care Under National Health Care Reform. 

• What are all of the different savings accounts - FSA and HSA?

  What are the different types of plans?

  • Healthcare FSA - flexible spending account for Qualified Medical Expenses (employee contributions up to $2,650 per year)
  • Limited Use FSA -  flexible spending account for vision and dental expenses only, can be used in conjunction with an HSA (employee contributions only)
  • HSA - health savings account for Qualified Medical Expenses (employee and employer contributions up to annual limits set by IRS)

   Who can participate in which plan?

  The type of health savings account you can participate is determined by the medical plan you are enrolled in.

  	HMO Blue New England	HMO Blue New England $500 Deductible	Blue Care Elect $500 Deductible PPO	Blue Care Elect Saver $1500 PPO w/HSA
  Medical FSA	x	x	x
  Limited Use FSA				x
  HSA				x

• How does the Blue Cross Blue Shield Telemedicine benefit work?

  Blue Cross Blue Shield now provides urgent care via your smartphone or computer with Telehealth and the office visit copay applies. Please see the BCBS Member Resources for details on utilizing this benefit, including a brochure explaining how to set up an account to use this service.

• What are alternatives to using the Emergency Room?

  The emergency room copay is $100. Please see the BCBS Member Resources for local urgent care centers, walk-in clinics, and telehealth options.  You will pay an office visit copay of $30 at these facilities.

 

 

 

Any questions? Contact Megan Childers [email protected] / 413-597-4355.