Blue Access for Producers

BlueEdgeSM Wellness Rewards HCA


Blue Cross and Blue Shield of Texas offers a variety of consumer-driven health plans (CDHPs) which can help your clients control rising health care costs. The BlueEdgeSM Wellness Rewards HCA plan puts members in charge of their health by empowering them to make their own decisions about how their health care dollars are spent. BCBSTX provides online tools and resources to help members make wise and informed decisions about their health care and better manage their health care benefits.

Here is what makes BlueEdge Wellness Rewards HCA an exciting option.

BlueEdge Wellness Rewards HCA is an incentive-based Health Care Account (HCA) that provides members the opportunity to earn rewards for completion of healthy activities. Your client contributes to the member's HCA balance only when certain wellness-related activities are completed. As members make smart choices about their health, funds are earned and added to the HCA. Members can earn incentives for various wellness activities selected by your client.

Funds in the Wellness Rewards HCA can be used to pay for PPO eligible expenses applied to the plan deductible. The more money earned in the HCA, the less the member has to pay out-of-pocket. Your client only funds claims as they are paid, so unused account balances remain part of the company’s cash flow.

If there is a remaining balance of unused HCA funds at the end of the calendar year, that amount rolls over to the next calendar year and can be used toward charges applied to the next year’s calendar year deductible. If the member changes jobs or medical plans, the HCA funds remain with your client.

The HCA account is coupled with a PPO plan. Benefit levels vary depending on whether care is received in-network or out-of-network. Members must use network providers to receive the higher (in-network) level of benefits.

BlueEdge Wellness Rewards HCA plans are available to clients through the BlueChoice Network, one of the largest networks in Texas. BlueChoice provides:

  • Access to the national BlueCard® network when members are outside of Texas
  • Over 600 participating hospitals and facilities in Texas
  • More than 800,000 doctors and 6,000 hospitals contracting with Blue Cross and Blue Shield plans nationwide

For care outside of Texas, members have access to the BlueCard national network of providers.

BCBSTX offers a variety of PPO plans with varying deductible, coinsurance and copayment amount options. All plans include an outpatient prescription drug benefit with either a three-tier or four-tier pharmacy copay design.

The three-tier pharmacy copay plan design includes three tiers of medications that are comprised of:

  • Generic drugs
  • Preferred brand-name drugs
  • Non-preferred brand-name drugs

The four-tier pharmacy copay plan design includes four tiers of medications that are comprised of:

  • Generic drugs
  • Preferred brand-name drugs
  • Non-preferred brand-name/preferred specialty drugs
  • Non-preferred specialty drugs

Prescription drugs are available through retail pharmacies throughout Texas and mail order pharmacy services.

For more detailed information on available benefit designs, a description of the services and supplies that are covered, a listing of those services and supplies that are limited or excluded, terms and general administration, or for any questions you may have regarding our products and services, contact us for the phone number of the regional sales office near you.

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