The BlueEdge HCA plans are another part of the Blue Cross and Blue Shield of Texas (BCBSTX) portfolio of consumer-driven health plans. BlueEdge HCA plans put 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.
With our standard plans:
- The HCA pays for the member's eligible expenses that are applied to the deductible until the balance is depleted. When the HCA balance reaches zero, any additional charges the member incurs for services covered under the PPO plan are then subject to the "self-pay corridor" portion of the deductible. The "self-pay corridor" is the difference between the calendar year deductible and the employer-funded HCA. It is the member's responsibility portion of the plan deductible that must be satisfied before benefits under the PPO health coverage begin.
- Preventive care services are covered at 100% with no calendar year deductible when services are received from in-network providers. The claims are paid directly from the PPO plan and not from the HCA.
- BlueEdge provides a seamless approach to claims payment.
- Members do not have to pay for services up front or submit claims for reimbursement when receiving services from in-network providers.
- Your client only funds claims as they are paid. 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 year and is added to your client's annual contribution.
- The total balance remains available to the member as long as he/she participates in the plan; however, to limit the company's financial liability, the amount that accumulates in this account is capped at the amount of the plan deductible.
- If the HCA balance equals the calendar year deductible amount, no additional contribution to the HCA is required by your client for that calendar year.
- If a member changes jobs or medical plans, the HCA funds remain with your client.
- No referral is needed to the doctor(s) of their choice.
- Well-child and adult care, including immunizations, and screenings such as cholesterol, breast cancer, prostate cancer, and cervical cancer are covered at 100% of the allowable amount when received by in-network providers.
- Standard PPO plan coverage includes office visits, hospital and surgical care, diagnostic testing, emergency benefits, maternity care, rehabilitation therapy, behavioral health, prescription drug coverage, and more.
- Benefit levels vary depending on whether care is received in-network or out-of-network. To get the higher level of benefits, members need to use network providers.
- Members have access to the national BlueCard® network when outside of Texas.
BCBSTX offers a variety of BlueEdge HCA plans to large clients with customized deductible and coinsurance options on an insured or self-funded basis.
For more detailed information on our BlueEdge HCA plans, visit the Contact Us page for the number of the regional sales office near you.