Under the last-month rule, if you are an eligible individual on the first day of the last month of your tax year , you are considered an eligible individual for the entire year. You are treated as having the same high-deductible health plan coverage for the entire year as you had on the first day of that last month. The total contribution for the year can be made in one or more payments at any time up to your tax-filing deadline . However, if you wish to have a contribution made between January 1 and April 15 treated as a contribution for the preceding tax year, please contact the HSA bank.
Once funds are deposited into your HSA, those funds can be used to pay for qualified medical expenses tax-free, even if you no longer have high-deductible health plan coverage. The funds in your account automatically roll over each year and remain in the account indefinitely until used. Once you discontinue coverage under a high-deductible health plan and/or get coverage under another health plan that disqualifies you from an HSA, you can no longer make contributions to your HSA.
However, since you own the HSA, you can continue to use it for future qualified medical expenses. If you have questions about the services rendered, you should contact the health care provider. If you have questions, please contact Member Service at the number on the front of your ID card.
You cannot use HSA funds to pay for qualified medical expenses incurred before you enrolled in a high-deductible health plan. In order to establish an HSA, you must enroll in a high-deductible health plan. Your eligibility to contribute to an HSA is determined by the effective date of your high-deductible health plan coverage. To enroll in a high-deductible health plan, complete the Blue KC application process. The Blue-Saver® PPO health insurance plan is a high-deductible health plan that allows you to establish an HSA as part of your health benefits.
When you enroll in the Blue Saver plan, you may be offered the opportunity to establish a HSA with one of our preferred banks. You will be presented with appropriate banking authorizations and disclosures necessary for Blue KC to work with the bank that will establish your HSA. Please note all financial institutions offering HSA products must comply with the USA Patriot Act, requiring your HSA bank to collect and verify information about you when processing your HSA application. Once your HSA has been established, you will be mailed a welcome kit and HSA debit card from the bank. If you're an HMO member, you will need to receive services from an in-network HMO provider. However, you will be able to receive emergency or urgent care services no matter where you are.
For details about your coverage, please review your Blue KC certificate, which outlines the benefits and exclusions related to your health insurance plan. You can view your certificate by logging in and accessing the Plan Benefit section. There are two times you can make a change to your enrollment options. Your employer schedules an open enrollment period once a calendar year when all employees may make changes to their health insurance plan. You may also make a change during a special enrollment period if you acquire a new dependent or if your coverage is terminated under another health insurance plan.
If you have health insurance through an employer, your group benefits administrator, typically someone in your Human Resources department, can help you make changes to your health insurance plan. If you do not have health insurance through an employer and instead pay your monthly premiums directly to Blue KC, call the Customer Service number listed on your member ID card. Telehealth benefits available to all plans either from Blue Cross NC or through the provider network. Blue Cross NC provides the telehealth program for your convenience and is not liable in any way for the goods or services received.
Blue Cross NC reserves the right to discontinue or change the program at any time without prior notice. Decisions regarding your care should be made with the advice of a doctor. Depending on your plan, selected programs may not be available to you at this time. Check with Blue Cross NC Customer Service to determine your eligibility.
Blue Cross NC has contracted with a third-party vendor independent from Blue Cross NC to bring you telehealth benefits. A Health Savings Account allows members enrolled in a qualified high-deductible health plan to contribute funds on a tax-free basis into the member's account. These funds are used for payment of qualified medical expenses as defined by the IRS.
Unused funds in an HSA roll over in the member's account at the end of each calendar year. When you receive a bill from your doctor, it is often for your copayment, co-insurance, or deductible. These are features of health plans, and basically have the member share in some of the cost of their health care. For example, some health plans require that the member pay $10 for an office visit and the rest is covered by the plan. Your PersonalBlue health insurance plan includes a prescription drug coverage plan with set copayments for both generic and brand name prescription drugs.
The PCA portion of your plan cannot be used to reimburse you for these copayments. The maximum amount that may be contributed to your HSA for any year is a certain amount established annually by the IRS. This amount depends on whether you have individual or family coverage under your qualified high-deductible health plan. The same annual contribution limit applies regardless of whether the contributions are made by an employee, an employer or both. Use your HSA debit card or other means provided by your HSA bank to pay for qualified medical expenses.
You should only use the debit card at healthcare-related locations. This may include an Internet transaction as long as the items being purchased are qualified medical expenses. You may also use your HSA debit card for online capabilities such as online bill pay. A qualified health-deductible health plan is a health plan with an annual deductible for an individual or a family that meet the minimum deductible amount published annually by the U.S. The annual out-of-pocket expenses required by the high-deductible health plan also does not exceed the out-of-pocket maximums published by the U.S.
Out-of-pocket expenses include deductibles, copayments and other amounts the member must pay for, but do not include premiums or amounts incurred for non-covered benefits. Each payment you make for covered healthcare services you've received from your providers such as a physical exam counts toward your deductible. Once Blue KC processes the claims we receive from your providers showing the payments that you have made for covered healthcare services, we apply those payments toward your deductible. A deductible is the amount that you are responsible for paying annually for healthcare services. Exceptions are outlined in your Blue KC certificate, which lists the exclusions related to your health insurance plan. Your children's coverage while they are away from home depends on the type of health insurance plan you have.
If you have health insurance through your employer, check with your group benefits administrator for more information. Because your PCP coordinates your care, you should always let our group know whenever you seek treatment of any kind. For further details about the specific cases that don't require a referral, please call Member Service at the number on the front of your ID card. After the funds in your PCA have been used, you will be responsible for a certain amount of your healthcare costs until your deductible amount has been met. You do have the benefit of the negotiated prices for healthcare from network providers, but you will pay for all of the healthcare until your individual or family deductible is met.
You can continue to use the funds in your account tax-free for out-of-pocket health expenses. If you enroll in Medicare, you can use your account to pay Medicare premiums, deductibles, copayments and coinsurance under any part of Medicare. If you have retiree health benefits through your former employer, you can also use your account to pay for your share of retiree medical insurance premiums. The one expense you cannot use your account for is to purchase a Medicare supplement insurance or "Medigap" policy. A copayment, or copay, is the dollar amount that you pay to a provider at the time you receive a service.
Policy Number On Insurance Card Blue Cross For example, you might pay a $30 copay each time you visit your allergy doctor. The copay amount is defined in your Blue KC certificate, which outlines your responsibilities for health insurance plan payments. Allowable charges are the maximum amount payable to you under your health insurance plan for a particular service. Contracted providers have agreed to accept this amount as payment in full. For example, if the provider charges $100 for a service and Blue KC pays $80 as the allowable charge, the provider cannot ask the member to pay the remaining $20. Keep in mind, however, that some health insurance plans have coinsurance.
In those cases, members are required to pay a percentage of the allowable charge. For specific details about your plan, review your Blue KC certificate, which outlines your payment responsibility. Billed charges are the amount charged or billed by your healthcare provider for the services/supplies you received. Not all provider charges will be paid by your health insurance plan.
To change a PCP, log in and visit you Profile by clicking on the icon by your name in the top right corner of your homepage. In the Coverage Information section you'll see a list of covered members for your Blue KC policy. From here select "Change PCP" for the appropriate member and you can search for and designate a new PCP. Once we have processed your PCP change request, we will send you a new member ID card that contains the information of your newly selected PCP. You may also call the Customer Service number listed on your member ID card to change your PCP.
Please note that if you have health insurance through your employer, you may be required to contact your group benefits administrator to change your PCP. If you have health insurance through your employer, check with your group benefits administrator to have a dependent added to your plan. He or she has the information and/or forms you need to add your dependent to your health insurance plan.
It's best to check your health care options before using the emergency room . Plus, when you visit in-network providers, you may pay less for care. When you and your primary care provider determine that you need specialized care, your PCP will "refer" you to a specialized provider from our trusted team. A referral is required by your HMO health plan before the plan will cover certain services. Each covered member of your family may choose his or her own primary care provider , and choosing the right one is important.
There are many different types of PCPs, including general practitioners, internists, pediatricians, family medicine physicians, and nurse practitioners. To choose the best fit for you or your family member, begin by asking for recommendations from the people you trust. You should also consider each PCP's distance and accessibility from your work or home. Most importantly, talk with us to be sure that the practice can meet your personal health care needs.
If your plan doesn't require that you choose a PCP, you can see a specialist or other health care provider without a referral. However, you'll still need to see a provider who participates with Blue Cross Blue Shield of Massachusetts in order to have your benefits covered at the highest level. If you forget or aren't sure what type of health insurance plan you have , you can find out on your BCBS ID card. If you have an HMO, your card may also list the physician or group you've selected for primary care.
Determining whether a provider is in-network is an important part of choosing a primary care physician. Routine Preventive care is a care benefit that is not subject to a deductible. A Primary Care Physician is the physician you choose to be your primary source for medical care. Your PCP coordinates all your medical care and knows your specific health history. You can designate a physician who specializes in family practice, general practice, internal medicine or pediatrics and is in your network as your PCP. Each dependent on your health insurance plan will also need a designed PCP.
Sometimes providers send statements to their patients before Blue KC has finished processing and paying the claim. If the provider you saw is out-of-network you will be responsible for paying the provider directly. We will send you a payment for the amount that is covered by your plan. You can view your EOBs and details about your claims, including how much you owe, by logging in and visiting the Claims and Usage section.
You might see a note on the bill that says "Insurance Pending." We will send you an Explanation of Benefits once we have processed your claim. If you are still unsure if you owe the provider, call their billing office. Please note, if your provider was not in the Blue KC HMO network, you will be responsible for paying all services and fees for seeing that provider. Distributions used for any other purpose are includable in income and may also be subject to an additional 20 percent tax. This 20-percent penalty tax does not apply to distributions made after your death, disability or attainment of age 65. In addition, excess contributions are subject to a six-percent excise tax.
Rollover contributions do not count in determining whether an excess contribution has been made. Yes, funds may be withdrawn and used to pay for qualified medical expenses for you and/or your tax dependent without a tax penalty. For purposes of medical deductible of a child of divorced or separated parents, they can be treated as a dependent of both parents. Each parent can include the medical expenses he or she pays for the child, even if the other parent claims the child's dependency exemption. Please consult a legal or tax adviser concerning questions you may have. Many people are insured under more than one health and/or dental insurance plan at the same time.
Because of dual insurance, Medicare Secondary Plans and Coordination of Benefit requirements, Blue KC needs to determine primary insurance based on the facts of each situation. Most health insurance and dental plans include a COB provision that defines these requirements. This provision prevents payments from all Plans from exceeding the total allowable expense.
When you see an out-of-network provider, we send a check to you for the covered amount of those services. We will send you an EOB that explains how that amount was calculated. Yes, you must pay your copayment when you see your in-network provider. Your copayment amount depends on the health insurance plan you have and the services you are receiving from your provider.
Offering health insurance for individuals, families, employers and Medicare, our health plans give you coverage that's focused on your health and well-being. We are here to help answer your questions and find the plan that fits your needs. People sometimes have insurance coverage under more than one health plan, so we periodically send a survey to our members asking them if they have other coverage.
This is to ensure that claims are processed correctly and that overpayments are not made. We see significant cost savings by coordinating payments with other insurers—savings that ultimately result in more affordable premiums for our members. It was developed by doctors and pharmacists after careful evaluation of clinical studies to determine which medications are most effective, safe, and maximize cost savings.
