BlueEdge^SM FAQs

BlueEdge is a consumer-driven health plan that combines a PPO health plan with a Spending Account, which can be funded by the employer, the employee or both. Consumer-driven plans such as BlueEdge give your employees more control over how they spend their health care dollars and give them access to online resources to make more informed health care decisions.

BlueEdge includes four major components:

1. Preventive care and wellness visits are paid in full for in-network services—nothing is deducted from the Spending Account and members don’t need to meet the deductible to enjoy these benefits.
2. Spending Account funds are used to pay for covered health care expenses. Money spent from this account counts toward the deductible.
3. PPO benefits begin after members meet the deductible. Members have the freedom to see any doctor without a referral.
4. Online resources help your employees increase their awareness and knowledge of health issues and help them keep track of their Health Care Account and health care expenses.

A Health Care Account is an employer-funded account used by employees to pay for health care expenses. Charges for covered medical care services are first paid from this account. Money spent from the Health Care Account is also applied toward the deductible. Unspent funds roll over from year to year. If the employee leaves the plan, funds return to the employer.

A Health Savings Account can be established with funds from the employer, the employee or both. Employees can use these funds to pay for covered medical care services and money spent from this account also counts toward the deductible. The employee owns the account and funds remain with the employee if he/she leaves the plan.

A traditional plan generally pays a percentage of the charges for covered medical expenses only after members satisfy a plan deductible or copay. With BlueEdge, preventive care and wellness services received in network are paid in full before the deductible is met. Employers can choose to set aside a specific amount of money for their employees each benefit year in a Health Care Account, and/or the employees can establish a Health Savings Account, which can be funded by the employer, the employee or both. These account funds pay for other covered health care expenses that are also applied to the deductible. Employees pay the remaining deductible amount and then PPO benefits begin. Unused funds roll over year-to-year, as long as the employee remains in the plan. If the employee leaves the plan, funds return to the employer. HSA funds roll over year to year and are portable and remain with the employee even if they leave the plan.

If an employee uses all of the funds in their Health Care Account, the employee is responsible for any remaining balance of the deductible before PPO benefits begin.

If there is a remaining balance in the employee’s Health Care Account at the end of the benefit year, it automatically rolls over to the next year and is added to the annual contribution made by the employer. The total balance remains available to the employee as long as he/she participates in the plan; however, to limit their company’s financial liability, the amount that can accumulate in this account can be capped by the employer.

If an employee chooses another plan or leaves the company without continuing the coverage (e.g., under COBRA), the balance in the Health Care Account returns to the employer.

HSA funds are portable and remain with the employee even if he/she leaves the plan.

BlueEdge empowers and engages employees to become more active in managing their health and health care costs—potentially saving them and their employer money over time. As an integrated consumer-driven plan, BlueEdge provides a seamless approach to claims processing—automatically paying claims from the Health Care Account or the PPO benefit plan. With BlueEdge, employer groups pay as they go. The company funds claims only as they are paid from the Health Care Account, so unused account balances remain part of the company’s cash flow.

BlueEdge HSA, a consumer-driven plan, gives employees the opportunity to make decisions about how to spend their health care dollars and has the potential to save the employee and the employer money over time. The Health Savings Account—funded by the employer, the employee or both—provides funds for employees to pay for eligible health care expenses and helps them meet the deductible before PPO benefits begin. Health Savings Account funds are portable and stay with the employee if he or she leaves the plan.

The family Health Care Account can be used to pay for any covered services received by any family member covered under the plan. The deductible works like most other Blue Cross and Blue Shield of Illinois PPOs—no family member has to satisfy more than the individual deductible before receiving PPO benefits, and the PPO benefits will be paid for the whole family once the family deductible is met.

We offer HSA plans with either an embedded or aggregate deductible. These deductibles are defined as follows:

Aggregate Deductible

If family coverage is selected, the family deductible amount must be satisfied before any benefits are available under the HSA plan. The family deductible amount may be satisfied by one participant or a combination of two or more participants.

Embedded Deductible

The individual deductible amount must be satisfied by every participant covered, each calendar year.  If dependents are covered, all charges applied to the individual deductible amount will be applied toward the family deductible amount. When the family deductible is reached, no further individual deductibles will have to be satisfied for the remainder of that calendar year. No participant will contribute more than the individual deductible amount to the family deductible amount.

Self-insured and Cost-plus groups:

Claims paid by Health Care Accounts are billed to the group through the same process as the self-insured benefit plan and are listed separately on one bill.

Groups insured on a premium basis:

Groups receive one consolidated bill—including the monthly premium billed in advance and the Health Care Account claims paid in the previous month.

All groups:

While the group does not need to deposit the full amount of the Health Care Accounts in advance, it has to account for this liability.

New employees

When new employees enroll in BlueEdge, the initial Health Care Account contribution may be prorated. Employees with effective dates before July 1 will receive the full single or family Health Care Account amount. Employees with effective dates after July 1 will receive half of the single or family amount.

From single to family coverage

If the effective date of family coverage is before July 1, the difference between the family and individual Health Care Account contribution will be added to the existing account. After July 1, half of the difference between the family and individual Health Care Account contribution will be added.

From family to single coverage

If the employee changes to single coverage any time during the benefit year, the Health Care Account will not be adjusted. The next annual contribution to the account will be based on single coverage.