BMC offers three medical plan choices:
A high-deductible medical plan with a tax-free Health Savings Account. This medical plan offers you a choice of medical care providers similar to a traditional PPO plan and provides in- and out-of-network benefits. In addition, BMC makes an annual contribution to your HSA for you to use during the year to pay your share of health-related expenses. Unused money in your HSA rolls over from year to year for you to use for future health expenses. Prescription drug coverage is provided through Express Scripts.
A medical plan that lets you decide where to receive care each time you need it. If you use a provider in the PPO network, you pay less for health services. If you receive care from a non-network provider, you pay a larger portion of the cost, and the cost itself is higher. Prescription drug coverage is provided through Express Scripts.
Available only in California, the Kaiser HMO is a managed care medical plan that provides medical and prescription drug benefits only when you receive care within the HMO network and when the care is coordinated by your primary care physician.
It’s easy to locate network providers for the BCBSTX HSA, the BCBSTX PPO and the Kaiser HMO. You can find a list of participating providers on the BCBSTX website and on the Kaiser website or you can contact BCBSTX and Kaiser directly by phone to request a provider directory. You can also access the applicable provider directory through the MyBMC Rewards website. Click on the Health & Insurance tab and select Find A Doctor.
If you are enrolled in one of the BCBSTX coverage options and you choose not to use a network provider for your medical services, your out-of-pocket costs will be higher (for a comparison of in- and out-of-network coverage, see Plan Details). You may also have to file a claim form to receive reimbursement for services within 12 months of the date of the service. Prescription drug claims through Express Scripts must be processed by an Express Scripts in-network pharmacy or through the Express Scripts mail-order program. If you choose not to use an Express Scripts network pharmacy, your benefit will be reduced to 50% of the drug cost and you will need to submit a claim form for reimbursement.
If you are enrolled in the Kaiser HMO coverage option, no benefits are payable for services or prescription drugs provided by facilities, providers or pharmacies outside of the Kaiser network except in certain emergency situations. This includes coverage for dependents living outside the coverage area and certain emergency situations for all covered members. Please check with Kaiser directly about this coverage.
Under the BCBSTX medical plans, you have a deductible to meet each plan year (the Kaiser HMO has no annual deductible). The deductible is fully paid by you. Once the plan deductible is met, the plan begins paying at the appropriate level. The BCBSTX PPO and HSA Plans have separate deductibles for in-network and out-of-network coverage. See the Plan Details for the deductibles and coinsurance or copay levels for the PPO and HSA plans.
IRS guidelines specify that if you enroll in a qualified High Deductible Health Plan (HDHP) like the BCBSTX HSA and elect coverage for one or more family members, individual deductibles do not apply. You must meet the entire family deductible before the plan begins paying for any covered individual (except preventive care and certain preventive prescription drugs).
If you reach the annual deductible, BMC pays 85% of eligible in-network expenses, and you pay the rest through coinsurance. Once you reach the out-of-pocket maximum, BMC pays 100% of most eligible in-network expenses for the rest of the year. If you are enrolled in the BCBSTX HSA Plan and have family coverage (employee plus spouse, employee plus child(ren) or employee plus family) the single out-of-pocket maximum does not apply. You will need to satisfy the $7,000 (in-network) or $14,000 (out-of-network) out-of-pocket maximum before BMC pays 100% of the cost.
If you are an active employee or covered dependent and you become eligible for Medicare, you can choose to:
If you delay enrollment in Medicare beyond age 65 because you are covered by the BMC plans, you will be able to enroll in Medicare later (after you are no longer covered by BMC) without the usual enrollment penalty. Typically, you will have a "special enrollment period" of eight months from the time you no longer have employer-based coverage to enroll in Medicare. If you wait longer than eight months to enroll, you will lose your special enrollment rights and will have to wait until the annual enrollment period, and you will have to pay higher Medicare premiums.
Additional rules apply concerning COBRA coverage and Medicare.
If you are already Medicare-eligible or soon expect to be, please visit the Social Security website.
If you are age 65 or older, you can contribute to a Health Savings Account (HSA) and receive BMC contributions to your HSA until the month you enroll in Medicare. You are responsible for confirming that you have not enrolled in any Medicare plan by contacting the Social Security Administration at 1-800-772-1213. Contributing to an HSA while enrolled in Medicare will result in tax liabilities. For more information, read page 3 of the IRS publication, Health Savings Accounts and Other Tax-Favored Health Plans.
If you are planning to enroll in Medicare, call the Benefits Center at 1-877-262-4849 to have your HSA contributions stopped on the first day of the month that your Medicare coverage becomes effective. Remember that when you sign up for Social Security retirement benefits and are at least six months beyond your full retirement age (currently 66), Social Security will give you six months of retirement “back pay” and backdate your Medicare Part A enrollment six months. Under IRS rules you are liable to pay tax penalties on any contributions to your HSA account during the six months you had Medicare Part A. To avoid the penalties, you must stop all contributions to your HSA account up to six months before you sign up for your Social Security retirement benefits.
You can continue coverage under the HSA Plan (medical insurance only) and use your remaining HSA funds to pay for qualified medical expenses, including Medicare premiums.
Your medical benefits travel with you when you venture outside the U.S. Before you leave home, contact your medical plan to learn what you would have to pay out of your own pocket if you need medical care while away. Remember, always carry your medical ID card with you, and in an emergency, go directly to the nearest hospital.
Visit www.mybmcbta.com for more information about benefits that cover you when you travel.