Ppo plan details
Get to know the Blue Care Elect Saver—Choice with HSA plan. Consider this plan if you live outside of New England, so you have access to a national network of providers.
HERE’S WHAT YOU SHOULD KNOW
About getting care
You aren’t required to choose a primary care provider (PCP) or get referrals.
In-network preventive care is 100% covered.1
You get more flexibility in choosing your providers.
About your costs
It’s lower cost per paycheck but higher deductible, compared to the HMO plan.
You’ll be auto-enrolled into a health savings account (HSA), with Blue Cross contributions and optional personal contributions.
You can choose to enroll in a limited purpose flexible spending account (FSA).
You'll be billed 100% of the charges until your deductible is met.
PPO Costs
| Paycheck Contributions2 for Annualized Base Salary < $80K | Paycheck Contributions2 for Annualized Base Salary ≥ $80K | Deductible3 | Out-of-Pocket Maximum | |
|---|---|---|---|---|
| Individual | $32.87 | $50.69 | $1,700 | $5,000 |
| Individual +1 | $65.30 | $100.89 | $3,400 | $10,000 |
| Family | $95.00 | $147.94 | $3,400 | $10,000 |
Pharmacy
| Retail Pharmacy (1-Month Supply) | Mail Order Pharmacy (3-Month Supply) | |
|---|---|---|
| Tier 1 (generic)4,5 | Deductible, then $10 copay | Deductible, then $20 copay |
| Tier 2 (brand)4,5 | Deductible, then $25 copay | Deductible, then $50 copay |
| Tier 3 (non-preferred brand) | Deductible, then $45 copay | Deductible, then $135 copay |
HOW PAYMENTS WORK WITH A PPO
Phase 1 - Start of the year
You pay in full for all services until your deductible is met, except for preventive care, which is 100% covered by Blue Cross.1 Your HSA, with contributions from Blue Cross, can help pay for these costs.
Phase 2 - After deductible is met3
You and Blue Cross begin to share costs. Blue Cross pays for most of the costs for covered services, while you pay for co-insurance and copayments. You’ll continue to share costs until you meet the out-of pocket maximum.
Phase 3 - After out-of-pocket maximum is met
You owe nothing. Blue Cross pays 100% of the cost for eligible, in-network expenses for the rest of the year.
Have family coverage?
With this plan, you and your family meet the family deductible as a group. Once your combined expenses as a family meet the deductible amount, Blue Cross will begin sharing the costs for everyone’s care.
THINGS TO CONSIDER
- Under this plan, the member is billed 100% of the charges until the deductible is met. Funds from your HSA, including the Blue Cross contributions, can be used to pay for costs.
- This plan has a slightly higher deductible and out-of-pocket maximum, but these increases are offset by a lower cost per paycheck and by using your HSA for eligible medical expenses.
- If you elect a limited purpose FSA for 2025, any unused funds up to $640 from your 2024 limited purpose or health care FSA will roll over and be available to use in 2025.
Financial Accounts for PPO
| Health Savings Account (HSA)6 | Limited Purpose FSA | Dependent Care FSA | |
|---|---|---|---|
| How is this funded? | Blue Cross automatically enrolls you into an HSA and contributes a set amount. You have the option to contribute additional personal funds. | You have the option to enroll, and can contribute personal funds up to the annual maximum. | You have the option to enroll, and can contribute personal funds up to the annual maximum. |
| Contributions from Blue Cross for Annualized Base Salary < $80K | Individual: $1,225 Individual +1: $2,450 Family: $2,450 Non-tax dependents, like domestic partners, aren’t eligible. | None | None |
| Contributions from Blue Cross for Annualized Base Salary ≥ $80K | Individual: $850 Individual +1: $1,700 Family: $1,700 Non-tax dependents, like domestic partners, aren’t eligible. | None | None |
| Optional Contributions from You for Annualized Base Salary < $80K | Individual: $3,075 Individual +1: $6,100 Family: $6,100 | Projected to be $3,300, but is subject to change pending Internal Revenue Service (IRS) adjustments | $5,000 per household or $2,500 if you’re married but filing separately |
| Optional Contributions from You for Annualized Base Salary ≥ $80K | Individual: $3,450 Individual +1: $6,850 Family: $6,850 | Projected to be $3,300, but is subject to change pending Internal Revenue Service (IRS) adjustments | $5,000 per household or $2,500 if you’re married but filing separately |
| Who Can I Use This Money For? | You, your spouse, your tax dependents (including children up to age 19, or age 24 if a full-time student) whether they're enrolled in the plan or not7 | You, your spouse, your tax dependents (including children up to age 26), whether they're enrolled in the plan or not7 | Your child under age 13, a disabled spouse or adult dependent — whether or not they're enrolled in the plan7 |
| What Can I Use This Money For? | All eligible8,9 medical, prescription drug, dental, and vision expenses that occur now10 or in the future | All eligible8 dental and vision expenses in the plan year11 | Childcare and adult day care expenses while you and your spouse work or attend school7 |
| What Happens to My Account Balance at the End of the Year? | Your unused balance rolls over year to year and can grow tax free with interest or can be invested | If you elect a Limited Purpose FSA for 2025, up to $640 of your unused balance from 2024 will roll over8 | Your unused balance will not roll over |
| What Happens to My Account if I Leave Blue Cross? | The money is yours to keep and save for future expenses, even into retirement | Your account is closed. You can file claims up to 90 days after your termination date for services received while you were working at Blue Cross. | Your account is closed. You can file claims up to 90 days after your termination date for services received while you were working at Blue Cross. |
1. Diagnostic tests and lab work aren’t covered under preventive care.
2. Paycheck contribution amounts are for full-time associates. For part-time rates, download part-time rates for 2025.
3. Under this plan, you’re responsible for the full cost of medical services, as well as any medication costs, until you reach your deductible.
4. The copay is waived for birth control (tier 1/generics only), smoking cessation drugs, and certain orally administered anti-cancer drugs.
5. These categories apply for most cases, but some medication tiers may vary.
6. Contribution rates reflect the current IRS contribution limits: $4,300 for individual plans and $8,550 for family and individual +1 plans. Those eligible for catch-up contributions may contribute an additional $1,000.
7. Cannot be used for domestic partner expenses.
8. Your unused balance will carry over into the next plan year, subject to IRS limits.
9. Withdrawals for non-eligible expenses are subject to a tax penalty.
10. “Now” refers to expenses incurred anytime this year.
11. All expenses must be incurred in the plan year — January 1, 2025 to December 31, 2025. You can file claims for reimbursement through March 31, 2026.