Blue Cross Blue Shield Vermont: Individual HSA Blue

Individual HSABlue
High-Deductible Health Plans and Health Savings Accounts

Smart planning for your health care and your future
Health planning doesn't have to be a gamble. Now it's possible to put money aside in case you need care, but keep the money if you stay healthy. You'll see the rewards when you make smart health purchasing decisions like using generic drugs and getting routine physicals.

How does an HSA Work?
Individual HSABlue is a two-part product: a high-deductible health plan (HDHP) and a health savings account.

High-deductible health plan coverage comes through a BCBSVT Vermont Freedom Plan health plan with a high deductible. Each year, you deposit money into a tax-favored savings account administered by our banking partner, Chittenden Bank.

Open your HSA on the same date your HDHP is effective. The account must be in place before you can submit claims for reimbursement. You may then use those tax-free dollars to pay for expenses applied to your deductible, including prescription drugs.

Once you meet your annual HDHP deductible, BCBSVT pays for covered medical expenses. We pay 100 percent of our allowed price if you use non-preferred providers.

The maximum annual contribution changes each year. To learn more, go to www.treas.gov or ask your tax advisor.

Any money left over in your account at the end of the year stays in the account for use in the future and earns interest. You may manage your balances through a variety of investment tools. Health Savings Accounts offer many of the same benefits as other consumer directed plans, plus some new advantages:
- There's no "use it or lose it" risk that exists with some other tax-favored accounts. Year-end funds remain in the account.
- If you are between 55 and 64 years of age, your maximum annual contribution amount is higher. The additional amount allowed increases each year between now and 2009.
- When you turn 65, you may close the account and use the money for anything you choose, subject to usual income taxes, but without penalty. Or you may use the funds to pay expenses like Medicare Part A and B or Medicare HMO premiums.

A benefit summary and rates for Individual HSABlue can be found below. If you have questions, please call our sales and service team at 1-800-255-4550

$5,000 individual deductible; $10,000 family deductible*

Office Visits	Your Costs (using Preferred Providers)	Limitations/Requirements	Your Costs (using Non-Preferred Providers)
Preventive office visits	Covered in full		$5,000 individual deductible, then 30% coinsurance until your $7,000 out-of-pocket limits is met. Then covered in full. $10,000 family deductible, then 30% coinsurance until your $14,000 out-of-pocket limit is met. Then covered in full.
Other visits with a physician or OB-GYN, maternity care	• $5,000 individual deductible per year • $10,000 family deductible per year • Then covered at 100% of our Allowed Price
Mental health and substance abuse care		You must get prior approval and use network providers.	No benefit
Chiropractic		You must use participating providers and get prior approval for more than 12 visits in a year.	No benefit
Hospital Care
Inpatient stay (semi-private room or intensive care), includes mental health and substance abuse care	• $5,000 individual deductible per year • $10,000 family deductible per year • Then covered at 100% of our Allowed Price	Prior approval is required for mental health and substance abuse treatment and for other services listed on your outline of coverage. We recommend precertification for all other inpatient stays.	$5,000 individual deductible, then 30% coinsurance until your $7,000 out-of-pocket limits is met. Then covered in full. $10,000 family deductible, then 30% coinsurance until your $14,000 out-of-pocket limit is met. Then covered in full. No out-of-network benefits for mental health or substance abuse treatment.
Outpatient diagnostic service (lab, x-ray)		Prior approval may be required.
Emergency		Covered when your condition is a true emergency.
Outpatient surgery		Prior approval may be required
Maternity/newborn care		Newborns must be enrolled within 31 days.
Outpatient physical, occupational and speech therapy		Limited to an aggregate of 30 visits per calendar year
Home Care and Rehabilitation Services
Inpatient skilled nursing or rehabilitation	• $5,000 individual deductible per year • $10,000 family deductible per year • Then covered at 100% of our Allowed Price	Precertification required for all inpatient admissions. Prior approval required for rehabilitation.	$5,000 individual deductible, then 30% coinsurance until your $7,000 out-of-pocket limits is met. Then covered in full. $10,000 family deductible, then 30% coinsurance until your $14,000 out-of-pocket limit is met. Then covered in full. No benefit for non-preferred rehabilitation services.
Home health and hospice care		Service-specific limitations outlined in subscriber certificate.
Private duty nursing		Prior approval required. Benefits limited to $2,000 per calendar year.
Other Services
Ambulance	• $5,000 individual deductible per year • $10,000 family deductible per year • Then covered at 100% of our Allowed Price	Prior approval may be required	Same as preferred provider benefits.
Medical equipment and supplies		Prior approval may be required	Subject to non-preferred deductible and coinsurance.
Prescription drugs (includes mail order		Network providers only. No annual maximum.	No benefit.