General FAQs

Interoperability is the ability of different information systems, devices, and apps to access, exchange, integrate and use data in a coordinated manner to provide timely and seamless portability of information and optimize the health of individuals and populations. Basically, interoperability refers to the ability of two electronic systems to interact with one another. Usually, this means creating standards around data formatting and structure and defined patterns on how to access the data. An example of interoperability is the special formatting of the routing number and account number on paper checks so that any bank can read that information from a check issued by any other bank. The Centers for Medicare and Medicaid Services (CMS) has provided specific rules for interoperability that require data from health insurance companies to be formatted and presented in a consistent way so that systems permitted to utilize that data can do so in a standard fashion.

Blue KC is committed to the idea that you own your own health data and should be able to consume it and use it as you desire. The interoperability standards defined by the government will make it easier and cheaper for others to develop applications or mobile apps that can look at your health data to help you make better decisions about your health care needs and health care spending. This means for you, as a member, you may be prompted to allow an application to access your health data from Blue KC. You get to decide if you want to allow this and use the services that the app provides, giving you more freedom and more choices on how to use your health data.

The goal of you controlling your health data is to open options for how you can make better use of your data. If you want to find out who sells a prescription for the lowest price in your area or a list of nearby pharmacies that accept your insurance plan there is an app that can help. If you want to see your latest health care expenses or your remaining deductible there is an app for that. Many of these things can already be found in your member account, but should you desire to access this through a third-party application that also accesses your health care records from your physician, interoperability will help make that possible.

The term “app” is short for “application,” which is how people interact with computers and mobile devices. So “app” is a computer program for interacting with people. Often this is called “software” as it is the set of instructions that control how the hardware, or physical device, behaves. Spreadsheets, word processing programs, browsers and email clients are all “applications.” On your mobile device, the various icons on your home screen that allow you to interact on your phone are all “apps.” Often “app” refers to an application on a mobile device, but in general, it is just software, or a computer program, designed for human interaction.

Third-party apps cannot get access to your Blue KC health data unless you grant them permission to do so. The app will prompt you to authorize the app to get your health data from Blue KC. The prompt will open a login page controlled and owned by Blue KC. Your username and password are the same as the username and password used on your Blue KC member account. The process will prompt you to provide consent for the app to access your data or for members that you represent, such as a child, on your policy. Once that is done, the app will be able to get your health data from Blue KC.

Interoperability makes it easier for third party apps to access your health data. Your health data exists separately from interoperability, but interoperability makes it much easier for apps to consume your health data and for you to authorize and allow an app to access your health data.

Your Blue KC health data is yours and only people or apps you authorize can access it. Blue KC is committed to helping you keep your data safe. Interoperability provides certain controls around access to your health data. Other people cannot authorize access to your health data unless they have legal authority to authorize access to your health data (e.g., a personal representative).

Blue KC is committed to helping you protect your health data, but interoperability rules prevent us from blocking apps from requesting you to let the app access your health data. It is important to carefully consider which apps you trust to access your health data. Consider looking at the apps’ privacy policy if the app can sell your data and whether or not you trust the app publishers. Only use apps that are trusted and well-known. Things you may wish to consider when selecting an App:

• Will this App sell my data for any reason?
• Will this App disclose my data to third parties for purposes such as research or advertising?
• How will this App use my data? For what purposes?
• Will the App allow me to limit how it uses, discloses, or sells my data?

Blue KC is at helping to lead the industry by ensuring that data is protected by strong encryption while in transit and strong authentication when transmitted to third-party applications. Protecting your data is a priority at Blue KC. There are government regulations that also help ensure your data is protected by health care and insurance companies. One of those regulations is known as the Health Insurance Portability and Accountability Act or HIPAA.

Your personal health data is protected while in Blue KC systems by HIPAA. All healthcare providers such as hospitals, doctors, clinics, and dentists are subjected to HIPAA and are required to keep your information safe.

You can find more information about your rights under HIPAA and who is obligated to comply with HIPAA here.

For more information regarding Blue KC’s Privacy and Security policies, including contact information for Blue KC’ Privacy Office, go here.

Each app creates a privacy policy and other policies that explain how they will use your health data and whether they can sell your health data to others. These policies control what they will do with your data, so it is important that you understand what you are agreeing to when you download a third-party app.

The app is also responsible for reporting inadvertent disclosure of your health data to you and appropriate government authorities. Interoperability means that Blue KC has virtually no control over which apps can ask you for access to your data, so the responsibility shifts to you to decide which apps you want to access your health data.

Once you choose to allow an app to have access to your personal heath data, that data is no longer protected by HIPAA or Blue KC.

For most hospitals, doctors’ offices, and health insurance companies, HIPAA governs the privacy and security of health records stored online. But many web-based businesses that collect people’s health information are not covered by HIPAA. These include online services people use to keep track of their health information and online applications that interact with those services.

The Federal Trade Commission (FTC), the nation’s consumer protection agency, has issued the Health Breach Notification Rule to require certain businesses not covered by HIPAA to notify their customers and others if there is a breach of unsecured, individually identifiable electronic health information. FTC enforcement began on February 22, 2010.

You can find more information regarding the FTC here.

By agreeing to share your data with an app, you authorize Blue KC to disclose certain information, which may include your name, address, diagnoses, treatments performed on you, amounts paid to providers, etc. Other information that could be disclosed might include claims and encounter data related to your interactions with health care providers, and clinical data that we collect in the process of providing case management, care coordination, or other services to you. The information we will disclose may include information about treatment for Substance Use Disorders, mental health treatment, HIV status, or other sensitive information.

Blue KC will include information we collect about you while you have been enrolled in all Lines of Business that relate to your membership(s) with Blue KC since January 1, 2016, for as long as we maintain the information.

There are two steps.

1. The first step is to stop the app from accessing any data immediately. You can do this by contacting Customer Service at the number listed on your member ID card or contact Customer Service via an email form in your member account using Contact Us. Select HIPAA in the drop-down and mention which app(s) you want to stop being able to access your data in the form.
2. The second step is to contact the app and ask them to delete your data. Each app is voluntarily complying with their own privacy policy which includes data retention policies. Contact the company that publishes the app and follow their procedure for removal of your data from their records.

Log in to your member account to reach the Life Event Updates page for instructions.

Log in to your member account to reach the Life Event Updates page for instructions.

Log in to your member account to reach the Life Event Updates page for instructions.

Log in to your member account to reach the Life Event Updates page for instructions.

Log in to your member account to reach the Life Event Updates page for instructions.

Log in to your member account to reach the Life Event Updates page for instructions.

Log in to your member account to reach Plan Benefits. You will see your Benefits Guide as well as Plan Documents for a list of services and coverage included with your plan.

Log in to your member account to reach Claims, EOBs and Usage. This will show information for medical, pharmacy, dental and vision depending on what your plan includes.

Log in to your member account to reach Contact Us and use the “Ask a Question” box to submit your update. Please make sure your e-mail includes your member ID number, the current date and the correct information.

Blue KC Listens is a special member panel we’ve created to gather input from our customers. As a participant of this panel, you’ll be asked to complete a brief online survey to tell us what Blue KC is already doing that works for you, what doesn’t work for you, and how our products, services and people can serve you better. Participants will be sent a new survey periodically. You can sign up for Blue KC Listens in your member account in Communication Preferences.

Simply log in to your member account to access your Profile and Communication Preferences. There you can update your preferences, including your preferred communication email and mobile phone number. At the time you change your preference, you may have communication from Blue KC that is in progress and may not be delivered according to your new preference.

The communication preferences you select for yourself will automatically be applied to dependents on your policy that are under the age of 18 and have not registered for a member account or established their own communication preferences. Due to HIPAA privacy rules, you can’t establish communication preferences for dependents over the age of 18. They will need to register for a member account, using the information from their member ID card, and designate their own preferences in the Communication Preferences section.

You can designate any email address you want for delivery of your Blue KC communication notifications; it does not have to be the same email address you use to access your member account.

Within your Profile in your member account, you can specify your preferred email address for Blue KC communications.

If at any time you change email addresses, be sure to update your Communications Preferences in your member account to ensure you continue receiving information from Blue KC.

Your Communication Preferences can be set inside your Profile on your member account. The Communication Preference options include:

• Blue KC Bill: Information related to your Blue KC premium bill (only applies to direct pay members).
• Your Explanation of Benefits (EOB).
• My Plan Information: Your member certificate, communication about activity status, and requests for information.
• Blue KC Listens: Special member panel to provide input about Blue KC products, services & staff.

Communication Preferences is a place inside your Profile on your member account so you can tell us how you want to receive your Blue KC communications. You can select email, text or US mail as your preferred delivery option.

Log in to your member account to access your digital ID card, or request an ID card by mail.

Coordination of Benefits (COB) establishes the order of payment when two or more medical plans (primary and secondary) cover an individual and makes sure that no insured person receives more than 100 percent of the allowable expenses for an insured service. The primary plan pays benefits as it would without the presence of a secondary plan. A secondary plan reduces its benefits so that the total benefits provided by both it and the primary plan are not more than the total allowable expenses.

Yourself, if you are insured under two or more group health insurance plans or Medicare; your spouse, if your spouse has health and/or dental insurance coverage through his or her employer or Medicare and also has coverage under your health insurance plan; and your dependent children, if they are insured under two or more health insurance plans or Medicare.

Blue KC is committed to processing your claims in a timely manner. However, if a claim is received and updated COB information is needed, the claims for that member will be delayed until Blue KC receives the requested information. After Blue KC receives the requested information and the COB information is updated with the appropriate information, Blue KC will process your claims. If you receive a COB letter requesting information about Medicare or other insurance, please respond as soon as possible.

Please note, Blue KC will send letters to you requesting the required information that may be missing in our COB file. Please follow the instructions given in the letter to respond by mail, phone or through our website. We update our files annually, so you will receive a request for updated COB information every 12 months.

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 (MSP) and Coordination of Benefit (COB) 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.

To avoid a delay in the processing of COB claims, please follow these steps:

• When your providers submit claims to Blue KC, make sure that they have the most current information on your family and other insurance. This will assist your provider in filing the claim first with the primary plan and then with the secondary plan.
• Make sure that Blue KC has current information on your family regarding other health insurance.
• Follow the instructions given in the letters that Blue KC mails to you requesting updated health information and whether to provide that information to us by mail, phone or through our website.

For a detailed explanation of COB and order of benefit determination rules, please review your Blue KC certificate located inside your member account. If you need a current copy, please call the Customer Service number listed on your Blue KC member ID card.

You can track your home delivery order status online by logging into your member account to reach the Pharmacy page.

Log in to your Blue KC member account to reach the Pharmacy page to learn more and set up home delivery.

Before you join a separate discount program, Blue KC’s pharmacy benefit site now offers a Price Edge solution where a number of generic medications cost less than what you may find offered through other programs. That said, if you can find a better price at Good Rx or elsewhere, you can certainly use that program. Please note that any price you pay for prescriptions while using outside programs will not be applied towards your deductible or out-of-pocket maximum spending limits. Log in to your member account to Compare Prices.

Drug manufacturers sometimes provide coupons that cover a limited amount of medication at a low price. Pharmacies will accept coupons you provide them and, at times, apply these coupons on your behalf when they have access to them. The price you do pay for that medication when a coupon has been used may not be applied towards your deductible or out-of-pocket maximum spending limits. Be aware that the price of future refills may be quite different from what you previously paid while using a coupon.

Prescription costs may vary based on whether you have met your plan’s deductible or out-of-pocket max spending limits for the plan year. While you may start out the year paying full price for a medication, the price you pay could reduce dramatically upon reaching those spending limits. To get the most up-to-date pricing that takes into account your current level of spending, use the Drug Pricing module on the pharmacy benefit site homepage to get started. Log in to your member account to start your search.

Blue KC partners with Rx Savings Solutions to help you save on the cost of your prescriptions. Enrolling in the Rx Savings Solutions program takes one click, and then the tool does the rest. Rx Savings Solutions monitors the medications you take to alert you of new savings opportunities via email or text. Savings can come in the form of trying an alternative or generic medication that treats your condition, through splitting a higher dose tablet in half, or by filling your prescription at a different pharmacy or through home delivery. Log in to your member account to start saving.

Go here to learn how Blue KC helps you save, including Rx Savings Solutions–our pharmacy savings program.

A formulary (also known as a Prescription Drug List or PDL) is a list of the most commonly prescribed medications covered by your plan. The list includes both brand-name and generic prescription medications approved by the Food and Drug Administration (FDA). Medications are listed by common categories or classes and placed in tiers that represent the cost you pay out of pocket. This makes it easier for you and your doctor to find other options to help you save money. To make sure you are viewing the correct prescription drug list, log in to your member account.

As an alternative, you can access all the Prescription Drug Lists below. But remember it is best to log in to your account to check your specific prescription drug list:

Employer-Covered members: View prescription drug list here

Individual & Family plan members: View prescription drug list here

Blue KC may make changes to the formulary (prescription drug list) over the course of the year. If you received a letter about a formulary change, it means that one or more of your medications is being reclassified, resulting in price changes, updated authorization requirements, and/or new quantity limitations. Formularies undergo changes because new medications are continuously introduced to the market and additional research can result in existing medications gaining approval for new uses and treatments. This results in lower-cost alternatives becoming available to treat a condition you may have. To make sure you are viewing the correct prescription drug list, log in to your member account and refer to the Prescription Drug List section and link.

As an alternative, you can access all the Prescription Drug Lists below. But remember it is best to log in to your account to check your specific prescription drug list:

Employer-Covered members: View prescription drug list here

Individual & Family plan members: View prescription drug list here

When a medication changes tiers, you may pay more or less for that medication, depending on the tier change. If one of your medications changes to a higher tier, talk with your doctor to decide if a lower-cost option may be available.

The Prescription Drug List (PDL) is a list of prescription medications that have been reviewed and recommended by the Blue KC Medical and Pharmacy Management Committee. The list has a combination of brand name and generic medications. Each of these medications has been reviewed for its safety, effectiveness, clinical outcomes, and cost. Physicians and pharmacists on the committee look at drug utilization issues, the number of adverse events, and any proven advantages over other drugs on the PDL. The most efficient and cost effective drugs are on Tier 1 of the PDL. All other drugs are designated Tier 2 or Tier 3 status.

To make sure you are viewing the correct prescription drug list, log in to your member account and refer to the Prescription Drug List section and link.

As an alternative, you can access all the Prescription Drug Lists below. But remember it is best to log in to your account to check your specific prescription drug list:

Employer-Covered members: View prescription drug list here

Individual & Family plan members: View prescription drug list here

Specialty medications treat chronic conditions such as cancer, multiple sclerosis and rheumatoid arthritis. They can be an injectable, oral or inhaled medication with one or more of the following characteristics:

• May require ongoing clinical oversight and additional education for best management.
• May have unique storage or shipping requirements.
• May not be available at retail pharmacies.

Ask your specialty pharmacist if there are any financial help programs available for your drug. Sometimes the manufacturer offers help with the cost.

Step therapy is all about taking one “step” at a time when determining which treatment or medicine works best for you. Blue KC may recommend that you first try medicine A based on the latest medical literature and research. If medicine A doesn’t work as expected, then you can try medicine B, then medicine C, if necessary. This works similarly for treatments where we may require physical therapy before moving forward with a surgical procedure, for example. Step therapy helps you avoid spending money on more expensive care when a proven, more cost-effective alternative exists.

Already tried a required medication? Here’s what to do:
If you have already tried a medication that Blue KC is requiring you to take as part of the step therapy program, your doctor can request an exception to the rules and limitations by submitting an online prior authorization request that includes supporting documentation. We also provide a form for members to submit these requests but recommend your doctor complete this step because they have your full set of medical records that allow us to complete a fair and thorough review.

If you have already tried a medication that Blue KC is requiring you take as part of the step therapy program, your doctor can request an exception to the rules and limitations by submitting an online prior authorization request that includes your medical history documentation here.

Some medications have lower-cost equivalents available. Step therapy is a process that requires you to first try more cost-effective medications before “stepping up” to medications that cost more. This process ensures you get the safest, most effective and reasonably priced medication available.

After establishing an HSA and reaching financial benchmarks set by the HSA bank, you may choose to maximize your potential wealth by electing investment options.

You are allowed a one-time, tax-free, trustee-to-trustee transfer of IRA funds into your HSA if the following certain conditions are met:

• The transfer of funds from the IRA to the HSA is made in direct trustee-to-trustee transfer
• You are covered by a high-deductible health plan and remain eligible for 12 months after your IRA rollover. If you are not eligible for 12 months after the rollover, the funds transferred will be treated as taxable income and subject to a 10 percent excise tax
• The IRA being rolled over into the HSA is a traditional or Roth IRA
• The amount of the IRA rollover to the HSA does not exceed the maximum annual contribution limits. The amount transferred from your IRA, plus your employer contributions, plus your contributions will all apply against the maximum annual contribution and you must ensure the total of all these do not exceed the maximum annual contribution limits

You may withdraw a portion or all of the funds from one HSA and roll them into an HSA with another custodian or trustee. However, you are required to roll the funds into a new HSA within 60 calendar days of your receipt of the funds. You are allowed to make only one HSA rollover in a 12-month period. The 12-month period begins on the date you receive the distribution, not on the date you roll it into another HSA. You may also transfer your HSA funds directly from one HSA custodian or trustee to another without ever having direct custody or control of the funds. Rollover and transfer contributions are not deductible and do not count against annual contribution limits.

Any insurance company or bank can be an HSA custodian or trustee. Any other persons already approved by the IRS to be custodians or trustees of IRAs are automatically approved to be HSA custodian or trustees.

If eligible, you can establish an HSA with a qualified HSA custodian or trustee. No permission or authorization from the IRS is required. The custodian or trustee will furnish you a written HSA trust or custodial agreement.

You can pick any bank you like or you can use one of our preferred banks.

You have the right at any time to designate one or more beneficiaries to whom distribution of your HSA will be made upon your death. You also have the right to revoke a prior beneficiary designation and, if desired, designate different individuals as beneficiaries. If no beneficiary is designated, the HSA bank will distribute the assets of your HSA upon your death to your estate. Please contact your bank for beneficiary designation forms or for more information.

If your spouse is the named beneficiary of your HSA, your HSA becomes the HSA of your spouse upon your death, subject to the completion of documents as required by your bank. Your surviving spouse is not required to include any amount in gross income for tax purposes as a result of your death and he or she is subject to income tax only on those distributions that are not made for qualified medical expenses.

If someone other than your spouse is named the beneficiary of your HSA, the HSA will no longer be considered an HSA as of the date of your death. Rather the beneficiary is required to include the fair market value of the HSA assets as of the date of death in his or her gross income for the taxable year that includes the date of death. The included amount is reduced by the amount in the HSA used, within one year of your death, to pay your qualified medical expenses that incurred prior to your death.

If there is no named beneficiary of your HSA, the HSA will no longer be considered an HSA as of the date of your death, and the fair market value of the HSA assets as of the date of death is included in your gross income for the year of your death.

You have the right at any time to designate one or more beneficiaries to whom distribution of your HSA will be made upon your death. You also have the right to revoke a prior beneficiary designation and, if desired, designate different individuals as beneficiaries. Please contact the HSA bank for beneficiary designation forms or for more information.

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.

Once you turn age 65, you can also use your account to pay for things other than qualified medical expenses. If you do choose to use your account for other expenses, the amount withdrawn will be taxable as income but will not be subject to any other penalties. Individuals under age 65 who use their accounts for non-medical expenses must pay income tax and a 20 percent penalty on the amount withdrawn.

No, neither Blue KC nor the HSA bank will provide tax advice concerning your HSA. The tax consequences of your HSA, including all contributions to and distributions from your HSA, are your sole responsibility. Please contact a tax adviser concerning questions you may have.

Earnings on amounts in an HSA are not taxable prior to distribution from the HSA.

If your employer makes a contribution to your HSA, you are not allowed to deduct that contribution on your income tax return. Your employer, however, will be able to deduct the contribution up to your maximum contribution limit for that year. Although you cannot deduct your employer’s HSA contribution, the contribution is not taxable to you or subject to income tax withholding or other employment taxes if it does not exceed your maximum contribution limit for the year.

When you make an eligible contribution to an HSA, the amount of your contribution (up to the maximum contribution limit) is deductible in computing your adjusted gross income. This means that your contributions are deductible whether or not you itemize your deductions.

Any person who may be claimed as a tax dependent on another taxpayer’s return may not claim a deduction for a contribution to an HSA.

A special rule applies to certain married couples. If either spouse has family coverage under a high-deductible health plan, both spouses will be treated as having only the family coverage (and if such spouses each have family coverage under different plans, both spouses will be treated as having the family coverage with the lowest annual deductible). The amount allowed as a deduction after application of this rule will be divided equally between the spouses unless they agree on a different division.

Distributions from an HSA for the qualified medical expense of you or your spouse or tax dependents who are covered by the high-deductible health plan are generally excludable from income for federal tax income purposes if such expenses are not covered by insurance. 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.

Self-employed persons may not contribute to an HSA on a pre-tax basis and may not take the amount of their HSA contribution as a deduction for SECA purposes. However, they may contribute to an HSA with after-tax dollars and take the above-the-line deduction.

Partners in a partnership or LLC cannot make pre-tax contributions to their HSAs through the partnership by salary reduction. However, they can make their own personal contributions to their HSAs and take the “above-the-line” deduction on their personal income taxes.

Owners and officers with greater than 2% share of a Subchapter S corporation cannot make pretax contributions to their HSAs through the company by salary reduction. In addition, any contributions made to their HSAs by the corporation are taxable as income. However, they can make their own personal contributions to their HSAs and take the “above-the-line” deduction on their personal income taxes.

A contribution made by you or your employer to an HSA that exceeds the amount allowed by law, or which is made during any year when you are not eligible to contribute, is called an “excess contribution.” Excess contributions are not deductible by you or your employer and are included in your gross income for each year they remain in your HSA. In addition, excess contributions are subject to a six-percent excise tax. However, you may avoid the excise tax if you remove the excess contribution from your HSA, together with any net income attributable to the excess contribution, before the due date for filing your federal income tax return, including extensions, for the year in which the excess contribution was made. In that case, the net income attributable to the excess contribution would be taxable as income for the year in which the distribution is made, but the removed excess contribution would not be taxable as income to you. Rollover contributions do not count in determining whether an excess contribution has been made.

You may make HSA contributions for a particular year no later than the deadline, without extensions, for filing your federal income tax return for that year. For calendar year taxpayers, this is generally April 15 following the year for which the contributions were made.

If you are age 55 or older, you can make additional “catch-up” contributions to your HSA. The amount of this additional catch-up contribution is published annually by the U.S. Treasury Department.

If your employer offers a “salary reduction” plan (also known as a Section 125 plan or cafeteria plan), you can make contributions to your HSA on a pre-tax basis (meaning before income taxes and FICA taxes). If you make a contribution on a pre-tax basis, you cannot take the “above-the-line” deduction on your personal taxes.

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. You are allowed to make the full deductible HSA contribution for the year regardless of when you enroll in a high-deductible health plan as long as you maintain coverage under the high-deductible health plan for 12 months.

Deposits to your HSA may be made directly with the HSA bank. If your employer allows payroll deductions, you may also make automatic deposits into your account. You may mail in a deposit by check or take advantage of wire transfer or electronic funds transfer. Please contact the HSA bank for more information on depositing funds into your account.

Yes, always retain your itemized receipts as proof of your qualified medical purchases. You will need the receipts if the IRS requests documentation to verify the funds in your HSA were used only for qualified medical expenses.

Please contact the HSA bank immediately if your debit card is lost or stolen.

Please contact the HSA bank to order additional debit cards or add people who may use your HSA debit card.

If your debit card does not work or is declined, you may need to use another form of payment. A declined transaction may be due to any of the following reasons:

• Your purchase was not considered a qualified medical expense under your HSA plan
• Your HSA balance was too low and there were insufficient funds to cover the cost of your transaction

Please contact the HSA bank to discuss problems with your debit card.

When you receive your HSA debit card in the mail from the HSA bank, you will receive instructions on activating the card. Please contact the HSA bank where you established your HSA regarding questions you may have about your HSA debit card.

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.

You can use your HSA funds to pay for eligible expenses incurred any time after you open your HSA. There is no time limit between when you incur the qualified expenses and when you withdraw the corresponding amount from your HSA. You may also elect to pay for current qualified medical expenses out-of-pocket, so that you may invest your HSA funds and grow the account for future use. It is recommended that you always save your itemized receipts and other paperwork to verify eligible expense for when you do withdraw funds, whether it is now or in the future.

Yes, funds may be withdrawn and used to pay for qualified medical expenses for you and/or your tax dependent(s) 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.

No. 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. Therefore, contributions to an HSA are not permitted before you enrolled in a high-deductible health plan and you cannot use HSA funds to pay for qualified medical expenses incurred prior to the date your HSA was established. Your eligibility to contribute to an HSA is determined by the effective date of your high-deductible health plan coverage.

It is your sole responsibility to ensure HSA funds are used for qualified medical expenses. It is also your responsibility to determine the tax consequences of any distributions, for maintaining adequate records for tax purposes, and for paying any taxes and penalties arising as a result of any such distribution. Please contact a legal or tax adviser with questions.

Qualified medical expenses include doctor visits, hospital charges, chiropractic care, prescriptions, dental care, vision care, COBRA premiums and qualified long-term care insurance premiums.

Please note it is your responsibility to withdraw funds for qualified medical expenses and maintain receipts for those expenses according to the IRS guidelines. Failure to do so could result in income taxes and a 20 percent penalty. Read the list and description of all qualified medical expenses.

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. There is no time limit on using the funds. 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.

You are still eligible for an HSA if you have a high-deductible health plan and one or more of the following:

• Insurance that relates to liabilities from workers’ compensation laws, torts or ownership or use or property (such as automobile insurance).
• Insurance for a specified disease or illness.
• Insurance paying a fixed amount per day (or other period) of hospitalization.
• Coverage (through insurance or otherwise) for accidents, disability, dental care, vision care or long-term care.

You may also have coverage under an Employee Assistance Program, and you may have a discount card that enables you to obtain discounts for healthcare services or products.

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.

A qualified health-deductible health plan is a health plan with an annual deductible for an individual (a member) or a family (a member and covered tax dependents) that meet the minimum deductible amount published annually by the U.S. Treasury Department. 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. Treasury Department. 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.

An HSA generally has a low monthly service fee used to maintain the account. Other fees may apply depending upon the services selected. A fee schedule will be provided for you with your enrollment kit from your HSA bank. For more information on HSA fees, contact your HSA bank.

You are eligible for an HSA if you are covered under a qualified high-deductible health plan, are not covered by any other health plan (with exception for certain types of permitted coverage), are not enrolled in Medicare benefits and cannot be claimed as a tax dependent on another person’s tax return.

A Health Savings Account (HSA) allows members enrolled in a qualified high-deductible health plan to contribute funds on a tax-free basis into the member’s account. A member’s employer may also contribute funds to the account. These funds are used for payment of qualified medical expenses as defined by the IRS. Unused funds in an HSA rollover in the member’s account at the end of each calendar year.

Please contact the HSA bank to update your personal information.

Please contact the HSA bank to check the status of your account as your HSA application is processed.

No, you cannot borrow against or pledge funds in your HSA.

No, any rollover amount in your PCA is not taxable as long as your account complies with certain IRS guidelines. Review information about the IRS guidelines.

Unused funds may be rolled over to the next year. By staying healthy and by managing your healthcare dollars wisely, you can build up a sizable account.

To view detailed information about your PCA including the status or your funds and claims data, log in to your member account to reach Claims and Usage where you can access your Personal Care Account.

If you have questions about your PCA balance or how a claim was processed, please let us know by calling the Customer Service number listed on your member ID card.

After you see a provider for healthcare services, your provider will send a claim for those services to Blue KC. The claim is paid directly from your PCA funds. Blue KC will send you an Explanation of Benefits (EOB) showing what was paid to the provider.

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.

Routine Preventive care is a care benefit that is not subject to a deductible. For example, when you receive your annual well-woman exam, annual mammography, annual prostate exam, etc. from a Blue KC in-network physician, you pay only the coinsurance amount (no deductible.) The coverage of some preventive healthcare services may be subject to a calendar year maximum limit.

Your PersonalBlue plan will cover your healthcare needs.

• The first part of your PersonalBlue plan is called a PCA. Your employer adds funds to this account each year. Those funds are used to pay for covered healthcare expenses.
• 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.

Note: Your PCA and individual or family deductible make up the total plan deductible amount. This is the amount that you will see referenced in your Explanation of Benefits (EOB).

• Once your PCA funds are exhausted and the remainder of your deductible has been met, your health insurance plan will start paying. A majority of in-network expenses will be covered by your health insurance plan. You will be responsible for the coinsurance. Once your out-of-pocket maximum has been met, your health insurance plan pays 100% of your covered expenses.

Yes, Blue KC offers our members a number of virtual care services – also available through the MyBlueKC mobile app on the App Store and Google Play – allowing members to choose from either 24/7 urgent care visits and the convenience of scheduling behavioral therapy when it works for you. In addition, many of our Blue KC in-network providers have embraced virtual visits. Talk with your doctor to schedule your next appointment.

Virtual visits give you the convenience of seeing a doctor privately and securely over your smartphone, tablet, or computer – no matter if it’s from the comfort of your home or when you’re traveling.

You can also benefit from a more diverse group of providers and the ability to learn more about your doctor by reading their bio in the MyBlueKC mobile app, available on the App Store and Google Play.

Virtual visits allow you the flexibility to receive care easily and conveniently within your busy schedule. With a virtual visit, there is no time spent driving to and from an office, taking hours off work, or being confined to regular office hours.

Once enrolled in Parts A and B, you can enroll in a Part D plan offered by Medicare-approved private insurers where you live. Go here to learn more about Medicare Prescription (Part D) coverage.

You can join a Part D plan during your Initial Enrollment Period when you first become eligible for Medicare. You can also enroll during the Annual Enrollment Period from October 15 to December 7 each year. During this time, any qualified Medicare member can join a Part D plan or switch Part D plans for coverage starting January 1. Go here to learn more about Medicare Prescription (Part D) coverage.

Go here to learn more about Medicare Prescription (Part D) coverage.

Once enrolled in Parts A and B, you can enroll in a Medicare Supplement plan offered by Medicare-approved private insurers where you live. Depending on when you were born, additional plans may be available. Go here to learn more about Medicare Supplement plans.

Medicare Supplement enrollment periods differ from other Medicare enrollment periods. Insurers must offer a six-month open enrollment period to all Medicare beneficiaries, regardless of health status, beginning with the first month in which you first enrolled for benefits under Part B. This open enrollment period begins on the first day of the month you were both 65 and older and enrolled in Part B. Once you are enrolled in a plan, it renews each year if you pay your premium, and the plan is available. After this six-month period ends, insurers may consider your health status for acceptance and premium. Go here to learn more about Medicare Supplement plans.

Go here to learn more about Medicare Supplement plans.