Compare BlueEdge Individual HSA Plans
BlueEdge HSA Comparison Chart
| Benefit Highlight | BlueEdgeSM Individual HSA (75/60) | BlueEdgeSM Individual HSA (90/70) | BlueEdgeSM Individual HSA (100/100) |
|---|---|---|---|
| Participating Provider | BlueChoice® or BlueCard® | ||
| Individual Deductible | |||
| $1,200 | √ | √ | |
| $1,750 | √ | √ | |
| $2,500 | √ | √ | |
| $3,500 | √ | ||
| $5,000 | √ | ||
| Individual Out of Pocket Expense Limit | You pay 25% after deductible | You pay 10% after deductible | Covered at 100% after deductible |
| Preventive Care | You pay 25% after deductible; $300 max per member per year | You pay 10% after deductible; $300 max per member per year | Covered at 100% after deductible; $300 max per member per year |
| Childhood Immunizations | Covered at 100% to 6 years of age | Covered at 100% to 6 years of age | Covered at 100% to 6 years of age |
| Coinsurance | You pay 25% | You pay 10% | You pay $0 |
| Optional Dental Coverage Deductible | $50 | $50 | $50 |
| Prescription Drugs | Medical deductible plus copay: $10 generic, $50 preferred, $65 non-preferred; $5,000 calendar year max | Medical deductible plus copay: $10 generic, $50 preferred, $65 non-preferred; $5,000 calendar year max | 100% after medical deductible; $5,000 calendar year max |
| Prescription Drug Deductible | None | None | None |
Outline of Coverage  |
Outline of Coverage |
Outline of Coverage |
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1. The BlueChoice network allows you to save on premiums and the cost of covered services when you use a contracting BlueChoice hospital, doctor or specialist. You do not need to select a primary care physician or obtain a referral to see a specialist.