Blue Links for Employers

We're Updating Our Plans for 2016

Effective January 1, 2016, we'll make the following changes to our health plans to meet the ongoing requirements of the Affordable Care Act (ACA). These changes will apply to:

  • Accounts with 100 or more enrolled subscribers
  • Accounts with greater than 50 eligible with 99 or fewer enrolled subscribers

Maximum Out-of-Pocket Limits
The annual maximum out-of-pocket limits for 2016 are:

  • $6,550 (individual) and $13,100 (family) for HSA qualified high deductible health plans
  • $6,850 (individual) and $13,700 (family) for non-HSA qualified high deductible health plans

Our health plans already include annual maximum out-of-pocket limits that are set at or below the 2016 ACA limits. Therefore, our maximum out-of-pocket amounts will not change for 2016's effective and renewal dates.

Annual Limitation on Cost Sharing
According to the 2016 Notice of Benefit and Payment Parameters Final Rule, the maximum annual out-of-pocket limit on cost sharing applies to each individual regardless of whether they're covered by an individual or a family plan. To comply, when our health plans renew in 2016, the maximum out-of-pocket calculation will be automatically updated so that no one member will have to pay more than the per member (individual) out-of-pocket maximum.

For accounts with 100 or more enrolled subscribers, HSA qualified plans include:

  • Preferred Blue PPO Basic Saver
  • Access Blue New England Basic Saver II

For accounts with greater than 50 eligible with 99 or fewer enrolled subscribers, HSA qualified plans include:

  • Access Blue New England Saver
  • Access Blue New England Basic Saver
  • Access Blue New England Basic Saver II
  • Access Blue New England Saver $2000
  • Preferred Blue PPO Saver $1,500 Deductible
  • Preferred Blue PPO Saver $2,000 Deductible
  • Preferred Blue PPO Saver $2,900 Deductible (This plan will become Preferred Blue PPO Saver $3,000 Deductible beginning January 1, 2016.)
  • Preferred Blue PPO Basic Saver

Impact of Annual Limitation on HSA Qualified High Deductible Plans
The annual limitation on cost sharing applies to the maximum out-of-pocket costs only under our health plans. There will be no change as to how the deductible operates on HSA qualified high deductible health plans. For our HSA qualified plans (e.g., Saver Plans), the entire amount of the family deductible must be met before benefits will be paid for any one member (individual) under the plan. However, if the family deductible exceeds in the individual maximum out-of-pocket amounts for these plans, we will lower the family deductible amounts.

Blue Options and Hospital Choice Cost Sharing Tier Update
In 2016, we'll update the hospital and primary care provider (PCP) tiers within our Blue Options and Hospital Choice Cost Sharing tiered plans. Periodic updating of our tiers is an important step in maintaining our tiered network plans as an affordable choice. It also encourages providers to continue to improve their cost and quality performance.

The tier update will change the cost of care for some doctors and hospitals. Member costs will go up or down, depending on the new tier their doctor or hospital is assigned. These changes will go into effect for all Blue Options plans the next time they renew in 2016. For plans that include Hospital Choice Cost Sharing, the changes will go into effect for all members on January 1, 2016.

Update to HMO Blue New England Options Tiered Network Plans In New Hampshire
As of January 1, 2016 upon renewal, members of our HMO Blue New England Options plans will have access to tiered providers in New Hampshire. These members will continue to have access to their current provider networks within New England states.

A network primary care provider or network general hospital located in New Hampshire will be considered either:

  • A Tier 1 (Enhanced Benefit Tier) provider
  • A Tier 2 (Standard Benefits Tier) provider

Network primary care providers, or general hospitals in the New England network located outside of Massachusetts or New Hampshire, will continue to be in the Enhanced Benefits Tier. For New England plans with the Hospital Choice Cost Sharing feature, there is no change to the member's cost share—all New Hampshire hospitals are considered Lower Cost Share.

Pharmacy Benefit Exclusion for 2017
Effective January 1, 2017, all drugs in the therapeutic class of inhaled nasal steroids used to treat allergies will be excluded from our pharmacy benefit coverage. Formulary exceptions, including those previously approved, will no longer be available for this class of medications. This exclusion will be noted in our 2016 account subscriber certificates.

New Plan Options for Accounts with 100 or more Enrolled Subscribers
Effective January 1, 2016, the following plans will be available:

  • Preferred Blue PPO Options Deductible II (Insured)
  • Preferred Blue PPO Options Deductible III (Insured)
  • PPO Blue Options Deductible II (ASC)
  • PPO Blue Options Deductible III (ASC)

With these tiered network plans, PCPs and acute-care hospitals are placed into one of three benefits tiers based on cost and quality benchmarks. These plans offer comprehensive coverage with lower premiums than a plan with similar levels of benefits. Members will enjoy significantly enhanced benefits with the most competitive rates when they choose providers who have met our highest cost and quality benchmarks—while still having full PPO network access.

New Plan Options for Employers with Greater than 50 Eligible with 99 or Fewer Enrolled Employees
Effective January 1, 2016, the following plans will be available:

HSA-qualified (Saver) options:

  • Access Blue New England Saver $2,500 (Insured and & Self-Funded/Blue Funding Solutions)
  • Access Blue New England Saver $3,000 (Insured and & Self-Funded/Blue Funding Solutions)

New PPO Tiered Options Deductible plans:

  • Preferred Blue PPO Options Deductible II (Insured)
  • Preferred Blue PPO Options Deductible III (Insured)
  • PPO Blue Options Deductible II (Self-Funded/Blue Funding Solutions)
  • PPO Blue Options Deductible III (Self-Funded/Blue Funding Solutions)
Blue Cross Blue Shield of Massachusetts

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