Frequently Asked Questions

You will have the choice between two medical plan options. The choices are:

• A Consumer-Directed Health Plan with a Health Savings Account (CDHP + HSA)
• A Consumer-Directed Health Plan with Health Reimbursement Account (CDHP + HRA)

Be sure to check out the Medical Matchup interactive feature so you can see which medical plan may be right for you.

Collective Health is the medical plan claims administrator. You will continue to utilize the BCBS network of providers. When you have a question, need to file a claim, or search for a doctor, you will contact Collective Health. Representatives will answer your questions and assist you as needed.

To find an in-network doctor visit bcbstx.collectivehealth.com or call 1-855-399-5599.

For 2025, all medical plan enrollees will receive a consolidated ID card with medical, pharmacy, and Collective Health contact information in late December. Additional ID cards can be ordered at bcbstx.collectivehealth.com and on the Collective Health app. Be sure that your home address in MyHR is correct.

There are several differences between the plans. Please see the Benefits Guide for a comparison of the plans to help you determine which plan is right for you and your family.

When you enroll in the CDHP + HRA, you will not have a separate account, like you will with the CDHP + HSA. Instead, a credit is applied to your account in January. When you receive services, you simply present your HRA debit card and medical ID card and have the doctor or other provider file your claim with AmeriBen.

If you are filling a prescription, you can simply use your HRA debit card to make a payment, up to the current balance in the HRA account. When you present your CVS/caremark ID card, the pharmacist should be able to calculate the amount you owe for your prescription, if you haven’t reached your deductible. Remember to check your HCA balance before using your debit card. You will be charged a fee if you have insufficient funds.

Since you need to meet the deductible before benefits begin (except for in-network preventive care, covered at 100%, or primary care doctor visits and generic prescriptions, where you pay a copay), your provider should file your medical claim with AmeriBen before you make any payments to them. Make sure you present your HSA Debit Card and BCBS member ID cards to the provider at the time of service. If your in-network medical provider asks for full payment, point out to them that you are in a consumer-directed health plan and should not be required to pay the full cost of service up front. When you receive your explanation of benefits (EOB) from AmeriBen, you will know the exact amount owed, if any. You can pay for eligible expenses in one of two ways:

1. Pay for services and products upfront. Then submit the proper form and receipts for reimbursement. You can have your funds automatically deposited into your checking or savings account or receive a check.
2. Pay eligible expenses with your HSA Debit Card. Payments are automatically withdrawn from your HRA, so you don’t have to pay out-of-pocket when you are purchasing.

You can register on the Wex Health Inc. website at Benefitslogin.wexhealth.com. In the New User section, click “Get Started” and complete the required information to set up your account. Once you set up your user access, you will be able to review your balance and view account activity.

When you enroll in the CDHP + HSA, the Partnership dollars, and any money you contribute, will go into a separate, tax-advantaged bank account under your name. The Partnership will place a portion of your HSA dollars in the account every pay period. You will receive a HSA Bank Visa card to present at the time of service, and the amount owed to your provider will be debited from your HSA.

Since you need to meet the deductible before benefits begin (except for in-network preventive care, covered at 100%), your provider should file your medical claim before you make any payments to them. In some cases medical providers require payment prior to filing a claim. If so, you should use your PNC Bank debit card, if funds are available. If your in-network medical provider asks for full payment, point out to them that you are in a consumer-directed health plan and should not be required to pay the full cost of service up front. Then, when you receive your explanation of benefits (EOB) from AmeriBen, you will know the exact amount owed and can pay your provider using funds in your HSA with the PNC Bank debit card or out-of-pocket.

If you are filling a prescription, you can simply use your PNC Bank debit card to make the payment, up to the current balance in your HSA account. When you present your CVS/caremark ID card, the pharmacist should be able to calculate the amount you owe for your prescription, if your deductible has not been met. Remember to check your HSA balance before using your credit card. You will be charged a fee if you have insufficient funds and/or use the debit feature.

You can use only the amount that is currently in your account. If there is not enough money in your account, you will have to pay for the service out of pocket. You always have the option of depositing funds directly to your HSA so money is there when you need it. You can deduct from your taxable income at year-end the amount sent directly to PNC Bank. This direct deposit feature is available whether or not you elect payroll deductions to fund your HSA.

If you enroll in the CDHP + HSA Medical Plan option, the Partnership will contribute to your HSA. Consider making additional contributions to the account as well. Contributions come out of your paycheck before taxes, which lowers your taxable income. Your account earns interest tax-free, and investment earnings on balances are tax-free. The most anyone can contribute to your HSA for 2025 is $4,300 for employee-only coverage and $8,550 for all other coverage levels. The maximum amounts include Partnership contributions of $750 for employee-only coverage and $1,500 for all other coverage levels.

With the CDHP + HRA, you only have a copay when you visit your primary care doctor (not a specialist) or if you are filling a generic prescription at a retail pharmacy or through mail service. You pay a $50 copay for primary care doctor office visits and a $10 (retail) or $20 (mail service) copay for generic drugs. With the CDHP + HSA, you do not have copays. If your provider’s office asks, tell them you do not have a copay – you have coinsurance. For eligible preventive care, your care is covered at 100% in-network. For non-preventive care, you will pay for the cost of your care based on the discounted cost after your provider has submitted a claim through AmeriBen.

When you enroll, you will need to indicate if you are a tobacco user or non-tobacco user by checking the appropriate box on for you and your covered dependents over the age of 18:

• Do not use tobacco products, and
• Have not used them for the past three months.

Remember, while the Partnership takes your self-elected designation with respect to your tobacco-free status, if it becomes known to the Partnership that you have misrepresented such status, you will be subject to removal from the Partnership’s Medical Plans and additional discipline, up to and including potential termination.

The Tria Health Stop Tobacco use by Optimizing Pharmacists (S.T.O.P.) Program can help you or any of your covered family members over the age of 18 kick the tobacco habit. The program provides you with confidential telephone coaching with a Tria pharmacist and other tools and resources.

Visit Tria Health online to or call 1-888-799-TRIA (8742) to get started.

Some non-emergency procedures, such as MRIs, CT scans, and surgeries, require prior authorization. Whether you are considering an in-network or out-of-network provider, when your doctor mentions you need a non-emergency procedure or test, your doctor will submit a prior authorization review request to Blue Cross Blue Shield (BCBS).

Collective Health will be your contact for support during the prior authorization process. They will provide updates and answer your questions. Please note that your treatment may not be covered if you do not receive prior authorization.

For more information about how the review process works, check out the Prior Authorization video.