Learn More about PersonalBlue Personal Care Accounts
Blue Cross and Blue Shield of Kansas City (Blue KC) is committed to keeping you informed when it comes to your health insurance plan. PersonalBlue is a type of health insurance plan that pairs a PPO plan with a Personal Care Account (PCA) also known as a Health Reimbursement Arrangement (HRA). Your employer puts money in the PCA that is used to pay for a portion of your PPO deductible. You only have to help pay for the deductible after your HRA balance has been spent. And if you don’t use all of the money in your PCA, some or all of it will typically roll over for use in the following year.
What is PersonalBlue?
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.
What is covered under my PersonalBlue health insurance plan?
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.
How are PCA claims paid?
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.
What if I have questions about my PCA balance or how a claim was paid?
If you have questions about your PCA balance or how a claim was processed, please let us know. Call the number listed on your member ID card or log in and click on “Contact Us.
How can I keep track of what is left in my PCA?
To view detailed information about your PCA including the status or your funds and claims data, log in, then click the “My Account” tab at the top of the page, then the “PCA” link.
What happens if I don’t spend all of the funds in my PCA?
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.
Is the rollover taxable?
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.