BCBSIL QHDHP (with HSA)

The QHDHP provides medical and prescription drug coverage to you and your eligible dependents in the continental United States. Blue Cross and Blue Shield of Illinois (BCBSIL) administers medical claims, and CVS Caremark handles prescription drug coverage.

To see how much you’ll pay for coverage, use the Pricing Modeler.

You must use in-network providers

Except for emergencies, you must use in-network providers for your care. Your network may vary based on where you (the employee) live.

Because networks are tied to subscriber location, coverage and in-network provider availability can differ—for instance, college students may fall under different networks while attending school versus when they are home.

You pay nothing for preventive care

You pay nothing for preventive care and for some preventive care drugs. You do not have to meet the deductible first. 

Getting annual physicals and recommended screenings and vaccinations can help you maintain good health and identify potential health issues as soon as possible.

For non-preventive services, you must meet your annual deductible before the plan helps cover the cost of your care

You pay the full cost of all other care and prescription drugs until you meet the annual plan deductible.

Once you meet your deductible, you and the plan share the cost of services through coinsurance

Once you meet the combined medical and pharmacy annual deductible, the plan covers 80%, and you pay 20% of the cost of covered services until you meet the annual out-of-pocket maximum limit.

With family coverage under this plan, when one member of the family meets the individual deductible, the plan will pay its share of costs for that person for the remainder of the calendar year. Similarly, when the family deductible is reached, the plan will cover its share of costs for the remainder of the calendar year. The full family deductible cannot be satisfied by a single family member.

After you reach the out-of-pocket maximum, the plan pays 100% of the cost of services for the rest of the year

The annual deductible and the amount you pay out of pocket for medical services and prescription drugs all count toward your out-of-pocket maximum.

Save money on expenses with your HSA

The QHDHP is the only plan that offers you the opportunity to set aside pre-tax dollars in a Health Savings Account (HSA) to cover out-of-pocket health care expenses. State Farm also contributes annually to your HSA ($600 per individual or $1,200 per family). You can use this money to cover current or future qualified health care expenses (including the deductible and coinsurance). Learn more about the advantages of an HSA.

Prior authorization may be required

Some medical services and prescription drugs require prior authorization before they are covered. This means your health care provider must get approval from your insurance provider in advance. If prior authorization isn’t obtained, you may be responsible for the full cost. This process helps ensure care is safe, appropriate, and covered under the plan. Review the plan documents on the My State Farm Benefits Resource website (auto sign-on with SSORestricted access information | log in) for more information. On the home page, select Plan Documents from the left navigation, then select the Health and Insurance dropdown.

Overall, the BCBSIL QHDHP covers the same types of health care services and supplies as the other medical plans, but it differs in how you pay for expenses, including the amount you pay in coinsurance and your deductible. Unlike the other plans, your prescription costs apply toward your medical deductible and maximum out-of-pocket expenses. The plan also differs in how much you pay for coverage through paycheck deductions (less than most of the other plans). 

The QHDHP may be a good fit for you and your family if you:

• Prefer to pay less from each paycheck, even if it means you have to pay more out of pocket for care before you meet your deductible 
• Want to take advantage of the tax benefits and company contributions that come with the plan’s companion Health Savings Account (HSA)
• Don’t use medical services frequently — an annual checkup and a few other visits during the year are typical for you
• Are comfortable choosing only in-network providers for your care
• Want to contribute to the plan’s companion HSA and you are not already enrolled in or planning to enroll in Medicare in the next six months. For details, review Medicare & You, available at medicare.gov.

You’ll pay less when you use an in-network provider. To find network providers near you, visit the BCBSIL website (auto sign-on with SSORestricted access information | log in), or call 844-287-3859.

As a reminder, before you schedule an appointment, confirm that your provider is in-network.

The BCBSIL QHDHP does not cover out-of-network care, except for emergencies.

For additional plan details, review the QHDHP with HSA Summary of Benefits and Coverage (SBC) on the My State Farm Benefits Resource website (auto sign-on with SSORestricted access information | log in). On the home page, select Plan Documents from the left navigation, then select the Health and Insurance dropdown.

For information about prescription drug coverage, view the Prescription Drugs page.