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A QLE is a significant life change that triggers a special enrollment period, allowing you to enroll in or update your benefits coverage even when it's not Annual Enrollment.

‍The following events are considered QLEs:

• Marriage or gaining a domestic partner
• Divorce, legal separation, or losing a domestic partner that affects eligibility
• Birth or adoption of a child
• Legal placement of a child
• Employment changes for you or your dependents that affect coverage eligibility
• Loss or gain of Medicare coverage
• Loss or gain of Medicaid or CHIP coverage
• Death of a dependent

Benefit changes can only be made after the event occurs. For example, you must wait until the day of your wedding or within 31 days after to update your coverage.

‍You have 31 days to make updates after:‍

• Marriage or gaining a domestic partner
• Divorce, legal separation, or losing a domestic partner that affects eligibility
• Birth or adoption of a child
• Legal placement of a child
• Employment changes for you or your dependents that affect coverage eligibility
• Loss or gain of Medicare coverage
• Gain of Medicaid or CHIP coverage
• Death of a dependent

‍You have 60 days to make updates after:

• Loss of coverage under Medicaid or CHIP

If you update your coverage and submit all required documentation by the deadline, your updated coverage will start:

• Birth: Coverage is retroactive to the baby’s date of birth
• All Other: Coverage begins on the 1st of the month after the event

You must provide proof of the QLE. Examples include:

• Marriage certificate or divorce decree
• Birth certificate or adoption papers
• Termination letter showing loss of coverage, etc.

‍In addition, if you are adding a dependent to your coverage, you will need to go through a dependent verification process to prove they are an eligible dependent.

You’ll receive instructions and a list of required documents by email or U.S. mail, based on your communication preferences. Please make sure your email and home address are up to date in mycloud. If documentation isn’t received on time, your dependents will not be added to your coverage.

If you miss the enrollment window for your type of QLE or you don't submit your dependent verification documents by the deadline, you must wait until the next Annual Enrollment period unless another qualifying life event occurs.

In all the Blue Cross and Blue Shield of Texas (BCBSTX) medical plans, in-network preventive care is covered at 100% without requiring you to meet the deductible. When you need more than preventive care the:

• HSA Basic and HSA Plus plans pair lower premiums with a Health Savings Account (HSA) and include a company contribution
• PPO medical plan trades higher premiums for predictable copays

Use the Medical Matchup tool to compare scenarios of real costs across all three medical plans in about five minutes.

Your coverage is designed to protect you and your family if you need medical care. Each plan covers the same treatments, including 100% coverage for in-network preventive care.

The main difference between the medical plans is how you pay for coverage.

• Premiums are what you pay from your paycheck.
• Out-of-pocket (OOP) costs include deductibles, copays, coinsurance, and other expenses you incur when you seek care.

The medical plans allow you to select a plan with higher premiums and lower OOP costs, or higher OOP costs and lower premiums. The plan you choose should be based on your and your family's health care needs.

‍You have three plan options:‍‍

• ‍HSA Basic is paired with an Health Savings Account (HSA) and the company contributes dollars to your HSA. You pay the lowest premiums out of your paycheck, but you have to pay all costs until you reach your OOP maximum, then the plan covers 100% of eligible services.
• ‍HSA Plus is paired with an HSA and lower deductible and OOP maximum than HSA Basic. The company contributes more dollars to your HSA and premiums are higher than the HSA Basic plan but lower than the PPO plan. After you meet the deductible, you pay 20% coinsurance for in‑network care until you reach your OOP maximum, then the plan covers 100%.
• ‍Copay PPO uses set copays so you know your costs upfront. This plan has the lowest deductible, and once you reach your OOP maximum, the plan covers 100% of eligible services. This plan has the highest premiums out of all three medical plans.

The medical plans are administered by Blue Cross and Blue Shield of Texas and offer a nationwide network of doctors and facilities. Click here to find an in-network provider.

The BCBSTX Benefits Value Advisor (BVA) can help you understand your medical plan and make confident decisions about your care. They can explain your coverage, review claims, help you find in‑network providers, and clarify costs before you get treatment — giving you quick, reliable support whenever questions come up. Call them at 866-856-9659.

Yes. When you enroll in any of our BCBSTX medical plans, prescription drug coverage is included through Optum Rx. See the Prescription Drugs page for more information.

An HSA is like a 401(k) account for your health care expenses. If you're enrolled in the HSA Basic or HSA Plus medical plan, you can contribute pre-tax dollars up to the IRS limits in your HSA each year to pay for eligible health care expenses, such as doctor's office visits, deductibles, prescriptions, and more. Or you can pay for your expenses out-of-pocket and let your HSA balance build. The company also contributes to the account each year on your behalf. Click here to learn more.

The HSA is flexible and offers several advantages, many of which are tax related. In addition to saving on taxes, the HSA also provides a way for you to set aside money to pay for future health care expenses, such as in retirement.

Here are just a few of them:

• ‍Pre-tax contributions: Contributions you make to the HSA are 100% tax-deductible (up to the annual IRS limits), like a 401(k) or IRA.
• ‍Tax-free withdrawals: If you use the money in your account to pay for eligible health care expenses, the money you take out of the account is never taxed.
• ‍Tax-free growth: In most states, interest and investment growth earnings on your account are not taxed until you use them. And if you use them to pay for qualifying health care expenses, they are tax-free.
• ‍Growth potential: When your HSA balance exceeds $1,000, you can invest some or all of that amount in a variety of mutual funds (not FDIC-insured).

If you enroll in the HSA Basic or HSA Plus medical plan, the HSA account will automatically be set up on your behalf with our plan administrator Inspira Financial. You must actively re-elect your HSA contribution amount each year during Annual Enrollment; it will not automatically continue from one year to the next. You can change your HSA contribution at any time throughout the year. To learn how to change your contributions, click here.

Yes, once you have at least $1,000 in your account. Your account will also earn interest.

A Flexible Spending Account (FSA) is a special account that allows you to set aside pre-tax money to pay for eligible expenses. It helps you save money by reducing your taxable income, but you must use the funds within the plan year, or you'll lose them.

‍Health Care FSA (HCFSA): An HCFSA allows you to save pre-tax dollars that can be used on eligible medical, dental, and vision care for yourself and your dependents, if applicable. You don't need to be enrolled in any other company benefits to participate in the HCFSA. You can not enroll in an HCFSA if you are enrolled in a HSA medical plan.

The HCFSA is a convenient way to set aside pre-tax dollars for eligible expenses throughout the plan year. Here are just a few of its advantages:

• ‍Pre-tax contributions: Contributions you make to the HCFSA are deducted from your paycheck before taxes (up to the annual IRS limit), lowering your taxable income.
• ‍Tax-free withdrawals: As long as you use the money in your account to pay for eligible health care expenses, the money you take out of the account is never taxed.
• ‍Immediate access to funds: Your full annual election is available to use on the effective date of your coverage, even though you have not yet contributed that full amount through payroll.
• ‍Easy, automatic savings: Contributions come directly out of your paycheck, so there's no separate transfer or account management needed to start saving.

In addition to saving on taxes, the HCFSA gives you a simple way to budget for health care expenses like copays, prescriptions, and other everyday health care costs.

‍Important: Budget carefully. Unlike an HSA, the HCFSA is a “use it or lose it” account. Funds must be used by the end of the plan year or you'll forfeit any remaining balance. Take a moment to estimate your upcoming eligible expenses before setting your annual contribution amount.

Both accounts allow you to set aside pre-tax dollars to pay for health care expenses. There are several differences between these two accounts:

‍Eligibility:‍

• You must be enrolled in the HSA Basic or HSA Plus medical plan to contribute to an HSA.
• You may elect the HCFSA if you enroll in the PPO medical plan or if you do not elect coverage.
• You cannot simultaneously contribute to an HCFSA and an HSA.

‍Company Contribution:‍

• If you enroll in the HSA, the company will contribute to your account.
• The company does not contribute to the HCFSA.

‍Access to Funds: ‍

• With an HSA, you must have the funds available in your account to pay for eligible health care expenses during the year. If you don't have the funds to cover an expense, you can reimburse yourself once funds are available in the account.
• An HCFSA allows you to use your funds at the beginning of the year, if needed, and gradually pay it back through payroll deductions the rest of the year.

‍Rollover Unused Dollars:‍

• When you contribute to an HSA, any unused funds in your account roll over from one year to the next until you withdraw them. If you leave the company, you can take your account with you.
• If you have unused funds at the end of the year in an FSA, you cannot roll over any remaining balances, so you will lose what you don't use each year.

IRS rules do not allow participation in both an HSA and an HCFSA during the same calendar year.

The IRS establishes annual contribution limits each year.

‍HSA: The HSA maximum amount includes your contribution + the company contribution.  

• ‍2026:‍
  
  • Coworker-only: $4,400
  • Coworker + dependent(s): $8,750
• ‍2027:‍
  
  • Coworker-only: $4,500
  • Coworker + dependent(s): $9,000
• If you're age 55+ you can contribute an additional $1,000 per year to a HSA.

‍FSA:

• ‍2026:‍
  
  • HCFSA: $3,400
• ‍2027:
  
  • Not yet released

HSA: Yes. Much like a 401(k), you have control over how much money you contribute to your account and the flexibility to increase, decrease, or stop your contributions at any time up to the IRS annual maximums. To learn how to change your contributions, click here.

‍FSA: No. You can not change your FSA contribution amount outside of Annual Enrollment and new hire or newly eligible enrollment, unless you experience a qualifying life event.

‍HSA & HCFSA: Funds can pay for eligible health care expenses, which include out-of-pocket expenses like doctor's office visits, lab fees, prescription drugs, certain over-the-counter medications, acupuncture, chiropractic services, and more. Browse the HSAstore.com and FSAstore.com, where all items are qualifying health care expenses.

For a complete list of IRS-qualifying expenses, click here.

No. These accounts are separate, and due to IRS rules, you cannot transfer funds between them.

HSA:

• If you're enrolled in the HSA, you own the account and any funds you have in that account.
• You can take the funds from the account with you and continue to contribute to the HSA on your own if you are enrolled in an HSA-eligible High-Deductible Health Plan (HDHP).

‍FSA:‍

• Under the IRS "use-it-or-lose-it" rule, any money left in a FSA is forfeited.