Coverage Disclaimer

Tobacco Use
You should answer "Yes" to the Tobacco Use question if you, your spouse or any of your Eligible Dependents (age 21 or older as of the requested effective date) have, within the past six months, used tobacco regularly (four or more times per week on average, excluding religious or ceremonial uses).

Coverage Information
I understand if I pay any portion of my health insurance premiums using pretax dollars (Section 125) or my employer pays any portion of my health insurance premiums (Section 106) or provides reimbursement for uninsured medical expenses for me and my dependents (Section 162), I should answer "yes" to the question, "Do you, your employer or any of your Eligible Dependents intend to treat this health Benefit Plan as part of a plan or program under Section 162, Section 125 or Section 106 of the U.S. Internal Revenue Code?" (located in Section 4, Coverage Information).

Who is eligible for the BlueEssential catastrophic plan?
The BlueEssential catastrophic plan may only be offered to individuals who:

  • are under age 30 as of the requested effective date, OR
  • have received a certification from the Health Insurance Marketplace (HIM) that they are exempt from the individual mandate because they do not have an affordable coverage option or because they qualify for a hardship exemption.

BlueDirect Benefit Plans
This overview describes a high deductible health plan designed to comply with Section 223 of the Internal Revenue Code and intended for use with a Health Savings Account (HSA)*. Blue Cross Blue Shield of North Dakota (BCBSND) is not authorized to provide legal or tax advice to members. BCBSND expressly disclaims responsibility for, and makes no representation or warranty regarding: (1) the eligibility of any member to establish or contribute to an HSA; or (2) the suitability of this product in all circumstances for use with HSAs.

*Note: cost-sharing reduction health plans purchased through the health insurance exchange may not comply for use with HSAs.

Limitations and Exclusions
I understand Members are subject to limitations and exclusions outlined in the relevant Benefit Plan or policy.