Alyssa Lane
Blue Cross Blue Shield of North Carolina (BCBSNC) is a leader in delivering innovative health care products and services to more than 3.6 million members. BCBSNC offers a range of health insurance plans, including Blue Value, which provides coverage for both in-network and out-of-network services. Blue Value is designed to help consumers control their costs without sacrificing benefits, by offering a limited provider network and formulary. This plan is available for individuals and groups, with benefits based on popular existing plans, such as Blue Advantage and Blue Options.
| Characteristics | Values |
|---|---|
| Company | Blue Cross and Blue Shield of North Carolina (BCBSNC) |
| Coverage | In-network and out-of-network |
| Area | North Carolina |
| Number of Members | 3.6 million |
| Year of Origin | 1944 (78 years as of 2012) |
| Plans | Blue Value, Blue Select, Blue Advantage, Blue Advantage Saver, Blue Options, Blue Options 1-2-3 |
| Discounts | 15% healthy lifestyle discount |
| Drugs | Generic drugs have a [$10 copayment, non-preferred generics have a $25-$35 copayment], brand-name drugs are covered at 50% after $2000 |
| Maternity Rider | Available for females aged 18 and over who aren't pregnant when they apply for coverage |
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What You'll Learn
Blue Value's cost-saving prescription drug plan
Blue Cross Blue Shield of North Carolina (BCBSNC) is committed to offering health insurance that is easy, affordable, and attainable for all. BCBSNC's Blue Value plan offers a limited provider network and formulary.
The Blue Value plan includes coverage for routine physical exams, including gynaecological exams, well-child and well-baby care, immunizations, surgery, lab work, therapy, and radiology. There is no annual limit for generic drugs. For brand-name drugs, Blue Value offers different benefits depending on the plan type. For example, Blue Value A, B, C, and Blue Value Saver 1 cover brand-name drugs at 50% after a certain amount. On the other hand, brand-name drugs are not covered on Blue Value Saver 2 and 3.
If you choose a brand-name drug when a generic equivalent is available, you may pay the difference between the brand-name and generic prices, in addition to any applicable copayment. For Blue Value A and Blue Value B, once the $2000 brand benefit is met, the member pays 50% of all brand-name drugs.
Preferred generic drugs have a low $10 copayment, while non-preferred generics have a $25-$35 copayment. It is important to note that you may have to pay additional charges for any tests, labs, or other medical costs outside the visit.
To save money on prescriptions, consider discussing with your doctor about switching to a similar drug on a lower tier. Additionally, Blue MedicareRx covers most Part D vaccines at no cost, and you won't pay more than $35 for a one-month supply of each insulin product covered, regardless of the cost-sharing tier.
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In-network and out-of-network coverage
Blue Cross Blue Shield of North Carolina (BCBSNC) provides health insurance coverage for both in-network and out-of-network services. In-network coverage refers to healthcare providers who have agreed to offer discounted rates to the insurance company's customers. Out-of-network coverage, on the other hand, refers to healthcare providers who have not entered into a contract with the insurer and can charge higher rates for their services.
BCBSNC's Blue Value plan offers a limited provider network, and it is important to determine whether your doctor or hospital of choice accepts this insurance plan. Out-of-network coverage can significantly increase out-of-pocket expenses. For example, under the Blue Value plan, you pay a copayment for an in-network doctor's visit, but you may have to pay additional charges for tests, labs, or other medical costs outside the visit if the provider is out-of-network.
The Blue Value plan covers routine physical exams, including gynecological exams, well-child and well-baby care, periodic assessments, and immunizations. It also covers surgery, lab work, therapy, and radiology performed by the same doctor on the same day in the office. For brand-name drugs, once the $2000 brand benefit is met, the member pays 50% of the cost. Generic drugs have a low $10 copayment, while non-preferred generics have a $25-$35 copayment.
It is important to note that in-network providers in North Carolina are responsible for filing claims directly with Blue Cross and Blue Shield of North Carolina. However, if you do not show your member ID card when obtaining a prescription, or if the pharmacy's records do not show you as eligible for coverage, you will have to file a claim. Additionally, the No Surprises Act protects people covered under group and individual health plans from receiving unexpected balance bills, or "surprise billing," which can occur when treated by an out-of-network provider.
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Maternity rider option
Blue Cross Blue Shield of North Carolina (BCBSNC) offers a maternity rider option to females (policyholder or spouse) aged 18 and over who aren't pregnant when they apply for coverage. The only exception is if their most recent coverage was underwritten by BCBSNC and included maternity coverage.
The maternity rider option is available during the annual renewal period (November for a January 1 effective date), as long as the policy has been in effect for at least 6 months. It's important to note that you cannot purchase the maternity rider option if you are already pregnant.
BCBSNC provides health insurance coverage in North Carolina, and their plans offer both in-network and out-of-network coverage. Out-of-network coverage can significantly impact your out-of-pocket expenses, so it's essential to check if your provider is in-network with your plan.
BCBSNC offers various plan options, including Blue Value, which has a limited provider network and formulary. With Blue Value, you pay a copayment for visits, and you may have to pay additional costs for tests, labs, or other medical expenses outside the visit. After meeting your prescription deductible, you pay a copayment for your prescription drugs.
It's worth noting that brand-name drugs are not covered on Blue Value Saver 2 and 3. Additionally, if you choose a brand-name drug when a generic equivalent is available, you may pay the difference between the brand-name and generic prices, in addition to any applicable copayment.
Remember, the maternity rider option is an add-on to your existing health insurance policy. It is not a standalone policy and must be purchased in conjunction with a BCBSNC health insurance plan.
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Blue Select for Employers
Blue Select Plus provides a mix of PPO and EPO plan designs on the broader Preferred Care Blue network and the competitively priced Blue Select Plus network. The Blue Select Plus network is designed for sustainable savings and easy access to quality healthcare in and around the Kansas City metropolitan area. Small businesses that switch to the Blue Select Plus network can benefit from significant savings.
The Blue Select Plus network includes specialty hospitals such as Ascentist Healthcare and over 50 Ambulatory Surgical Centers (ASC). ASCs are modern care facilities that provide same-day surgical care, including diagnostic and preventive procedures, and may offer cost-effectiveness. The network also includes St. Joseph Medical Center and St. Mary's Medical Center.
Blue Select Plus offers affordability by leveraging a strong hospital and provider network of more than 5,400 providers and 16 hospitals. When traveling outside the 32-county Blue KC service area, Blue Select Plus members are covered under the BlueCard PPO network.
Blue KC employer networks, including Blue Select Plus, provide affordable healthcare access throughout Kansas City and beyond. They blend comprehensive coverage with exceptional value. Blue KC offers flexible plans that give employees the coverage they need with pricing that fits the employer's budget.
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Blue Cross NC's purpose and values
Blue Cross Blue Shield of North Carolina (BCBSNC) is a fully taxed not-for-profit health insurance company. It is committed to making health insurance easy, affordable, and attainable for all. BCBSNC provides plans that cover both in-network and out-of-network services, which can significantly impact out-of-pocket expenses.
The company's purpose is to improve the health and well-being of its customers and communities, and it is committed to serving every part of North Carolina. BCBSNC aims to address the state's most pressing health challenges and drive long-term, sustainable change. It leverages community partnerships, data-driven solutions, and its workforce's expertise to achieve these goals.
BCBSNC also prioritizes the well-being of its employees and promotes a culture of wellness within the company. It encourages healthy habits, provides a range of benefits and resources, and supports professional development and personal growth. The company believes that managing work, family, and personal life is crucial for employees' well-being and strives to help them achieve their professional goals without sacrificing their personal lives.
In addition to its commitment to its customers and employees, BCBSNC values its community partnerships. After Hurricane Helene struck Western North Carolina, the company partnered with a local organization to provide care, food, and essentials to those affected. BCBSNC also provides tips, news, and updates on its blog, promoting reading as a tool for healthier children, stronger families, and thriving communities.
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Frequently asked questions
Blue Cross and Blue Shield of North Carolina (BCBSNC) is a leader in delivering innovative health care products, services and information to more than 3.6 million members. Blue Value is a health insurance plan that offers a limited provider network and formulary.
BCBSNC Blue Value covers routine physical exams, including gynecological exams, well-child and well-baby care, periodic assessments, immunizations, surgery, lab work, therapy, and radiology. It also covers prescription drugs, although brand name drugs are not covered on Blue Value Saver 2 and 3.
BCBSNC was able to lower costs for the Blue Value plan by collaborating with various healthcare providers to reduce the price of coverage by as much as 15%. For preferred generic drugs, there is a $10 copayment, while non-preferred generics have a $25-$35 copayment.
Blue Value is available across North Carolina, except in the Charlotte region. It is also covered in nearly 200 countries and territories worldwide through the Blue Cross and Blue Shield Association BlueCard® program.
