Health care has changed
We’re here to help
There’s a lot to think about when it comes to choosing health insurance. As the only homegrown, local insurer in all 100 counties of the state, Blue Cross and Blue Shield of North Carolina (BCBSNC) is here for you. With our expertise and broad range of plans, you can find the coverage that’s right for you and your budget.
Take advantage of benefits like annual wellness visits, coverage for emergency services, programs to help you stop smoking, a 24-hour nurse hotline and a variety of other in-network services. Discover how a BCBSNC plan can help you access and pay for the health care you need.
With our plans you’ll enjoy:
- Customer service to make using insurance easier – Our customer service professionals are ready to answer your questions quickly and accurately.
- Online member tools – Blue ConnectSM is your source for all tools and what you need to know about your health plan. And you can use it on any mobile phone, tablet or laptop. Need to find a doctor? Planning for surgery? Can’t remember all of your benefits? Blue Connect is customizable so what you need is ready for you right away. It’s designed to make health care easier. And it’s yet another benefit of choosing Blue.
- Doctor and hospital choices – BCBSNC offers a range of network choices to meet your needs and budget. A network is a group of doctors, hospitals, pharmacies and other health care experts. Blue Advantage, our broadest plan, has a network that includes more than 92% of doctors and 98% of the hospitals in North Carolina.1 Other plans, like Blue Local, 2 feature care from specific health care systems.
- Your health plan goes where you go – With BlueCard® your coverage extends worldwide, which means you have coverage at home and when you travel.3
- Blue Connect is customizable so the tools and information you need are one click away. It’s designed to make health care easier. It gives you on-the-go access, when, where and how you want it. And it’s yet another benefit of being Blue.
Our Plans Offer Key Benefits:4
The benefits that are important for getting and staying healthy are at the core of all of our plans. We offer a wide range of options to help you find what fits your needs and budget. It’s what makes BCBSNC the right choice for you.
- No waiting period for pre-existing conditions – All BCBSNC health insurance plans are available with no pre-existing condition(s) waiting periods.5
- Preventive care benefits – For all BCBSNC individual plans mentioned in this brochure, preventive services are covered at 100% when you go to an in-network doctor.6 These covered services include annual exams, colonoscopies, mammograms and more. See bcbsnc.com/preventive for a full list of covered services.
- Essential health benefits – All BCBSNC plans mentioned in this brochure provide coverage for essential health benefits, which are required by law.
These services include:
* Preventive care
* Professional services
* Hospital services
* Outpatient services
* Urgent and emergency services
* Maternity services
* Mental health/chemical dependency services
* Pediatric dental and pediatric vision care
For a complete list, visit bcbsnc.com/essential.
To see a sample member booklet, visit bcbsnc.com/booklets.
- No lifetime maximums – There are no lifetime dollar maximums on the plans featured in this brochure.
- Dental insurance – Dental coverage is available through Dental Blue for IndividualsSM, a separate plan that provides dental-only coverage at an additional cost to your health plan premium.7 You may also purchase dental insurance with or without the purchase of BCBSNC health coverage.
Choose the plan that’s right for you
Everyone has different needs when it comes to health insurance. Our range of products let you weigh the balance between price, provider access and prescription coverage to find the plan that best meets your needs and your budget.
Limitations & Exclusions
Blue Local with Duke Medicine and WakeMed, Blue Advantage, Blue Select and Blue Value have some limitations and exclusions. Once you’re enrolled, a Member Guide will be made available to you. It will contain detailed information about your plan benefits, exclusions and limitations. This is a partial list of benefits that are not covered for Blue Local with Carolinas HealthCare System, Blue Local with Duke Medicine and WakeMed, Blue Advantage, Blue Select and Blue Value members:
- Services for or related to assisted reproductive technology or for reversal of sterilization
- Treatment of sexual dysfunction not related to organic disease
- Services that are investigational in nature or obsolete, including any service, drugs, procedure or treatment directly related to an investigational treatment, except as specifically covered by this health benefit plan
- Side effects and complications of non-covered services, except for emergency services in the case of an emergency
- Services that are not medically necessary
- Dental services provided in a hospital, except as specifically covered by your health benefit plan
- Services or expenses that are covered by any governmental unit except as required by federal law
- Services received from an employer-sponsored dental or medical department
- Services received or hospital stays before (or after) the effective dates of coverage
- Custodial care, domiciliary care or rest cures
- Eyeglasses or contact lenses or refractive eye surgery, except as specifically covered by your health benefit plan
- Routine eye examinations for adults
- Services for cosmetic purposes, except as specifically covered by this health benefit plan
- Services for routine foot care that is palliative or cosmetic
- Travel, except as covered by your health benefit plan
- Inpatient admissions that are primarily for physical therapy, diagnostic studies, or environmental change
- Services that are rendered by or on the direction of those other than doctors, hospitals, facility and professional providers; services that are in excess of the customary charge for services usually provided by one doctor when done by multiple doctors
- For any condition suffered as a result of any act of war or while on active or reserve military duty
- Services for which a charge is not normally made in the absence of insurance, or services provided by an immediate relative
- Non-prescription drugs, except as specifically covered by your health benefit plan
- Prescription drugs or refills which exceed the maximum supply
- Personal hygiene, comfort and/or convenience items
- For telephone consultations, charges for failure to keep a scheduled visit, charges for completion of a claim form, charges for obtaining medical records, and late payment charges
- Services primarily for educational purposes
- Services not specifically listed as covered services
Your coverage will automatically renew. Your coverage may be canceled by BCBSNC for fraud or intentional misrepresentation of material fact on your application. Coverage for dependent children ends at the end of the month they become age 26. Members will be notified 30 days in advance of any change in coverage. The policy form number for Blue Value, Blue Local is ACAPOS-I, 5/16. The policy form number for Blue Select and Blue Advantage is NGFPPO-I, 5/16. This brochure contains a summary of the benefits only. It is not your insurance policy. Your policy and application are your contract. If there is any difference between this brochure and the policy, the provisions of the policy will control. Visit bcbsnc.com for more information.
- Consortium Health Plans, Inc., MarketQuest Network Compare, March 2015. Percentages indicated represent BCBSNC’s PPO network. Note: Not all plans are available in all areas.
- BCBSNC has collaborated with Carolina Health Systems and Duke/WakeMed. Blue Local is a health insurance plan offered by BCBSNC with a limited provider network. Carolina Health Systems and Duke/WakeMed are independent companies and each one is solely responsible for the physicians and medical facilities it owns/operates and does not offer BCBS products or services.
- Blue Cross and Blue Shield Association Internal Data: bcbs.com/shop-for-health-insurance/coverage-home-and-away.html (accessed September, 2016).
- All information discussed in this brochure pertains to BCBSNC individual-market, medical health insurance plans that are eligible for sale in 2017 and meet Affordable Care Act guidelines. The information contained does not apply to plans that are grandfathered, transitional, group, dental-only or other plan types. All details regarding plan benefits and design contained herein are for informational purposes only. Please see the product benefit booklet for all terms and conditions that apply.
- Eligibility requirements apply. See benefit booklet for details.
- Preventive care services as defined by recent federal regulations are covered at no charge to you. For Blue Advantage, Blue Select and Blue Value and Blue Local: Coverage for certain preventive care services (such as routine physical exams, well-baby and well-child care, and immunizations) is limited to in-network benefits only. However, state-mandated preventive services are available out-of-network, for which members will pay deductible and coinsurance, plus charges over the allowed amount. Visit bcbsnc.com/preventive for more details.
- Dental Blue for Individuals has a six-month waiting period for basic services and a 12-month waiting period for major services. Dental Blue for Individuals is not part of the covered health insurance benefits of any BCBSNC plans. Dental Blue for Individuals must be purchased separately. For costs and further details about Dental Blue for Individuals, including exclusions and reductions or limitations and terms under which the policy may be continued in force, contact your agent or BCBSNC.
- If you qualify for a health coverage exemption you don’t have to pay the fee. More information at healthcare.gov/fees-exemptions/exemptions-from-the-fee/
- Subsidies only available for plans purchased through the federal health insurance marketplace. Eligibility for and actual amount of any subsidy is determined by the federal marketplace.
- You must have a qualifying life event to enroll in the federal marketplace outside of the open enrollment period. The federal marketplace determines if you qualify.
- Chart provides an overview of key benefits. For full benefits see your benefit booklet.
- U.S. News & World Report, 2014-15.
- As compared to our other BCBSNC plans.
- Source: http://www.wakemedkeycc.org/wkcc-accountable-care organization (accessed September, 2016).
- 2016 HSA Aggregate Cost Share – Starting in 2016, the “self-only” dollar limit will apply to each covered person. Thus, each covered family member may reach the self-only limit or the family limit, whichever comes first.
- You must be under 30 years of age when the plan begins or qualify for a hardship exemption through the federal government to be eligible for a Catastrophic plan. Visit bcbsnc.com for more details.
- Tier 2 providers may not have met one or more of the standards necessary for inclusion in Tier 1.
- Source: familiesusa.org/product/federal-poverty-guidelines (accessed June, 2016). These 2016 FPL guidelines are for the 48 contiguous states and Washington D.C.
Morrow Insurance Agency, Inc.
800 Beverly Hanks Centre
Hendersonville, NC 28792
Meredith Tidwell is an independent authorized producer licensed to sell and promote products from Blue Cross and Blue Shield of North Carolina (BCBSNC). The content contained in this site is maintained by Morrow Insurance Agency, Inc. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association®. Blue Cross and Blue Shield of North Carolina products can be only sold to those residing in North Carolina. ® Registered mark of the Blue Cross and Blue Shield Association