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| Blue Advantage® |
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| Our most popular individual Preferred Provider Organization (PPO) plan. With Blue Advantage®, you can have access to many of the best doctors, hospitals and specialists in North Carolina. Blue Cross and Blue Shield of North Carolina®’s (BCBSNC®) networks are large and member copayments and coinsurance are predictable.1 Just visit an in-network provider, show your BCBSNC® ID card and pay the copayment. The doctor handles all the |
| administrative details and files the claims. You can go directly to in-network specialists without a referral, and you can go outside the network for most services.2,3 The only difference is the out-of-pocket cost. Blue Advantage® offers three plans that allow you to choose the benefits and deductible that work best for you, with costs as low as $15 for copayments and $10 for generic prescription drugs.4 Blue Advantage® has you covered across the nation and in more than 200 countries and territories worldwide through the BlueCard® network.5 To find a nearby network provider, call 1-800-810-BLUE (1-800-810-2583) or search the provider directory at bcbsnc.com. You can also purchase coverage for children. With Blue Advantage®, children rec-eive full benefits, including coverage for well-child and well-baby care and immunizations. Maternity coverage is available for an extra charge when you first purchase a policy, renew a policy (if the policy has been in effect for at least six months) or if you have a family status change, like marriage.6 Blue Advantage® provides you with access to a variety of online resources and programs designed to maximize your health care experience. Resources include Member Health Page 2 of 9 PartnershipsSM1, our confidential health management program for adults and children – offered at no additional cost – that can help you better manage health conditions like asthma and diabetes. And, our value-added Rewards and Discounts offer you member discounts on every-thing from vitamins to gym memberships.7,8 To be eligible for Blue Advantage®, you must be a North Carolina resident, under age 65, medically eligible and not eligible for Medicare. Enrollment takes approximately 15-30 days. |
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Some services and supplies received by members in an office setting or in connection with an office visit
are in fact outpatient hospital-based services provided by hospital-owned or operated practices. These
services and supplies may be subject to your deductible and coinsurance. Please see the BCBSNC® provider
listing to identify these providers. |
| 2 |
Referrals may be needed for certain mental health and substance abuse services. |
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Preventive care is limited to in-network benefits. |
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Refers to Plan A, Preferred Tier, policy form number M58, 7/07 |
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Blue Cross and Blue Shield Association® Internal Data, 2007:www.bcbs.com/news/press/facts/bluecard.html. (09/08) |
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Maternity coverage is offered through Blue Advantage® at an additional rate. |
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BCBSNC® provides the Member Health Partnerships (MHP) program for your convenience and is not liable in any way for the services received. BCBSNC® reserves the right to discontinue or change the program at any time. Benefits available through MHP are subject to your current benefit plan and pre existing waiting periods. |
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Blue ExtrasSM programs may not apply to all health plans. Discounts on certain goods and services may not be provided directly by BCBSNC®, but may instead be arranged by BCBSNC® for member conven-ience.
Any discounts are outside your health plan benefits. BCBSNC® is not liable for problems resulting from goods and services it does not provide directly, such as goods and services not being provided or being provided negligently. BCBSNC® may change or discontinue these programs at any time. |
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| Blue Cross and Blue Shield of North Carolina® is an independent licensee of the Blue Cross and Blue Shield
Association®, SM Marks of the Blue Cross and Blue Shield Association®. SM1 Mark of Blue Cross and Blue Shield of North Carolina®. |
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| Blue Options HSASM |
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| Our high-deductible health plan with a tax-advantaged savings account for qualified medical expenses
Blue Options HSA provides lower premiums and savings as much as 34% off Blue Advantage®, giving you the ability to take control of your health care costs.1 Blue Options HSA combines a high-deductible health plan (HDHP) with a health savings account (HSA), which enables you to pay for qualified medical expenses tax-free.2,3 Out-ofpocket maximums protect you from high-dollar medical costs. And, your HSA is
portable. Any unused balance rolls over at the end of the year. With Blue Options HSA, you can choose your own doctor from our largest provider network in the state. Preventive care services are covered at 100%, including routine physical exams and screening tests, and well-baby and well-child care.4 Generic drugs
coverage is unlimited and brand-name drugs include a $2,000 combined in- and out-ofnetwork
maximum (per person, per benefit period). The HSA is automatically included with the health plan if you choose Mellon Trust as the fund administrator. Mellon includes a convenient debit card at no charge, and HSA
contributions and with-drawals are tax-free.2, 3 To be eligible for Blue Options HSA, you must be a North Carolina resident, under age 65, medically eligible, and not eligible for Medicare. Individual or family plans are
available. You can also select maternity coverage for an extra charge when you first purchase a policy, renew a policy (if the policy has been in effect for at least six months), or if you have a family status change, such as marriage.5 |
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Blue Cross and Blue Shield of North Carolina® Internal Data, 2009: Based on Blue Advantage® $2,500 deductible with 80% coinsurance and Blue Options HSA $2,000 deductible with 80% coinsurance. Pricing is for a single male, age 40-44, residing in Wake County. |
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BCBSNC® does not administer your HSA and is not affiliated with your HSA custodian or administrator. Your HSA custodian is Mellon Trust of New England, N.A. |
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Withdrawals are tax free only if used for qualified medical expenses. See www.irs.gov for specific regulations. |
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Includes in-network annual routine physical exam, well-baby and well-child care and certain immunizations and screenings. Other covered services may be subject to deductible and coinsurance. Members who receive covered services out-of-network may be required to pay the difference between the provider's actual charge and the BCBSNC® allowed amount, in addition to the coinsurance amount. |
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Maternity coverage is offered through Blue Advantage® at an additional rate. |
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| Blue Cross and Blue Shield of North Carolina® is an independent licensee of the Blue Cross and Blue Shield Association®. SM Mark of the Blue Cross and Blue Shield Association®. SM1 Marks of Blue Cross and Blue Shield of North Carolina®. |
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