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Getting started
Use your Blue Cross and Blue Shield of North Carolina (Blue Cross NC) plan’s preventive care, telehealth, discount programs, and other built-in benefits to save money while you gain control of your health.
Common health insurance terms
Here are a few words and phrases you will often come across when using your health plan.
The maximum amount that Blue Cross NC determines is reasonable for covered services provided to a member. The allowed amount includes any Blue Cross NC payment to the provider, plus any deductible, coinsurance, or copayment.
The fixed dollar amount you must pay for some covered services at the time you receive them, if this health benefit plan includes copayments. Copayments are not credited to the deductible; however, they are credited to the total out-of-pocket limit.
The amount of money you must pay for covered services in a benefit period before Blue Cross NC begins to pay for covered services. The deductible does not include coinsurance, charges in excess of the allowed amount, amounts exceeding any maximum, or charges for noncovered services.
The sharing of charges by Blue Cross NC and you for covered services, after you have met your benefit period deductible. This is stated as a percentage. The coinsurance listed is your share of the cost of a covered service.
The maximum amount of coinsurance that is payable by the member in a benefit period before Blue Cross NC pays 100% of covered services. It does not include deductible, or any applicable copayments.
Visit our glossary for more definitions. You can bookmark it and search for any unfamiliar terms you come across.
Making changes to your plan
Your annual Open Enrollment Period (OEP) is when you can make changes for the next plan year. Ask your employer’s Human Resources (HR) department about your OEP dates and other details.
You can make changes at other times if you have a qualifying life event. Check with your HR representative about which events qualify through your employer and plan. For many plans, you would qualify to make a change if:
- You get married or divorced
- You have or adopt a baby
- You move
- Your job situation changes
- You lose your main health coverage (or help paying for coverage)
- There is an error in your plan / enrollment
(NOTE: Not all events on the above list qualify you to make a change, depending on your employer and plan. Your HR representative can confirm what applies to you.)
Other events, such as natural disasters and enrollment in government programs, may also make you eligible. Please see HR if you feel your situation warrants a plan change.
Ways to save
Blue Cross NC has negotiated special lower rates within our network of doctors, hospitals, and other health care facilities. Get all of your care in-network so we can pass those savings on to you.
Find care in your plan’s network
Our networks provide savings and more coordinated care. When every doctor, specialist, hospital, and facility you use is in your network, your out-of-pocket costs are lower.
Get discounts on health and fitness products with Blue365
With Blue 365®, you can access personalized discounts and deals year-round on products that will help you take care of your health and your family – including fitness memberships, meal delivery subscriptions, athletic footwear, glasses and contact lenses, travel deals, and so much more.1 To sign up, all you need is the info on your member ID card.
Visiting the doctor
Preventive care helps you avoid developing health problems. Many preventive care services from in-network doctors are covered at 100% with no out-of-pocket costs for most members.2 Don’t skip these doctor visits, screenings, and immunizations!
Covered preventive care services
Screenings
- Abdominal aortic aneurysm
- Blood pressure
- Cholesterol
- Colon cancer
- Depression
- Diabetes
- Lung cancer
Other services
- Immunizations, including flu shot
- Obesity screening and counseling
- Quitting tobacco
- Sexually transmitted infection (STI) counseling
Screenings
- Blood pressure
- Breast cancer counseling for genetic testing
- Cervical cancer screening (Pap test and / or HPV)
- Chlamydia and gonorrhea
- Cholesterol
- Colon cancer
- Depression
- Diabetes
- Lung cancer
- Mammogram (breast cancer)
- Osteoporosis
Other services
- Contraception
- Immunizations, including flu shot
- Intimate partner violence screening
- Obesity screening and counseling
- Quitting tobacco
- Sexually transmitted infection (STI) counseling
Screenings
- Bacteria in urine
- Gestational diabetes
- Hepatitis B
- Iron deficiency anemia
- Postpartum depression
Services
- Breastfeeding support, supplies, and counseling
- Folic acid supplementation
Routine screenings / services
- Developmental and behavioral
- Fluoride dental varnish and oral health check
- Hearing/vision test
- Immunizations, including flu shot
- Newborn and infant screenings
- Well-baby / well-child care
Other services
- Depression screening
- Lead exposure test
- Obesity counseling
- Sexually transmitted infection (STI) screening and counseling
- Tobacco and alcohol use counseling
- Chest X-rays
- Thyroid tests
- EKGs (electrocardiograms)
- Urine test
- Hormone tests
- Vitamin D tests
These lists are not complete. Learn more about our preventive care services for members.
What to ask your doctor about medical costs
Make sure your doctor is part of your plan’s network before you schedule an appointment! (You can ask the office staff to check for you.) Once you’re there at your preventive care visit, you can avoid surprise costs by asking:
- Will any additional tests or treatments I get during my appointment not be considered preventive care?
- Will talking about other topics that are not considered preventive care during my appointment lead to out-of-pocket costs?
- Can any routine lab work be sent to a Blue Cross NC in-network lab to lower any out-of-pocket costs?
Your benefit booklet includes a detailed list of services covered by your health plan. Not all covered services are covered at 100%. Use this list to help predict costs before you go to the doctor or hospital.
Get top-rated care at a Blue Distinction Center
The Blue Distinction Center® program helps you find hospitals and other health care facilities that meet specific quality standards. Blue Distinction Centers are recognized for their specialty care expertise. Blue Distinction Centers+ meet these standards and also deliver care at lower costs. Depending on your plan, you may be eligible for a 10% discount when you use these facilities.3
Blue Distinction Centers feature:
- Doctors, nurses, and staff with a great deal of specialized experience
- The highest level of patient support at all stages of treatment
- Fewer complications after treatment
- Bariatric surgery
- Cardiac care
- Knee and hip replacement
- Maternity care
- Spine surgery
- Substance use treatment and recovery
- Transplants
Read the FAQ to learn more about Blue Distinction Centers.
At the pharmacy
Save money on your medications
If you have prescription drug coverage with Blue Cross NC, your Blue Connect account includes a Prescriptions section. From there, you can:
- Find in-network pharmacies
- Use the Find a Medication tool to look for lower cost options
- See how to cut down on medication costs
- Manage your prescriptions
- Opt for home delivery of eligible prescriptions
- Formulary
- Network
- Tiers
- Prior review
- Step therapy
- Brand vs. generic drugs
Check out this presentation for more tips on managing your prescriptions, .
Medications are sorted into copayment or coinsurance tiers. The lower the tier, the lower the cost is to you. You can save money if you find an equally effective drug in a lower tier!
Our prescription drug search tool within Blue Connect can show you which tier applies to a specific medication based on your benefits plan.
Mental health and more
Mind + Body = Total Health
Blue Cross NC works with both primary care providers and behavioral health (mental health + substance use) providers to help you get the care you need at the right time. We connect you with your health care team so they can find and treat any behavioral health concerns early.
- If you are in crisis, call or text the National Suicide and Crisis Lifeline at 988.4
- Use our Blue Connect member site to find an in-network provider. Search for keywords like: Psychologist, Psychiatrist, Social Worker, Therapist, Substance Use Facility or Counselor. You may be able to work with providers remotely through telehealth.5
- Talk to your PCP. They are the best starting point. If needed, they can refer you to a behavioral health provider. Get tips on how to talk to your doctor about mental health.
- Contact our Care Navigation team for help getting the right mental health support. Use the Find Care tool in Blue Connect or call the Care Navigation line at 800-755-0798.
- Use your Employee Assistance Program (EAP), if available.6 (Ask your employer’s HR representative about your options.)
For health and wellness
So much of any person’s health depends on the choices they make every day. We offer tools and resources to help you build a healthy lifestyle.
Nutrition counseling
Personalized nutrition counseling is covered by most Blue Cross NC plans as preventive care. You can log in to Blue Connect to learn more, or find a nutritionist in your network with our Find a Doctor tool. Check your benefit booklet for details.
Finally quit for good
QuitlineNC offers Blue Cross NC members counseling and nicotine replacement therapy at no extra cost to you.
Call 844-8NCQUIT (844-862-7848) to quit for good.
Focus on small steps to better health
Little things – done day by day – build healthy habits that can last a lifetime. The wellness resources and education on Blue Connect can help. We may also mail or email you personal invitations to join programs for your specific health needs.
Disclosures:
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Blue365 offers access to savings on items that members may purchase directly from independent vendors, which are different from items that are covered under the policies with Blue Cross NC. Any disputes regarding these products and services may be subject to the Blue Cross NC grievance process. Blue Cross and Blue Shield Association (BCBSA) may receive payments from Blue365 vendors. Neither Blue Cross NC nor BCBSA recommends, endorses, warrants or guarantees any specific Blue365 vendor or item. This program may be modified or discontinued at any time without prior notice.
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Preventive care is covered at 100% when 1) it is provided by an in-network doctor, 2) the claim is filed as a preventive visit and 3) services are identified as preventive care under the Affordable Care Act (ACA). Most plans are covered at 100%, but not all (e.g., grandfathered plans). Check the full list of services and any limitations on our website at BlueCrossNC.com/Preventive or in your Benefit Booklet.
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Blue Distinction Centers (BDC) met overall quality measures, developed with input from the medical community. A Local Blue Plan may require additional criteria for providers located in its own service area; for details, contact your Local Blue Plan. Blue Distinction Centers+ (BDC+) also met cost measures that address consumers’ need for affordable health care. Each provider’s cost of care is evaluated using data from its Local Blue Plan. Providers in CA, ID, NY, PA, and WA may lie in two Local Blue Plans’ areas, resulting in two evaluations for cost of care; and their own Local Blue Plans decide whether one or both cost of care evaluation(s) must meet BDC+ national criteria. National criteria for BDC and BDC+ are displayed on www.bcbs.com. Individual outcomes may vary. For details on a provider’s in-network status or your own policy’s coverage, contact your Local Blue Plan and ask your provider before making an appointment. Neither Blue Cross and Blue Shield Association nor any Blue Plans are responsible for non-covered charges or other losses or damages resulting from Blue Distinction or other provider finder information or care received from Blue Distinction or other providers. Shatterproof, a national non-profit dedicated to reversing the addiction crisis in the US, is leading the implementation of ATLAS, a quality measurement system for addiction treatment facilities. Shatterproof does not offer Blue Cross or Blue Shield products or services.
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Learn more and get help on the National Suicide Prevention Lifeline website: www.suicidepreventionlifeline.org. The National Suicide Prevention Lifeline is a 24-hour, toll-free, confidential suicide prevention hotline available to anyone in suicidal crisis or emotional distress. The Lifeline is offered by the Suicide Prevention Resource Center. Neither Blue Cross NC nor the Blue Cross and Blue Shield Association (BCBSA) recommends, endorses, warrants or guarantees any specific result or service provided by another organization.
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Telehealth benefits are available on all plans either from Blue Cross NC or through the provider network. Blue Cross NC provides the telehealth program for your convenience and is not liable in any way for the goods or services received. Blue Cross NC reserves the right to discontinue or change the program at any time without prior notice. Decisions regarding your care should be made with the advice of a doctor. Depending on your plan, selected programs may not be available to you at this time. Check with Blue Cross NC Customer Service to determine your eligibility. Blue Cross NC has contracted with a third-party vendor independent from Blue Cross NC to bring you telehealth benefits.
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EAP is a confidential, voluntary, work-based program that offers free counseling for work-related and / or personal problems. Ask your employer if there's an EAP program where you work.
Blue Cross NC offers several decision support tools to aid our members in making decisions around their health care experience. These tools are offered for convenience and should be used only as reference tools. Members should consult their own legal counsel, tax advisor or personal physician as applicable throughout their health care experience.
QuitlineNC is an independent company that is solely responsible for the services it provides. QuitlineNC does not offer Blue Cross or Blue Shield products or services.All other marks and trade names are the property of their respective owners.
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Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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