The following benefit booklets are only samples. For a copy of your specific Benefit Booklet, please log in to Blue Connect after your policy's effective date or call 877-275-9787.
2024 individual benefit booklets
- Blue Advantage Catastrophic | 3 PCP $35 | Integrated | Nationwide Doctors(PDF)
- Blue Advantage Bronze | 3 Free PCP | $20 Tier 1 Rx | Integrated | Nationwide Doctors(PDF)
- Blue Advantage $0 | Nationwide Doctors (AI/AN)(PDF)
- Blue Advantage Bronze | HSA Eligible | Integrated | Nationwide Doctors(PDF)
- Blue Advantage $0 | Nationwide Doctors (AI/AN)(PDF)
- Blue Advantage Bronze | Integrated | Nationwide Doctors (300% AI/AN)(PDF)
- Blue Advantage Bronze Standard | Nationwide Doctors(PDF)
- Blue Advantage Bronze Standard $0 | Nationwide Doctors (AI/AN)(PDF)
- Blue Advantage Bronze | $60 PCP | $20 Tier 1 Rx | Nationwide Doctors(PDF)
- Blue Advantage $0 | Nationwide Doctors (AI/AN)(PDF)
- Blue Advantage Silver Access | 3 Free PCP | $15 Tier 1 Rx | Nationwide Doctors(PDF)
- Blue Advantage Silver Preferred | 3 Free PCP | $10 Tier 1 Rx | Integrated | Nationwide Doctors(PDF)
- Blue Advantage Silver Preferred | 3 Free PCP | $10 Tier 1 Rx | Integrated | Nationwide Doctors (CSR 73%)(PDF)
- Blue Advantage Silver Preferred | 3 Free PCP | $5 Tier 1 Rx | Integrated | Nationwide Doctors (CSR 87%)(PDF)
- Blue Advantage Silver Preferred | $0 Deductible | $0 PCP | $0 Tier 1 Rx | Nationwide Doctors (CSR 94%)(PDF)
- Blue Advantage $0 | Nationwide Doctors (AI/AN)(PDF)
- Blue Advantage Silver Standard | Nationwide Doctors(PDF)
- Blue Advantage Silver Standard | Nationwide Doctors (CSR 73%)(PDF)
- Blue Advantage Silver Standard | Nationwide Doctors (CSR 87%)(PDF)
- Blue Advantage Silver Standard $0 | Nationwide Doctors (CSR 94%)(PDF)
- Blue Advantage Silver Standard $0 | Nationwide Doctors (AI/AN)(PDF)
- Blue Advantage Silver Secure | $15 PCP | $15 Tier 1 Rx | Nationwide Doctors(PDF)
- Blue Advantage Silver Secure | $10 PCP | $15 Tier 1 Rx | Nationwide Doctors (CSR 73%)(PDF)
- Blue Advantage Silver Secure | $10 PCP | $10 Tier 1 Rx | Nationwide Doctors (CSR 87%)(PDF)
- Blue Advantage Silver Secure | $0 Deductible | $0 PCP & Specialist | $0 Tier 1 Rx | Nationwide Doctors (CSR 94%)(PDF)
- Blue Advantage $0 | Nationwide Doctors (AI/AN)(PDF)
- Blue Advantage Silver Choice | 3 Free PCP | $15 Tier 1 Rx | Nationwide Doctors(PDF)
- Blue Advantage Silver Choice | 3 Free PCP | $15 Tier 1 Rx | Nationwide Doctors (CSR 73%)(PDF)
- Blue Advantage Silver Choice | 3 Free PCP | $10 Tier 1 Rx | Nationwide Doctors (CSR 87%)(PDF)
- Blue Advantage Silver Choice | $0 Deductible | 3 Free PCP | $4 Tier 1 Rx | Nationwide Doctors (CSR 94%)(PDF)
- Blue Advantage $0 | Nationwide Doctors (AI/AN)(PDF)
- Blue Advantage Gold | 3 Free PCP | $10 Tier 1 Rx | Nationwide Doctors(PDF)
- Blue Advantage $0 | Nationwide Doctors (AI/AN)(PDF)
- Blue Advantage Gold Standard | Nationwide Doctors(PDF)
- Blue Advantage Gold Standard $0 | Nationwide Doctors (AI/AN)(PDF)
- Blue Value Catastrophic | 3 PCP $35 | Integrated | Statewide Doctors(PDF)
- Blue Value Bronze | 3 Free PCP | $20 Tier 1 Rx | Integrated | Statewide Doctors(PDF)
- Blue Value $0 | Statewide Doctors (AI/AN)(PDF)
- Blue Value Bronze | HSA Eligible | Integrated | Statewide Doctors(PDF)
- Blue Value $0 | Statewide Doctors (AI/AN)(PDF)
- Blue Value Bronze | Integrated | Statewide Doctors (300% AI/AN)(PDF)
- Blue Value Bronze Standard | Statewide Doctors(PDF)
- Blue Value Bronze Standard $0 | Statewide Doctors (AI/AN)(PDF)
- Blue Value Bronze | $60 PCP | $20 Tier 1 Rx | Statewide Doctors(PDF)
- Blue Value $0 | Statewide Doctors (AI/AN)(PDF)
- Blue Value Silver Access | 3 Free PCP | $15 Tier 1 Rx | Statewide Doctors(PDF)
- Blue Value Silver Preferred | 3 Free PCP | $10 Tier 1 Rx | Integrated | Statewide Doctors(PDF)
- Blue Value Silver Preferred | 3 Free PCP | $10 Tier 1 Rx | Integrated | Statewide Doctors (CSR 73%)(PDF)
- Blue Value Silver Preferred | 3 Free PCP | $5 Tier 1 Rx | Integrated | Statewide Doctors (CSR 87%)(PDF)
- Blue Value Silver Preferred | $0 Deductible | $0 PCP | $0 Tier 1 Rx | Statewide Doctors (CSR 94%)(PDF)
- Blue Value $0 | Statewide Doctors (AI/AN)(PDF)
- Blue Value Silver Standard | Statewide Doctors(PDF)
- Blue Value Silver Standard | Statewide Doctors (CSR 73%)(PDF)
- Blue Value Silver Standard | Statewide Doctors (CSR 87%)(PDF)
- Blue Value Silver Standard $0 | Statewide Doctors (CSR 94%)(PDF)
- Blue Value Silver Standard $0 | Statewide Doctors (AI/AN)(PDF)
- Blue Value Silver Secure | $15 PCP | $15 Tier 1 Rx | Statewide Doctors(PDF)
- Blue Value Silver Secure | $10 PCP | $15 Tier 1 Rx | Statewide Doctors (CSR 73%)(PDF)
- Blue Value Silver Secure | $10 PCP | $10 Tier 1 Rx | Statewide Doctors (CSR 87%)(PDF)
- Blue Value Silver Secure | $0 Deductible | $0 PCP & Specialist | $0 Tier 1 Rx | Statewide Doctors (CSR 94%)(PDF)
- Blue Value $0 | Statewide Doctors (AI/AN)(PDF)
- Blue Value Silver Choice | 3 Free PCP | $15 Tier 1 Rx | Statewide Doctors(PDF)
- Blue Value Silver Choice | 3 Free PCP | $15 Tier 1 Rx | Statewide Doctors (CSR 73%)(PDF)
- Blue Value Silver Choice | 3 Free PCP | $10 Tier 1 Rx | Statewide Doctors (CSR 87%)(PDF)
- Blue Value Silver Choice | $0 Deductible | 3 Free PCP | $4 Tier 1 Rx | Statewide Doctors (CSR 94%)(PDF)
- Blue Value $0 | Statewide Doctors (AI/AN)(PDF)
- Blue Value Gold | 3 Free PCP | $10 Tier 1 Rx | Statewide Doctors(PDF)
- Blue Value $0 | Statewide Doctors (AI/AN)(PDF)
- Blue Value Gold Standard | Statewide Doctors(PDF)
- Blue Value Gold Standard $0 | Statewide Doctors (AI/AN)(PDF)
- Blue Local Catastrophic | 3 PCP $35 | Integrated | with Atrium Health(PDF)
- Blue Local Bronze | 3 Free PCP | $20 Tier 1 Rx | Integrated | with Atrium Health(PDF)
- Blue Local $0 | with Atrium Health (AI/AN)(PDF)
- Blue Local Bronze | HSA Eligible | Integrated | with Atrium Health(PDF)
- Blue Local $0 | with Atrium Health (AI/AN)(PDF)
- Blue Local Bronze | Integrated | with Atrium Health (300% AI/AN)(PDF)
- Blue Local Bronze Standard | with Atrium Health(PDF)
- Blue Local Bronze Standard $0 | with Atrium Health (AI/AN)(PDF)
- Blue Local Bronze | $60 PCP | $20 Tier 1 Rx | with Atrium Health(PDF)
- Blue Local $0 | with Atrium Health (AI/AN)(PDF)
- Blue Local Silver Access | 3 Free PCP | $15 Tier 1 Rx | with Atrium Health(PDF)
- Blue Local Silver Preferred | 3 Free PCP | $10 Tier 1 Rx | Integrated | with Atrium Health(PDF)
- Blue Local Silver Preferred | 3 Free PCP | $10 Tier 1 Rx | Integrated | with Atrium Health (CSR 73%)(PDF)
- Blue Local Silver Preferred | 3 Free PCP | $5 Tier 1 Rx | Integrated | with Atrium Health (CSR 87%)(PDF)
- Blue Local Silver Preferred | $0 Deductible | $0 PCP | $0 Tier 1 Rx | with Atrium Health (CSR 94%)(PDF)
- Blue Local $0 | with Atrium Health (AI/AN)(PDF)
- Blue Local Silver Standard | with Atrium Health(PDF)
- Blue Local Silver Standard | with Atrium Health (CSR 73%)(PDF)
- Blue Local Silver Standard | with Atrium Health (CSR 87%)(PDF)
- Blue Local Silver Standard $0 | with Atrium Health (CSR 94%)(PDF)
- Blue Local Silver Standard $0 | with Atrium Health (AI/AN)(PDF)
- Blue Local Silver Secure | $15 PCP | $15 Tier 1 Rx | with Atrium Health(PDF)
- Blue Local Silver Secure | $10 PCP | $15 Tier 1 Rx | with Atrium Health (CSR 73%)(PDF)
- Blue Local Silver Secure | $10 PCP | $10 Tier 1 Rx | with Atrium Health (CSR 87%)(PDF)
- Blue Local Silver Secure | $0 Deductible | $0 PCP & Specialist | $0 Tier 1 Rx | with Atrium Health (CSR 94%)(PDF)
- Blue Local $0 | with Atrium Health (AI/AN)(PDF)
- Blue Local Silver Choice | 3 Free PCP | $15 Tier 1 Rx | with Atrium Health(PDF)
- Blue Local Silver Choice | 3 Free PCP | $15 Tier 1 Rx | with Atrium Health (CSR 73%)(PDF)
- Blue Local Silver Choice | 3 Free PCP | $10 Tier 1 Rx | with Atrium Health (CSR 87%)(PDF)
- Blue Local Silver Choice | $0 Deductible | 3 Free PCP | $4 Tier 1 Rx | with Atrium Health (CSR 94%)(PDF)
- Blue Local $0 | with Atrium Health (AI/AN)(PDF)
- Blue Local Gold | 3 Free PCP | $10 Tier 1 Rx | with Atrium Health(PDF)
- Blue Local $0 | with Atrium Health (AI/AN)(PDF)
- Blue Local Gold Standard | with Atrium Health(PDF)
- Blue Local Gold Standard $0 | with Atrium Health (AI/AN)(PDF)
- Blue Home Catastrophic | 3 PCP $35 | Integrated | with UNC Health Alliance(PDF)
- Blue Home Bronze | 3 Free PCP | $20 Tier 1 Rx | Integrated | with UNC Health Alliance(PDF)
- Blue Home $0 | with UNC Health Alliance (AI/AN)(PDF)
- Blue Home Bronze | HSA Eligible | Integrated | with UNC Health Alliance(PDF)
- Blue Home $0 | with UNC Health Alliance (AI/AN)(PDF)
- Blue Home Bronze | Integrated | with UNC Health Alliance (300% AI/AN)(PDF)
- Blue Home Bronze Standard | with UNC Health Alliance(PDF)
- Blue Home Bronze Standard $0 | with UNC Health Alliance (AI/AN)(PDF)
- Blue Home Bronze | $60 PCP | $20 Tier 1 Rx | with UNC Health Alliance(PDF)
- Blue Home $0 | with UNC Health Alliance (AI/AN)(PDF)
- Blue Home Silver Access | 3 Free PCP | $15 Tier 1 Rx | with UNC Health Alliance(PDF)
- Blue Home Silver Preferred | 3 Free PCP | $10 Tier 1 Rx | Integrated | with UNC Health Alliance(PDF)
- Blue Home Silver Preferred | 3 Free PCP | $10 Tier 1 Rx | Integrated | with UNC Health Alliance (CSR 73%)(PDF)
- Blue Home Silver Preferred | 3 Free PCP | $5 Tier 1 Rx | Integrated | with UNC Health Alliance (CSR 87%)(PDF)
- Blue Home Silver Preferred | $0 Deductible | $0 PCP | $0 Tier 1 Rx | with UNC Health Alliance (CSR 94%)(PDF)
- Blue Home $0 | with UNC Health Alliance (AI/AN)(PDF)
- Blue Home Silver Standard | with UNC Health Alliance(PDF)
- Blue Home Silver Standard | with UNC Health Alliance (CSR 73%)(PDF)
- Blue Home Silver Standard | with UNC Health Alliance (CSR 87%)(PDF)
- Blue Home Silver Standard $0 | with UNC Health Alliance (CSR 94%)(PDF)
- Blue Home Silver Standard $0 | with UNC Health Alliance (AI/AN)(PDF)
- Blue Home Silver Secure | $15 PCP | $15 Tier 1 Rx | with UNC Health Alliance(PDF)
- Blue Home Silver Secure | $10 PCP | $15 Tier 1 Rx | with UNC Health Alliance (CSR 73%).(PDF)
- Blue Home Silver Secure | $10 PCP | $10 Tier 1 Rx | with UNC Health Alliance (CSR 87%)(PDF)
- Blue Home Silver Secure | $0 Deductible | $0 PCP & Specialist | $0 Tier 1 Rx | with UNC Health Alliance (CSR 94%)(PDF)
- Blue Home $0 | with UNC Health Alliance (AI/AN)(PDF)
- Blue Home Silver Choice | 3 Free PCP | $15 Tier 1 Rx | with UNC Health Alliance(PDF)
- Blue Home Silver Choice | 3 Free PCP | $15 Tier 1 Rx | with UNC Health Alliance (CSR 73%)(PDF)
- Blue Home Silver Choice | 3 Free PCP | $10 Tier 1 Rx | with UNC Health Alliance (CSR 87%)(PDF)
- Blue Home Silver Choice | $0 Deductible | 3 Free PCP | $4 Tier 1 Rx | with UNC Health Alliance (CSR 94%)(PDF)
- Blue Home $0 | with UNC Health Alliance (AI/AN)(PDF)
- Blue Home Gold | 3 Free PCP | $10 Tier 1 Rx | with UNC Health Alliance(PDF)
- Blue Home $0 | with UNC Health Alliance (AI/AN)(PDF)
- Blue Home Gold Standard | with UNC Health Alliance(PDF)
- Blue Home Gold Standard $0 | with UNC Health Alliance (AI/AN)(PDF)
- Blue Home Catastrophic | 3 PCP $35 | Integrated | with Novant Health(PDF)
- Blue Home Bronze | 3 Free PCP | $20 Tier 1 Rx | Integrated | with Novant Health(PDF)
- Blue Home $0 | with Novant Health (AI/AN)(PDF)
- Blue Home Bronze | HSA Eligible | Integrated | with Novant Health(PDF)
- Blue Home $0 | with Novant Health (AI/AN)(PDF)
- Blue Home Bronze | Integrated | with Novant Health (300% AI/AN)(PDF)
- Blue Home Bronze Standard | with Novant Health(PDF)
- Blue Home Bronze Standard $0 | with Novant Health (AI/AN)(PDF)
- Blue Home Bronze | $60 PCP | $20 Tier 1 Rx | with Novant Health(PDF)
- Blue Home $0 | with Novant Health (AI/AN)(PDF)
- Blue Home Silver Access | 3 Free PCP | $15 Tier 1 Rx | with Novant Health(PDF)
- Blue Home Silver Preferred | 3 Free PCP | $10 Tier 1 Rx | Integrated | with Novant Health(PDF)
- Blue Home Silver Preferred | 3 Free PCP | $10 Tier 1 Rx | Integrated | with Novant Health (CSR 73%)(PDF)
- Blue Home Silver Preferred | 3 Free PCP | $5 Tier 1 Rx | Integrated | with Novant Health (CSR 87%)(PDF)
- Blue Home Silver Preferred | $0 Deductible | $0 PCP | $0 Tier 1 Rx | with Novant Health (CSR 94%)(PDF)
- Blue Home $0 | with Novant Health (AI/AN)(PDF)
- Blue Home Silver Standard | with Novant Health(PDF)
- Blue Home Silver Standard | with Novant Health (CSR 73%)(PDF)
- Blue Home Silver Standard | with Novant Health (CSR 87%)(PDF)
- Blue Home Silver Standard $0 | with Novant Health (CSR 94%)(PDF)
- Blue Home Silver Standard $0 | with Novant Health (AI/AN)(PDF)
- Blue Home Silver Secure | $15 PCP | $15 Tier 1 Rx | with Novant Health(PDF)
- Blue Home Silver Secure | $10 PCP | $15 Tier 1 Rx | with Novant Health (CSR 73%)(PDF)
- Blue Home Silver Secure | $10 PCP | $10 Tier 1 Rx | with Novant Health (CSR 87%)(PDF)
- Blue Home Silver Secure | $0 Deductible | $0 PCP & Specialist | $0 Tier 1 Rx | with Novant Health (CSR 94%)(PDF)
- Blue Home $0 | with Novant Health (AI/AN)(PDF)
- Blue Home Silver Choice | 3 Free PCP | $15 Tier 1 Rx | with Novant Health(PDF)
- Blue Home Silver Choice | 3 Free PCP | $15 Tier 1 Rx | with Novant Health (CSR 73%)(PDF)
- Blue Home Silver Choice | 3 Free PCP | $10 Tier 1 Rx | with Novant Health (CSR 87%)(PDF)
- Blue Home Silver Choice $0 Deductible | 3 Free PCP | $4 Tier 1 Rx | with Novant Health (CSR 94%)(PDF)
- Blue Home $0 | with Novant Health (AI/AN)(PDF)
- Blue Home Gold | 3 Free PCP | $10 Tier 1 Rx | with Novant Health(PDF)
- Blue Home $0 | with Novant Health (AI/AN)(PDF)
- Blue Home Gold Standard | with Novant Health(PDF)
- Blue Home Gold Standard $0 | with Novant Health (AI/AN)(PDF)
2023 individual benefit booklets
2024 sample small group benefit booklets
2023 sample small group benefit booklets
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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© 2024 Blue Cross and Blue Shield of North Carolina. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. All other marks and names are property of their respective owners. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.