Know Your Plan
Get more from your plan
When you know your plan, you know how to make the most of it. And that includes getting the best care for the best cost. Get all your plan details in your Summary of Benefits and Coverage, which you can find in your Documents Library on Blue Connect.
Your copayment is the amount you pay for medical services and prescriptions when you check out. Not all plans have copays.
Your deductible is the set amount you pay toward medical services and prescriptions before Blue Cross NC starts paying toward those services during your benefit period.
Your coinsurance is your share of medical costs and some prescriptions after you’ve met your deductible for your benefit period.
The maximum you will pay from your own funds for covered services in a benefit period. Once met, Blue Cross NC will pay 100% of your remaining covered services. Deductibles, copayments and coinsurance for covered medical and drug benefits apply to this limit. Premiums and non-covered services, as well as out-of-network charges beyond the allowed amount, do not apply.
Explanation of Benefits (EOB)
An EOB shows how medical claims were processed by your plan. It includes the price of the service, how much your health plan paid, member savings and any amount you may owe. See How to Read Your EOB for details.
Key Don’t-Miss Benefits
100% coverage for preventive care
Annual physicals and many other routine screenings and services are covered at no cost.
No-cost COVID-19 testing and vaccines
FDA-approved COVID-19 vaccines are available at no additional cost to all Blue Cross NC members. Most testing is also covered. To learn more about the COVID-19 virus and how coverage for testing is determined, visit our COVID-19 FAQ page.
3 free primary care provider (PCP) visits
Your first three in-network PCP visits are on us with select plans. Check your benefit booklet to see if you are eligible.
3 free behavioral health visits
Your first three in-network behavioral health or substance use visits are no additional cost with select plans. Check your benefit booklet to see if you are eligible.
100% coverage for preventive prescriptions
No-cost preventive drugs for certain chronic conditions at in-network pharmacies for those with bronze HSA-eligible plans. Check your metallic level.
Prenatal and postpartum care
Healthy babies start with healthy moms. To help make sure you get the care you need, prenatal and postpartum care are included as part of your plan. Check your benefit booklet for details.
Pediatric dental care
Did you know that your Blue Cross NC medical plan includes dental coverage for dependents up to age 19? It covers a range of dental services including evaluations, cleanings, fillings, extractions, surgeries, crowns and more. It also covers orthodontic services if necessary, under certain conditions. Check your benefit booklet for details.
Staying in-network lowers your costs and allows doctors to provide you with coordinated care. The Find a Doctor tool can help you stay in-network so you can save money. You can also choose a PCP to get more coordinated care.
Connect to your digital health plan
The fastest, easiest way to access your health plan is through Blue Connect or the Blue Connect MobileSM app. Blue Cross NC created it just for you, so you can easily connect to tools and information about your health plan.
Already connected? Take a moment to make sure your info is up-to-date.
Download the Blue Connect Mobile app to access your digital ID card.
Make life easier
Get Texts. Stay Informed.
Receive important plan information quickly and easily and be the first to know about wellness tools and resources. Opt-in to get text messages. It’s easy! Just check the “Text Message” box under “Using Your Health Plan” and “Health & Wellness.”
Choose Paperless Delivery.
Receive electronic instead of paper communications for less clutter and anywhere access to your plan-related documents.
Sign Up for AutoPay.
Have one less thing to remember each month with AutoPay. You can set up recurring automatic payments using a bank draft or credit card.
Your Primary Care Provider
Connect with your partner in health
It's important to have a doctor you see regularly, and when they're in-network, your out-of-pocket costs are lower. Think of your primary care provider (PCP) as your medical “home” – or the quarterback of your entire health care team.
Your PCP's job is to handle most of your medical needs, including preventive care, which is covered at 100%, and routine tests. They provide coordinated care and help you achieve the best health possible. That’s why the first thing you should do on Blue Connect is select a PCP. Don’t wait until you’re sick. Choose your doctor now, so you’re ready to go when the need arises.
Earn a $35 gift card when you get a wellness exam!
Here’s how it works:
- Make an appointment with your in-network primary care physician for a wellness exam. Let them know that you want preventive care screenings and tests that are 100% covered by your plan.
- Get your annual wellness exam. To avoid extra costs, ask your doctor if any tests or treatments you’re getting won’t be covered as preventive care. Learn more here.
- Once we process the claim, we'll notify you by mail, email and/or SMS text when you can go online to get your $35 gift card in the Blue Connect Activity Center.1 Please allow 4 to 6 weeks for your doctor to send us the wellness exam claim.
Get 3 FREE doctor visits!
Members with select plans can receive their first three PCP visits (in person, by video or on the phone) at no charge. You can also get your first three behavioral health or substance use doctor visits at no charge. Check your benefit booklet to see if you are eligible.
Get Care 24/7
In 2022, we switched telehealth vendors to bring you Teladoc. Teladoc offers both medical and behavioral health care. You can connect with a board-certified doctor or therapist 24 hours a day, seven days a week – even on holidays. In one video consult you can receive a diagnosis, any necessary e-prescriptions or advice on where to go for further care. Be sure to activate your account now, so it’s ready when you need it!
Download the Teladoc mobile app
Teladoc is at the ready for:
Non-emergency health concerns
- Cough, cold and flu
- Ear problems
- Insect bites
- Joint aches and pains
- Nausea and vomiting
- Pink eye
- Sinus problems
- Sore throat
- Urinary problems and UTIs
- And more
Behavioral health concerns
- Bipolar disorder
- Eating disorders
- Grief and loss
- And more
Get the right care
When you need health care services, we want to make sure you get the best care possible and avoid unnecessary out-of-pocket costs. That means getting care at the right place:
1. Primary Care Provider – If it’s not an emergency, always try your regular doctor first, whether in person or virtually. They know you best and can save you money.
2. Teladoc – Most non-emergency medical and behavioral concerns can be handled by Teladoc, our telehealth provider. Teladoc is available for virtual visits 24/7.
3. Urgent Care – If you can’t get in to see your PCP and have a non-life-threatening illness or injury, urgent care is a good option.
Still not sure where to go?
Our Know Where To Go Sheet has more detail and is handy for quick reference.
Tools for Your Total Well-Being
– and Healthy Savings
Boost Your Total Health
Blue Cross NC is committed to your total health, and that includes finding ways to save you money! We offer a wide variety of products, wellness programs and resources as well as a member-only discount program that helps you save on health and fitness products and services.
This member discount program helps you get exclusive deals on health and fitness products. Choose weekly discounts from health and wellness categories including:
- Apparel & Footwear
- Healthy Eating
- Hearing & Vision
- Home & Family
- Personal Care
Joining Blue365 is easy
Taking advantage of the discounts is even easier.
Smile Brighter with Dental Blue®
Dental health is an important part of your overall health and impacts more than just your teeth. Add dental coverage to your plan at any time.
Focus on Your Vision Health with Blue 20/20℠
Regular eye exams not only address vision health, they can reveal many underlying health concerns such as heart disease, diabetes and cancer before other symptoms arise. You can add vision coverage at any time.
We’re excited to share with you myStrength, a new health benefit offered at no cost to you. myStrength is a flexible and comprehensive digital program with proven tools and dedicated support for stress, depression, sleep and more—all tailored to your unique needs. This program is offered to Blue Cross NC members ages 18 and older. Sign up today to build a healthier mind for a stronger you.
Use registration code: BCNC4
Get Nurse Support
Do you have a complex or ongoing medical condition? Now you can get help – at no additional cost through our Nurse Support Program. Our highly trained nurses can suggest support programs, help you navigate the health care system and more.
Save Money on Prescriptions
Blue Cross NC programs like Rx Savings Solutions are designed to help you get the best deal on all your medications. Be sure to activate your profile to get email alerts about savings opportunities!
Manage Your Pregnancy with 24/7 Support
We’re with you every step of the way with the free and confidential My Pregnancy app. This helpful app offers tools, resources and support from your first trimester through baby’s first years.
Quit for Good
Ready to leave tobacco behind? QuitlineNC can help you succeed with counseling and nicotine replacement therapy – and it won’t cost you a thing!
Get the Big Picture
The Blue Cross NC Health Survey asks you to answer a few questions about yourself to find out what you're doing well and what you can improve for your overall health. You can access the survey through your Wellness Portal.