Physicians/Specialists
Facilities/Hospitals
Publication Date: 
2020-12-07

Dec. 7, 2020, Update: We have added a PDF of the BlueHPN service area maps to the Resources section below.


Beginning January 1, 2021, Blue Cross NC will offer a new product in the Triad and Charlotte areas called the Blue High Performance NetworkSM (BlueHPNSM). BlueHPN is a national quality-based network that will provide members with access to a comprehensive set of high-quality doctors, hospitals, and specialists, while lowering costs for employers. More than 185 million Americans in over 55 major markets will have access to BlueHPN across the country. 
 
BlueHPN Providers 

  • Blue Cross NC is collaborating with participants of Blue Premier for BlueHPN. Blue Premier holds health systems and Blue Cross NC jointly accountable for better health outcomes, exceptional experience and lower costs.  
  • Triad area: Wake Forest Baptist Health  
  • Charlotte area: Atrium Health 
  • BlueHPN will expand to other areas of the state following the January 2021 rollout. 

 

BlueHPN as an EPO Health Plan  

BlueHPN is an Exclusive Provider Organization (EPO). An EPO is a health plan that offers a large, national network of doctors and hospitals for members to choose from. If a member seeks medical care outside of their EPO plan’s network (such as a doctor, hospital, clinic or pharmacy that is not an EPO provider), those out-of-network services are typically not covered under your EPO health plan. Urgent/emergent care will be covered out-of-network outside of the member’s medical service area. 

Please refer to the grid below for further details: 

BlueHPN High Level Medical Scenarios 

BlueHPN Member's Medical Benefit Covered 

Urgent Care 

  

Urgent care by participating UC provider in the BlueHPN-MSA 

Yes  

Urgent care by non-participating UC provider in the BlueHPN-MSA 

No   

Urgent care by non-participating UC provider outside the BlueHPN-MSA 

Yes  

Emergent Care 

  

Emergent care by participating and non-participating ER providers in the BlueHPN-MSA 

Yes  

Emergent care by participating and non-participating ER providers outside the BlueHPN-MSA 

Yes  

Non-Urgent/Non-Emergent Care 

  

Non-Urgent and Non-Emergent Care by participating provider in the BlueHPN-MSA 

Yes  

Non-Urgent and Non-Emergent Care by a non-participating provider in the BlueHPN-MSA 

No 

Non-Urgent and Non-Emergent Care by a non-participating provider outside the BlueHPN-MSA 

No 

Note: MSA stands for Metropolitan Service Area 

 

Blue Cross NC EPO Product High Level Benefit Comparison 

EPO Products 

Standard Product Offering 

Nonstandard Product Offering 

Participating Providers 

In-Network Only Medical Benefits 

OON Emergency Care 

OON Urgent Care 

OON BDC Transplants 

Blue Options (PPO/EPO) 

No 

Yes, 250+ ASO 

All PPO Participating Providers 

Yes 

Yes 

No 

No 

BlueHPN (HPN/EPO) 

Yes, 20+ ASO  

Yes, 250+ ASO 

Exclusive Providers Atrium/WFBH 

Yes 

Yes 

Yes 

Yes 

Blue Options EPO ID Card Disclaimer – OON Emergency Care –  

  • No Out of Network benefits except for emergencies 

BlueHPN EPO ID Card Disclaimer – Urgent and Emergency Care –  

  • Visit BlueHPN Urgent Care provider if in BlueHPN area. Visit any Urgent Care provider if outside of BlueHPN area. Emergency Care is covered. 

 

Recognizing BlueHPN Members 

A BlueHPN member can easily be identified by their member ID card. The BlueHPN name will be prominently displayed on the front of the member ID card, along with the “HPN in a suitcase” logo. This “HPN in a suitcase” logo indicates that BlueHPN rates apply. If the BlueHPN name or logo is not on the front of the member ID card, member is not in BlueHPN and other rates apply. Detailed information for providers describing the specifics of BlueHPN can be found in the BlueHPN Provider Playbook.  

       FRONT OF MEMBER ID CARD                                     

 

BACK OF MEMBER ID CARD 

  

 

Member Benefits 

Enrolled members have in-network benefits only. There are no out of network benefits except for urgent and emergent care. However, members enrolled in BlueHPN will have seamless access to quality care with the following benefits: 

  • Over 10 percent total cost of care savings, on average, on top of the five to nine percent savings delivered by BlueCard, Blue Cross and Blue Shield companies’ broad preferred provider organization (PPO) 
  • Area-specific savings for employers, including savings of up to 13 percent in the Triad and up to 17 percent in Charlotte 

 

Impacted Lines of Business 

At this time, BlueHPN is only offered to Administrative Services Only (ASO), Self-Funded commercial employer groups. Fully-insured U65 Groups, State Health Plan (SHP), Medicare, Federal Employee Program (FEP) and Medicaid patients are NOT included in BlueHPN.
 

Resources

For further information, see the BlueHPN FAQs document and full news releases: