Physicians/Specialists
Facilities/Hospitals
Ancillary
Publication Date: 
2020-05-15

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) offers smart benefit packages that empower our members to access the care they need from local and limited, value-based point-of-service (POS) provider networks. These packages help ease consumers' concerns about meeting out-of-pocket health care expenses by limiting their access to in-network services to designated POS provider networks.

Key Points

  • Members enrolled in Blue Cross NC's Blue LocalSM and Blue ValueSM products are eligible to receive in-network benefits when services are obtained from providers contracted for participation in members' specific Blue Local or Blue Value POS provider network.
     
  • Services received from providers outside a member's specific Blue Local or Blue Value POS network are considered out-of-network under the member's benefit package - even when the service provider is contracted and participating in another Blue Cross NC provider network.
     
  • It's important for providers participating in other Blue Cross NC provider networks to be aware of their own participation status:
    • Providers not participating in any of the Blue Local or Blue Value POS provider networks are always out-of-network for Blue Cross NC's Blue Local and Blue Value members' services.
    • Providers participating in a Blue Local or Blue Value network are only eligible to provide in-network services to members enrolled in a matching POS product.
       
  • Smart benefit packages are not unique to Blue Cross NC. You may encounter members from other Blue Plans (plans other than Blue Cross NC) carrying ID cards that display the Blue Local or Blue Value names. If this occurs and members from other Blue Plans present ID cards including a Blue Local or Blue Value product name and displaying a suitcase logo (which can be empty or contain PPO, HMO, or CMM logos, as well as another plan's name), you are only eligible to see these members for in-network services if you are contracted for participation in a Blue Cross NC Blue Local or Blue Value network.

    These simple rules can help you understand:
     
    • Blue Value – these members will carry ID cards displaying the Blue Value product name and a suitcase logo. Blue Value cards may be issued from any Blue Cross and/or Blue Shield Plan.
      • If you participate in the Blue Value network, you can provide in-network services to Blue Value members with coverage through Blur Cross NC or any of the other Blue Plans.
      • If you do not participate in the Blue Cross NC Blue Value network, you are not eligible to provide in-network services to Blue Value members with coverage through Blue Cross NC or any of the other Blue Plans, regardless of the suitcase logo on the ID card.
         
    • Blue Local – these members will carry ID cards that display the Blue Local product name and a suitcase logo. Blue Local cards may be issued from any Blue Cross and/or Blue Shield Plan.
      • If you participate in a Blue Local network, you can provide in-network services to Blue Local members with coverage through Blue Cross NC or any of the other Blue Plans.
      • If you do not participate in a Blue Cross NC-offered Blue Local network, you are not eligible to provide in-network services to Blue Local members with coverage through Blue Cross NC or any of the other Blue Plans, regardless of the suitcase logo on the ID card.