Individual Under 65 ACA Products Moving From Point of Service to Exclusive Provider Organization

Effective January 1, 2023, the following Blue Cross and Blue Shield of North Carolina (Blue Cross NC) Individual Under 65 ACA Point of Service (POS) products will transition to Exclusive Provider Organization (EPO) products: 

• Blue Home with UNC Health Alliance POS
  
• Blue Home with Novant Health POS
• Blue Local with Atrium Health POS
• Blue Local with Wake Forest Baptist Health POS

The above products will now become known as:

• Blue Home with UNC Health Alliance EPO
• Blue Home with Novant Health EPO
• Blue Local with Atrium Health EPO
• Blue Local with Wake Forest Baptist Health EPO

“EPO” is an exclusive provider organization benefit plan offered by Blue Cross NC and designated as EPO by Blue Cross NC in the Provider Manual and/or Benefit Plan Exhibit of the Network Participation Agreement. 

Please note that the products mentioned above are narrow network, system-specific products. Providers currently participating in these POS products will remain participating in the new EPO products after the transition takes place on 1/1/23.

Benefit coverage will be limited to in-network providers for the Blue Local and Blue Home EPO products. All providers outside of the EPO product are considered out-of-network and not covered. Out-of-network benefit coverage is limited to emergency services, urgent care outside of the product service area, and medically necessary covered services when an in-network provider is not reasonably available per Blue Cross NC’s access to care standards. Please ensure that your staff refer all members to in-network providers. 

Note: Out-of-state providers are also out-of-network and not covered. When traveling outside of North Carolina or the United States, only emergency services and urgent care will be covered at the in-network benefit level. All other services will be out-of-network and not covered. 

Providers are required to direct members to utilize in-network providers and facilities identified by using the Blue Cross NC online directory or Blue Cross NC’s customer service department. Members will incur significant out-of-pocket expenses when out-of-network providers are used.