Reminder April 14, 2025: As a reminder, Blue Cross NC posted the below communication regarding a new product offering effective January 1, 2025. All Blue Advantage PPO providers are in-network for Blue Care HMO. Please see below for additional details and information on this product offering.

Update January 23, 2025: As a reminder, Blue Cross NC posted the below communication regarding a new product offering. All Blue Advantage PPO providers are in-network for Blue Care HMO. Providers can view their participation status on the Find a Doctor tool available on the Bluecrossnc.com website.
 

Effective January 1, 2025, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will offer the Blue Care HMO product, with ACA (Affordable Care Act) compliant plans for the IU65 (Individual U65) market, both On- and Off- Exchange. This Blue Care HMO product will give members the freedom to go directly to participating in-network Primary Care Providers (PCP) or specialists without a referral and provide wellness programs to help keep our members healthy.

• The benefit coverage will be limited to in-network providers. All other providers are considered out-of-network and not covered.
• Out-of-network benefit coverage is limited to emergency services and urgent care, and medically necessary covered services when an in-network provider is not reasonably available per Blue Cross NC’s access to care standards.
• 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. 

The Blue Care HMO product will not be offered in the following counties:

Alamance, Anson, Cabarrus, Caswell, Chatham, Cleveland, Davidson, Davie, Durham, Forsyth, Franklin, Gaston, Guilford, Johnston, Lee, Lincoln, Mecklenburg, Nash, Orange, Person, Randolph, Rowan, Stanly, Stokes, Union, Wake, Wilkes and Yadkin

Recognizing Blue Care Members  

A Blue Care member can easily be identified by their member ID card. The Blue Care name will be prominently displayed on the front of the member ID card, along with the “Empty suitcase” logo. Blue Care HMO product/plans will be offered to IU65 members in certain regions/counties of the state of North Carolina.

Member Benefits 

Member benefits include preventive care, which includes but not limited to regular check-ups, vaccinations, screenings, and promoting overall health and early detection of potential health issues. Under Blue Care HMO, members are asked, but not required, to select a primary care physician. Enrolled members have in-network benefits only. There are no out-of-network benefits except for urgent and emergency care.

Impacted Lines of Business  

Individual Under 65 market.