Frequently Asked Questions
Download our free Blue Connect MobileSM app today!
AEP/Open Enrollment
What is the status of my application?
Individual and Family
If you enrolled through the Marketplace® (www.healthcare.gov) it typically takes around 24 hours for those applications to be received by Blue Cross NC. Once it is received you will receive an email advising you to go complete the application online by making the initial payment. Once the payment is made the policy can be enrolled. If it’s been more than 48 hours and you haven’t received an email, check back with the Marketplace in case there was an error regarding the application.
Medicare
You may check the status of your application by logging in using your username and password created to complete the application online, through your agent, or by calling the Member Contact Center:
- HMO – 888-310-4110
- PPO – 877-494-7647
- PDP – 888-247-4142
Where can I see Policy/Plan options?
Individual and Family
After 10/28 you will be able to log in to your Blue Connect account and under the Health / Coverage section you will be able to see your current, future, and past plans. Once you select the plan you want to review, you will see options for Summary of Benefits, Benefit Booklet, Coverage Summary, member ID Card1, Find a Doctor2 in your Network, and other topics related to the policy you selected.
Medicare
While logged into your Blue Connect account, select Manage Plan. Plan change options will be available for review. You can also Shop Plans without being logged into your Blue Connect account.
How do I know what I can expect as benefits from my plan?
Individual and Family
Blue Cross NC will provide a comprehensive Member Guide, which will be mailed to your home after you enroll. The Member Guide includes detailed information about your specific benefits and covered services.
You may also receive additional information about your plan by contacting Customer Service toll-free at 1-877-258-3334, Monday through Friday from 8:00 a.m. to 7:00 p.m.
Additionally, Blue Cross NC provides valuable information and services on this Web site. You can either surf the site for the information you need or log in to Blue Connect to access information about your specific policy. With Blue Connect, you can accomplish the following:
- Request up to two new member ID cards1
- Update your policy's contact information
- Review your claim status
- Check eligibility for benefits for you and your family members included on your policy
- Access a brief benefit summary that includes copayment amounts, coinsurance percentages, deductible amounts and how much of your deductible has been paid
Medicare
Blue Cross NC provides an Annual Notice of Change in preparation for AEP. An Evidence of Coverage that includes detailed information about your specific benefits and covered services is available upon request. You may also receive additional information about your plan by contacting the Member Contact Center through the number listed on the back of your ID card. TTY users dial 711. Customer Service is available Sunday – Saturday: 8 a.m. – 8 p.m. You may also log on to Blue Connect to access information about your specific policy.
When do my benefits begin?
Individual and Family
Your new policy has an effective date (e.g., Health Plan - Active as of 01/01/2022) which is when your coverage begins. Note: you still may have coverage under a current plan which is still in effect
If you make your plan selection and enroll during the Open Enrollment Period of November 1 through December, 15 2022, the effective date for that policy will be January 1 2023. Any changes made from December 16 2022 through January 15 2023 will have a February 1, 2023 effective date. After January 15 2023 a qualifying life event is required to be eligible for a Special Enrollment Period (SEP)3.
Medicare
Your new policy has an effective date (ie. Health Plan - Active as of 01/01/2023) which is when your coverage begins. Note: you still may have coverage under a current plan which is still in effect. If you make your plan selection and enroll during the Annual Enrollment Period of October 15 through December 7 2022, the effective date for that policy will be January 1 2023. After December 7, certain changes can only be made during Open Enrollment January 1 – March 31, 2023. The effective date of change will be the first of the following month after we receive the request for change.
Benefits
How do I know what I am eligible for?
Individual and Family
Once enrolled, your benefit booklet provides comprehensive information about your Plan’s benefits. You can also find benefit information through your Blue Connect account by logging in and clicking on the Coverage tab. You will find a link to your benefit booklet, a summary of benefit, and links to other helpful guides to answer your questions. You can also contact us through the Contact Us link, or you can call the Member Contact Center through the number listed on the back of your ID card.
If you are not yet a member, please review our benefits booklets for more information on coverage and benefit information.
Medicare
Your Evidence of Coverage provides comprehensive information about your Plan’s benefits. You can also find benefit information through your Blue Connect account by logging in and clicking on the Coverage tab. You will find a link to your Evidence of Coverage and links to other helpful guides to answer your questions. You can also contact us through the Contact Us link, or you can call Customer Service through the number listed on the back of your member ID card.
Where can I see if my provider is in network?
Individual and Family
Access the most up-to-date provider information with our Find a Doctor search tool2. Here, you can locate providers by name, specialty, county, or Zip Code. The Provider Search information is updated weekly.
Note: Many plans participate in the SmartShopper program4. If your plan participates you will receive messages about possible savings on many procedures.
You can also contact Customer Service at 1-877-258-3334 for assistance locating a provider or to obtain a paper copy of a directory. Additionally, many employers stock directories in their Benefits Department.
Medicare
Access the most up-to-date provider information with our Find a Doctor search tool. Here, you can locate providers by name, specialty, county, or zip code. The Provider Search information is updated weekly.
You can also contact Customer Service by calling the number on the back of your ID card for assistance locating a provider or to obtain a paper copy of a directory.
How do I research a code and the associated costs?
Individual and Family
As of 1/1/2023, a new feature will be added to the Find a Doctor search tool2 that will allow you to research procedure codes.
Note: Many plans participate in the SmartShopper program4. If your plan participates you will receive messages about possible savings on many procedures.
Medicare
The Medicare Cost Estimator Tool is a way for members to research procedures and providers beforehand to get a better idea of expected costs. You may log into your Blue Connect account and select Find Costs.
Billing
I am owed a refund, when can I expect it?
Individual and Family
Depending on the reason for the refund or how the refund is issued we advise members to allow 20 days for processing and mail to arrive after the 10-day system hold. It can take up to 30 days total to receive a refund.
| Last Premium Payment | How Refund is Issued |
|---|---|
|
Check or Bank Draft |
|
| Credit Card within the last 60 days *refund amount must be equal to or less than the last paid amount |
|
|
Credit Card within the last 60 days OR Last refund amount is more than last paid amount |
|
Medicare
Your refund should be issued in about six to eight weeks.
Is there a grace period if I miss a payment?
Individual and Family
There is a grace period to pay premiums past the due date and avoid auto-termination. The grace period for paying premiums on Individual policies differs depending on whether the policy has federal subsidies or not.
On Marketplace policies cannot be reinstated if terminated.
| Type of Policy | Grace Period |
|---|---|
|
Off Marketplace OR On Marketplace WITHOUT Advance Premium Tax Credit (APTC) or Cost Sharing Reduction (CSR) |
25-day grace period |
| On Marketplace with APTC or CSR | 3-month grace period |
Medicare
There is a two-month grace period to pay premiums past the due date and avoid auto-termination.
What happens if I miss a payment?
Individual and Family Plans
For Off Marketplace plans or On Marketplace plans with no APTC/CSR with the standard 25-day grace period:
- Claims do not pay during the grace period until the premium payment is posted and the paid through date is advanced to cover that month
- If the member receives an invoice for multiple months, such as a two-month bill, the full amount is due by the due date.
- Payment is always due on the 1st of the month and no delinquency letters are sent—the invoice is considered a first and final notice. If the account is not paid in full the policy will auto-term.
For On Marketplace plans with APTC/CSR:
- There is a three-month grace period
During the first month of grace period Blue Cross NC will pay on medical and pharmacy claims - After the first month, if the full payment is not paid claims will be pended for payment, meaning that Blue Cross NC is unable to process claims for medical services received, and if members have prescriptions they will process at the full cost at the pharmacy as benefits cannot be applied.
Medicare
Premium payments are due on the 1st of each month. If payment is not received by the 2nd day of the month then members are considered late and eligible to receive a late letter. The first letter must be mailed by the 15th of the month and informs the member that if the past due premium payment of $XX is not received by the end of the following month (2-month grace period), disenrollment will occur on the first of the next month.
How much do I owe?
Individual and Family Plans
Full payment is expected by the due date shown on the invoice in order to keep the account current.
If a member enters the grace period:
- The member will receive an invoice for two months—the previous month and the current month. In order to exit the grace period the full amount shown on the invoice must be paid. Members cannot pay for only one month and exit the grace period.
- If the member receives a third invoice for the third month of the grace period, the member must pay the full amount shown on the invoice by the due date to keep the policy from terming for non-payment. This means that the member must pay for all three months in full to keep the policy from terming and to bring it out of the grace period.
- Once the full payment posts any claims can be processed and paid according to the member’s benefits.
Medicare
Full payment is expected by the due date shown on the invoice in order to keep the account current. There is a 2-month grace period. Account balances may be obtained by accessing your Blue Connect account or by dialing the automated pay-by-phone system, 1-844-395-4535.
Medicare requires that we send out late letters within 15 days of the payment due date. The billing schedule cannot be adjusted and is set to go out as required. To avoid receiving late letters, premium payments should be paid on the first of each month.
What is my due date?
Premium payments are due by the 1st of the month.
How long does it take for my payment to go through?
Payments are applied to your account once they are received. How you choose to make a payment can determine how quickly the payment is applied to your account.
How can a member make a payment?
There are several ways for members to make a payment:
- Mail a personal check or money order to the address on the paper invoice
- Send payment through PC Banking (online bill-pay set up through your bank)
- Set up and use bank draft which automatically drafts your premium payment each month
- Set up and use a recurring credit card payment which will charge your credit card each month
- Use our Pay-by-Phone service that accepts either bank draft or credit card information to pay your invoice
- Pay through your Blue Connect account using the Make a Payment feature
I need to cancel, how do I do that?
Individual and Family
If you purchased your own plan through HealthCare.gov, you will need to cancel your plan on HealthCare.gov.
If you purchased your own plan without going through HealthCare.gov, you can request to cancel your plan through Blue Connect.
Here's how:
- Log in and go to your Blue Connect Inbox
- Click the Compose button
- Select Cancel My Plan as your message topic
- Fill out the request form and submit
Otherwise, please call the number on the back of your member ID card for assistance.
Medicare
Please call the Customer Service number on the back of your ID card for assistance.
Claims
How can I find out the status of my claim?
You can check the status of a claim by logging in to Blue Connect . With Blue Connect, you can access the following information regarding a submitted claim:
- Processing status
- Date received
- Billing and payment amounts
- How much money has been applied toward deductible
- Coverage ratios for any member covered on the policy
I need access to my medical records, how do I get them?
Members can request their medical records by completing a Request to Access Protected Health Information - COP form to request access to their Protected Health Information (PHI). It gives them several options of PHI to request, including claims records. Once the form is received, a Members’ Rights Coordinator will complete the request.
If the member needs medical information regarding treatment, conditions, medical notes, etc., from their providers, they will need to reach out to their specific providers for those records.
How do I file an appeal of a denial of benefit coverage?
Individual and Family
You have the right to request a formal appeal of a denial of benefit coverage. A detailed description of this process may be found in your Member Guide or on the back of any Explanation of Payment you receive for the denied service. Customer Service can also assist you in starting the appeal process.
Blue Cross NC will work with you to resolve the issue. For each step in the appeals process, there are specified time frames for filing a grievance and for Blue Cross NC to notify you or your provider of the decision.
Medicare
You have the right to request a formal appeal of a denial of benefit coverage. A detailed description of this process may be found in your Evidence of Coverage or on the back of any Explanation of Benefits you receive for the denied service or notice of denial letter. Customer Service can also assist you in starting the appeal process.
Blue Cross NC will work with you to resolve the issue. For each step in the appeals process, there are specified time frames for filing an appeal and for Blue Cross NC to notify you or your provider of the decision.
How do I file a complaint about a provider?
Individual and Family
If you have a complaint regarding a provider, please contact Customer Service at 1-877-258-3334. The complaint will then be researched and handled appropriately.
Medicare
If you have a complaint regarding a provider or our Plan, please contact Customer Service by calling the number on the back of your ID card. The complaint will then be researched and handled appropriately.
Eligibility
I am on COBRA, what do I need to know?
COBRA is for members covered under Group Plans. It is not available for members covered under an Individual Plan.
There has been a qualifying event for the qualified beneficiary to lose their group health coverage for a member to qualify for COBRA. North Carolina Law does NOT recognize legal separation as an event that affects eligibility for health coverage; therefore, it is not considered a COBRA qualifying event.
North Carolina takes the stance that a person is either married or not married. Legal separation would be considered still married, which allows the spouse to still be eligible for group coverage under a covered employee.
A qualifying event for a spouse or dependent child under a Blue Cross NC policy to receive COBRA benefits can include:
- A covered employee's termination of employment (other than for gross misconduct)
- A covered employee's reduction in hours of employment
- A covered employee's death
- A spouse's divorce from a covered employee
- A covered employee's entitlement to Medicare
- A dependent child's loss of dependent status under the plan
- an employer's filing of a bankruptcy proceeding
Note: ASO policies, including the State Health Plan, have the right to make their own determination regarding qualifying events. This includes legal separation.
- Coverage for COBRA is arranged through the Group Administrator for the employer’s Plan, so payment is sent to the COBRA administrator.
- COBRA continuation is for 18 months
Member ID Cards
When can I expect to receive my member ID card1?
We will mail you a new member ID card within 7-10 business days of your policy being enrolled. In the meantime, you can view or print a temporary member ID card online.
You'll need to follow these steps:
- Log in to Blue Connect
- Click Account
- Click Get a New ID Card. You'll see the option to print a temporary member ID card.
If your policy is canceled, you won't be able to order a new one.
Note: Current members will not receive new member ID cards unless there was a change made to the plan.
Do I need to wait to receive for my ID card1 before I can make an appointment?
Individual and Family
No. Members can obtain a Verification of Coverage (VOC) letter to take to a doctor before their effective date. After their effective date they can register for Blue Connect and obtain a temporary member ID Card. The VOC is available upon enrollment completion (approximately nine business days after payment is made) and remains available for 30 days.
Medicare
No, you can view or print a temporary member ID card online.
Can I access my member ID card online?
Yes, Use the following steps to access a member ID card in Blue Connect:
- Log in to Blue Connect.
- On the Home page, click ID Card on any plan tab (Health, Dental, Prescription).
- The member ID Card appears on the Coverage page.
- From here you can print your member ID card or request a new wallet-size card.
Pharmacy
How can I find out if my prescriptions are covered?
As a member, you can log in to your Blue Connect account and select your Pharmacy plan. You will see your plan summary, your deductible and Out-of-Pocket information, and other related drug/prescription information. Please make sure you are selecting your plan that is currently active.
If you are not yet a member, please use our Find a Drug tool to find out if your prescription is covered.
Why is my prescription not covered?
The medication prescribed is not listed on your Plan’s Formulary, or it's a medication that requires other steps first (i.e., trying other similar types of medications first) or Prior Approval.
What are my options if my medication is not covered by my plan?
If the medication is not on the formulary list for your Plan it is considered “Non-Formulary” or “Excluded” from the plan. The member has the option to request an exception for a “Non-Formulary” or “Excluded” drug to try and get that drug covered. You can call the Customer Contact Center number on the back of your member ID Card for further assistance with requesting a Formulary Exception Request.
Where can I learn more about my prescription benefits?
As a member, you can log in to your Blue Connect account and select your Pharmacy plan. You will see your plan summary, your deductible and Out-of-Pocket information, and other related drug/prescription information.
If you are not yet a member, please use our Find a Drug tool to find out if your prescription is covered.
Support
How can I manage my health plan needs on my phone?
You can download the Blue Connect Mobile App from the Apple Store or the Google Play store. It has the same features and functions as the Blue Connect website.
I have a gift card but I am having challenges using it. How can I get help?
Individual and Family
If you have earned gift cards through Blue Rewards5 or if there are missing rewards and you need gift card assistance, please contact Rally Health at 877-484-7022 for support.
Medicare
If you have earned gift cards or if there are missing rewards and you need gift card assistance, contact Customer Service by calling the number on the back of your ID Card.
Additional Questions
Medicare
Am I eligible for Medicare?
Medicare is health insurance for people 65 or older. You’re first eligible to sign up for Medicare 3 months before you turn 65. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease).
You can check your eligibility at Medicare.gov.
How do I enroll in Medicare?
You can begin your Medicare enrollment at ssa.gov. If you’d like to purchase a Medicare Advantage plan, Medicare Supplement plan or Medicare Prescription Drug plan (PDP), you need to enroll in Parts A and/or B before purchasing those plans.
Am I automatically enrolled in Medicare when I turn 65?
Some people get Medicare Part A and Medicare Part B automatically, and other people have to sign up. In most cases, it depends on whether you’re getting Social Security benefits. You can learn more at Medicare.gov.
Is Medicare free?
Medicare Part A is usually available at no cost if you or your spouse made payroll contributions to Social Security for at least 10 years. Medicare Part B comes with a monthly premium based on your income. Some Medicare Advantage (Part C) plans, Medicare Supplement and Medicare Rx (Part D) also come with a monthly premium.
What if I’m not retiring at 65?
You still qualify for Medicare at age 65, but it may or may not make sense to enroll. Check with your employer’s human resources manager, benefits specialist, or a Blue Cross NC agent to learn about your options.
In some cases, if you keep your current coverage and wait until later to join Medicare, you may have fewer choices and/or pay more.
What happens to my Medicare benefits if I go back to work after retiring?
You can discontinue your Medicare coverage to enroll under an employer plan. When you’re ready for Medicare again, you’ll still be eligible under a Special Enrollment Period.
What if I have retiree benefits that include health insurance?
Check with your human resources manager or benefits specialist to see your options. In some cases, if you keep your current coverage and wait until later to join Medicare, you may have fewer choices and/or pay more.
What is a late enrollment penalty?
If you enroll in Parts A, B or D after 3 months from your eligibility date, you may have to pay a higher premium for Parts B and D. This penalty is required by the federal government. For more information about late enrollment, visit Medicare.gov.
Must I continue to pay my Part B premium if I enroll in Medicare Advantage (Part C), a Medicare Prescription Drug Plan (PDP) or a Medicare Supplement plan?
Yes. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.
Can I qualify for financial assistance if I have limited income?
If you have Medicare and Medicaid, you already qualify for low income assistance. If you don't qualify for Medicaid, you may still qualify for some assistance. The amount of assistance will depend on your income and resources and will be applied to the cost of the Medicare prescription drug coverage portion of your Blue Medicare HMO or PPO plan.
Learn more about financial assistance.
What if I want to change plans?
There are two opportunities for everyone to switch plans: the Annual Enrollment Period (AEP) October 15 to December 7 and the Open Enrollment Period (OEP) January 1 to March 31.
For example, if you enroll or switch plans in the fall but decide you don’t like the plan once your coverage begins in January, you can switch back to Original Medicare or another Medicare Advantage plan before March 31.
You can also change plans anytime you qualify for a Special Enrollment Period. Visit Medicare.gov for more information about Special Enrollment Periods.
Blue Connect