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BlueCross BlueShield of North Carolina

All of our plans help protect you from unexpected medical costs, but they have many different options and features.

Knowing which plan best suits your particular needs can help you save money and ensure that you have the right amount of health insurance coverage.

Financial Considerations

Would you rather have:

  • Higher monthly payments but pay a fixed cost when you receive medical services?
  • Lower monthly payments but pay the full cost of medical services until your deductible is met?

Look for these features when you review our plans.

  • Blue Advantage® offers two choices - predictable copayments so that you have a better idea of what you'll spend for medical services or the option to pay a deductible and coinsurance to have lower premiums.
  • Blue SelectSM gives you predictable copayments as well as a network of tiered providers for savings on premiums.
  • Blue ValueSM provides the same payment options as Blue Advantage, but in a smaller, more streamlined network for some of the lowest premiums our plans offer.

Provider Network

Do you have a strong provider preference?

  • Blue Advantage offers a broad, deep network at affordable premiums.
  • Blue Select provides members access to the same large network as Blue Advantage, but the in-network providers are tiered for savings on copayments and coinsurance.
  • Blue Value offers a smaller, more streamlined network at a lower monthly premium.

Prescription Drug Coverage

Do you take prescription drugs regularly?

  • Blue Advantage offers copayments for prescription drugs or the option to pay more out-of-pocket costs, until you meet your deductible. After you meet your deductible, you'll pay coinsurance.
  • Blue Select offers predictable copayments for prescription drugs and a formulary with more requirements.
  • Blue Value plans offer the same flexible payment options as Blue Advantage, but a limited pharmacy network.
All of our plans involve two important features: deductibles and coinsurance. Knowing how these work can help you better understand how health insurance works.
Deductible Coinsurance Full Coverage
You Pay 100% 0%-50% 0%
BCBSNC Pays 0% 50%-100% 100%
You pay the full amount of your health care costs until you reach your deductible. Once you've reached your deductible, BCBSNC shares your health care costs with you. This is known as coinsurance. The percentage you pay can range from 0% - 50%, depending on the plan you pick. You pay coinsurance until you reach your out-of-pocket limit. Then BCBSNC pays 100% of your covered health care costs for the rest of the year, including copayments.
Deductible
You Pay 100%
BCBSNC Pays 0%
You pay the full amount of your health care costs until you reach your deductible.
Coinsurance
You Pay 0%-50%
BCBSNC Pays 50%-100%
Once you've reached your deductible, BCBSNC shares your health care costs with you. This is known as coinsurance. The percentage you pay can range from 0% - 50%, depending on the plan you pick.
Full Coverage
You Pay 0%
BCBSNC Pays 100%
You pay coinsurance until you reach your out-of-pocket limit. Then BCBSNC pays 100% of your covered health care costs for the rest of the year, including copayments.

Meet Fred: A real-world example

Fred's Insurance Plan

Deductible: $5,500
Coinsurance: : 20%
Out-of-Pocket Limit: $6,350

Medical Services for the Year

Billed Amount Fred's Cost
Fred is in a serious accident in June and requires x-rays. $700 $700
After the accident, Fred needs surgery and a brief hospital stay. $4,800 $4,800
Total Deductible $5,500
Fred is in a serious accident in June and requires x-rays.
Billed Amount $700
Fred's Cost $700
After the accident, Fred needs surgery and a brief hospital stay.
Billed amount $4,800
Fred's Cost $4,800
Total Deductible $5,500

At this point, Fred has met his $5,500 deductible. He'll only have to pay 20% of future covered medical services plus his usual copayments until he reaches the out-of-pocket limit for the year.

Billed Amount Fred's Cost
After surgery, Fred needs regular physical therapy for ten weeks. $4,250 $850
(20% of $4,250)
Total (including deductible) $6,350
After surgery, Fred needs regular physical therapy for ten weeks.
Billed Amount $4,250
Fred's Cost $850
(20% of $4,250)
Total (including deductible) $6,350

Fred has now met his out-of-pocket limit for the year. He won't have to pay for any covered medical expenses for the rest of the year.

Figures are for illustrative purposes only. Your actual coverage depends on the type of plan you choose.

Questions about our dental plans? Visit our Dental Blue FAQ.

General Coverage

When can I enroll?

For the initial enrollment period, you can enroll between October 1, 2013 and March 31, 2014.

There is, however, a special enrollment period going on throughout the year. This enrollment period allows individuals meeting certain criteria to enroll outside of the initial enrollment period.

How do I know if I am eligible for health insurance coverage?

To be eligible, you must be:

  • A North Carolina resident
  • Not enrolled in Medicare
When will my health insurance coverage begin?

If you are purchasing a policy that provides tax credits, your policy will begin on the 1st of the month as long as you apply by the 15th of the prior month.

For the initial enrollment period, you may apply from October 1 through December 15th for a January 1st start date.

If you are purchasing a policy without tax credits your coverage can begin on the 1st or the 15th of the month. If your online application is submitted by the 8th of the month, your coverage can begin as soon as the 15th of that same month. If your online application is submitted by the 22nd of the month, your coverage can begin as soon as the 1st of the following month. Requested effective dates may not be more than 60 days from the date you submit your application.

How do I renew my health insurance coverage?

Your coverage is automatically renewed when you continue to pay premiums as they are due. BCBSNC must renew your policy unless we discontinue all policies like yours.

If I visit a doctor or hospital outside the network, am I still covered?
Yes, you can see any doctor you choose, but remember: you save money when you visit a participating, in-network provider. Our Blue Advantage network includes 91% of doctors in North Carolina and 99% of hospitals in North Carolina.1 Our Blue Value network is more streamlined to help you save money but you will still have coverage out of network at a higher cost. Our online provider search can help you find out whether your physician is in our network.
Do all of your health insurance plans use the same provider network?

No. Blue Advantage has the broadest, deepest network of providers. Blue Select offers a large network of tiered doctors and hospitals. Blue Value has a smaller, limited network of providers.

What is the difference between an in-network provider and an out-of-network provider?

In-network providers are contracted with BCBSNC to provide services to members at discounted rates. Out-of-network providers aren't contracted, so their services usually cost more for members. Health insurance plans usually pay a lower percentage of out-of-network costs, which may increase member out-of-pocket expenses for those services.

What are limited office visits?

Some of our plans offer unlimited office visits that require a copayment while other plans only a set number of copayment office visits. If a member goes beyond that set number of visits, they have to pay out of pocket until they meet their deductible.

Health Savings Account (HSA)

What is a Health Savings Account (HSA)?

A Health Savings Account (HSA) is a savings account that offers a tax-advantaged way for consumers to pay for their health care expenses2. Usually paired with a High Deductible Health Plan (HDHP), HSAs help consumers pay for current health expenses and save for future qualified medical and health expenses in retirement.

Contributions to an HSA are tax-deductible and distributions can be taken tax-free.3

You own and control the money in your HSA. You make the decisions on how to spend the money, within IRS guidelines for eligible expenses. The money in HSAs can be invested to take advantage of the potential for future growth. Investment options vary depending on who is managing the account.

What is a High Deductible Health Plan (HDHP)?

A High Deductible Health Plan (HDHP) is a health insurance plan offering lower premiums in exchange for first dollar expenses going toward a deductible instead of copayments. The plan generally covers health care expenses after the deductible is met. You can also opt for varying coinsurance rates which can also affect your premium.

Preventive care is covered at 100% under an HDHP, and there is a cap on the out-of-pocket expenses you are responsible for during the year. HDHPs are frequently paired with HSAs to help you pay for expenses your plan does not cover. You must have an eligible HDHP to open an HSA.

Can I have other health coverage in addition to my HDHP?

Yes, but to open and contribute to an HSA you cannot be covered by any plan other than eligible HDHPs, except for:

  • Dental or vision coverage
  • Long-term care coverage
  • Accident/disability coverage
  • Hospital Insurance Plan (HIP)-type coverage or disease-specific coverage
Who can open and contribute to an HSA?

You must be covered by an eligible HDHP to open or contribute to an HSA.

An HSA is an individual account; you cannot open a jointly-held HSA. Multiple adults covered under a family plan may each open an HSA, but the collective total of both accounts may not exceed the family contribution maximum. Note: Although HSAs are individual accounts, the funds in the HSA can be used for your spouse, yourself or a dependent's eligible medical expenses.

A husband and wife enrolled in an eligible family HDHP can:

  • Open an HSA in one spouse's name and contribute up to the family maximum. Those funds can be used to pay for medical expenses for anyone covered by the plan.
  • Open individual HSAs and contribute to both, but the collective total of both must not exceed the family contribution maximum including any catch-up amounts. This may be an appealing option if you and your spouse are both eligible for catch-up contributions to an HSA after age 55, because each person's catch-up contribution must be made to their own account.

If you later unenroll from your HDHP, enroll in Medicare or become covered by a non-HDHP, you can keep your HSA and continue to use the remaining funds, but you can no longer contribute to it.

What are the annual contribution limits for an HSA?

For 2013, the combined maximum contributions to your HSA, including any made by your employer, are:

  • $3,250 if you have individual coverage
  • $6,450 if you have family coverage

For 2014, the maximum contribution amounts are:

  • $3,300 if you have individual coverage
  • $6,550 if you have family coverage

If you turn age 55 or older during the plan year, you can add up to $1,000 more as a catch-up contribution. These amounts are valid as long as you are enrolled in qualified HDHP coverage for the entire tax year, or you enroll before the first day of December - meaning you have held at least one full month of HDHP coverage and then continue to maintain qualified HDHP coverage for the next 12 months (13 months total).

* Contribution limits are set by the IRS and are subject to change. Visit irs.gov for the most up-to-date information.

Can I make contributions if I am not enrolled in an HDHP for the entire year?

If you are an eligible individual on December 1, it is possible to contribute up to the maximum annual limit for that year - even if you did not have eligibility for the full calendar year. This is known as the last month rule. Please note that the the IRS requires that you maintain HSA eligibility through December 31 of the following year (referred to as the "testing period").

If you do not remain HSA-eligible through the testing period, income taxes plus a penalty tax likely apply. For more information, please see IRS Publication 969, consult a tax advisor, or both.

Can I open an HSA for my child?

No. You cannot establish separate accounts for dependent children, including children who can legally be claimed as dependents on your tax return. You can use your (or your spouse's) HSA funds to pay for your child's eligible medical expenses however, as long as the child is claimed as a dependent on your tax return.

I turned 55 this year. Can I make the full catch-up contribution?

If you are an eligible individual on December 1, you can make the full catch up contribution regardless of when your 55th birthday falls during the year; however, if you did not have HDHP coverage for the full year, you must prorate your catch up contribution for the number of full months you had HDHP coverage. See IRS guidelines for information about prorating a contribution.

Each eligible individual covered by a HDHP, (i.e., the policy holder and his/her spouse, if both are at least 55) can make a catch-up contribution of up to $1,000 annually. Each spouse must have an HSA in their name to receive the catch-up contribution.

Note that the total contributions to all HSA accounts under a family plan must not exceed the family contribution maximum.

What happens if I exceed the annual contribution limit?

Contributions made to your HSA that exceed the contribution limits are not tax-deductible. In addition, a tax penalty is imposed on excess contributions. You can avoid the penalty on excess contributions by withdrawing excess contributions before the last day prescribed by law (including extensions) for filing your federal income tax return for the tax year.

I don't have earned income, can I have an HSA?

Yes. You do not have to have earned income to fund a Health Savings Account.

Can someone other than the plan participant contribute to the participant's HSA?

Anyone can contribute to an HSA on your behalf including individuals not covered by the plan, i.e., extended family.

HSA contributions made by a family member on your behalf are tax-deductible by you when you are computing your adjusted gross income.

When can contributions to an HSA be made?

Contributions to an HSA can be made at any time during the year in any increment, including:

  • All at once at the beginning of the year
  • All at once at the end of the year
  • In equal amounts during the year

Contributions to an HSA for the current year can be made through April 15 of the following year.

Can HSA funds be invested?

Yes. When your account balance reaches a certain amount, you can invest the excess funds. The same types of investments permitted for IRAs are allowed for HSAs, including stocks, bonds, mutual funds, and certificates of deposit. The investment options for your HSA account are determined by the investments offered by the HSA manager. BenefitWalletTM is the administrator of the HSA, and BNY Mellon or Mellon Trust of New England, N.A. is the custodian or trustee. After you purchase a BCBSNC HDHP, Benefit Wallet will send you a Welcome Kit with further information about the options for your HSA.

What medical expenses can HSA funds be used for?

Review a list of eligible medical expenses

Review a list of noneligible medical expenses

HSA distributions are tax-free if used for eligible medical expenses as defined by Internal Revenue Code Section 213(d). Non-eligible distributions will be taxed as part of gross income and will incur a tax penalty. After age 65, the tax penalty is dropped, though the distribution is still treated as taxable income. Eligible medical expenses include doctor's office visits, pre-deductible amounts and coinsurance.

Are claims incurred prior to establishing the HSA eligible for reimbursement?

No. Your HSA is established on the effective date of your Blue Options HSA policy. However, to officially activate your HSA, you must send in your signature card. If you delay, the IRS may infer you intended to open your account at a later date.

Some information about HSAs in this article was sourced from www.ustreas.gov.

Dental Blue

Who's eligible for Dental Blue for Individuals?

Applicants and their dependents (spouses or children under the age of 26) who are residents of North Carolina.

If I cancel my Dental Blue for Individuals coverage, how soon can I reapply?

Reapplying for coverage isn't permitted for 12 months from your policy's termination date.

Are my monthly premiums subject to change?

You may experience a change in your monthly premiums at the time of your annual renewal (January 1 of each year), or when you add or remove dependents.

Download dental claim form

Mail the completed claim form to:

Blue Cross and Blue Shield of North Carolina
Dental Claims Unit
P.O. Box 2100
Winston-Salem, NC 27102-2100


1. CHP Market Quest, Network Compare, July 2012 (data as of May 9, 2012)
® Mark of the Blue Cross and Blue Shield Association. ®1, SM Mark of Blue Cross and Blue Shield of North Carolina.
2. Blue Options HSA is a high-deductible health plan that may be combined with a health savings account (HSA). BCBSNC does not administer the HSA and is not affiliated with your HSA custodian or administrator.
3. Withdrawals are tax free only if used for qualified medical expenses. Specific regulations and a list of qualified medical expenses can be found in IRS publication 502, available at www.irs.gov.

If you have questions, we've got answers.

Give us a call at 1-800-324-4973.

Hearing and speech impaired (TDD/TTY), please call 1-800-922-3140.

Licensed agents are available to assist you Monday - Thursday, 8 a.m. - 6 p.m. and Friday, 8 a.m. - 5 p.m.

You can also find a local agent now.

For inquiries about membership, claims, billing or your plan's benefits, please call the phone number on the back of your Member ID card.

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