Blue Advantage
Our classic health insurance plan
- Features low copayments for doctor visits and prescription drugs
- A wide range of deductibles for medical and prescription drugs
- Ideal for those who want more predictable health care costs
How It Works
With Blue Advantage:
- You get the most comprehensive coverage we offer
- You pay more in monthly premiums, but you pay less when going to the doctor
- Preventive care is covered at 100% 1
How Blue Advantage Works 2
Going to a Doctor or Specialist
You pay a copayment for the visit. You may have to pay additional for any tests, labs or other medical costs outside the visit.
Going to the Pharmacy
You pay a copayment for your prescription drugs. For generic drugs, you'll pay a low $10 copayment. Brand-name drugs are also covered.
Going to the Hospital
You pay toward the hospital costs until your deductible is met. After that, you and BCBSNC share the medical costs (coinsurance ) until your coinsurance maximum is met. Then, BCBSNC pays for all your covered medical expenses (excluding copayments).
1 Certain preventive care services are covered at 100%, before deductible, when received in an in-network office or outpatient setting. Other covered services may be subject to deductible and coinsurance. When you receive preventive care out-of-network you may pay more. Visit bcbsnc.com/preventive for a full list of preventive services.
2 The figures on this page are for illustrative purposes only. The examples provided on this page relate to in-network services only. When using out-of network providers, in addition to deductible and coinsurance amounts, you may be responsible for the difference between the BCBSNC allowed amount and the provider's actual charge.
Benefits
Benefits Summary
Review complete in-network and out-of-network benefits in the Summary of Benefits and Coverage.
| Plan A | Plan B | Plan C | |||||||||||||||||||||||||||||||
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| Available Deductibles | $1,000-$2,500 (Per Person) |
$1,000-$5,000 (Per Person) |
$3,500-$5,000 (Per Person) |
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| Coinsurance | You pay 20% | You pay 30% | You pay 50% | ||||||||||||||||||||||||||||||
| Coinsurance Maximum | $2,000 individual $4,000 family |
$3,000 individual $6,000 family |
$3,000 individual $6,000 family |
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| Preventive Care | You pay $0 | You pay $0 | You pay $0 | ||||||||||||||||||||||||||||||
| Primary Physician
You're not feeling well and visit your primary care physician about the flu-like symptoms you are experiencing. Based on the average billed amount for a visit like this, you would pay $106 without insurance.* |
$15 copayment
With this plan you pay: $15 copayment |
$25 copayment
With this plan you pay: $25 copayment |
$30 copayment
With this plan you pay: $30 copayment |
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| Specialist Physician
Your knee has been hurting a lot lately and you need to see an orthopedic specialist. Based on the average billed amount for a visit like this, you would pay $125 without insurance.* |
$30 copayment
With this plan you pay: $30 copayment |
$50 copayment
With this plan you pay: $50 copayment |
$60 copayment
With this plan you pay: $60 copayment |
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| Prescription Drugs |
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| Urgent Care | $30 copayment | $50 copayment | $60 copayment | ||||||||||||||||||||||||||||||
| Emergency Room You injure your leg while exercising and have to go to the emergency room. Based on the average billed amount for a visit like this, you would pay $1,381 without insurance.* |
$150 copayment for initial visit $500 copayment for subsequent visits (waived if admitted) With this plan you pay: $150 copayment for initial visit $500 copayment for subsequent visits |
$150 copayment for initial visit $500 copayment for subsequent visits (waived if admitted) With this plan you pay: $150 copayment for initial visit $500 copayment for subsequent visits |
$150 copayment for initial visit $500 copayment for subsequent visits (waived if admitted) With this plan you pay: $150 copayment for initial visit $500 copayment for subsequent visits |
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| Hospitals
and Major Medical Procedures You have a heart attack and need to be admitted to the hospital for a coronary artery bypass. Based on the average billed amount for a hospital stay like this, you would pay $68, 563 without insurance.* |
You pay 20% (after deductible is met) With this plan you pay: $3,000 - $4,500 depending on the plan deductible This amount assumes you have not paid anything toward your deductible for the year. |
You pay 30% (after deductible is met) With this plan you pay: $4,000 - $8,000 depending on the plan deductible This amount assumes you have not paid anything toward your deductible for the year. |
You pay 50% (after deductible is met) With this plan you pay: $6,500 - $8,000 depending on the plan deductible This amount assumes you have not paid anything toward your deductible for the year. |
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| Vision | $15 copayment | $25 copayment | $30 copayment | ||||||||||||||||||||||||||||||
| Mental Health and Substance Abuse | You pay 50% after deductible is met | You pay 50% after deductible is met | You pay 50% after deductible is met | ||||||||||||||||||||||||||||||
| Other Services | You pay 20% (after deductible is met) |
You pay 30% (after deductible is met) |
You pay 50% (after deductible is met) |
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| Summary of Benefits and Coverage |
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Review complete in-network and out-of-network benefits in the Summary of Benefits and Coverage.
| Available Deductibles | |
|---|---|
| Plan A | $1,000-$2,500 (Per Person) |
| Plan B | $1,000-$5,000 (Per Person) |
| Plan C | $3,500-$5,000 (Per Person) |
| Coinsurance | |
|---|---|
| Plan A | You pay 20% |
| Plan B | You pay 30% |
| Plan C | You pay 50% |
| Coinsurance Maximum | |
|---|---|
| Plan A | $2,000 individual $4,000 family |
| Plan B | $3,000 individual $6,000 family |
| Plan C | $3,000 individual $6,000 family |
| Preventive Care | |
|---|---|
| Plan A | You pay $0 |
| Plan B | You pay $0 |
| Plan C | You pay $0 |
| Primary Physician
You're not feeling well and visit your primary care physician about the flu-like symptoms you are experiencing. Based on the average billed amount for a visit like this, you would pay $106 without insurance.* |
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|---|---|
| Plan A | $15 copayment
With this plan you pay: $15 copayment |
| Plan B | $25 copayment
With this plan you pay: $25 copayment |
| Plan C | $30 copayment
With this plan you pay: $30 copayment |
| Specialist Physician
Your knee has been hurting a lot lately and you need to see an orthopedic specialist. Based on the average billed amount for a visit like this, you would pay $125 without insurance.* |
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|---|---|
| Plan A | $30 copayment
With this plan you pay: $30 copayment |
| Plan B | $50 copayment
With this plan you pay: $50 copayment |
| Plan C | $60 copayment
With this plan you pay: $60 copayment |
| Prescription Drugs | |||||||||||
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| Plan A |
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| Plan B |
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| Plan C |
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| Urgent Care | |
|---|---|
| Plan A | $30 copayment |
| Plan B | $50 copayment |
| Plan C | $60 copayment |
| Emergency Room You injure your leg while exercising and have to go to the emergency room. Based on the average billed amount for a visit like this, you would pay $1,381 without insurance.* |
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|---|---|
| Plan A | $150 copayment (waived if admitted) With this plan you pay: $150 copayment |
| Plan B | $150 copayment (waived if admitted) With this plan you pay: $150 copayment |
| Plan C | $150 copayment (waived if admitted) With this plan you pay: $150 copayment |
| Hospitals
and Major Medical Procedures You have a heart attack and need to be admitted to the hospital for a coronary artery bypass. Based on the average billed amount for a hospital stay like this, you would pay $68, 563 without insurance.* |
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|---|---|
| Plan A | You pay 20% (after deductible is met) With this plan you pay: $3,000 - $4,500 depending on the plan deductible This amount assumes you have not paid anything toward your deductible for the year. |
| Plan B | You pay 30% (after deductible is met) With this plan you pay: $4,000 - $8,000 depending on the plan deductible This amount assumes you have not paid anything toward your deductible for the year. |
| Plan C | You pay 50% (after deductible is met) With this plan you pay: $6,500 - $8,000 depending on the plan deductible This amount assumes you have not paid anything toward your deductible for the year. |
| Vision | |
|---|---|
| Plan A | $15 copayment |
| Plan B | $25 copayment |
| Plan C | $30 copayment |
| Mental Health and Substance Abuse | |
|---|---|
| Plan A | You pay 50% after deductible is met |
| Plan B | You pay 50% after deductible is met |
| Plan C | You pay 50% after deductible is met |
| Other Services | |
|---|---|
| Plan A | You pay 20% (after deductible is met) |
| Plan B | You pay 30% (after deductible is met) |
| Plan C | You pay 50% (after deductible is met) |
| Summary of Benefits and Coverage | |||||||||||
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| Plan A |
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| Plan B |
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| Plan C |
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Notice: Your actual expenses for covered services may exceed the stated coinsurance percentage because actual provider charges may not be used to determine the health benefit plan's and member's payment obligations.
* Figures are for illustrative purposes only. The examples provided in the chart relate to in-network service only. When using out-of network providers, in addition to deductible and coinsurance amounts, you may be responsible for the difference between the BCBSNC allowed amount and the provider's actual charge.
Download Plan Summary/Limitations and Exclusions
Maternity Rider Option
BCBSNC offers a maternity rider option to females (policy holder or spouse) ages 18 and over who aren't pregnant when they apply for coverage, unless their most recent coverage was underwritten by BCBSNC and included maternity coverage. If you choose not to purchase the maternity rider when you first apply, you can add the option at the following times, so long as you aren't pregnant at the time:
- During the annual renewal period (November for a January 1 effective date), as long as the policy has been in effect for at least 6 months
- Within 30 days following marriage (this requires a copy of the marriage certificate)
- Upon adding your spouse as a dependent for reasons other than marriage (this requires supporting documentation)
Here are some additional things to consider:
- The maternity rider option covers maternity services under the core health plan's deductible and coinsurance. There are usually no office visit copayments and no separate deductible for maternity coverage.
- Complications from pregnancy are covered even if you don't have the maternity rider option.
- You can add your newborn to your existing policy within 30 days of the date of birth (without medical underwriting), regardless of whether you have the maternity rider option. Coverage will be effective as of the baby's date of birth, so long as your policy was active on the day of birth.
- Many people see the maternity option simply as a means to help pre-pay and choose to purchase it only if they're planning on getting pregnant in the near future.
Optional Dental Coverage
- Includes coverage for basic services like routine fillings and extractions and major services like crowns, dentures and bridges
- You pay no deductible for preventive services
- Plus there's no waiting period on pre-existing conditions
How To Apply
Get a free rate quote on your mobile device.
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Click the Free Rate Quote button and enter a little information about yourself so we can list the right plans for you. |
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Use the tools and tips on the rate quote results page to compare prices and plan details. We also provide links to more information about our plans and advice on how to pick the right plan. |
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Found a plan? Great. All you need are 20 minutes to complete an online application.
Found a plan? Great. All you need is 20 minutes to complete an online application. Get started by saving your rate quote. Then you'll be sent an email with a link that will take you to the application. You'll need to complete the application on your computer or laptop (non-mobile device).
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Rate quotes are estimates only. Final rates are determined after you complete an application. Actual rates are based on the deductible and plan you choose, your age, the number of family members covered, and your county of residence. Deductibles, coinsurance, limitations and exclusions apply to this coverage. Preexisting condition waiting periods may also apply.
Contact
Contact Us
If you have questions, we've got answers.
Phone
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.
Please do not send membership, claims, billing or benefit inquiries by email. For questions about your plan, please call the phone number on the back of your Member ID card.
U7316, 09/10
®, SM Mark of the Blue Cross and Blue Shield Association. SM1 Mark of Blue Cross and Blue Shield of North Carolina.