Includes surgery, lab work, therapy and radiology performed by the same doctor on the same day in office. Copayments do not apply to deductible.
A plan that gives you more control over your health care dollars
- Save more money with low monthly premiums
- Enjoy tax savings with a health savings account
Combine a high-deductible health plan (HDHP) with a health savings account (HSA) and you can potentially reduce your monthly premium significantly and save money.1
- Coverage for preventive care and catastrophes2
- The money you contribute to your HSA is tax-deductible.3
- When you need to pay for medical services, you can pay for them with the funds from your HSA.
- Your HSA rolls over from year to year. That means you keep what you put into it. It's your HSA - it's your money.
Typical Health Insurance Plan
You pay a monthly premium, regardless of whether you use the health benefits.
Monthly premium for regular copayment health insurance plan.
After 12 months, you would have spent
$3,000 on monthly premiums.
Blue Options HSA
You could save significantly on monthly premiums and invest the premium difference you save in an HSA.
Each month, you put $150 into your HSA and use that money to pay for qualified medical expenses.
Monthly premium for comparable HSA plan
After 12 months, you would have spent
$1,200 on monthly premiums and have
$1,800 in your HSA to use for future medical expenses.4
Let's say that over the course of a year: |
Blue Advantage Plan A Deductible: $2,500 Monthly Premium: $283 |
Blue Options HSA 5000 Deductible: $5,000 Monthly Premium: $100 |
You see your doctor for your annual physical |
$15 copayment ($0 in 2011) |
$0 |
A minor accident sends you to an urgent care clinic |
$30 copayment |
$300 |
You fill a prescription for a generic allergy medication |
$120 |
$200 |
Your total out-of-pocket medical expenses: |
$165 |
$500 |
Your annual premium (over 12 months): |
$3,396 |
$1,200 |
Total annual out-of-pocket expenses: |
$3,561 |
$1,700 |
Money left over in your HSA account:5 |
N/A |
+$1,465 |
If you put the $150 you saved on premiums each month in your HSA, you would have $1,100 left over at the end of the year that you could use next year or save to gain tax-free interest. Expenses are for illustrative purposes only.
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.
1 Tax savings are not guaranteed. Blue Options HSA combines a high-deductible health plan and a health savings account (HSA). BCBSNC does not administer the HSA and is not affiliated with your HSA custodian or administrator. The HSA custodian is The Bank of New York Mellon. Consult your tax advisor for information on tax savings.
2 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.
3 Blue Options HSA contribution amounts are limited to the amount established by the IRS for each year for single or family coverage. Anyone age 55 or older can contribute an additional $1,000 to their HSA in 2011.
4 A full list of qualified medical expenses can be found in IRS publication 502, available at irs.gov.
5 BCBSNC internal data, 2010: Compares rates for Blue Advantage Plan A $2,500 deductible / 80% coinsurance and Blue Options HSA $5,000 deductible / 100% coinsurance for a 45-year-old male in Wake County on Preferred Risk Tier based on 2010 rates. Most commonly chosen plans were selected for comparison.
Benefits Summary
0% coinsurance plans |
20% coinsurance plans |
50% coinsurance plans |
|
| Available Deductibles | $2,700 or $5,000 (individual) $5,450 or $10,000 (family) |
$2,700 (individual) $5,450 (family) |
$2,700 (individual) $5,450 (family) |
| Coinsurance | You pay 0% | You pay 20% | You pay 50% |
| Coinsurance Maximum | You pay 0% (after deductible is met) |
$2,300 individual $4,550 family |
$2,300 individual $4,550 family |
| Preventive Care | You pay $0 | You pay $0 | You pay $0 |
| Primary Physician | You pay 0% (after deductible is met) |
You pay 20% (after deductible is met) |
You pay 50% (after deductible is met) |
| Specialist Physician | You pay 0% (after deductible is met) |
You pay 20% (after deductible is met) |
You pay 50% (after deductible is met) |
| Prescription Drugs | You pay 0% (after deductible is met) |
You pay 20% (after deductible is met) |
You pay 50% (after deductible is met) |
| Urgent Care | You pay 0% (after deductible is met) |
You pay 20% (after deductible is met) |
You pay 50% (after deductible is met) |
| Emergency Room |
You pay 0% (after deductible is met) |
You pay 20% (after deductible is met) |
You pay 50% (after deductible is met) |
| Hospitals and Major Medical Procedures A heart attack and coronary artery bypass requires an inpatient hospital stay. Average billed amount: $68,563* |
You pay 0% (after deductible is met) With this plan you pay: $2,700 - $5,000 (individual) or $5,450-$10,000 (family) depending on the plan deductible This amount assumes you have not paid anything toward your deductible for the year. |
You pay 20% (after deductible is met) With this plan you pay: $5,000 (individual) or $10,000 (family) 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: $5,000 (individual) or $10,000 (family) This amount assumes you have not paid anything toward your deductible for the year. |
| Vision | You pay 0% (after deductible is met) |
You pay 20% (after deductible is met) |
You pay 50% (after deductible is met) |
| Mental Health and Substance Abuse | You pay 0% (after deductible is met) |
You pay 20% (after deductible is met) |
You pay 50% (after deductible is met) |
| Other Services | You pay 0% (after deductible is met) |
You pay 20% (after deductible is met) |
You pay 50% (after deductible is met) |
Download Plan Summary/Limitations and Exclusions
* 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.
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
Get a free, no-obligation rate quote by visiting our full website at www.bcbsnc.com. Get started by clicking the free rate quote button. Use your computer or laptop (non-mobile device) to best refine your search results, compare prices and explore plan details.
Find a plan that interests you? Great. Simply continue to apply online. The application process takes about 20 minutes.
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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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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 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.
Give us a call at 1-800-324-4973. 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.
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.
U7318, 09/10
What you pay each year for covered medical expenses before your health insurance begins paying toward those expenses. A general rule of thumb: The higher your deductible, the lower your premium.
A fixed-dollar amount that's payable at the time a covered service is provided.
The amount you pay for covered services before your health insurance plan pays for all or part of the remaining covered services.
The percentage you pay for covered services after you meet your deductible.
The total amount of coinsurance you have to pay for covered services per benefit period. Deductibles, copayments and amounts exceeding the allowed amounts for covered services don't apply.
Routine physical exams, including gynecological exams, well-child and well-baby care, including periodic assessments and immunizations.
Routine eye exams
Includes surgery, lab work, therapy and radiology performed by the same doctor on the same day in office. Copayments do not apply to deductible.
No annual limit for generic drugs. For brand name drugs, the following benefits apply:
Blue Advantage A, B, C and Blue Advantage Saver 1 -- Brand name drugs are covered at 50% after $2,000 in brand name drug coverage per person, per benefit period. Blue Options HSA prescription drug benefits are subject to the plan deductible and coinsurance. Brand name drugs are not covered on Blue Advantage Saver 2 and 3.
Services provided for a sudden or unexpected condition requiring prompt diagnosis or treatment to prevent chronic illness, prolonged impairment or a more hazardous treatment.
Health care items and services furnished or required to screen for or treat an emergency medical condition until the condition is stabilized.
Inpatient and outpatient facility services, drugs, blood, supplies, medical care, surgical care, therapy services, diagnostic test, x-rays, lab work.
Five inpatient days and 10 outpatient visits per person, per benefit period.
Durable medical equipment, home health care, home infusion therapy, hospice care, private duty nursing, ambulance services, skilled nursing facilities (to 60 days per year) and dental accident.
Before you met the plan's deductible, you would pay the full billed amount. The amount you pay would go toward your deductible.
After you met your plan's deductible, you would pay a percentage of the full billed amount (coinsurance) until you reached the coinsurance maximum for the year. Then, all covered expenses are covered 100% by your plan.
The family deductible is met using all eligible medical expenses from each family member. Each family member contributes to this single deductible amount.