Blue Value
The coverage you need, the savings you want.
- Point-of-service (POS) which is a type of HMO with in-network and out-of-network benefits
- A smaller network for those who don't have a strong provider preference (View a list of participating hospitals)
- Lower monthly premiums
- A plan that doesn't require a primary care provider or referrals for service
Search for a provider or pharmacy in the limited network.
May not be available in all major metropolitan areas.
How It Works
With Blue Value:
- You get a limited network with lower monthly premiums
- You pay copayments for doctor visits and prescription drugs for predictable health care costs
- Certain preventive care is covered at 100%1
Blue Value offers a limited provider network and formulary. Search for an in-network doctor, NC pharmacy or nationwide pharmacy. Find a prescription drug on the Blue Value formulary.
How Blue Value Works2
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
After your prescription deductible is met, you pay a copayment for your prescription drugs. For preferred generic drugs, you'll pay a low $10 copayment. Nonpreferred generics have a $25-$35 copayment. Brand-name and specialty 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).
- 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.
- 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.
® Mark of the Blue Cross and Blue Shield Association. SM Mark of Blue Cross and Blue Shield of North Carolina.
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 | Plan D | |||||||||||||||||||||||||||||||||||||||||||||||||
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| Available Deductibles | $1,000-$2,500 (Per Person) |
$1,000-$5,000 (Per Person) |
$2,500-$3,500 (Per Person) |
$3,500-$5,000 (Per Person) |
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| Coinsurance | You pay 20% after deductible is met | You pay 30% after deductible is met | You pay 20% after deductible is met | You pay 30% after deductible is met | ||||||||||||||||||||||||||||||||||||||||||||||||
| Coinsurance Maximum | $2,000 individual $4,000 family |
$3,000 individual $6,000 family |
$3,000 individual $6,000 family |
$4,000 individual $8,000 family |
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| Preventive Care | You pay $0 | 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 |
$25 copayment
With this plan you pay: $25 copayment |
4 visits at a $25 copayment. Additional visits: you pay 30% after deductible is met
With this plan you pay: $25 copayment Note: This would count as 1 of your 4 primary care visits for the year. After 4 visits you would be charged the full billed amount until your deductible has been met. |
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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
With this plan you pay: $30 copayment |
$50
With this plan you pay: $50 copayment |
You pay 20% after deductible is met | You pay 30% after deductible is met | ||||||||||||||||||||||||||||||||||||||||||||||||
| Prescription Drugs |
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| Urgent Care | $30 copayment | $50 copayment | You pay 20% after deductible is met | You pay 30% after deductible is met | ||||||||||||||||||||||||||||||||||||||||||||||||
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Emergency Room (1st visit/additional visits)****
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/$500 copayment (waived if admitted)
With this plan you pay: $150 copayment This amount assumes this is your first visit to the emergency room. Additional visits have a $500 copayment. |
$150/$500 copayment (waived if admitted)
With this plan you pay: $150 copayment This amount assumes this is your first visit to the emergency room. Additional visits have a $500 copayment. |
You pay 20% after deductible is met
With this plan you pay: Before Deductible: $1,381 After Deductible: $276.20 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: Before Deductible: $1,381 After Deductible: $414.30 This amount assumes you have not paid anything toward your deductible for the year. |
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Hospitals
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.* |
For inpatient, you pay 20% after deductible is met
With this plan you pay: $3,000 - $4,500 This amount assumes you have not paid anything toward your deductible for the year. |
For inpatient, you pay 30% after deductible is met
With this plan you pay: $4,000 - $8,000 This amount assumes you have not paid anything toward your deductible for the year. |
For inpatient, you pay 20% after deductible is met
With this plan you pay: $5,500 - $6,500 This amount assumes you have not paid anything toward your deductible for the year. |
For inpatient, you pay 30% after deductible is met
With this plan you pay: $7,500 - $9,000 This amount assumes you have not paid anything toward your deductible for the year. |
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| Vision | $15 copayment | $25 copayment | $25 copayment | $25 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 | 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 20% after deductible is met | You pay 30% after deductible is met | ||||||||||||||||||||||||||||||||||||||||||||||||
| 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 | $2,500-$3,500 (Per Person) |
| Plan D | $3,500-$5,000 (Per Person) |
| Coinsurance | |
|---|---|
| Plan A | You pay 20% after deductible is met |
| Plan B | You pay 30% after deductible is met |
| Plan C | You pay 20% after deductible is met |
| Plan D | You pay 30% after deductible is met |
| 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 |
| Plan D | $4,000 individual $8,000 family |
| Preventive Care | |
|---|---|
| Plan A | You pay $0 |
| Plan B | You pay $0 |
| Plan C | You pay $0 |
| Plan D | 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 | $25 copayment
With this plan you pay: $25 copayment |
| Plan D | 4 visits at a $25 copayment. Additional visits: you pay 30% after deductible is met
With this plan you pay: $25 copayment Note: This would count as 1 of your 4 primary care visits for the year. After 4 visits you would be charged the full billed amount until your deductible has been met. |
| 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
With this plan you pay: $30 copayment |
| Plan B | $50
With this plan you pay: $50 copayment |
| Plan C | You pay 20% after deductible is met |
| Plan D | You pay 30% after deductible is met |
| Prescription Drugs | |||||||||||||
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| Plan A |
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| Plan B |
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| Plan C |
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| Plan D |
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| Urgent Care | |
|---|---|
| Plan A | $30 copayment |
| Plan B | $50 copayment |
| Plan C | You pay 20% after deductible is met |
| Plan D | You pay 30% after deductible is met |
| Emergency Room (1st visit/additional visits)****
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/$500 copayment (waived if admitted)
With this plan you pay: $150 copayment This amount assumes this is your first visit to the emergency room. Additional visits have a $500 copayment. |
| Plan B | $150/$500 copayment (waived if admitted)
With this plan you pay: $150 copayment This amount assumes this is your first visit to the emergency room. Additional visits have a $500 copayment. |
| Plan C | You pay 20% after deductible is met
With this plan you pay: Before Deductible: $1,381 After Deductible: $276.20 This amount assumes you have not paid anything toward your deductible for the year. |
| Plan D | You pay 30% after deductible is met
With this plan you pay: Before Deductible: $1,381 After Deductible: $414.30 This amount assumes you have not paid anything toward your deductible for the year. |
| Hospitals
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 | For inpatient, you pay 20% after deductible is met
With this plan you pay: $3,000 - $4,500 This amount assumes you have not paid anything toward your deductible for the year. |
| Plan B | For inpatient, you pay 30% after deductible is met
With this plan you pay: $4,000 - $8,000 This amount assumes you have not paid anything toward your deductible for the year. |
| Plan C | For inpatient, you pay 20% after deductible is met
With this plan you pay: $5,500 - $6,500 This amount assumes you have not paid anything toward your deductible for the year. |
| Plan D | For inpatient, you pay 30% after deductible is met
With this plan you pay: $7,500 - $9,000 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 | $25 copayment |
| Plan D | $25 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 |
| Plan D | 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 20% after deductible is met |
| Plan D | You pay 30% after deductible is met |
| Summary of Benefits and Coverage | |||||||||||
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| Plan A |
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| Plan C |
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| Plan D |
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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.
** Preventive care services, such as routine physical exams, including gynecological exams, well-child and well-baby care, including periodic assessments and immunizations, are covered at 100%, after copayment, when received in an in-network office setting. When you receive preventive care out-of-network you may pay more out-of-pocket.
*** If you choose a brand-name drug when a generic equivalent is available, you may pay the difference between the brand-name and generic in addition to any applicable copayment. For Blue Value A and Blue Value B, once $2000 brand benefit is met, member pays 50% of all brand-name drugs.
**** The first claim received by BCBSNC will be considered the first visit.
† There is a $100 per drug minimum and a $200 per drug minimum for each 30-day supply of specialty drugs (Tier 5).
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.