Blue ValueSM is a point-of-service (POS) product, which is a type of an HMO with in-network and out-of-network benefits. It is a lower-cost plan offering quality, cost-effective coverage. We've collaborated with providers across the state to create a plan that lets you trade full access to our network of providers for a limited network - with as much as 11% savings in targeted markets.1
How It Works
For Your Business
- Blue Value features the quality coverage you've come to expect from BCBSNC and access to many quality, cost-effective providers. By visiting participating Blue Value providers, easily located through our Find a Doctor tool, your employees will enjoy significant savings.
- Blue Value is designed for businesses who:
- Want to maximize health care spend
- Have employees located in the targeted Blue Value markets
- Want to avoid cutting benefits
- Are comfortable with a provider network smaller than the full BCBSNC provider network See a list of participating hospitals [PDF]
For Your Employees
- Employees may receive care in or out-of-network
- There are no claims for members to file for in-network care. Those who choose to use out-of-network providers are responsible for submitting their own claims to BCBSNC in accordance with our procedures. Employees enjoy the best benefit value by choosing providers within the network.
- Offers a more affordable choice for employees who may not have strong provider preferences.
Blue Value Benefits Summary
This summary shows the range of coverage available.
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.
|Blue Value (Copayment/Coinsurance) Benefit Options|
|Preventive*||Not applicable||30% after the deductible*|
|Office Visit (Primary)||from $20 to $40 copayments or coinsurance from 0% to 40%||from 30% to 70% after the deductible|
|Office Visit (Specialist, such as therapies)||from $20 to $80 copayments or coinsurance from 0% to 20%||from 30% to 70% after the deductible|
|Inpatient Care||from 0% to 40% coinsurance after deductible||from 30% to 70% coinsurance after deductible|
First visit: $150 copayment or coinsurance amounts of 0%-40% or 30%-70%**
Second and subsequent visits: $500 copayment or deductible/coinsurance
|Individual Deductible||from $0 to $6,350||from $1,000 to $19,050|
|Coinsurance||from 0% to 40% coinsurance after deductible||from 30% to 70% coinsurance after deductible|
Individual Out-of-Pocket Limit
(maximum amount a member pays including copayments, deductible and coinsurance)
|from $1,000 to $6,350||from $4,000 to $25,400|
* Only state-mandated preventive benefits are covered out-of-network.
** For copayment purposes, the first claim received by BCBSNC will be considered the first visit.
|Blue Value (1-2-3) Benefit Options|
|In-network copayment or coinsurance amounts||Level 1 - Primary care||$20 or $25||from 30% to 60% after the deductible|
|Level 1 - Preventive care||Not applicable||30% after the deductible*|
|Level 2 - Inpatient care||from 0% to 30% after the deductible||$500 for each inpatient stay plus from 30% to 60% after the deductible|
|Level 3 - Outpatient Care/Professional Specialist Care||from 20% to 50% after the deductible||from 30% to 60% after the deductible|
|Individual Deductible||from $500 to $3,500||from $2,000 to $14,000|
|Individual Coinsurance Maximum||from $1,500 to $6,350||from $6,000 to $25,400|
* Only state-mandated preventive benefits are covered out-of-network.
Blue Value Prescription Drug Information:
|Blue Value and Blue Value 1-2-3 Prescription Drug Options (In-Network and Out-of-Network Member Liability)|
All Pharmacy plans are offered Non-Integrated or Integrated
|Deductible||$0; $100; $200; $300 Deductible amount can apply to any plan option below|
* Integrated medical deductible so drug deductibles count toward total deductible required.
** Pharmacy deductibles do not apply to Tier 1 and Tier 2 generics.
*** There is a $50 OR $100 per drug minimum and a $200 per drug maximum for each 30-day supply of Tier 5 Specialty Drugs.
This product offers a 5-Tier benefit option available on our Basic-Open formulary which is beginning in 2014. Some drugs and devices may have step-therapy requirements in which you must try lower-cost alternatives before receiving approval for the higher-cost drug or device, or prove medical necessity.
Blue Select and Blue Value health plans include a limited network of pharmacies. To see which pharmacies are in-network, please choose one of the following options:
Why Blue Value?
Is it right for your business?
Blue Value, the first plan of its kind in North Carolina, helps businesses address costs head on by offering a limited provider network with a much lower price. The result? The same quality you expect from BCBSNC with savings.
Is it right for your employees?
By visiting participating Blue Value providers, easily located through our Find a Doctor tool, your employees will enjoy significant savings.
- Most preferred health insurance company in North Carolina2
- Get personalized service and a dedicated team including client engagement representative, group service advisor, account manager and member professional
- HRA and FSA options now available with all plans
BCBSNC offers support and programs for members, including:
- Web and mobile access to benefits and claims information at mybcbsnc.com
- Health Line BlueSM, our 24/7 nurse line providing support at no additional cost to members
- Exclusive member discounts from top retailers on fitness gear, gym memberships, family activities, healthy eating options and much more with Blue365®,3
- Fully integrated case management, condition care and the Healthy OutcomesSM1 wellness program4
- Access to valuable health improvement resources for those who are healthy or those who may need additional support.
What You Get With All Plans
- A dedicated team: Client engagement representative, group service advisor, account manager and member professional
- Exclusive member discounts with Blue365®,3
- Turnkey wellness solution with Healthy OutcomesSM1, offering several flexible options including data-based health assessments with reporting4
- Enhanced, integrated HRA options available with all plans
1. BCBSNC Internal Data; January 2013 premium difference for Blue Value compared to a comparable Blue Options PPO plan with $1,000 Deductible, $2,000 Coinsurance Max, 80% Coinsurance. Actual savings will depend on geography and plan design(s) selected by group. Blue Value may not be available in all major metropolitan areas.
2. Brand Tracking Study; Prophet; March 2013.
3. Blue365® offers access to savings on items that Members may purchase directly from independent vendors, which are different from items that are covered under the policies with BCBSNC. Blue Cross and Blue Shield Association (BCBSA) may receive payments from Blue365 vendors. Neither BCBSNC nor BCBSA recommends, endorses, warrants or guarantees any specific Blue365 vendor or item. This program may be modified or discontinued at any time without prior notice.
4. BCBSNC contracts with Alere Health Improvement Company, an independent third party vendor, for the provision of certain aspects of Healthy Outcomes programs.