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 15% savings in targeted markets and as much as 6% statewide.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 and don't need a referral to see a specialist.2 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||100%||70% after the deductible*|
|Office Visit (Primary)||from $10 to $40||from 30% to 70% after the deductible|
|Office Visit (Specialist, such as therapies)||from $20 to $80||from 30% to 70% after the deductible|
|Inpatient Care||from 60% to 100%||from 30% to 70% the after deductible|
$150 first visit; $500 for second and subsequent visits or deductible/coinsurance**
|Individual Deductible||from $0 to $10,000||from $1,000 to $30,000|
|Coinsurance||from 60% to 100%||from 30% to 70%|
|Individual Coinsurance Maximum||from $0 to $10,000||from $2,000 to $20,000|
* Only state-mandated 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 40% to 70% after the deductible|
|Level 1 - Preventive care||100%||70% after the deductible*|
|Level 2 - Inpatient care||from 70% to 100% after the deductible||$500 for each inpatient stay plus from 40% to 70% after the deductible|
|Level 3 - Outpatient care/Professional specialist care||from 50% to 80% after the deductible||from 40% to 70% after the deductible|
|Individual deductible||from $500 to $5,000||from $2,000 to $20,000|
|Individual coinsurance maximum||from $1,000 to $10,000||from $4,000 to $20,000|
* Only state-mandated benefits are covered out-of-network.
Blue Value Prescription Drug Information:
|Blue Value Prescription Drug Options (In-network and Out-of-network)|
|Prescription drugs||Deductible||$0; $100; $200; $300|
* Deductible does not apply to Tier 1 and Tier 2.
** There is a $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 formulary which is a closed formulary. Only the drugs and devices listed on our formulary will be covered under this plan.
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.
- Rated #1 in customer satisfaction 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 11 flexible options with data-based health assessments with reporting4
- Enhanced, integrated HRA options available with all plans
NOTICE: Deductibles, coinsurance, limitations and exclusions apply to this coverage. Pre-existing condition waiting periods may also apply. Further details of coverage, limitations and exclusions, and terms under which the policy can be continued in force will be provided in your free information package.
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. Frederick Polls, April 2011.
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. Any disputes regarding these products and services may be subject to BCBSNC's grievance process. Blue Cross and Blue Shield Association (BCBSA) may receive payments from Blue365 vendors. BCBSA does not recommend, endorse, warrant or guarantee any specific Blue365 vendor or item.
4. BCBSNC contracts with Alere Health Improvement Company, an independent third party vendor, for the provision of certain aspects of Healthy Outcomes programs.
Blue Value, 7/12