FAQs about purchasing health insurance for your small business

Understanding health insurance

Why should I offer health insurance to my employees?

Choosing a health plan

What plans does BCBSNC offer?

• HMOs - Blue Care® is a Health Management Organization (HMO) plan. It offers a full suite of benefits to members with predictable payments.⁵ This traditional plan requires very little management from members since it operates under a managed network.
• PPO - Blue Options^SM is a Preferred Provider Organization (PPO) plan. It features the same cost predictability of an HMO with the flexibility to see providers outside the BCBSNC network
• PPO with tiered coverage - Blue Options 1-2-3^SM is a lower-cost PPO featuring benefit levels that pay more for health services like preventive care and primary care, while members pay more out of pocket for services like specialist visits and outpatient services. This plan encourages active management of health care expenses without moving to a High Deductible Health Plan (HDHP).
• HSA - Blue Options HSA^SM is a high deductible PPO plan partnered with a health savings account that has tax advantages. This plan keeps premiums low and gives employees tax advantages to help offset the out-of-pocket expenses.

How can I determine what type of plan I need?

Finding the plan that works best for both you and your employees is a matter of determining the type of coverage you need, balanced with your budget.

Some insurance plans provide copayment coverage for most routine needs: annual physicals or monitoring a health condition. A plan with copayments covers doctors visits and prescriptions with a known copayment. The premiums for these plans reflect this level of coverage.

Other insurance plans offer a higher deductible, which results in a lower premium, but have higher out-of-pocket costs until the deductible and any coinsurance requirements are met. This type of plan provides coverage for significant medical expenses and can be right for people who don't anticipate needing to see the doctor frequently. There are two ways that individual policy-holders can control how much they pay for health insurance, and health care.

• The first is to weigh the plan features that affect the price (premium) of the plan
• The second is to use the health insurance coverage in a way that maximizes health care while controlling costs

What are the typical features of a health insurance plan and how do they affect its price?

As you work with BCBSNC to find the plan that fits your needs, you will make decisions about factors which affect how much you and your employees will pay (the premium). From the factors with the highest impact to those with less of an effect on the premiums of a plan, the factors are:

Plan deductible	Like any insurance deductible, this is how much you will pay before the insurer will cover expenses. The lower the plan deductible, the higher the premium. In some health care plans, some services, like an annual physical and certain preventive care tests, like mammograms and prostate screenings, are covered from day one, either entirely or with a copay.
Coinsurance maximum and out-of-pocket maximum	The coinsurance maximum is the maximum coinsurance amount that a member is required to pay for covered services during a benefit period. The out-of-pocket maximum is the maximum annual amount your insurer will require you to contribute out-of-pocket towards the cost of your care After the out-of-pocket or coinsurance maximum is met, the plan will pay 100% of the allowed amount for covered expenses. The lower the coinsurance maximum or out-of-pocket maximum, the higher the premium.
Coinsurance level	Coinsurance is the percent of the allowed amounts for covered services that BCBSNC will pay after you meet your deductible. Plans range from 100% (BCBSNC covers all expenses for covered services after the deductible has been met) to 50%. (The member pays 50%, and BCBSNC pays 50% of the allowed amounts).6
Copayment for services	A copayment is a fixed-dollar amount which is due and payable by the member at the time a covered service is provided. Usually this is all the member will pay for the provided service(s). Copayments mean the plan covers a large part of the costs of services.

Controlling costs

How can we effectively use our health plan to reduce costs while maximizing benefits?

Making sure you understand the parameters of your health insurance coverage can help you get the most value from your plan. BCBSNC provides Quick Start Guides to members to help them understand the best way to use their health coverage to minimize out-of-pocket expenses. And be sure to talk to your employees about the value of their health insurance. Talking about the benefits you offer helps employees understand and appreciate the benefit you are providing.

• Tip #1 Choose an in-network provider
  The BCBSNC network of doctors and hospitals is extensive. You can visit any provider in our network and you'll be covered by your plan. You can visit out-of-network providers, but coverage levels will vary by plan. Our network includes 95% of all doctors practicing in North Carolina⁷ .
• Tip #2 See your primary care doctor first
  Primary care doctors can provide many of the health care services you need on a regular basis. And you'll typically pay less when you visit a primary care doctor than if you visit a specialist.
• Tip #3 Know before you go
  Know what type of facility you're visiting before you go. You may pay more for services provided by outpatient clinics and by providers who are affiliated with certain hospitals in certain locations than when you visit your primary care provider in an office setting⁵. When you understand what, how and where your plan provides coverage, you are better able to plan your health care choices.

Additional benefits

What health and wellness benefits does BCBSNC offer?

From our website bcbsnc.com, all members can find a doctor, get more information about prescription drugs and coverage, and review benefits and claims.

Members of most plans are also able to access Blue Extras^SM which are available to members at no additional cost and complement your health insurance plan.⁸ The Extras programs provide information on health related topics and discounts on everything from vitamins and supplements, to massage therapy and laser vision correction.

BCBSNC also offers wellness programs to members of most plans including, Blue Points^SM , which can help lower medical costs, reduce employee absenteeism, reduce disability claims, improve productivity and transform your corporate culture by offering your employees real incentives for healthier living.⁹

With Blue Points, just 30 minutes a day of physical activity or participation in specific wellness activities can earn your employees points toward valuable rewards such as brand-name merchandise, gift cards, and more.

Workplace wellness pays: It's estimated that every dollar invested in a wellness program brings a $3 return in savings on average.⁸ What's more, some of the costliest health conditions, such as heart disease and diabetes, can be dramatically improved by positive lifestyle changes - the kind of changes that Blue Points encourages and rewards.

What other types of insurance are available through Blue Cross and Blue Shield of North Carolina?

Dental Blue is BCBSNC's dental insurance offering. This dental coverage can be added to a health plan or purchased as a stand-alone plan. Life insurance as well as short-term and long-term disability are offered by Saegis Benefits, an authorized agency of Blue Cross and Blue Shield of North Carolina. Saegis offers a variety of insurance options that can help you create an attractive benefit offering for your employees.

Can't afford to fund additional benefits? Let your employees choose. Saegis also offers voluntary products that add value to employee benefit packages at little to no cost to you. Plans such as short-term and long-term disability, life, supplemental hospital coverage, cancer, accident and critical illness policies can all be offered on a voluntary basis.

Note: All ancillary products, except dental, are offered by Saegis Benefits through USAble Life. USAble Life does not offer Blue Cross and/or Blue Shield products or services. BCBSNC and USAble Life are not affiliated companies.

Why should I use BCBSNC to facilitate all my benefit offerings?

When you work with BCBSNC for your insurance, you can simplify your administration. You'll have one point of contact for your benefits. By offering both medical and dental from BCBSNC, you pay only one bill and your employees keep track of one card. If you add life insurance and/or disability coverage offered by Saegis Benefits through USAble Life, you still pay only one bill. How easy is that?

Note: All ancillary products, except dental, are offered by Saegis Benefits through USAble Life. USAble Life does not offer Blue Cross and/or Blue Shield products or services. BCBSNC and USAble Life are not affiliated companies.