Blue OptionsSM

What is it?

Blue OptionsSM is a Preferred Provider Organization (PPO) plan that offers flexible and convenient copayment and coinsurance options for primary care, specialist office visits and prescription drugs.

View Plan Summary

How does it work?

For your business
  • Blue Options' familiar plan design takes the guesswork out of health care choices for employees leading to high satisfaction with the plan.
For your employees
  • Employees may receive care in or out-of-network and don't need a referral to see a specialist.1 There are no claims for employees to file for in-network care.
  • Our network includes 95% of all doctors practicing in North Carolina.2
Blue Options benefits summary

This summary shows the range of coverage available. Your plan benefits can be customized to the needs of your business and employees.3

Copayment Options Primary/Specialist

$15/$30; $20/$30; $20/$40; $25/$50; $35/$70
Individual deductible

$0; $250; $500;$750; $1,000; $1,750; $2,500; $3,500; $5,000
Family deductible

Two or three times individual deductible
Coinsurance for inpatient services and outpatient procedures
In-network/out-of-network

100%/80%; 100%/70%; 90%/70%; 80%/70%; 70%/50%; 60%/40%; 50%/50%; 50%/ 30%
Individual coinsurance maximum

$0; $1,000; $2,000; $3,000; $4,000; $5,000; $10,000
Family coinsurance maximum

Two or three times individual coinsurance
Prescription drugs

Options available for both copayment/coinsurance and 4 Tier coverage

Is it right for your business?

Blue Options could be right for your business if you're looking for a plan with the advantages of a traditional PPO plan, including copayments for routine care like primary care and specialist visits and access to in and out-of-network providers.4 Blue Options is the easiest health plan to manage and administer.

Is it right for your employees?

Employees can receive in- or out-of-network care. No referral is needed to see a specialist.1 And employees never have to go far to find a doctor; our network includes 95% of all doctors practicing in North Carolina.2 Plus, there are no claims for employees to file in-network.

Why BCBSNC?

  • Coverage in all 100 counties in North Carolina and just about everywhere else on the planet5
  • 2 out of 3 small businesses in North Carolina choose Blue Cross and Blue Shield of North Carolina6
  • Rated #1 in customer satisfaction in North Carolina7

BCBSNC offers support and programs for members, including:

  • Online access to benefits and claims information at bcbsnc.com
  • Blue PointsSM - Earn rewards, including brand-name merchandise and gift cards, just for being active and living healthy8
  • Blue ExtrasSM - Discounts on chiropractic services, laser eye surgery, vitamins and more8
After the deductible is met, BCBSNC pays this percentage of the cost
A tier is the level of member copayment for a specific prescription drug. Tier 1 medications have the lowest and Tier 4 have the highest copayment amounts. Tier 1 medications are generic medications. Tier 2 medications are preferred brands. Tier 3 medications are non-preferred brands. Tier 4 medications are specialty drugs.

  1. Referrals may be needed for mental health and substance abuse services.
  2. BCBSNC Internal Data, 2008: Network Management Report, PowerMHS. Percentage indicated represents BCBSNC's PPO network.
  3. Your actual expenses for covered services may exceed the stated coinsurance percentage or copayment amount because actual provider charges may not be used to determine the health benefit plan's and member's payment obligations. For costs and further details of the coverage, including exclusions, and reductions or limitations and terms under which the policy may be continued in force, see your agent or contact BCBSNC.
  4. Some services and supplies received by members in an office setting or in connection with an office visit are in fact outpatient hospital-based services provided by hospital-owned or operated practices. These services and supplies may be subject to your deductible and coinsurance. Preventative care is limited to in-network benefits. Members should refer to the Member Guide for complete details
  5. "Taking Care of NC," BCBSNC, 2008
  6. 2008 Government Accountability Report: State Small Group health Insurance Markets (GAO-09-363R). Number is representative of small business that purchase health insurance in North Carolina.
  7. Frederick Polls, September 2008.
  8. BCBSNC provides Blue Points and Blue Extras for your employees' convenience and is not liable in any way for the goods or services received. Decisions regarding their care should be made with the advice of their doctor. BCBSNC reserves the right to discontinue or change these programs at any time.