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Blue Options 1-2-3SM

What is it?

Blue Options 1-2-3SM is our fastest growing plan.1 It's the middle ground for small businesses that want to provide the benefits of a PPO in a cost effective manner, and don't want to move completely to a high-deductible health plan (HDHP) and/or health savings account (HSA). It is designed to provide the best of both worlds.

How does it work?

Blue Options 1-2-3 divides health care services into three benefit levels, from Level 1 where most of the cost of care is covered by a copayment, to Level 3 where more of the costs of care are shared with the member.

The plan supports primary and preventive care at Level 1, while Level 2 and Level 3 coverage for inpatient, outpatient or specialist care encourages closer management of costs.

This approach also helps lower premiums. In fact, Blue Options 1-2-3 premiums are lower than traditional PPO plans. Employers can expect premium savings of up to 27% when compared to our most popular PPO plan.2

Blue Options 1-2-3 benefits summary

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

Level 1 Level 2 Level 3
Type of service Primary/preventive care

Inpatient care

 Outpatient care/professional specialist care
In-network copayment or coinsurance Copayments for services Fee plus coinsurance after deductible Higher coinsurance rate after deductible
In-network covered services
  • Primary care office visits
  • Preventive care
 Inpatient hospital services and other care Outpatient hospital services and other care
(See plan documents for a more detailed listing of covered services)
Prescription drug coverage Covered by our standard Tier 4 coverage.
Deductible

In-network: $250-$5,000 (Individual); $500-$10,000 (Family) Out of network: $500-$10,000 (Individual); $1,000-$20,000 (Family)

Out-of-pocket maximum (includes deductible)

In-network: $2,000-$10,000 (Individual); $4,000-$20,000 (Family)
Out-of-network: $4,000-$20,000 (Individual); $8,000-$40,000 (Family)

Is it right for your business?

Blue Options 1-2-3 works for businesses looking for a plan with lower premiums that still offers many of the advantages of a traditional PPO plan. If you and your employees are not quite ready to jump into the hand-on cost management encouraged by a high-deductible health plan, Blue Options 1-2-3 provides the opportunity to manage health care costs with a lower level of employee engagement.

Is it right for your employees?

Getting employees more involved in managing their health care costs is a challenge for any business. Blue Options 1-2-3 is designed to give your employees what they want (primary care copayments) while giving you what you want (lower premium costs).

You can expect preventive and primary care to account for nearly 50% of your employees' health care services.2 With Blue Options 1-2-3, employees only pay a manageable $15-25 copayment for this care.

Why BCBSNC?

  • The largest network in North Carolina - 95% of doctors in North Carolina and 96% of hospitals in North Carolina are part of our network6
  • Over 68% of small businesses in North Carolina who offer their employees health insurance, chose Blue Cross and Blue Shield of North Carolina7
  • Rated #1 in customer satisfaction in North Carolina8
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 healthy9
  • Blue ExtrasSM - Discounts on chiropractic services, laser eye surgery, vitamins and more9
Includes lab tests and X-rays
Includes routine exams, immunizations, diagnostic procedures, well baby and well child care, well woman care, prostate exam
Includes admitted hospital stay, including maternity care), Home health care, hospice care, skilled-nursing facility care, inpatient mental health services or substance abuse are, emergency room service (if admitted)
Includes lab tests and X-rays, outpatient surgery, therapeutic services, emergency room services, Urgent care services, Ambulatory surgery services, Specialist office visits.
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. BCBSNC Internal Data 2009. Group Trend Report.
  2. BCBSNC Internal Data, 2007.
  3. BCBSNC Internal Data, 2008: Network Management Report, PowerMHS.
  4. 2008 Government Accountability Report: State Small Group Health Insurance Markets (GAO-09-363R)
  5. Frederick Polls, September 2008.
  6. Blue Extras programs may not apply to all health plans. Discounts on certain goods and services may not be provided directly by BCBSNC, but may instead be arranged by BCBSNC for member convenience. Any discounts are outside your health plan benefits. BCBSNC is not liable for problems resulting from goods and services it does not provide directly, such as goods and services not being provided or being provided negligently. BCBSNC may change or discontinue these programs at any time.

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