Blue SelectSM is a Preferred Provider Organization (PPO) plan that offers two tiers of in-network benefits in addition to out-of-network coverage. It's a tiered benefit plan that offers the kind of quality, cost-effective coverage employers and employees have been asking for. You will find it an effective way to cut costs - as much as 5% compared to our traditional Blue Options plan - while covering employees all across the state.1
How It Works
For Your Business
We've taken the full PPO network you know today and tiered its hospitals and specially selected physicians in OB/GYN, general surgery, cardiology, orthopedics and gastroenterology. This tiered approach means there is a smaller number of providers available in Tier 1.
- Tier 1 provides a richer benefit and represents the hospitals and selected specialists that received our top ratings for both clinical quality outcomes, cost-efficiency and accessibility. Also included in Tier 1 are providers outside of the specialist categories listed above as well as providers located outside the state through the BlueCard® network. Tier 2 provides a less rich benefit and represents the remaining in-network hospitals and specialists that meet our standards for clinical quality outcomes, cost-efficiency and/or accessibility.2
For Your Employees
- It's now easier for employees to find the best providers in a way that can save them money. Employees enjoy the best cost by choosing in-network Tier 1 providers. The plan provides choice and empowers your employees to make their own health care choices. By using our Find a Doctor tool at mybcbsnc.com, employees will be able to easily see whether their provider is in Tier 1 or Tier 2. They can even see an estimate of how much they'll owe with our enhanced provider search tool.
- 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.
Blue Select benefits summary
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.
This summary shows the range of coverage available.
|Blue Select Benefit Options|
|In-Network Tier 1 (Member Liability)||In-Network Tier 2 (Member Liability)||Out-of-Network (Member Liability)|
|Preventive||No charge||No charge||70% after the deductible*|
|Office Visit (Primary)||from $20 to $50||N/A||50% after the deductible|
|Office Visit (Specialist, such as therapies)||from $40 to $100||from $60 to $150||50% after the deductible|
|Inpatient Care||80%||60% plus a per admission copayment of $500||50%|
|Individual Deductible**||from $1,000 to $2,000||from $2,000 to $4,000|
|Coinsurance||20% after deductible||40% after deductible||50%|
|Individual Out-of-Pocket Limit***||from $3,000 to $6,000||from $6,000 to $12,000|
* Only state-mandated preventive benefits are covered out-of-network.
** Combined deductible includes charges for in-network Tier 1 and in-network Tier 2 services.
*** Combined out-of-pocket limit includes combined deductible, combined coinsurance and combined copayment charges for in-network Tier 1 and in-network Tier 2.
Blue Select Prescription Drug Information:
|Blue Select Prescription Drug Options (In-Network and Out-of-Network)|
* There is either a $100 per drug minimum or a $100 or $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 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 Select?
Is it right for your business?
Blue Select is a more cost-effective way to get the most of your health care dollars without sacrificing the quality and service you expect from BCBSNC. Blue Select is ideal for businesses who:
- Are looking for cost savings and wide choice
- Are wanting to encourage employees to seek out quality, cost-effective providers
- Are seeking to control costs without cutting benefits
Is it right for your employees?
It's now easier for employees to find the best providers in a way that can save them money. By using our Find a Doctor tool at mybcbsnc.com, employees will be able to easily see whether their provider is in Tier 1 or Tier 2. They can even see an estimate of how much they'll owe with our enhanced provider search tool.
- BCBSNC is the No. 1 choice of small businesses in North Carolina3
- Most preferred health insurance company in North Carolina4
- Now small businesses have access to wellness resources and health assessments with reporting
- New! HRA options now available for small businesses
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
- Fully integrated case management, condition care and the Healthy OutcomesSM1 wellness program5
- Exclusive member discounts from top retailers on fitness gear, gym memberships, family activities, healthy eating options and much more with Blue365®,6
- Access to valuable health improvement resources for those who are healthy or those who may need additional support.
NOTICE: Deductibles, coinsurance, limitations and exclusions apply to this coverage. Further costs and 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; Represents 2014 product premium savings assuming no change in levels of member cost sharing. Actual savings will depend on geography and plan design(s) selected by group. Blue Select offers two tiers of benefits in addition to out-of network coverage. Tier 2 providers may not have met one or more of the standards necessary for inclusion in Tier 1.
2. Tier 2 providers may not have met one or more of the standards necessary for inclusion in Tier 1.
3. NAIC 2012 Supplemental Health Care Exhibit Report.
4. Brand Tracking Study; Prophet; March 2013.
5. BCBSNC contracts with Alere Health Improvement Company, an independent third party vendor, for the provision of certain aspects of Healthy Outcomes programs.
6. 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.