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 10% - 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.1
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||In-Network Tier 2||Out-of-Network|
|Preventive||100%||100%||70% after the deductible*|
|Office Visit (Primary)||from $10 to $40||N/A||from 30% to 70% after the deductible|
|Office Visit (Specialist, such as therapies)||from $20 to $70||from $40 to $120||from 30% to 70% after the deductible|
|Inpatient Care||from 60% to 100%||from 40% to 80% plus a per admission copayment of $500 to $1,000||from 30% to 70%|
|Individual Deductible**||from $0 to $10,000||from $250 to $20,000|
|Coinsurance||from 60% to 100%||from 40% to 80%||from 30% to 70%|
|Individual Coinsurance Maximum**||from $1,500 to $10,000||from $3,000 to $20,000|
* Only state-mandated benefits are covered out-of-network.
** Combined deductible and a combined coinsurance maximum includes 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)|
|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 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 Carolina2
- Rated #1 in customer satisfaction in North Carolina3
- 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 program4
- Exclusive member discounts from top retailers on fitness gear, gym memberships, family activities, healthy eating options and much more with Blue365®5
- 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. Pre-existing condition waiting periods may also apply. 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; January 2013 premium difference for Blue Select compared to a comparable Blue Options PPO plan with $1,000 Deductible and 80% Coinsurance. 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. Triangle Business Leader, "Top 100 North Carolina Small Businesses" June 2010 and Internal BCBSNC data, June 2010.Frederick Polls, April 2011.
3. Frederick Polls, April 2011.
4. BCBSNC contracts with Alere Health Improvement Company, an independent third party vendor, for the provision of certain aspects of Healthy Outcomes programs.
5. 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.
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