Google+ Blue Value Health Insurance Plan| BCBSNC

Blue Value

Blue ValueSM is a point-of-service (POS) product, which is a type of an HMO with in-network and out-of-network benefits. It is a lower-cost plan offering quality, cost-effective coverage. We've collaborated with providers across the state to create a plan that lets you trade full access to our network of providers for a limited network - with as much as 9% savings in targeted markets.1

For Your Business

  • Blue Value features the quality coverage you've come to expect from BCBSNC and access to many quality, cost-effective providers. By visiting participating Blue Value providers, easily located through our Find a Doctor tool, your employees will enjoy significant savings.
  • Blue Value is designed for businesses who:
    • Want to maximize health care spend
    • Have employees located in the targeted Blue Value markets
    • Want to avoid cutting benefits
    • Are comfortable with a provider network smaller than the full BCBSNC provider network. See a list of participating hospitals [PDF]

For Your Employees

  • Employees may receive care in or out-of-network. There are no claims for employees 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.
  • Offers a more affordable choice for employees who may not have strong provider preferences.

Blue Value benefits summary

This summary shows the range of coverage available.

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.

Blue Value (Copayment/Coinsurance) Benefit Options
  In-Network (Member Liability) Out-of-Network (Member Liability)
Preventive* No charge 30% after the deductible
Office Visit (Primary) from $15 to $50 from 40% to 60% after the deductible
Office Visit (Specialist, such as therapies) from $30 to $100 from 40% to 60% after the deductible
Inpatient Care from 10% to 30% after the deductible from 40% to 60% after the deductible
Emergency Room**

From $150 to $500 visit

Individual Deductible from $1,250 to $2,000 from $2,500 to $4,000
Coinsurance 10%-30% after deductible 40%-60% after deductible
Individual Out-of-Pocket Limit from $3,750 to $6,000 from $7,500 to $12,000

* Only state-mandated benefits are covered out-of-network.

** ER copayment waived if admitted.



Blue Value Prescription Drug Information:

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.

Blue Value Prescription Drug Options (In-Network and Out-of-Network)
Prescription drugs Deductible $0
Tier 1
Preferred Generic
$4 $10 $15 $20 $25
Tier 2
Non-Preferred Generic
$25 $25 $25 $35 $40
Tier 3
Preferred Brand
$35 $40 $50 $45 $80
Tier 4
Non-Preferred brand
$75 $80 $90 $90 $105
Tier 5
Specialty Drug*
25% 25% 25% 25% 50%

* There is a $100 per drug minimum and a $50 per drug minimum and either $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. 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:

North Carolina Pharmacies

Outside North Carolina Pharmacies

Is it right for your business?

Blue Value, the first plan of its kind in North Carolina, helps businesses address costs head on by offering a limited provider network with a much lower price. The result? The same quality you expect from BCBSNC with savings.

Is it right for your employees?

By visiting participating Blue Value providers, easily located through our Find a Doctor tool, your employees will enjoy significant savings.

Why BCBSNC?

  • BCBSNC is the No. 1 choice of small businesses in North Carolina2
  • Most preferred health insurance company 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. 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 Value may not be available in all major metropolitan areas.

2. NAIC 2012 Supplemental Health Care Exhibit Report.

3. Brand Tracking Study; Prophet; March 2013.

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. 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.

U9631, 4/13