Revised: New Products for 2013: Blue Select and Blue Value
Original Release Date: December 12, 2012
Revised Release Date: January 11, 2013
Note: This article has been revised from the original version. We are providing clarification about the Blue Value network.
Blue Cross and Blue Shield of North Carolina (BCBSNC) is offering Blue SelectSM, a new tiered-benefit plan for employer groups, and Blue ValueSM, a new lower-cost point-of-service (POS) plan for both individual consumers and employer groups, with effective dates on or after January 1, 2013.
Blue Select is a preferred-provider organization (PPO)-based tiered benefit plan for employer groups that offers two in-network tiers of benefits in addition to out-of-network coverage. All of our PPO providers are considered in network for this product.
- Hospitals and specialists in five initial categories (OB/GYN, general surgery, cardiology, orthopedics, and gastroenterology) were rated based on clinical quality outcomes, cost efficiency, and accessibility metrics as either Tier 1 or Tier 2.
- All other specialists, such as dermatology or neurology, will be Tier 1 initially.
- All specialty and critical-access hospitals are Tier 1.
- Out-of-network benefits are also available.
Consumers will experience less out-of-pocket costs when visiting Tier 1 providers. Details about our transparent tiering methodology are available on our website via the Provider portal on the “Quality-Based Programs” page.
Blue Value is a lower-cost POS product, which offers a smaller, more streamlined provider network while providing an affordable choice for our most cost-conscious employer groups and members. We created Blue Value to meet the needs of this emerging, price-sensitive consumer segment, which values price over access to providers.
Blue Value will be available throughout North Carolina, but will be initially marketed in the Triangle, Triad and Wilmington areas. The initial, anchor health care systems for Blue Value are: Wilmington Health, UNC Health Care and Rex Healthcare, WakeMed Health and Hospitals, Key Physicians (Triangle area), and Wake Forest Baptist Health.
During the development of the Blue Value product, it became evident that a point-of-service network would be required to support the resulting benefit structure and network needs. As a result, some of our participating providers who already had point-of-service in their contractual agreements with BCBSNC had their participation reactivated.
Those providers who did not have point-of-service in their contractual agreements received notification from BCBSNC in August regarding the need to add it to their contracts in order to participate in the Blue Value product. Other providers were also notified who may have had the point-of-service benefit plan removed from their contracts in light of the current network infrastructure within the Blue Value target market locations.
New Rx Formulary
For extra premium savings, Blue Select and Blue Value will be offered in combination with a Basic, or closed, Formulary. Only the prescription drugs and devices listed on this Basic Formulary will be covered for these two products.
This Basic Formulary will be offered with a slightly smaller, yet statewide lower-cost network of pharmacies. As a result, some pharmacies will be considered out of network for these two products. In these cases, the member will be required to submit a paper claim to BCBSNC for consideration. The member’s cost of the prescription will be based on the in-network allowed cost. Any costs above this amount will be the member’s responsibility.
Also, a 5-Tier pharmacy benefit structure will be available to large employer groups, which includes different out-of-pocket costs for preferred generics, nonpreferred generics, preferred brands, nonpreferred brands, and specialty drugs.
Referrals for Blue Select or Blue Value Members
It will be important for you to be aware of which hospitals and providers are participating in Blue Select or Blue Value in order for your patients to get the most out of their benefits if they are enrolled in one of these new plans. Blue Select members will have more rich benefits when they see Tier 1 providers, and Blue Value members will need to be seen by in-network Blue Value providers to receive in-network benefits. If they are referred to non-Blue Value providers, they will be subject to higher, out-of-network benefits for services.
Members and providers can visit bcbsnc.com and use the Find a Doctor tool to determine if a provider is participating in one of these new plans. The plan type “Blue Select” or “Blue Value” must be selected first, then the in-network provider’s name entered, and the tool will indicate whether the hospital or provider is participating in either Blue Select (will appear as a Tier 1 or Tier 2 provider) or Blue Value.
Here are examples of the new Blue Select and Blue Value member ID cards (please note new alpha prefixes for these products) that you may start seeing in your offices in the new year. The benefit amounts listed on these sample cards are for illustrative purposes only, so please always verify the member’s specific benefits.
You can go to our online Media Center to view our press release about these new products. A Web-based training module about the new products will be available via the Provider portal’s Education and Learning Center later this month.
If you have any questions, please contact the Provider Blue LineSM at 1.800.214.4844.