Blue Advantage

Our classic health insurance plan

With Blue Advantage:

  • You get the most comprehensive coverage we offer
  • You pay more in monthly premiums, but you pay less when going to the doctor
  • Preventive care is covered at 100%1

How Blue Advantage Works2

Going to a Doctor or Specialist

You pay a copayment for the visit. You may have to pay additional for any tests, labs or other medical costs outside the visit.

Going to the Pharmacy

You pay a copayment for your prescription drugs. For generic drugs, you'll pay a low $10 copayment. Brand-name drugs are also covered.

Going to the Hospital

You pay toward the hospital costs until your deductible is met. After that, you and BCBSNC share the medical costs (coinsurance) until your coinsurance maximum is met. Then, BCBSNC pays for all your covered medical expenses (excluding copayments).

  1. Certain preventive care services are covered at 100%, before deductible, when received in an in-network office or outpatient setting. Other covered services may be subject to deductible and coinsurance. When you receive preventive care out-of-network you may pay more. Visit [link] bcbsnc.com/preventive [body copy] for a full list of preventive services.
  2. The figures on this page are for illustrative purposes only. The examples provided on this page relate to in-network services only. When using out-of network providers, in addition to deductible and coinsurance amounts, you may be responsible for the difference between the BCBSNC allowed amount and the provider's actual charge.

SM, ® marks of the Blue Cross and Blue Shield Association. SM BlueValue and SM Dental Blue for Individuals marks of Blue Cross and Blue Shield of North Carolina. SM1 Mark of Blue Cross and Blue Shield of North Carolina.



Blue Advantage

Our classic health insurance plan

  • Features low copayments for doctor visits and prescription drugs
  • A wide range of deductibles for medical and prescription drugs
  • Ideal for those who want more predictable health care costs

Benefits Summary

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Plan A
Plan B
Plan C
Available Deductibles $1,000-$2,500
(Per Person) 		$1,000-$5,000
(Per Person) 		$3,500-$5,000
(Per Person)
Coinsurance You pay 20% You pay 30% You pay 50%
Coinsurance Maximum $2,000 individual
$4,000 family		 $3,000 individual
$6,000 family		 $3,000 individual
$6,000 family
Preventive Care You pay $0 You pay $0 You pay $0
Primary Physician

What would it cost if...?

You see your primary care doctor for flu-like symptoms.

Average billed amount: $106*

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 $15 copayment

With this plan you pay:

$15 copayment

 $25 copayment

With this plan you pay:

$25 copayment

 $30 copayment

With this plan you pay:

$30 copayment
Specialist Physician

What would it cost if...?

You see an orthopedic specialist for knee pain.

Average billed amount: $125*

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 $30 copayment

With this plan you pay:

$30 copayment

 $50 copayment

With this plan you pay:

$50 copayment

 $60 copayment

With this plan you pay:

$60 copayment
Prescription Drugs
Rx Deductible: $0
Generic: $10
Preferred: $45
Brand: $65
Specialty: You Pay 25%
Rx Deductible: $200
Generic: $10
Preferred: $45
Brand: $65
Specialty: You Pay 25%
Rx Deductible: $500
Generic: $10
Preferred: $45
Brand: $65
Specialty: You Pay 25%
Urgent Care $30 copayment $50 copayment $60 copayment
Emergency Room

What would it cost if...?

A minor injury requires a visit to the emergency room.

Average billed amount: $1,381*

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$150 copayment for initial visit

$500 copayment for subsequent visits

(waived if admitted)

With this plan you pay:

$150 copayment for initial visit

$500 copayment for subsequent visits

$150 copayment for initial visit

$500 copayment for subsequent visits

(waived if admitted)

With this plan you pay:

$150 copayment for initial visit

$500 copayment for subsequent visits

$150 copayment for initial visit

$500 copayment for subsequent visits

(waived if admitted)

With this plan you pay:

$150 copayment for initial visit

$500 copayment for subsequent visits
Hospitals and Major Medical Procedures

What would it cost if...?

A heart attack and coronary artery bypass requires an inpatient hospital stay.

Average billed amount: $68,563*

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 You pay 20%
(after deductible is met)

With this plan you pay:

$3,000 - $4,500 depending on the plan deductible

This amount assumes you have not paid anything toward your deductible for the year.

 You pay 30%
(after deductible is met)

With this plan you pay:

$6,500 - $8,000 depending on the plan deductible

This amount assumes you have not paid anything toward your deductible for the year.

 You pay 50%
(after deductible is met)

With this plan you pay:

$4,000 - $8,000 depending on the plan deductible

This amount assumes you have not paid anything toward your deductible for the year.
Vision $15 copayment $25 copayment $30 copayment
Mental Health and Substance Abuse Includes 10 office or outpatient visits and 5 inpatient day limits. Includes 10 office or outpatient visits and 5 inpatient day limits. Includes 10 office or outpatient visits and 5 inpatient day limits.
Other Services You pay 20%
(after deductible is met)		 You pay 30%
(after deductible is met)		 You pay 50%
(after deductible is met)
Download Plan Summary/Limitations and Exclusions

* Figures are for illustrative purposes only. The examples provided in the chart relate to in-network service only. When using out-of network providers, in addition to deductible and coinsurance amounts, you may be responsible for the difference between the BCBSNC allowed amount and the provider's actual charge.

Maternity Rider Option

BCBSNC offers a maternity rider option to females (policy holder or spouse) ages 18 and over who aren't pregnant when they apply for coverage, unless their most recent coverage was underwritten by BCBSNC and included maternity coverage. If you choose not to purchase the maternity rider when you first apply, you can add the option at the following times, so long as you aren't pregnant at the time:

  • During the annual renewal period (November for a January 1 effective date), as long as the policy has been in effect for at least 6 months
  • Within 30 days following marriage (this requires a copy of the marriage certificate)
  • Upon adding your spouse as a dependent for reasons other than marriage (this requires supporting documentation)

Here are some additional things to consider:

  • The maternity rider option covers maternity services under the core health plan's deductible and coinsurance. There are usually no office visit copayments and no separate deductible for maternity coverage.
  • Complications from pregnancy are covered even if you don't have the maternity rider option.
  • You can add your newborn to your existing policy within 30 days of the date of birth (without medical underwriting), regardless of whether you have the maternity rider option. Coverage will be effective as of the baby's date of birth, so long as your policy was active on the day of birth.
  • Many people see the maternity option simply as a means to help pre-pay and choose to purchase it only if they're planning on getting pregnant in the near future.

More on our maternity rider option

Optional Dental Coverage

Dental Blue
  • Includes coverage for basic services like routine fillings and extractions and major services like crowns, dentures and bridges
  • You pay no deductible for preventive services
  • Plus there's no waiting period on pre-existing conditions

Learn more about Dental Blue

U7316, 09/10

What you pay each year for covered medical expenses before your health insurance begins paying toward those expenses. A general rule of thumb: The higher your deductible, the lower your premium.

A fixed-dollar amount that's payable at the time a covered service is provided.

The amount you pay for covered services before your health insurance plan pays for all or part of the remaining covered services.

The percentage you pay for covered services after you meet your deductible.

The total amount of coinsurance you have to pay for covered services per benefit period. Deductibles, copayments and amounts exceeding the allowed amounts for covered services don't apply.

Routine physical exams, including gynecological exams, well-child and well-baby care, including periodic assessments and immunizations.

Routine eye exams

Includes surgery, lab work, therapy and radiology performed by the same doctor on the same day in office. Copayments do not apply to deductible.

Includes surgery, lab work, therapy and radiology performed by the same doctor on the same day in office. Copayments do not apply to deductible.

No annual limit for generic drugs. For brand name drugs, the following benefits apply:

Blue Advantage A, B, C and Blue Advantage Saver 1 -- Brand name drugs are covered at 50% after $2,000 in brand name drug coverage per person, per benefit period. Blue Options HSA prescription drug benefits are subject to the plan deductible and coinsurance. Brand name drugs are not covered on Blue Advantage Saver 2 and 3.

Services provided for a sudden or unexpected condition requiring prompt diagnosis or treatment to prevent chronic illness, prolonged impairment or a more hazardous treatment.

Health care items and services furnished or required to screen for or treat an emergency medical condition until the condition is stabilized.

Inpatient and outpatient facility services, drugs, blood, supplies, medical care, surgical care, therapy services, diagnostic test, x-rays, lab work.

Five inpatient days and 10 outpatient visits per person, per benefit period.

Durable medical equipment, home health care, home infusion therapy, hospice care, private duty nursing, ambulance services, skilled nursing facilities (to 60 days per year) and dental accident.