Blue Value

The coverage you need, the savings you want

Search for a provider or pharmacy in the limited network.

Note: Blue Value is available with an effective date of 1/1/2013 or later. May not be available in all major metropolitan areas.

With Blue Value:

  • You get a limited network with lower monthly premiums
  • You pay copayments for doctor visits and prescription drugs for predictable health care costs
  • Certain preventive care is covered at 100%1

Blue Value offers a limited provider network and formulary. Search for an in-network doctor, NC pharmacy or nationwide pharmacy. Find a prescription drug on the Blue Value formulary.

How Blue Value Works2

Going to a Doctor or Specialist

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

Going to the Pharmacy

After your prescription deductible is met, you pay a copayment for your prescription drugs. For preferred generic drugs, you'll pay a low $10 copayment. Nonpreferred generics have a $25-$35 copayment. Brand-name and specialty 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 Value

The coverage you need, the savings you want

  • A limited network for those who don't have a strong provider preference
  • Lower monthly premiums
  • A plan that doesn't require a primary care provider or referrals for service

Benefits Summary

Value A
Value B
Value C
Value D
Available Deductibles $1,000-$2,500
(Per Person)
$1,000-$5,000
(Per Person)
$2,500-$3,500
(Per Person)
$3,500-$5,000
(Per Person)
Coinsurance After deductible, you pay 20% After deductible, you pay 30% After deductible, you pay 20% After deductible, you pay 30%
Coinsurance Maximum $2,000 individual
$4,000 family
$3,000 individual
$6,000 family
$3,000 individual
$6,000 family
$4,000 individual
$8,000 family
Preventive Care** You pay $0 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

$25 copayment

With this plan you pay:

$25 copayment

4 visits at $25 copayment each, additional visits are subject to deductible and coinsurance

With this plan you pay:

$25 copayment

Note: this would count as 1 of your 4 primary care visits for the year. After 4 visits you would be charged the full billed amount until your deductible has been met.

Specialist Physician

What would it cost if...?

Your knee has been hurting a lot lately and you need to see an orthopedic specialist.

Based on the average billed amount for a visit like this, you would pay $125 without insurance.*

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$30 copayment

With this plan you pay:

$30 copayment

$50 copayment

With this plan you pay:

$50 copayment

After deductible is met, you pay coinsurance

With this plan you pay:

Before Deductible: $125

After Deductible: $25

After deductible is met, you pay coinsurance

With this plan you pay:

Before Deductible: $125

After Deductible: $37.50

Prescription Drugs
Rx Deductible: $200
Preferred Generic: $10
Non-Preferred: $25
Preferred Brand: $50
Non-Preferred Brand: $75
Specialty: 25%
Rx Deductible: $200
Preferred Generic: $10
Non-Preferred: $25
Preferred Brand: $50
Non-Preferred Brand: $75
Specialty: 25%
Rx Deductible: $500
Preferred Generic: $10
Non-Preferred: $35
Preferred Brand: $60
Non-Preferred Brand: $80
Specialty: 25%
Rx Deductible: $500
Preferred Generic: $10
Non-Preferred: $35
Preferred Brand: $60
Non-Preferred Brand: $80
Specialty: 25%
Urgent Care $30 copayment $50 copayment After deductible is met, you pay coinsurance After deductible is met, you pay coinsurance
Emergency Room

What would it cost if...?

You injure your leg while exercising and have to go to the emergency room.

Based on the average billed amount for a visit like this, you would pay $1,381 without insurance.*

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$150/$500 copayment (waived if admitted)

With this plan you pay:

$150 copayment

This amount assumes this is your first visit to the emergency room. Additional visits have a $500 copayment.

$150/$500 copayment (waived if admitted)

With this plan you pay:

$150 copayment

This amount assumes this is your first visit to the emergency room. Additional visits have a $500 copayment.

After deductible is met, you pay coinsurance

With this plan you pay:

Before Deductible: $1,381

After Deductible: $276.20

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

After deductible is met, you pay coinsurance

With this plan you pay:

Before Deductible: $1,381

After Deductible: $414.30

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

Hospitals and Major Medical Procedures

What would it cost if...?

You have a heart attack and need to be admitted to the hospital for a coronary artery bypass.

Based on the average billed amount for a hospital stay like this, you would pay $68,563 without insurance.*

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For inpatient, you pay coinsurance 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.

For inpatient, you pay coinsurance 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.

For inpatient, you pay coinsurance after deductible is met

With this plan you pay:

$5,500 - $6,500 depending on the plan deductible

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

For inpatient, you pay coinsurance after deductible is met

With this plan you pay:

$7,500 - $9,000 depending on the plan deductible

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

Vision $15 copayment $25 copayment $25 copayment $25 copayment
Mental Health and Substance Abuse After deductible is met, you pay 50% After deductible is met, you pay 50% After deductible is met, you pay 50% After deductible is met, you pay 50%
Other Services After deductible is met, you pay coinsurance After deductible is met, you pay coinsurance After deductible is met, you pay coinsurance After deductible is met, you pay coinsurance

* 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.

** Preventive care services, such as routine physical exams, including gynecological exams, well-child and well-baby care, including periodic assessments and immunizations, are covered at 100%, after copayment, when received in an in-network office setting. When you receive preventive care out-of-network you may pay more out-of-pocket.

*** If you choose a brand-name drug when a generic equivalent is available, you may pay the difference between the brand-name and generic in addition to any applicable copayment. For Blue Value A and Blue Value B, once $2000 brand benefit is met, member pays 50% of all brand-name drugs.

**** The first claim received by BCBSNC will be considered the first visit.

Download Plan Summary/Limitations and Exclusions

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.

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

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 Value A, B, C and Blue Value 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 Value 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.