Includes surgery, lab work, therapy and radiology performed by the same doctor on the same day in office. Copayments do not apply to deductible.
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.
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.
You pay a copaymentfor the visit. You may have to pay additional for any tests, labs or other medical costs outside the visit.
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.
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).
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.
The coverage you need, the savings you want
Value A |
Value B |
Value C |
Value D |
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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) |
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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 |
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Preventive Care** | You pay $0 | You pay $0 | You pay $0 | You pay $0 | ||||||||||||||||||||||||||||||||||||||||||||||||
Primary Physician | $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. |
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Specialist Physician
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.* |
$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 | After deductible is met, you pay coinsurance | ||||||||||||||||||||||||||||||||||||||||||||||||
Prescription Drugs |
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Urgent Care | $30 copayment | $50 copayment | After deductible is met, you pay coinsurance | After deductible is met, you pay coinsurance | ||||||||||||||||||||||||||||||||||||||||||||||||
Emergency Room 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.* |
$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. |
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Hospitals and Major Medical Procedures 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.* |
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. |
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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.
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:
Here are some additional things to consider:
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.