Benefit booklets

Choose a plan below to see a sample summary of what's covered in that plan.
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The following benefit booklets are only samples. For a copy of your specific Benefit Booklet, please log in to Blue Connect after your policy's effective date or call 877-275-9787.
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2027 individual benefit booklets

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Blue Advantage Gold Premier A | 3 Free PCP | $10 Tier 1 Rx | Nationwide Doctors (PDF)
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/content/dam/bcbsnc/pdf/featured/benefit-booklets/2027/blue-advantage/blue-advantage-gold-premier-a.pdf
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Blue Advantage Gold Standard A | $30 PCP | $15 Tier 1 Rx | Nationwide Doctors (PDF)
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/content/dam/bcbsnc/pdf/featured/benefit-booklets/2027/blue-advantage/blue-advantage-gold-standard-a.pdf
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Blue Advantage $0 | Nationwide Doctors (AI/AN) (PDF)
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/content/dam/bcbsnc/pdf/featured/benefit-booklets/2027/blue-advantage/blue-advantage-0-dollar-aian.pdf
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Blue Advantage $0 A | Nationwide Doctors (AI/AN) (PDF)
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/content/dam/bcbsnc/pdf/featured/benefit-booklets/2027/blue-advantage/blue-advantage-0-dollar-a-aian.pdf
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Blue Advantage $0 | HSA Eligible | Nationwide Doctors (AI/AN) (PDF)
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/content/dam/bcbsnc/pdf/featured/benefit-booklets/2027/blue-advantage/blue-advantage-0-dollar-aian-hsa.pdf
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Blue Advantage Bronze Balanced A | $0 Medical Deductible | 3 Free PCP | $20 Tier 1 Rx | HSA Eligible | Nationwide Doctors (PDF)
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/content/dam/bcbsnc/pdf/featured/benefit-booklets/2027/blue-advantage/blue-advantage-bronze-balanced-a.pdf
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Blue Advantage Bronze Basic | 3 Free PCP | $25 Tier 1 Rx | HSA Eligible | Integrated | Nationwide Doctors (PDF)
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/content/dam/bcbsnc/pdf/featured/benefit-booklets/2027/blue-advantage/blue-advantage-bronze-basic.pdf
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Blue Advantage Bronze Basic A | 3 Free PCP | $25 Tier 1 Rx | HSA Eligible | Integrated | Nationwide Doctors (PDF)
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/content/dam/bcbsnc/pdf/featured/benefit-booklets/2027/blue-advantage/blue-advantage-bronze-basic-a.pdf
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Blue Advantage Bronze Complete | $60 PCP | $20 Tier 1 Rx | HSA Eligible | Nationwide Doctors (PDF)
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/content/dam/bcbsnc/pdf/featured/benefit-booklets/2027/blue-advantage/blue-advantage-bronze-complete.pdf
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Blue Advantage Bronze Complete A | $60 PCP | $20 Tier 1 Rx | HSA Eligible | Nationwide Doctors (PDF)
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/content/dam/bcbsnc/pdf/featured/benefit-booklets/2027/blue-advantage/blue-advantage-bronze-complete-a.pdf
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Blue Advantage Bronze Essential A | HSA Eligible | Integrated | Nationwide Doctors (PDF)
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/content/dam/bcbsnc/pdf/featured/benefit-booklets/2027/blue-advantage/blue-advantage-bronze-essential-a.pdf
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Blue Advantage Bronze HSA Eligible Plus | Integrated | Nationwide Doctors (PDF)
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/content/dam/bcbsnc/pdf/featured/benefit-booklets/2027/blue-advantage/blue-advantage-bronze-hsa-eligible-plus.pdf
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Blue Advantage Bronze HSA Eligible Plus A | Integrated | Nationwide Doctors (PDF)
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Blue Advantage Bronze Standard | $50 PCP | $25 Tier 1 Rx | HSA Eligible | Integrated | Nationwide Doctors (PDF)
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/content/dam/bcbsnc/pdf/featured/benefit-booklets/2027/blue-advantage/blue-advantage-bronze-standard.pdf
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Blue Advantage Bronze Standard A | $50 PCP | $25 Tier 1 Rx | HSA Eligible | Integrated | Nationwide Doctors (PDF)
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/content/dam/bcbsnc/pdf/featured/benefit-booklets/2027/blue-advantage/blue-advantage-bronze-standard-a.pdf
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Blue Advantage Silver Access A | 3 Free PCP | $15 Tier 1 Rx | Nationwide Doctors (PDF)
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/content/dam/bcbsnc/pdf/featured/benefit-booklets/2027/blue-advantage/blue-advantage-silver-access-a.pdf
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Blue Advantage Silver Choice A | $0 Deductible | 3 Free PCP | $5 Tier 1 Rx | Nationwide Doctors (CSR 94%) (PDF)
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Blue Advantage Silver Choice A | 3 Free PCP | $10 Tier 1 Rx | Nationwide Doctors (CSR 87%) (PDF)
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Blue Advantage Silver Choice A | 3 Free PCP | $15 Tier 1 Rx | Nationwide Doctors (PDF)
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Blue Advantage Silver Choice A | 3 Free PCP | $15 Tier 1 Rx | Nationwide Doctors (CSR 73%) (PDF)
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Blue Advantage Silver Preferred | $0 Deductible | $0 PCP | $0 Tier 1 Rx | Nationwide Doctors (CSR 94%) (PDF)
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Blue Advantage Silver Preferred | 3 Free PCP | $15 Tier 1 Rx | Integrated | Nationwide Doctors (PDF)
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Blue Advantage Silver Preferred | 3 Free PCP | $15 Tier 1 Rx | Integrated | Nationwide Doctors (CSR 73%) (PDF)
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Blue Advantage Silver Preferred | 3 Free PCP | $5 Tier 1 Rx | Integrated | Nationwide Doctors (CSR 87%) (PDF)
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Blue Advantage Silver Preferred A | 3 Free PCP | $15 Tier 1 Rx | Integrated | Nationwide Doctors (PDF)
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Blue Advantage Silver Signature A | $35 PCP | $15 Tier 1 Rx | Nationwide Doctors (PDF)
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Blue Advantage Silver Standard | $0 Deductible | $0 PCP | $0 Tier 1 Rx | Nationwide Doctors (CSR 94%) (PDF)
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Blue Advantage Silver Standard | $40 PCP | $20 Tier 1 Rx | Integrated | Nationwide Doctors (PDF)
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Blue Advantage Silver Standard | $40 PCP | $20 Tier 1 Rx | Integrated | Nationwide Doctors (CSR 73%) (PDF)
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Blue Advantage Silver Standard | $20 PCP | $10 Tier 1 Rx | Integrated | Nationwide Doctors (CSR 87%) (PDF)
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Blue Advantage Silver Standard A | $40 PCP | $20 Tier 1 Rx | Integrated | Nationwide Doctors (PDF)
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Blue Advantage Gold All Copay A | $30 PCP | $10 Tier 1 Rx | Nationwide Doctors (PDF)
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/content/dam/bcbsnc/pdf/featured/benefit-booklets/2027/blue-advantage/blue-advantage-gold-all-copay-a.pdf
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Blue Advantage Gold Signature A | $30 PCP | $4 Tier 1 Rx | Nationwide Doctors (PDF)
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/content/dam/bcbsnc/pdf/featured/benefit-booklets/2027/blue-advantage/blue-advantage-gold-signature-a.pdf
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Blue Advantage Standard $0 | Nationwide Doctors (AI/AN) (PDF)
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/content/dam/bcbsnc/pdf/featured/benefit-booklets/2027/blue-advantage/blue-advantage-standard-0-dollar-aian.pdf
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Blue Advantage Standard $0 A | Nationwide Doctors (AI/AN) (PDF)
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Blue Advantage Standard $0 | HSA Eligible | Nationwide Doctors (AI/AN) (PDF)
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/content/dam/bcbsnc/pdf/featured/benefit-booklets/2027/blue-advantage/blue-advantage-standard-0-dollar-aian-hsa.pdf
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Blue Value $0 | Limited Statewide Doctors (AI/AN) (PDF)
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Blue Value $0 A | Limited Statewide Doctors (AI/AN) (PDF)
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Blue Value $0 | HSA Eligible | Limited Statewide Doctors (AI/AN) (PDF)
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Blue Value Bronze Balanced A | $0 Medical Deductible | 3 Free PCP | $20 Tier 1 Rx | HSA Eligible | Limited Statewide Doctors (PDF)
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Blue Value Bronze Basic | 3 Free PCP | $25 Tier 1 Rx | HSA Eligible | Integrated | Limited Statewide Doctors (PDF)
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Blue Value Bronze Basic A | 3 Free PCP | $25 Tier 1 Rx | HSA Eligible | Integrated | Limited Statewide Doctors (PDF)
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Blue Value Bronze Complete | $60 PCP | $20 Tier 1 Rx | HSA Eligible | Limited Statewide Doctors (PDF)
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Blue Value Bronze Complete A | $60 PCP | $20 Tier 1 Rx | HSA Eligible | Limited Statewide Doctors (PDF)
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Blue Value Bronze Essential A | HSA Eligible | Integrated | Limited Statewide Doctors (PDF)
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Blue Value Bronze HSA Eligible Plus | Integrated | Limited Statewide Doctors (PDF)
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Blue Value Bronze HSA Eligible Plus A | Integrated | Limited Statewide Doctors (PDF)
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Blue Value Bronze Standard | $50 PCP | $25 Tier 1 Rx | HSA Eligible | Integrated | Limited Statewide Doctors (PDF)
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Blue Value Bronze Standard A | $50 PCP | $25 Tier 1 Rx | HSA Eligible | Integrated | Limited Statewide Doctors (PDF)
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Blue Value Gold All Copay A | $30 PCP | $10 Tier 1 Rx | Limited Statewide Doctors (PDF)
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/content/dam/bcbsnc/pdf/featured/benefit-booklets/2027/blue-value/blue-value-gold-all-copay-a.pdf
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Blue Value Gold Premier A | 3 Free PCP | $10 Tier 1 Rx | Limited Statewide Doctors (PDF)
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Blue Value Gold Signature A | $30 PCP | $4 Tier 1 Rx | Limited Statewide Doctors (PDF)
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Blue Value Gold Standard A | $30 PCP | $15 Tier 1 Rx | Limited Statewide Doctors (PDF)
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Blue Value Silver Access A | 3 Free PCP | $15 Tier 1 Rx | Limited Statewide Doctors (PDF)
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Blue Value Silver Choice A | $0 Deductible | 3 Free PCP | $5 Tier 1 Rx | Limited Statewide Doctors (CSR 94%) (PDF)
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Blue Value Silver Choice A | 3 Free PCP | $10 Tier 1 Rx | Limited Statewide Doctors (CSR 87%) (PDF)
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Blue Value Silver Choice A | 3 Free PCP | $15 Tier 1 Rx | Limited Statewide Doctors (PDF)
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Blue Value Silver Choice A | 3 Free PCP | $15 Tier 1 Rx | Limited Statewide Doctors (CSR 73%) (PDF)
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Blue Value Silver Preferred | $0 Deductible | $0 PCP | $0 Tier 1 Rx | Limited Statewide Doctors (CSR 94%) (PDF)
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2027 dental and vision booklets

Blue 2020 for Individuals Exam Only (PDF)

Blue 2020 for Individuals Exam Plus (PDF)

Dental Blue for Individuals Core 1000 (PDF)

Dental Blue for Individuals Preventive Plus (PDF)

Dental Blue for Individuals Value 1500 (PDF)

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2026 sample small group benefit booklets

Blue Options Benefit Booklet (PDF)

BlueHPN Benefit Booklet (PDF)

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2025 sample small group benefit booklets

Blue Options Specialist Step Benefit Booklet (PDF)

BlueHPN Specialist Step Benefit Booklet (PDF)

Blue Options HSA Benefit Booklet (PDF)

BlueHPN HSA Benefit Booklet (PDF)

Blue Options All Copay Benefit Booklet (PDF)

BlueHPN All Copay Benefit Booklet (PDF)

Blue Options Copay Benefit Booklet (PDF)

BlueHPN Copay Benefit Booklet (PDF)

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