Introducing Blue Home with Cone Health for the Individual Under 65 (IU65) Market

Effective January 1, 2026, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will offer an EPO product in partnership with Cone Health in the Greensboro region. This new product will offer ACA compliant plans both On- and Off-Exchange for the IU65 market segment.

Product highlights:

• Effective date: Policies available beginning January 1, 2026

• Coverage area: Greensboro region including Guilford, Randolph and Rockingham counties (Rating Region 7)

• Network design: A high-quality provider network anchored by Cone Health

• Coverage restrictions: No out-of-network or out-of-state coverage, except for urgent and emergent care.

  • The benefit coverage will be limited to in-network providers. All other providers are considered out-of-network and not covered.
  • Out-of-network benefit coverage is limited to emergency services and urgent care, and medically necessary covered services when an in-network provider is not reasonably available per Blue Cross NC’s access to care standards.
  • Out-of-state providers are also out-of-network and not covered. When traveling outside of North Carolina or the United States, only emergency services and urgent care will be covered at the in-network benefit level. All other services will be out-of-network and not covered.
  • Providers are required to direct members to utilize in-network providers and facilities identified by using the Blue Cross NC online directory or Blue Cross NC’s customer service department. Members will incur significant out-of-pocket expenses when out-of-network providers are used.

Recognizing Blue Home with Cone Health members

A Blue Home with Cone Health member can easily be identified by their member ID card. The Blue Home name will be prominently displayed on the front of the member ID card, along with the EPO logo in the suitcase. Blue Home with Cone Health product / plans will be offered to IU65 members in Guilford, Randolph, and Rockingham counties.

Front of Member ID Card (On Exchange) - EAX Prefix

Back of Member ID Card (On Exchange) - EAX Prefix

Front of Member ID Card (Off Exchange) - EBX Prefix

Back of Member ID Card (On Exchange) - EAX Prefix

Member benefits

Member benefits include preventive care, which includes but not limited to regular check-ups, vaccinations, screenings, and promoting overall health and early detection of potential health issues. Enrolled members have in-network benefits only. There are no out-of-network benefits except for urgent and emergency care.

Impacted lines of business

Individual under 65 market.