Individual Health Insurance

With Blue Advantage^®, you have a range of choice in plans. All of Blue Cross Blue Shield of North Carolina's^® plans offer the security of great coverage with predictable copayments for doctor visits, emergency room services and prescription drugs.

See the doctor you want

With Blue Advantage, you can have access to many of the best doctors, hospitals and specialists in North Carolina. Blue Cross and Blue Shield of North Carolina's (BCBSNC) networks are large and member copayments and coinsurance are predictable.¹ Just visit an in-network provider, show your BCBSNC ID card and pay the copayment. The doctor handles all the administrative details and files the claims. You can go directly to in-network specialists without a referral, and you can go outside the network for most services.², ³ The only difference is the out-of-pocket cost.

Blue Advantage offers three plans that allow you to choose the benefits and deductible that work best for you, with costs as low as $15 for copayments and $10 for generic prescription drugs.⁴

You can also purchase coverage for children. With Blue Advantage, children receive full benefits, including coverage for well-child and well-baby care and immunizations. Maternity coverage is available for an extra charge when you first purchase a policy, renew a policy (if the policy has been in effect for at least six months) or if you have a family status change, like marriage.

Member Health Partnerships

Blue Advantage provides you with access to a variety of online resources and programs designed to maximize your health care experience. Resources include Member Health PartnershipsSM1, our confidential health management program for adults and children - offered at no additional cost - that can help you better manage health conditions like asthma and diabetes. And, our value-added Rewards and Discounts offer you member discounts on everything from vitamins to gym memberships.⁷, ⁸

Low-cost, high-quality options

Whether you're looking for a traditional PPO or a high-deductible health plan, Blue Advantage® and Blue Options HSASM,⁹ plans offer choices to meet your needs and your budget. Both plans offer protection against covered services that can be expensive. And with either plan, you're covered up to at least $5 million for covered expenses over your lifetime.

Preventive care coverage to keep you and your family healthy^10,11

Preventive care is important to your health. Whether it's a routine annual physical, a gynecological exam, or screenings for cervical and prostate cancer, Blue Advantage and Blue Options HSA plans provide you with coverage for a variety of preventive care procedures. Mammography screenings, standard immunizations, well-baby and well-child care are also included.

Prescription drug coverage plus greater savings with generics

Blue Advantage¹² and Blue Options HSA plans feature prescription drug coverage through a large network of pharmacies. And you'll save money when you purchase generic drugs. Your provider can give you additional information about generic drugs and lower-cost alternatives for your prescriptions.

Extensive provider network

Blue Advantage and Blue Options HSA plans offer access to an extensive statewide provider network, which means many of North Carolina's best doctors and hospitals are at your fingertips. With both plans, you have the freedom to receive care in or out of network - and you don't need a referral to see a specialist.¹³ When you're traveling, you're covered across the nation and in more than 200 countries and territories worldwide through the BlueCard® network.¹⁴

Commitment to quality... then, now, always

For 75 years, North Carolinians have depended on Blue Cross and Blue Shield of North Carolina for their health coverage. We have a tradition of providing plans and programs that improve the health of our communities. And we remain committed to being your plan for better health.

Eligibility

To be eligible for Blue Advantage, you must be a North Carolina resident, under age 65, medically eligible, and not eligible for Medicare. Enrollment takes approximately 15-30 days.

1 Some services and supplies received by members in an office setting or in connection with an office visit are in fact outpatient hospital-based services provided by hospital-owned or operated practices. These services and supplies may be subject to your deductible and coinsurance. Please see the BCBSNC provider listing to identify these providers.
2 Referrals may be needed for certain mental health and substance abuse services.
3 Preventive care is limited to in-network benefits.
4 Refers to Plan A, Preferred Tier, policy form number M58, 7/07
5 Blue Cross and Blue Shield Association Internal Data, 2007: www.bcbs.com/news/press/facts/bluecard.html. (09/08)
6 Maternity coverage is offered through Blue Advantage at an additional rate.
7 BCBSNC provides the Member Health Partnerships (MHP) program for your convenience and is not liable in any way for the services received. BCBSNC reserves the right to discontinue or change the program at any time. Benefits available through MHP are subject to your current benefit plan and pre-existing waiting periods.
8 Blue ExtrasSM programs may not apply to all health plans. Discounts on certain goods and services may not be provided directly by BCBSNC, but may instead be arranged by BCBSNC for member convenience. Any discounts are outside your health plan benefits. BCBSNC is not liable for problems resulting from goods and services it does not provide directly, such as goods and services not being provided or being provided negligently. BCBSNC may change or discontinue these programs at any time.
9 Blue Options HSA combines a high-deductible health plan and a health savings account (HSA). BCBSNC does not administer the HSA and is not affiliated with your HSA custodian or administrator. The HSA custodian is Mellon Trust of New England, N.A.
10 Blue Advantage preventive care is limited to in-network benefits and includes in-network annual routine physical exams, well-baby and well-child care and certain immunizations. Screenings or other covered services may be subject to copayment or deductible and coinsurance. Members who receive covered services out-of-network may be required to pay the difference between the provider's actual charge and the BCBSNC allowed amount, in addition to the coinsurance amount.
11 Blue Options HSA covers preventive care services, such as routine physical exams, gynecological exams, well-child and well-baby care, including periodic assessments and immunizations. Preventive care services are covered at 100%, after copayment, when received in an in-network office setting. Other covered services may be subject to deductible and coinsurance. When you receive preventive care out-of-network you may pay more out of pocket.
12 Blue Advantage prescription drug benefits are divided into four drug-formulary tiers with varying copayment/coinsurance amounts based on the tier placement of a drug. Specific drug information can be found on the Prescription Drug Search tool at bcbsnc.com. Diabetic supplies are covered at 75% under the prescription drug benefit. In addition, benefits are provided for over-the-counter drugs when listed as covered in the formulary and a provider's prescription for that drug is presented at the pharmacy. Specialty brand drugs require member coinsurance.
13 When you see an out-of-network provider, you may pay more out of pocket. For Blue Advantage: Referrals may be needed for mental health and substance abuse services.
14 Blue Cross and Blue Shield Association Internal Data, 2007: www.bcbs.com/news/press/facts/bluecard.html (Accessed September 2008).

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