The fastest way to find answers is through your Blue Connect account. If you’ve tried that, or just want to connect directly with a Customer Service specialist, you can use these options:
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Learn how to use your plan
Getting Started
Understanding how your health care plan works allows you to better manage your overall health. And by taking advantage of built-in benefits like preventive care, telehealth, nutrition counseling, discount programs and more, you not only gain control of your health, you also save money.
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has created this page to help you understand how your plan works. We want you to think of it as a reference tool. Bookmark it and come back when you have questions, or when you want to remind yourself how something works.
Now, let's get started!
Get the most out of your plan with Blue Connect member portal
It's easy for Blue Cross NC members to manage their plans and access tools, documents, and benefits on the go with Blue Connect℠.
Where’s my member ID card?
No matter the reason, accessing your member ID card is easy! Simply log in to your Blue Connect℠ account, and it’s right there on the homepage.
Get to know these important terms
As you use your health insurance plan, you’re going to come across some or all of the following terms. The better you understand what they mean, the better you’ll understand how your plan works.
An allowed amount is the amount in-network doctors and health care facilities have agreed to accept as full payment on covered services for Blue Cross NC members. It’s usually lower than their normal charge.
Your copayment (copay) is how much you pay for medical services when you receive them. It’s a fixed cost you pay when you check out at the doctor’s office (usually around $20 or so – though the cost varies by plan). Not all plans have a copay.
Your deductible is the set amount you pay toward medical services before Blue Cross NC starts paying toward those services during your benefit period (plan year).
Your coinsurance is the share of medical costs you pay after you’ve met your deductible for your benefit period (plan year). Coinsurance amounts (usually 10-30%) vary based on plan and type of provider. Not all plans have coinsurance.
This is the limit on the amount of money you can pay during a plan year. If you meet the out-of-pocket limit, we pay 100% of covered medical services and procedures.
How to contact us
Online
If you prefer to work electronically, log in to Blue Connect or Blue Connect Mobile and use the secure inbox to connect with Customer Service.
Phone
If you prefer to speak with someone, call the Customer Service number on the back of your member ID card. Don’t have your card? You can find the right number on Blue Connect!
Know when you can make changes to your plan
The Open Enrollment Period (OEP) is the one time a year when you can make changes for the next plan year.* Your employer will tell you when your OEP is, and give you information to help you make coverage decisions. If you have questions, your HR department is there to help.
What if I need to make a change outside the OEP?
You can make changes during the year if you have what’s called a qualifying life event. You’ll find a list of the most common qualifying life events below. Check this list and talk to HR to determine if you can make changes to your plan outside of OEP.**
- You involuntarily lose your main health coverage
- Your household size changes (more or fewer dependents, etc.)
- Your address (where you live) changes
- You’re eligible for coverage when you weren’t before
- You used to have help paying for coverage and you no longer do
- There is an error in your plan, or there was an error when you enrolled in your plan
Other, less common life events, such as natural disasters and enrollment in government programs, may also make you eligible. Please see HR if you feel your situation warrants a plan change.
*You can make changes outside of OEP if you have a “qualifying life event.”
**Having a situation on this list is not a guarantee that you can make changes. Please talk to your HR representative.
Ways to save
Your plan is built around a network of doctors, hospitals and other health care facilities. Blue Cross NC has negotiated special lower rates with these groups, and we pass those savings on to you. It’s how we help you save money. Remember – if you don’t stay in-network, you don’t get those savings.
Find a doctor in your plan’s network
One of the best ways to save money is to visit an in-network doctor or hospital. Our thoughtfully crafted provider networks provide both savings and more coordinated care. When your primary care provider (PCP) is in your network, your out-of-pocket costs are lower. If you need a specialist, the network matters even more since costs can be higher.
Click the button above and log in to Blue Connect. Select “Look up a Doctor or Drug.” You can browse by specialty or use the search bar to quickly find the kind of care you’re looking for.
Estimate health care costs
What you pay for medical services can vary based on where you go. Not only do different doctors charge different rates for the same service, but the same doctor can cost you more depending on which facility they use.
The bottom line is that our cost estimator tool is a great way to compare costs for a range of medical services and procedures covered by your plan.
Click the button above and log in to Blue Connect. Select “Find a Cost.” Then, click the Browse Categories drop-down and choose Medical Procedures to find a specific service. You can also just enter the procedure you’re looking for in the search bar.
Get discounts and deals with Blue365
Your plan includes Blue365, which is a member discount program that helps you get exclusive deals on health and fitness products.1
With Blue365, you’ll find weekly discounts from health and wellness categories including:
- Apparel & Footwear
- Fitness
- Hearing & Vision
- Home & Family
- Nutrition
- Personal Care
Joining Blue365 is easy – and taking advantage of the discounts is even easier.
Click the button above and log in to Blue Connect. Select “Find a Cost.” Then, click the Browse Categories drop-down and choose Medical Procedures to find a specific service. You can also just enter the procedure you’re looking for in the search bar.
Visiting the doctor
Preventive care is routine health care that includes screenings, services and counseling to help prevent illness, disease or other health problems. It also includes well-baby visits and immunizations that can keep your family healthy.
Many preventive care services from in-network doctors are covered at 100% with no out-of-pocket costs to you for most members.2
Common preventive care services
Immunizations, like the flu shot, screenings and tests
- Blood pressure
- Cancer screenings, such as colon, breast and cervical
- Cholesterol
- Diabetes
Annual wellness visit, well-baby and well-child visits, counseling and support
- Alcohol misuse
- Nutrition
- Sexually transmitted infections
- Tobacco cessation
Services that are not considered preventive care
Below are examples of common services your doctor may do that are not identified as preventive care by the Affordable Care Act (ACA).* This means they are not 100% covered, and may cost you money at your doctor’s office or lab:
*This is not a complete list. Check your benefit booklet, ask your doctor or contact Blue Cross NC Customer Service if you have a question about your coverage, including whether a service is considered preventive care.
Avoid extra costs
View our preventive care flyer for more information on common covered services for men, women and children. It even includes questions to ask your doctor to avoid a surprise bill later.
Beyond preventive care, you'll find a detailed list of services covered by your health plan in your benefit booklet. Read through it carefully to help avoid any unexpected costs when you go to the doctor.
Get top-rated care at a Blue Distinction Center
The Blue Distinction Center program helps you find hospitals that meet specific quality standards for patient safety and outcomes. Blue Distinction Centers (BDC) are recognized for their specialty care expertise, and Blue Distinction® Centers+ (BDC+) go a step further. They not only meet all the Blue Distinction quality standards but also deliver care at lower costs.
These highly-rated Centers feature:
- Doctors, nurses and staff with a great deal of specialized experience
- The highest level of patient support at all stages of treatment
- Fewer complications after treatment
Specialty care areas include:
- Bariatric Surgery
- Cardiac Care
- Knee and Hip Replacement
- Maternity Care
- Spine Surgery
- Substance Use Treatment and Recovery
- Transplants
At the pharmacy
Managing your medications can help you save
If you have prescription drug coverage with Blue Cross NC, you have access to a Prescriptions section in Blue Connect. From there, you can:
- Find in-network pharmacies
- Use the Find a Drug tool to look for lower cost options
- Discover various ways cut down on medication costs
- Manage your prescriptions
- Choose between picking up prescriptions at a local retail pharmacy or having them delivered to your home via mail order
View this presentation for more tips on managing your prescriptions.
What are copayment tiers, and why should I care?
Medications are assigned to categories known as copayment or coinsurance tiers. They’re assigned based on drug usage, cost and clinical effectiveness. The lower the tier, the lower the cost to you. This means, if you can find an equally effective drug in a lower tier, you have a chance to save!
Our prescription drug search tool, available on Blue Connect, can show you which tier applies to a specific medication based on your benefits plan.
NOTE: If your employer does not provide prescription drug coverage through Blue Cross NC, you will not have access to the Blue Connect Prescriptions page. Check your benefit booklet for more information on your coverage.
Understanding these terms will help you get the most value from your pharmacy benefit
A list of prescription drugs covered by your health benefit plan. Also called a drug list.
A select group of pharmacies that have contracted with Blue Cross NC to provide members access to medications at agreed-upon prices.
All medications are grouped into tiers within each formulary, which define coverage and copayment amounts. Generics are often in the lower tiers, while more specialized drugs are in higher tiers.
Some medications require approval from Blue Cross NC before they’re covered. This process helps manage costs and ensures that the member receives the correct medication at the proper dosage. Also called prior authorization.
For non-preferred prescription drugs, Blue Cross NC requires that a member first try a preferred drug in our formulary. Members may receive coverage for a non-preferred drug if the preferred equivalent proves ineffective or detrimental to their health.
Mental health and more
Mind, not just body
Your well-being is about more than just your physical health. It’s important to remember to take care of both mind and body – the total health package. That’s why Blue Cross NC is working with both PCPs (primary care providers) and behavioral health (mental health + substance use) providers to help you get the care you need at the right time. We have programs, partnerships and tools in place to connect your health care team and identify behavioral health concerns early, so you can live your best life.
What to do if you need help now
- If you are in crisis, call the National Suicide Prevention Lifeline:3 800-273-8255.
- Access our Blue Connect member site to find an in-network provider. Search for keywords like: Psychologist, Psychiatrist, Social Worker, Therapist, Substance Use Facility or Counselor.
- Talk to your primary care provider. They can address your concerns in the office or refer you to a behavioral health provider. Get tips on how to talk to your doctor about mental health.
- Call Blue Cross NC: 800-359-2422. We will help connect you to a high-quality behavioral health provider or program.
- Use your Employee Assistance Program (EAP), if available.4
- Access therapy or psychiatry through your telehealth benefit, if available.5
- Use Shatterproof’s ATLAS® to find an addiction and substance use disorder treatment facility for you or a loved one.
For health and wellness
Many believe better health starts in the kitchen. We've created a nutrition website to help you find healthy and delicious recipes, get information on nutrition counseling and locate local farmers’ markets where you can get fresh foods for your kitchen.
Did you know personalized nutrition counseling is covered by most Blue Cross NC plans as preventive care? Check your benefit booklet for details. You can go to Blue Connect to learn more, or find a nutrition counselor in your network with our Find Care tool.
Finally quit for good
QuitlineNC offers Blue Cross NC members counseling and nicotine replacement therapy at no extra cost to you.
Call 800-QUIT-NOW (800-784-8669) to quit for good.
Take the first steps twoards a healthier, tobacco-free life with our helpful tobacco cessation guide (PDF).
Focus on small steps to better health
Little things – done day-by-day – build healthy habits that can last a lifetime. The wellness resources and education information on Blue Connect can help. Keep an eye out for our emails and letters, too. You may find an invitation to join a special program or take a specific action to improve your health!
Disclosures:
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Blue365 offers access to savings on items that members may purchase directly from independent vendors, which are different from items that are covered under the policies with Blue Cross NC. Any disputes regarding these products and services may be subject to the Blue Cross NC grievance process. Blue Cross and Blue Shield Association (BCBSA) may receive payments from Blue365 vendors. Neither Blue Cross NC nor BCBSA recommends, endorses, warrants or guarantees any specific Blue365 vendor or item. This program may be modified or discontinued at any time without prior notice.
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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 BlueCrossNC.com/preventive for a full list of preventive services.
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Learn more and get help on the National Suicide Prevention Lifeline website: www.suicidepreventionlifeline.org. The National Suicide Prevention Lifeline is a 24-hour, toll-free, confidential suicide prevention hotline available to anyone in suicidal crisis or emotional distress. The Lifeline is offered by the Suicide Prevention Resource Center. Neither Blue Cross NC nor the Blue Cross and Blue Shield Association (BCBSA) recommends, endorses, warrants or guarantees any specific result or service provided by another organization.
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EAP is a confidential, voluntary, work-based program that offers free counseling for work-related and/or personal problems. Ask your employer if there's an EAP program where you work.
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Telehealth benefits are available on all plans either from Blue Cross NC or through the provider network. Blue Cross NC provides the telehealth program for your convenience and is not liable in any way for the goods or services received. Blue Cross NC reserves the right to discontinue or change the program at any time without prior notice. Decisions regarding your care should be made with the advice of a doctor. Depending on your plan, selected programs may not be available to you at this time. Check with Blue Cross NC Customer Service to determine your eligibility. Blue Cross NC has contracted with a third-party vendor independent from Blue Cross NC to bring you telehealth benefits.
Blue Cross NC offers several decision support tools to aid our members in making decisions around their health care experience. These tools are offered for convenience and should be used only as reference tools. Members should consult their own legal counsel, tax advisor or personal physician as applicable throughout their health care experience.
Blue Distinction Centers (BDC) met overall quality measures, developed with input from the medical community. A Local Blue Plan may require additional criteria for providers located in its own service area; for details, contact your Local Blue Plan. Blue Distinction Centers+ (BDC+) also met cost measures that address consumers’ need for affordable health care. Each provider’s cost of care is evaluated using data from its Local Blue Plan. Providers in CA, ID, NY, PA, and WA may lie in two Local Blue Plans’ areas, resulting in two evaluations for cost of care; and their own Local Blue Plans decide whether one or both cost of care evaluation(s) must meet BDC+ national criteria. National criteria for BDC and BDC+ are displayed on www.bcbs.com. Individual outcomes may vary. For details on a provider’s in-network status or your own policy’s coverage, contact your Local Blue Plan and ask your provider before making an appointment. Neither Blue Cross and Blue Shield Association nor any Blue Plans are responsible for non-covered charges or other losses or damages resulting from Blue Distinction or other provider finder information or care received from Blue Distinction or other providers.Shatterproof, a national non-profit dedicated to reversing the addiction crisis in the U.S., is leading the implementation of ATLAS, a quality measurement system for addiction treatment facilities. Shatterproof does not offer Blue Cross or Blue Shield products or services.
QuitlineNC is an independent company that is solely responsible for the services it provides. QuitlineNC does not offer Blue Cross or Blue Shield products or services.All other marks and trade names are the property of their respective owners.
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Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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