Frequently asked questions

Yes, you can pay your monthly premium bill online by logging in to your Blue Connect℠ member portal or paying as a guest.

Log in to your Blue Connect member portal and select Billing & Payments to make a one-time payment or to set up AutoPay (recurring payments). You can pay your bill by using:

• Electronic bank draft
• Debit card
• Credit card, including Visa, MasterCard, Discover, or American Express

Members or their authorized representatives or caregivers can make a one-time payment without logging in to Blue Connect by paying as a guest. When you choose to make a one-time payment as a guest, you can pay by:

• Credit card
• Debit card
• PayPal 
• Venmo
• Apple Pay or Google Pay (if using a mobile device) 

You have the right to request a formal appeal of the claim payment or denial. Log in to Blue Connect℠ to check your Benefit Booklet or call the Customer Service number on the back of your member ID card for a detailed description of this process.

Blue Cross NC will work with you to resolve the issue. For each step in the appeals process, there are specified time frames for filing a grievance and for Blue Cross NC to notify you or your provider of the decision.

If you get health coverage through an employer:

• Contact your group administrator or HR department to make changes to your account.
• Get an Enrollment and Change Application from Customer Service (call the number on the back of your member ID card) or through your employer. Complete sections A and B.

If you buy your own health coverage:

• Log in to Blue Connect℠ to update your contact information when your address, cell phone number, or email address changes.
• Or contact Customer Service for help by calling the number on the back of your member ID card.

Access the most up-to-date provider information with our Find Care search tool in Blue Connect℠. With it, you can locate providers by name, specialty, county or ZIP Code. The Provider Search information is updated weekly.

You can also contact Customer Service at 877-258-3334 for help locating a provider. Also, many employers have a directory in their Human Resources department.

An insurance card from Blue Cross NC looks like this:

Keep this card with you. It's your identification that says, "I am a Blue Cross NC member." You'll need to show it every time you visit an emergency room, urgent care center or health care provider. And, the back of your card has several important phone numbers to use when you need help. 

Are you already a member? 

On Blue Connect℠, your member portal, you can see, download and print your member ID card, and order new ones. Replacement cards are typically mailed to your home address in 3–5 business days. Simply log in to Blue Connect or call Customer Service at 877-258-3334.

Member ID cards are not available for expired or cancelled policies.

Travel coverage varies according to the health plan you have. Log in to Blue Connect℠ to check your Benefit Booklet or call the Customer Service number on the back of your member ID card.

A deductible is the dollar amount you must pay for covered services in a benefit period before benefits are payable by Blue Cross NC. You must satisfy your deductible amount once each benefit period. The deductible does not apply to most services where a copayment applies, with the exception of emergency room visits or in-patient stays. In those cases, the copayment is couple with the applicable deductible.

A copayment is the fixed dollar amount you must pay for some covered services. The provider usually collects this amount at the time the service is provided. Copayments are not credited toward the individual or family benefit period deductible.

First, have your Member ID card ready, then log in to Blue Connect℠ and follow these steps:

1. Click Profile then Link a Plan.
2. Enter your Subscriber / Member ID, Member Code, and ZIP Code then click Submit.
3. You should see the policy added to your Profile page.

If you've already registered another plan on another user account, you'll see "Your policy has already been registered." You'll be asked to sign in to that account.

Visit HealthCare.gov, to cancel any plans you purchased there.

If you purchased your own plan elsewhere, you can ask to cancel that plan in the Blue Connect℠ member portal.

Here's what to do next:

1. Send a Secure Message to Customer Service through your Blue Connect Inbox.
2. Click the Compose button.
3. Select Cancel My Plan as your message topic.
4. Fill out the request form and submit.

Otherwise, please call the Customer Service number on the back of your member ID card for assistance.

If you get health coverage through an employer:

• Contact your group administrator or HR department to make changes to your account.
• Get an Enrollment and Change Application from Customer Service (call the number on the back of your member ID card) or through your employer. Complete sections A and B.

If you buy your own health coverage:

• Log in to Blue Connect℠ to update your contact information when your address, cell phone number, or email address changes.
• Or contact Customer Service for help by calling the number on the back of your member ID card.

Log in to Blue Connect℠ and select Billing & Payments.

If you're cancelling recurring payments and no further action is taken, the change to your account profile will take affect for the next billing period.

You can make changes as long as the recurring billing process has not begun. During this period you will be unable to cancel recurring payments.

You can reset your username and password online. If you no longer have access to the email address on record, call Web Technical Support at 888-705-7050 to get a one-time passcode sent to your cell phone. Web Technical Support can also add your cell phone number to your account for easier access in the future.

Prior approval and referrals depend on your plan. Visit the Coverage page of your Blue Connect℠ member portal to find the rules listed in your Benefit Booklet.

If you do not receive prior approval or certification for services (except emergency care or maternity), your claim may be denied, paid at a lower benefit or a penalty may be applied.

Prior approval and referrals depend on your plan. Visit the Coverage page of your Blue Connect℠ member portal to find the rules listed in your Benefit Booklet.

You do not need to get a referral from your primary care provider to receive covered services from a participating specialist. However, some participating specialists may require a new patient introduction from your treating doctor.

Yes, you can pay your monthly premium bill online by logging in to your Blue Connect℠ member portal or paying as a guest.

Log in to your Blue Connect member portal and select Billing & Payments to make a one-time payment or to set up AutoPay (recurring payments). You can pay your bill by using:

• Electronic bank draft
• Debit card
• Credit card, including Visa, MasterCard, Discover, or American Express

Members or their authorized representatives or caregivers can make a one-time payment without logging in to Blue Connect by paying as a guest. When you choose to make a one-time payment as a guest, you can pay by:

• Credit card
• Debit card
• PayPal 
• Venmo
• Apple Pay or Google Pay (if using a mobile device) 

Blue Cross NC offers several convenient methods for paying your premium. In all cases, premium payments must be made by 5 PM Eastern Standard Time (EST) to be considered paid the same day. 

Online: You can log in to your Blue Connect℠ member portal and select Billing & Payments to make a one-time payment or to set up AutoPay (recurring payments). When you set up AutoPay, you will no longer receive invoices via paper mail. Emailed invoices are available.

Pay as a Guest: Members or their authorized representatives or caregivers can make a one-time payment by paying as a guest. When you choose to make a one-time payment as a guest, you can pay by credit card, debit card, PayPal, Venmo, and Apple Pay or Google Pay (if using a mobile device).

Phone: Contact us by calling 800-333-7009 to make a one-time payment with a credit card, debit card, or bank draft. 

Check: Pay your bill by including a check with your monthly invoice. Simply mail your check to Blue Cross NC at the address listed on your invoice. 

In Person: Visit us in person to pay by check only at our Raleigh Blue Cross NC location: 

8511 Brier Creek Parkway, Suite 107 
Raleigh, NC 27617 

Monday – Friday 
9 AM to 5 PM (excluding holidays) 

Yes. To enroll in AutoPay with a bank account, credit card, or debit card, simply log in to your Blue Connect℠ member portal, go to Billing & Payments to set up AutoPay.

As a reminder, if you have a Medicare plan, you can only use a bank account to set up AutoPay.

Yes, you can pay your premium by phone.

For individual and family plans, call: 800-333-7009.

For Medicare plans, call: 844-395-4535.

To pay by phone, you can use a debit card, credit card, or a bank draft.

No, Blue Cross NC is unable to accept partial premium payments. You may choose to pay your past due amount or total amount due with a one-time payment. However, there is no guarantee that your claims will be paid, or your policy will remain active if the full amount is not received by the due date.

No, Blue Cross NC doesn’t charge fees when you pay your bills online through your Blue Connect℠ member portal or pay as a guest.

While Blue Cross NC does not charge for bill payment services, some banks may charge a fee for automatic bank drafts. Check with your bank for more information about their potential automatic bank draft fees.

It depends on the type of payment you’re making (one-time or recurring) and whether you have a balance due. Here’s more information:

For a one-time card payment: Your card payment will be charged immediately.

For automatic recurring (monthly) card payments: If you don't have a balance due when you sign up for recurring payments, your card will be automatically charged on the 1st day of each month.

When signing up for recurring debit or credit card payments with a balance due: If you have a balance due, your card will immediately be charged for that amount. All payments after that will be automatically charged on the 1st day of each month.

When signing up for recurring credit or debit card payment: If you have a balance due, your credit or debit card will be charged for that amount when you make that payment. All payments after that will be automatically charged on or around the 1st day of each month.

For a one-time bank draft payment: Your payment will usually be withdrawn from your bank account within 48 hours of submitting the payment.

For automatic, recurring bank draft payments: If you don't have a balance due when you sign up for recurring payments, your payment will be withdrawn from your bank account on the 3rd day of each month (or the next business day if the 3rd falls on a weekend or holiday).

When signing up for recurring bank draft payments: If you have a balance due, the amount of your balance will usually be withdrawn from your bank account within 48 hours of payment. All payments after that will be drafted on the 3rd day of each month (or the next business day if the 3rd falls on a weekend or holiday). 

Yes. All members have a grace period and it starts from the due date on the invoice. The standard grace period is 25 days. You should pay no later than the 1st of the month following the due date.

If you purchased your plan on the Health Insurance Marketplace and aren't eligible for a tax credit, you have a 25 day grace period.

If you purchased your plan on the Health Insurance Marketplace and are eligible for a tax credit, you have a 90 day grace period.

Yes, a grace period is a specific amount of time allowed after a due date to make your payment so that services can continue. In this case, your policy is not canceled immediately after a missed payment.

• All members have a grace period, and it starts from the due date on the invoice. The standard grace period is 25 days.
• If you purchased your plan on the Health Insurance Marketplace and aren't eligible for a tax credit, you have a 25-day grace period.
• If you purchased your plan on the Health Insurance Marketplace and are eligible for a tax credit, you have a 90-day grace period.

Risks of late payments: It is still possible during this time for your claims to be denied. There is no guarantee that your claims will be paid, or your policy will remain active if the full amount is not received by the due date.

The Past Due date doesn't include your grace period. You have until your grace period expires to make a payment.

Individual & Medicare Supplement℠ plans

To reinstate your policy, you’ll need to first pay the outstanding balance. To do that, log in to your Blue Connect℠ member portal. Go to Billing & Payments. Then, select Pay Now under the plan you would like to pay and follow the prompts.

If you have questions, send us a secure message or chat, and we’ll be happy to help. If you prefer, you can also call us at the number listed on the back of your member ID card.

Blue Medicare Advantage℠ & Blue Medicare Rx℠ plans

Members of these plans are not able to reinstate their policy online. However, you can log in to your Blue Connect℠ member portal to send us a secure message or chat, and we’ll be happy to help you. If you prefer, you can also call us at the number listed on the back of your member ID card.

Yes. First, log in to your Blue Connect℠ member portal and select the Billing & Payments. Once there, you’ll see the option to receive email notifications when an electronic bill is ready to be viewed. If you choose to set up AutoPay, you will automatically be enrolled in email billing notifications.

All other paperless delivery options for your plan documents, such as your Explanation of Benefits (EOBs), are located in the Contact Preferences Center of your Blue Connect member portal.

You may change your billing address online. When you log in to your Blue Connect℠ member portal, select the Billing & Payments and then choose Edit Billing Preferences. Any change you make will be processed within 48 hours.

Visit your Blue Connect℠ member portal to view your payment history, send us a secure message, or call Web Technical Support at 888-705-7050.

You have the right to request a formal appeal of the claim payment or denial. Log in to Blue Connect℠ to check your Benefit Booklet or call the Customer Service number on the back of your member ID card for a detailed description of this process.

Blue Cross NC will work with you to resolve the issue. For each step in the appeals process, there are specified time frames for filing a grievance and for Blue Cross NC to notify you or your provider of the decision.

Access the most up-to-date provider information with our Find Care search tool in Blue Connect℠. With it, you can locate providers by name, specialty, county or ZIP Code. The Provider Search information is updated weekly.

You can also contact Customer Service at 877-258-3334 for help locating a provider. Also, many employers have a directory in their Human Resources department.

Blue Cross NC will mail a comprehensive Benefit Booklet to your home after you enroll. Your Benefit Booklet is also available on the Coverage page in your Blue Connect℠ member portal. It has detailed information about your specific benefits and covered services.

You'll find a lot of information on benefits, claims and other member services on our website and in your Blue Connect member portal.
Log in to Blue Connect to see your:

• Member ID cards
• Plan benefits
• Claim status
• Bill pay options
• Deductible balances, copayment amounts, coinsurance percentages, and other out-of-pocket costs
• Contact information in the Contact Preferences Center

Need help?
You can send a secure message anytime through Blue Connect or call 877-258-3334, Monday to Friday, 8 AM to 7 PM ET.

The coverage rules are different for every type of plan. To find the information you need, log in to Blue Connect to see the coverage details in your Benefit Booklet or call the Customer Service number on the back of your member ID card.

If your employment ends, you may have certain options such as continuing health insurance under this health benefit plan or purchasing a nongroup conversion policy. Contact your employer or group administrator to learn about the options available.

Continuation of Coverage Under COBRA

Under a federal law known as COBRA, covered employees and their dependent(s) of employers with 20 or more employees can elect to continue coverage for up to 18 months by paying applicable fees to their employer in the following circumstances: your employment is terminated (unless the termination is the result of gross misconduct) or your hours worked are reduced, causing you to be ineligible for coverage. 

For more information about your coverage options under COBRA, contact your group administrator or refer to your Member Guide.

Continuation of Coverage Under State Law

Under state law, employees and their dependent(s) of any size group have the option to continue group coverage for 18 months from the date that they cease to be eligible for coverage under the health benefit plan. Employees are not eligible for continuation under state law if:

• The employee is currently eligible for COBRA coverage
• The employee's insurance is terminated because they failed to pay the appropriate contribution
• The employee or their dependent(s) requesting continuation are eligible for another group health plan
• The employee was covered less than three consecutive months prior to termination

You must notify the group of your intention to continue coverage and pay the applicable fees before your period of eligibility has ended. The state law benefits run concurrently and not in addition to any applicable federal continuation rights.

For more information about your coverage options under state law, contact your group administrator or refer to your Member Guide.

Purchasing a Non-Group Conversion Policy

If you would like more information about purchasing a non-group policy, please contact Customer Service at 877-258-3334 or visit the Plans for Individuals section of our site.

You may be eligible to continue your coverage under your group health plan for a certain period of time after you retire. Your group administrator will advise you about continuation of coverage under your health benefit plan.

You may experience a change in your monthly premiums at the time of your annual renewal (January 1 of each year), or when you add or remove dependents.

Orthodontia service is an optional benefit which your employer can choose to include in coverage. Please contact your Group Administrator or refer to your Benefit Booklet to determine if Orthodontia is part of your plan.

Dependents can be added to your dental plan at any time; however, standard waiting periods, if applicable, will apply.

You can only change your dental plan within 60 days of a qualifying life event, like marriage, adoption, or divorce, or during the annual renewal period each year. Standard waiting periods, if applicable, will apply.

Most dentists will file a claim on your behalf, then bill you for any charges not covered under your Blue Cross NC plan. If your dentist will not file the claim for you, pay the dentist at your visit and submit a dental claim form to Blue Cross NC for reimbursement.

Many participating providers will file the claim on your behalf. If your dentist office doesn't file claims, you should pay the dentist in full and submit your claim to Blue Cross NC for reimbursement. Download a dental claim form and mail it to us within 180 days from the date of your service.

Mail a completed claim form to:

Blue Cross and Blue Shield of North Carolina

Dental Claims Unit

P.O. Box 2100

Winston-Salem, NC 27102-2100

You can look for your dentist by using our Find Care search tool.

Yes, you will have an ID card for your medical plan and a different ID card for your Dental Blue Select plan.

Yes, you may apply for dental coverage that covers your child only.

No. There is no waiting period for diagnostic and preventive services such as routine checkups and cleanings. Waiting periods may apply to basic and major services. Please refer to your Benefit Booklet for details on your specific dental plan.

No, there is no annual deductible. Dental Blue Select features a $100 lifetime deductible that applies to all services (diagnostic and preventive, basic and major services), except orthodontia services. Orthodontia services do not have a deductible.

Your initial payment can be made by credit card or bank draft. After that, monthly premium payments can be set up for credit card, bank draft or direct bill.

Download the Dental Blue Select claim form, complete it and mail to:

Blue Cross NC

Dental Blue Select Claims Unit

PO Box 2400

Winston-Salem, NC 27102

Please call Dental Blue Select Claim Customer Service at 888-471-2738.

North Carolina residents of all ages and their dependents are eligible. A person is considered ineligible for the individual dental plan if they are already covered under another Dental Blue for Individuals policy. Members may be enrolled in only one Dental Blue for Individuals plan, regardless of whether they are the subscriber or the member.

Yes, Blue Cross NC may waive or reduce any applicable dental waiting period by the number of months of prior dental coverage. Proof of prior dental coverage with less than 63 days lapse in coverage is required.

You must have had full coverage for preventive, basic and major services. Preventive only, Discount Only or Dental Savings Plans do not count as full coverage for prior credit. The DBFI PPO Preventive plan offers a benefit for preventive, basic and major services, therefore members who enroll in the DBFI PPO Preventive plan will earn coverage credit.

To find out if your doctor has gotten prior plan approval from Blue Cross NC before the scan is done, call Blue Cross NC Customer Service at the toll-free number on your ID card.

Blue Cross NC is working with a company called American Imaging Management (AIM) for the approval of high-tech scans. AIM has a website that lets doctors request approval for high-tech scans 24 hours per day, seven days a week. If your doctor does not have access to the Internet and the request is urgent, your doctor has two business days to file the paperwork to AIM in order for Blue Cross NC to approve the scan. If your doctor does not file the paperwork within two business days after an urgent request, Blue Cross NC may not pay for the scan.

If your doctor is in the Blue Cross NC network, he or she is responsible for getting prior plan approval from Blue Cross NC on your behalf. If your doctor is out-of-network or located outside of North Carolina, you are responsible for the cost of the scan if the doctor does not obtain prior plan approval before the scan is done. 

Note: You do not need prior plan approval for a high-tech scan if it is part of an emergency room visit or an inpatient hospital stay.

Any outpatient scans (scans not done in an emergency room or as part of an inpatient hospital stay) on or after February 15, 2007, need prior plan approval from Blue Cross NC.

No. Prior plan approval is not required for "low-tech" scans such as X-rays, mammograms or ultrasounds.

If you have a scan in the emergency room or as part of an inpatient hospital stay, your doctor does not need to get approval from Blue Cross NC for the scan.

Answers vary according to your plan. To learn more, log in to Blue Connect to see the coverage details in your Benefit Booklet or call the Customer Service number on the back of your member ID card.

No. Employers can shop for group ancillary plans* any time during the year and set their own enrollment periods for their employees. They can also add extra benefits (like life insurance) at any time.

*Group plans are plans that are offered through an employer.

If you have an individual or family health insurance plan: You can cover a newborn from their date of birth if the parent already has a health insurance plan in effect at the time of birth. The parent has 60 days to contact Customer Service to add the newborn to their existing plan.

 If you have a health insurance plan through your employer: You must notify your employer or group administrator to add a newborn to your coverage. Some employer groups opt for a 60-day notice.

Please check your Benefit Booklet to find out how much notice is required by your plan.

Have a plan through work?

Talk to your group administrator about making changes, then complete any required forms. Note: To ensure coverage is active on the date a dependent becomes eligible, you must complete your forms in 30 days or less after they become eligible.

Did you buy your own health plan?

If you’re adding or removing a family member to or from your plan:

1. Go to your member portal on Blue Connect
2. Click Manage Plan in the menu
3. Click Manage Changes to this Plan in the correct plan 
4. Choose change the name of a person or remove a person 

Note: To ensure coverage is active on the date a dependent becomes eligible, you must complete this change in 30 days or less after they become eligible.

Did you buy a plan on healthcare.gov?

You must visit healthcare.gov to complete any needed forms.

Have a plan through work?

If you’re adding an adopted child to your coverage, you must notify your employer, provide documentation if needed, and complete the proper form. For the adopted child to be covered from the date of placement in the home, submit the form as soon as possible. 

If you need to change your coverage type (from Individual to Family, for instance), you must notify us within 60 days. (Note: Some employers require you to notify them within 60 days. Check your Member Guide for details.)

Did you buy your own health plan?

If you’re adding an adopted child to your plan:

1. Go to your member portal on Blue Connect 
2. Click Manage Plan in the menu
3. Click Manage Changes to this Plan  
4. Choose: Change your benefits or add a person to your plan because of a qualifying life event

Note: For an adopted child to be covered from the date of placement in the home, complete this update as soon as possible. 

Did you buy a plan on healthcare.gov?

You must visit healthcare.gov to complete any needed forms.

You or your spouse's dependent children are eligible for coverage until their 26th birthday. Please review your Member Guide or consult your employer regarding dependent eligibility requirements.

You or your spouse's dependent children are eligible for coverage until their 26th birthday. Please review your Member Guide or consult your employer regarding dependent eligibility requirements.

A dependent child who is either mentally retarded or physically handicapped and incapable of self-support may continue to be covered under the health benefit plan regardless of age if the condition exists and coverage is in effect when the child reaches the age of 19. The handicap must be medically certified by the child's doctor and may be verified annually by Blue Cross NC.

We will mail you a new ID card. You should receive it within 7–10 business days. In the meantime, you can see your digital ID card on the member portal.

Just follow these steps: log in to Blue Connect℠ and select ID Card to see your digital card. You can also print a temporary ID card or select View Full Card to download it to your smart phone or laptop.

Note: If your policy has been canceled, you won't be able to order a new ID card.

Many groups only offer one health benefit plan. Groups offering more than one health benefit plan may have an annual or open enrollment period in which to change to a different benefit plan. Please contact your group administrator for more information.

An open enrollment period is a period of at least 10 days during which your employer will allow you to enroll or to make changes/adjustments to your coverage. Open enrollment periods are held once a year for those employer groups that offer open enrollment. Review your Member Guide or contact your group administrator for additional information regarding plan changes.

Everyone under the age of 65 has the opportunity to purchase health insurance during the Open Enrollment Period.

Open Enrollment is from November 1 to December 15 every year for coverage starting on January 1.

You can purchase or change a plan outside of Open Enrollment if you have a qualifying life event. There are many things that can be considered a qualifying life event, like: loss of health coverage (losing a job, turning 26, or graduating and losing a student plan), turning 65 and needing to purchase a Medicare plan, changes to your household (having a baby, getting married or divorced, death in the family), changes to your physical location (moving to a new county or ZIP Code, moving from a shelter into a home), becoming a US citizen, leaving jail or prison, and/or changes to your income that may affect a subsidy you qualify for.

You can find your Rx letter code in the lower right corner of your member ID card (shown in the blue circle below). If you don't have a letter on your member ID card, please log in to Blue Connect℠ to find the name of your drug plan.

If you have a Blue Cross and Blue Shield of North Carolina (Blue Cross NC) plan, you'll find the name of your plan at the top of your member ID card.

You'll find the name of your Medicare plan at the top right of your member ID card or the bottom left. You can also find more plan details in the center of your card, below your Subscriber ID.

During 2024, our offices are closed in observance of the following holidays:

• New Year's Day: January 1
• MLK Day: January 15
• Memorial Day: May 27
• Independence Day: July 4
• Labor Day: September 2 
• Thanksgiving: November 28
• Day after Thanksgiving: November 29
• Christmas: December 24 & 25

Reimbursement varies according to plans. For more information, please refer to your Member Guide to find out if benefits are available for pharmacies outside of your network.

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has a mail order prescription drug program for individual and family plan members under age 65. You can get up to a 90-day supply of medications delivered to you with free standard shipping through Amazon Pharmacy (MedsYourWay®) and Express Scripts® Pharmacy (ESI). You can request your prescriptions online or through the mail.

Amazon Prime members can get their orders with free 2-day delivery. All others can get their orders with 5-day delivery.

Here are your next steps:

• To sign up for MedsYourWay, follow the steps at Amazon Pharmacy for Blue Cross NC members or call 855-963-4546.
• New to Amazon? You’ll need to sign up, confirm your identity, and then follow the steps.
• For ESI, register online at Express Scripts or call 833-599-0450.

If you will be going out of town for an extended time, benefits are available for an extended supply of up to 90 days for prescription drugs. However, you cannot refill a prescription until three-fourths of your current supply has been used. If you have not used three-fourths of your current supply but do not have enough medication to last through your trip, speak with your pharmacist about an early refill for up to an additional 30-day supply. If this amount is not enough, call Blue Cross NC Customer Service at 877-258-3334 for assistance. 

Note: In some cases, employer groups carve out the prescription drug benefit and contract with a vendor separately, please refer to your Member Guide to confirm that your pharmacy benefits are offered through Blue Cross NC.

The Blue Cross NC prescription drug formulary is a list of FDA-approved prescription drugs reviewed and maintained by the Blue Cross NC Pharmacy and Therapeutics (P&T) Committee, comprised of independent physicians and pharmacists. Blue Cross NC offers an open formulary; therefore, no drugs are considered non-formulary.

If your prescription drug benefit is based on copayments, the formulary can help you determine your copayment for a specific drug. It also provides a list of possible therapeutic alternatives that may be available at a lower copayment.

If your prescription drug benefit is based on coinsurance, the formulary can help you identify any available low-cost, generic drugs.

Formulary information is available in the Find Care search tool in Blue Connect℠. If you would like a full copy of the formulary, free of charge, please call Blue Cross NC's Customer Service at 877-258-3334. You should bring your copy of the formulary with you when you visit the doctor. 

Note: In some cases, employer groups carve out the prescription drug benefit and contract with a vendor separately. Please refer to your Member Guide to confirm that your pharmacy benefits are offered through Blue Cross NC.

A generic drug is identical, or bioequivalent, to a brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use. Certain inactive ingredients that give the generic product its shape, color or flavor may be different than the brand product. Health professionals and consumers can be assured that FDA approved generic drugs have met the same rigid standards as the innovator drug. Although generic drugs are chemically identical to their branded counterparts, they are typically sold at substantial discounts from the branded price.

Depending upon your benefit design, you may substantially lower your out-of-pocket expense by using a generic drug instead of the branded drug. For example, if you have a $10 generic copay (tier 1) and $35 non-preferred brand copay (tier 3), you can save $25 on every prescription just by choosing generics. For drugs you take each month, that's a savings of $300 over an entire year. If your prescription drug benefit is based on coinsurance, generic drugs will save you money because they cost less than their branded counterparts. (In some cases, employer groups carve out the prescription drug benefit and contract with a vendor separately, please refer to your Member Guide to confirm that your pharmacy benefits are offered through Blue Cross NC.)

Sometimes you go to the doctor for preventive care and end up with a charge on your bill. You can avoid surprising costs by following these steps:

• When you schedule an appointment, ask for preventive care screenings and tests that are 100% covered by your plan.
• Ask if any tests or treatments done during your appointment are not considered preventive care.
• Ask if talking about other health problems that are not considered preventive care during your appointment will lead to extra costs.
• Ask if lab work can be sent to a Blue Cross NC in-network lab.

Preventive services are services you get when you are symptom-free and have no reason to think you are sick. These services may include immunizations, routine cholesterol checks, pap tests and blood pressure screenings. They are covered at no extra cost.

Diagnostic services, on the other hand, are services you get when you have symptoms of an illness or risk factors that might indicate a health problem. These services may include chest X-rays, thyroid tests, EKGs, urine tests and iron level testing. You may be responsible for some out-of-pocket costs.

You can find in-network providers in North Carolina, outside of North Carolina, and worldwide by using this provider search tool.

To gain access to a personalized online account, student members can create an account on the Blue Connect℠ member portal.

Student members can request member ID cards, view benefits, and check claim status.

If you see an in-network provider in the US, the provider will file a claim for you. Please be sure to present your member ID card at the time of service so a claim can be filed under your plan.

If a provider is out-of-network and doesn't file a medical claim for you, you will be responsible for filing the claim. There is an 18-month timely filing limit for medical claims. You will need to follow these steps:

• Print and complete the member claim form (PDF)
• Attach an itemized receipt for the service, including the: 
  • subscriber name
  • subscriber number
  • provider name
  • provider ID number
  • procedure code(s)
  • diagnosis code(s)
  • charged amount(s)
• Note: Credit card receipts are not acceptable as itemized receipts. 
• We highly recommend you keep a copy of the claim form and receipt for your records.

You should present your member ID card each time you have a prescription filled. If the pharmacy doesn't file a prescription claim for you, you will be responsible for filing the claim. There is a 1-year timely filing limit for prescription claims.

You will need to follow these steps:

• Print and fill out the prescription claim form (PDF).
• Include an itemized receipt for your purchase.
• See page 2 of the claim form to find a list of items your receipt must include. 
• Note: Credit card receipts are acceptable as itemized receipts. 
• We highly recommend you maintain a copy of the claim form and receipt for your records.

If the student has paid the health fee for the current semester, we recommend they visit the health center on campus first to receive the highest level of benefit available on the plan. If you're out of the area or the health center is closed, we recommend you see an in-network provider.

You can only change your plan under certain circumstances. During the year, you can only change your vision plan if you have a qualifying life event like a marriage, divorce or birth. But you can change to a new plan at renewal.

Yes. You can use your insurance information at many online eye care centers. You can shop at:

• LensCrafters
• Target Optical
• Glasses.com
• ContactsDirect
• Ray-Ban

You can see a full list of network providers once you become a Blue Connect℠ member.

Vision insurance plans are only for diagnosing and treating vision-related problems. If you visit your eye doctor for a medical issue, like pink eye, dry eye or eye surgery, you would use your regular health insurance as these are considered medical services.

We have an easy-to-use Find Care tool that lets you search for an in-network eye doctor. You can choose an eye doctor nearest you or who offers the services you want. You can also check to see if your current eye doctor is in our provider network.

Your provider's office will submit claims for you when you visit an in-network eye doctor. But if you go to an out-of-network eye doctor, you'll be responsible for filing your own claims and may have to pay a higher fee for services.

Choose an in-network eye doctor from our Find Care tool. Schedule your visit for a routine eye exam. Go in for your appointment and show your member ID card.

You should visit the eye doctor each year – especially if you have vision loss or need corrective lenses. It can be hard to notice subtle changes to your vision, so it’s important to visit your doctor each year. If you have an eye disease or progressive vision issue, your doctor may require you to have more frequent visits.