Blue Advantage® NC Rate Quote FAQ
Blue Cross and Blue Shield of North Carolina®
1. What are the eligibility requirements for Blue Advantage®?
A: To be eligible for coverage, you must be a North Carolina resident under 65 years of age, not be covered under another health insurance policy, not be enrolled in Medicare, and qualify medically.
2. Is maternity included?
A: The maternity option is available for an extra charge when you first purchase a policy, when you renew, or when you have a family status change, such as marriage.
3. If I am pregnant, can I still apply for the maternity option?
A: No, you or your spouse cannot be pregnant at the time of applying.
4. How does prescription drug coverage work under the Blue Advantage® Plan?
A: To guarantee you receive the negotiated discounts, you must show your Blue Cross NC ID card at any participating Blue Advantage® pharmacy. The 4 Tier Drug Formulary separates prescription drugs into four co-payment categories based on usage, cost and effectiveness. Generic drugs have the lowest copay, but you will pay more for brand name drugs. To keep your costs low, ask for generic drugs! There are no annual limits on generic drugs. With Plan A, there is no deductible and there are no claims to file.
5. What does it mean to be in-network versus out-of-network?
A: With Blue Advantage®, members are covered across the nation and in more than 200 countries and territories worldwide4. When you use a network provider, BCBSNC® will pay more of the expense (eg: co-pays or higher coinsurance versus lower coinsurance amounts for out-of-network claims.) However, you are still covered if you use an out-of-network provider, but at the out-of-network benefit level. To search for a provider, visit BCBSNC® online provider search at www.bcbsnc.com.
6. What guidelines determine a routine physical exam?
A: Services recommended by the American Medical Association and other services that are considered medically necessary by your doctor.
7. Is coverage available for doctors or hospitals in another State?
A: If you visit a provider in another State, and the provider is an in-network provider for Blue Cross of that State, you should receive the same level of benefits as when visiting an in-network provider within NC. If the doctor or hospital is not a network provider, then you would receive out-of-network benefits.
8. What are the differences between Plan A and Plan B?
A: Plan A is the most popular Blue Advantage® plan, however, Plan B costs a little less (about 15% on average). Please see the chart below for some of the differences:
| Plan A | Plan B | |
| Lifetime Benefit | Unlimited | Unlimited |
| Copay | $15 (primary care physician) $30 (specialist) |
$25 (primary care physician) $50 (specialist) |
| In-Network Coinsurance | 80% | 70% |
| Out-of-Network Coinsurance | 70% | 60% |
| Annual Prescription Drug Deductible | None | $200 per member |
9. When do deductibles apply?
A: Deductibles apply for some services, such as hospital care, including inpatient facility charges, outpatient facility, home health care, ambulatory surgery centers and lab/x-rays performed outside of a doctor’s office visit. They also may apply for out-of-network office visits.
10. Do I have to use bank draft, or can I just be billed monthly?
A: You can choose bank draft by completing all of the information for the bank draft option in Section 3 of the application and including a voided check. You may also request the first month’s premium be charged to a credit card by completing all of the information in that area under Section 3. If you wish to be billed monthly, you may leave the bank draft and credit card information blank, and Blue Cross will send you a billing statement monthly.
11. What is coinsurance and when does it apply?
A: Coinsurance is the sharing of the costs of covered services between you and BCBSNC®. It applies after you have satisfied your calendar year deductible. Co-insurance options under Plan A is 80/20 and Plan B is 70/30.
12. Can I change my deductible after my policy is issued? When?
A: You can raise your deductible at any time during the policy, but you can only lower it during open enrollment dates beginning November 1st through November 30th of each year. If you choose to lower it, you will need to complete the Blue Advantage® application and answer all health questions, and you must have been on the policy a minimum of six months at open enrollment.
13. Can I choose when my coverage will begin?
A: Yes, you can choose the 1st or 15th of any month, but your application must be signed and dated at least 7 days prior to the requested effective date to be honored.
14. Can I change from Plan A to Plan B or Plan B to Plan A?
A: As with changing your deductible, you can change from Plan A to Plan B at any time. However, moving from Plan B to Plan A would follow the same guidelines as lowering your deductible.
15. What do I need to do to renew my coverage?
A: Coverage is automatically renewed when you continue to pay your premiums when due. BCBSNC® must renew your policy unless they discontinue all policies like yours.
16. When do premiums change and what determines this change?
A: Premiums may be adjusted as you age, add or remove eligible dependents, or if you move. They may also be adjusted on January 1st of each year.
17. How do I add or remove dependents from my policy?
A: You may add dependents at any time by completing a Blue Advantage® application along with all sections applicable to adding a dependent that are noted on the form. This will include all health questions. You may also remove dependents at any time by completing all sections that pertain to removing a dependent on the Blue Advantage® application.
18. How can I receive a Blue Advantage® Rate Quote?
A: Simply click Blue AdvantageŽ Rate Quote for an instant on-line health insurance quote for individuals and families.