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 and not be enrolled in Medicare.

2. Is maternity included?

A: Yes.

3. If I am pregnant, can I still apply for the maternity option?

A: Yes.

4. 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 Blue Cross NC online provider search at

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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 15th, 2014.

11. Can I choose when my coverage will begin?

A: Yes, you can choose only the 1st of any month if your plan is written through the Exchange. Your application, if written off the Exchange, must be signed and dated at least 7 days prior to the requested effective date in order to get a 1st or 15th of the month effective date.

12. 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.

13. 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.

14. How can I receive a Blue Advantage® Rate Quote?

A: Simply click Blue Advantage® Rate Quote for an instant on-line health insurance quote for individuals and families.