Blue Advantage®

BlueADVANTAGE® from Blue Cross and Blue Shield of North Carolina® is the state's most popular health insurance plan for individuals and families.⁺
For a Free Quote on BlueADVANTAGE® enter your county of residence below Questions? Call 1-800-588-9025

Below are abbreviated benefit highlights for BlueADVANTAGE®.

In-Network Coverage8,9
Preventive care	Plan A	Plan B	Plan C
Preventive care	100% After a $15 copay for primary physicians10 or a $30 copay for specialists2. No Deductible	100% After a $25 copay for primary physicians10 or a $50 copay for specialists2. No Deductible	100% After a $30 copay for primary physicians10 or a $60 copay for specialists2. No Deductible
physician office visit	100% After a $15 copay for primary physicians10 or a $30 copay for specialists2. No Deductible	100% After a $25 copay for primary physicians10 or a $50 copay for specialists2. No Deductible	100% After a $30 copay for primary physicians10 or a $60 copay for specialists2. No Deductible
prescription drugs*	100% After a $10 copay for generic, $35 copay for preferred brand, $50 copay for brand, or 25% member coinsurance for specialty brand.1 No Deductible	100% After a $200 annual deductible per member, then $10 copay for generic, $35 copay for preferred brand, $50 copay for brand, or 25% member coinsurance for specialty brand.1	100% After a $500 annual deductible per member, then $10 copay for generic, $35 copay for preferred brand, $50 copay for brand, or 25% member coinsurance for specialty brand.1
emergency room services	100% After a $150 copay12. (copay waived if admitted) No Deductible	100% After a $150 copay12. (copay waived if admitted) No Deductible	100% After a $150 copay12. (copay waived if admitted) No Deductible
hospital care	80% or 100% After benefit period deductible.	70% After benefit period deductible.	50% After benefit period deductible.
outpatient surgery	80% or 100% After benefit period deductible.	70% After benefit period deductible.	50% After benefit period deductible.
benefit period deductibles	Deductible options: $250, $500, $1000 or $2500	Deductible options: $500, $1000, $2500, $3500 or $5000	Deductible options: $1000, $2500, $3500 or $5000
coinsurance maximum	$2000 per individual, $4000 per family	$3000 per individual, $6000 per family	$3000 per individual, $6000 per family
Vision Care	100% After a $15 copay. No Deductible	Not available.	Not available.
mental health & substance abuse	50% After benefit deductible. $2000 benefit period max per person per benefit period; $10,000 lifetime per peson	50% After benefit deductible. $2000 benefit period max per person per benefit period; $10,000 lifetime per peson	50% After benefit deductible. $2000 benefit period max per person per benefit period; $10,000 lifetime per peson
other services	80% or 100% After benefit deductible. Including durable medical equipment, home health care, private duty nursing and ambulance services.	70% After benefit deductible. Including durable medical equipment, home health care, private duty nursing and ambulance services.	50% After benefit deductible. Including durable medical equipment, home health care, private duty nursing and ambulance services.

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Footnotes:
1. 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.
2. Some services and supplies received by members in an office setting or in connection with an office visit are in fact outpatient hospitalbased
services provided by hospital-owned or operated practices. These services and supplies may be subject to your deductible and
coinsurance. Please see the provider listing to identify these providers.
3. Referrals may be needed for mental health and substance abuse services.
4. 2007 Blue Cross and Blue Shield Association Internal Data: www.bcbs.com/news/facts_bcbsa.html.
5. Blue Advantage Plan B requires a $200 prescription drug deductible. Plan C requires a $500 prescription drug deductible.
6. Certain limitations may apply. Please refer to your insurance contract for more details.
7. Blue Extras 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 provides the Decision Support Tools for member convenience. These are meant to be reference tools only and are not
intended to provide legal, medical or tax advice. BCBSNC provides the Member Health Partnerships program for your convenience and
is not liable in any way for the services received. BCBSNC reserves the right to discontinue or change these programs at any time.
8. All services subject to the allowed amount.
9. NOTICE: Your actual expenses for covered services may exceed the stated coinsurance percentage or copayment amount because
actual provider charges may not be used to determine the payment obligations for BCBSNC and it members.
10. Primary physicians are in-network providers designated by BCBSNC as a primary care provider (PCP). Please check with BCBSNC to
confirm your provider is in our network.
11. Only gynecological exams, cervical cancer screening, ovarian cancer screening, screening mammograms, colorectal screening and
prostate specific antigen (PSA) tests are covered out-of-network subject to benefit period deductible and coinsurance.
12. If admitted to the hospital from the emergency room, inpatient hospital benefits apply to all covered services provided. If held for
observation, outpatient benefits apply to all covered services provided. If you are sent to the emergency room from an urgent care
center, you may be responsible for both the emergency room copayment and the urgent care copayment.
13. Dental Blue has a 6-month waiting period for basic services; 12-month waiting period for major services.
14. BCBSNC does not administer your HSA and is not affiliated with your HSA custodian or administrator. Your HSA custodian is Mellon
Trust of New England, N.A. Withdrawls are tax-free only if used for qualified medical expenses. See irs.gov for specific regulations.
15. Includes in-network annual routine physical exam, well-baby and well-child care and certain immunizations and screenings. Other
covered services may be subject to deductible and coinsurance.
16. Pre-existing conditions are those for which medical advice, diagnosis, care or treatment was received or recommended within
12. months of the date that your Blue Advantage coverage begins. You may receive credit toward the 12-month waiting period if we
receive your completed Blue Advantage application within 63 days of the termination of your previous health coverage.
* No annual limit for generic drugs ($2,000 maximum for brand name drugs per person per benefit period)
⁺BCBSNC® internal data 2007