Employer Benefit Solutions

Health Insurance, HSA Medical Insurance

terrystanley59 — Tue, 17 Aug 2010 20:50:46 +0000

Regular preventive care can help you stay in better overall health.
Make sure you understand how your preventive care benefits work,
and be sure to take advantage of them.

How your preventive care benefits work
Preventive care services are generally covered at
100 percent of the allowed amount when they meet
the following conditions:
• The service is delivered by an in-network provider.
• The service is performed in an in-network, office-based
setting or stand-alone clinic and filed as an office visit.
• The service is received only once per benefit period.
• The service does not include any additional procedures

Your covered preventive care services
Screening tests (adult and child)
Each of these services is covered once per benefit period:
• Pap smear
• Routine pelvic exam
• Chlamydia screening
• Clinical breast exam
• Cholesterol
• Lipid screening
• Hemoglobin
• Prostate specific antigen
• Digital rectal exam
• Osteoporosis screening

individual-medical health insurance charlotte

terrystanley59 — Fri, 02 Jul 2010 17:41:25 +0000

Health care coverage
designed for you and your budget

Low-cost, high-quality options
Whether you’re looking for a traditional PPO or a high-deductible
health plan, Blue Advantage® and Blue Options HSASM,1 plans
offer choices to meet your needs and your budget. Both plans
offer protection against covered services that can be expensive.
And with either plan, you’re covered up to at least $5 million for
covered expenses over your lifetime. HSA plans have unlimited
lifetime benefits.
Preventive care coverage to keep you and
your family healthy2,3
Preventive care is important to your health. Whether it’s a routine
annual physical, a gynecological exam, or screenings for cervical
and prostate cancer, Blue Advantage and Blue Options HSA
plans provide you with coverage for a variety of preventive care
procedures. Mammography screenings, standard immunizations,
well-baby and well-child care are also included.

Prescription drug coverage plus greater
savings with generics
Blue Advantage4 and Blue Options HSA plans feature
prescription drug coverage through a large network of
pharmacies. And you’ll save money when you purchase generic
drugs. Your provider can give you additional information about
generic drugs and lower-cost alternatives for your prescriptions.
Extensive provider network
Blue Advantage and Blue Options HSA plans offer access to an
extensive statewide provider network, which means many of
North Carolina’s best doctors and hospitals are at your fingertips.
With both plans, you have the freedom to receive care in or out
of network – and you don’t need a referral to see a specialist.5
When you’re traveling, you’re covered across the nation and in
more than 200 countries and territories worldwide through the
BlueCard® network.6
Commitment to quality… then, now, always
For over 75 years, North Carolinians have depended on
Blue Cross and Blue Shield of North Carolina for their health
coverage. We have a tradition of providing plans and programs
that improve the health of our communities. And we remain
committed to being your plan for better health.

Life stages
Find out what you need
As your life changes, so do your health coverage needs. The Life stages chart displayed below will help you
determine which plan could meet your current needs. Take a look at the life stage that sounds most like yours
and review our recommended plans. Wherever you are, we’re here to help

Life stage Is this you?

Just starting out Since graduation, you’ve had a lot to think about – which job to take, where to live and how to keep up
with new living expenses. Among these important decisions should be which health care plan will give
you the coverage you want at a price you can afford. So whether you’re used to your parents’ traditional
copayment plan but need lower premiums, or you’re in good health and ready for a high-deductible plan
with low premiums, we have options for quality coverage that will keep your budget on target.

Starting or
raising a family
Preventive care coverage is important to keep your family healthy. That’s why our plans cover standard
immunizations, well-baby care and well-child care.2,3 You’re also covered for a variety of preventive care
procedures and routine annual exams. You can choose a traditional PPO plan with low copayments, fast
and easy access to an extensive provider network, and access to specialists without a referral.5 Or, you
can choose a high-deductible health plan that covers 100% of certain preventive care services3 even
before you meet the deductible

Self-employed or
on your own
Maybe you’re self-employed or working for a company that doesn’t offer health coverage. Or, maybe
you’re recently divorced and are no longer covered by your spouse’s health plan. Whatever your life’s
challenges, we have a variety of traditional PPO and high-deductible plans that empower you to make
good decisions about your health coverage, your budget and your future

Retiring early You worked hard. You played smart. Now you’re ready to retire early. You earned it, so you deserve
health coverage options that will protect your health and your investments. Blue Options HSA offers a
tax-free way to help you pay for current or future out-of-pocket health care expenses.7 And annual outof-
pocket maximums mean your savings can be protected from high-dollar covered services.8 So, when
you’re ready to do the traveling you’ve always dreamed about, you can keep your mind on the road, not
on your health coverage

Child-only
coverage
When you need coverage just for your child, our Blue Advantage and Blue Options HSA plans can
provide health coverage to protect your most important priority. Select from a variety of premium levels
with options for copayment and deductible amounts

Our traditional PPO plan

Blue Advantage is a PPO plan – a preferred provider organization
plan – which means you pay convenient copayments or coinsurance
for things like primary care visits, specialist office visits and
prescription drugs Offers low-cost premium options to fit most budgets Deductibles as low as $250 per person

Offers preventive care coverage for a variety of services important
to your good health

Offers convenient copayments for most prescription drugs
purchased at a network pharmacy.4 (A separate prescription
deductible may apply.)

Offers an option for a maternity rider for adult female subscribers or enrolled spouses (age 18 and over) at an additional cost to your plan premium.11
You can choose to purchase Dental Blue for Individuals SM , a separate plan that provides dental-only coverage at an additional cost to
your health plan premium.12
Offers separate coverage for dependent children without you having to cover yourself. Child-only HSA policies are not eligible to receive tax advantages

Private Health-Medical Insurance Charlotte

terrystanley59 — Fri, 02 Jul 2010 16:41:25 +0000

Extensive provider network
Blue Advantage and Blue Options HSA plans offer access to an
extensive statewide provider network, which means many of
North Carolina’s best doctors and hospitals are at your fingertips.
With both plans, you have the freedom to receive care in or out
of network – and you don’t need a referral to see a specialist.5
When you’re traveling, you’re covered across the nation and in
more than 200 countries and territories worldwide through the
BlueCard® network

Commitment to quality… then, now, always
For over 75 years, North Carolinians have depended on
Blue Cross and Blue Shield of North Carolina for their health
coverage. We have a tradition of providing plans and programs
that improve the health of our communities. And we remain
committed to being your plan for better health.

Health Insurance Charlotte-Medical Insurance NC

terrystanley59 — Fri, 02 Jul 2010 16:40:03 +0000

Low-cost, high-quality options
Whether you’re looking for a traditional PPO or a high-deductible
health plan, Blue Advantage® and Blue Options HSASM,1 plans
offer choices to meet your needs and your budget. Both plans
offer protection against covered services that can be expensive.
And with either plan, you’re covered up to at least $5 million for
covered expenses over your lifetime. HSA plans have unlimited
lifetime benefits.
Preventive care coverage to keep you and your family healthy2,3
Preventive care is important to your health. Whether it’s a routine
annual physical, a gynecological exam, or screenings for cervical
and prostate cancer, Blue Advantage and Blue Options HSA
plans provide you with coverage for a variety of preventive care
procedures. Mammography screenings, standard immunizations,
well-baby and well-child care are also included

Health care coverage
designed for you and your budget

Health Insurance in Charlotte, NC. Health Insurance reform includes Charlotte NC

terrystanley59 — Mon, 22 Mar 2010 18:51:07 +0000

As most of you have probably heard, the House of Representatives passed the Senate health reform bill last night, as well as the reconciliation language making changes to that bill. The vote was very close with 38 Democrats voting “no” alongside all of the Republicans on the Senate bill and 33 Democrats voting "no" on the reconciliation "fix" bill. You can see how your member of Congress voted on the Senate bill here, and I hope you will take the time to thank those who voted "no" for their courageous effort.

The good news is that agents and brokers will be very much a part of a reformed health insurance system moving forward. We are still concerned about the minimum loss ratio provisions, which would take effect in 2011, and their impact on agents and brokers as well as the likelihood that they would reduce the ability of insurers to implement innovative programs for health care cost containment. However, we are working on changes and/or a delay to the medical loss ratio provisions as part of the reconciliation process. We will also work with the National Association of Insurance Commissioners (NAIC), which is charged by the legislation with crafting the definitions that will govern the medical loss ratio requirements, as well as with the carriers on the implementation of those provisions over the next year, to hopefully minimize their effect on the private market.

The issue of cost containment is critical, and the bad news is that this bill does practically nothing to reduce the cost of health care, which is the ultimate driver of health insurance costs. We will continue to voice this message on behalf of our members and their clients for whom affordability is the most critical factor.

The next step will be for the Senate to take up the reconciliation language, which we anticipate they will begin tomorrow. In the meantime, the Senate bill has now been passed by both the House and Senate, which means it will become the law of the land as soon as it is signed by the President. Passage of the reconciliation bill in the Senate could be completed this week if no changes are made to the House language, or it could stretch on for weeks if the Senate makes changes that must go back to the House for a final vote. We will, of course, keep you informed of new developments, and will be providing a specific revised timeline on how this will affect you and your employer clients, based on what was passed last night in the reconciliation bill, in the next few days.

In the meantime, we need to address what is in the Senate bill now, and we have prepared two documents we hope you will find helpful. One is our chart showing the Senate bill provisions and what was included in the reconciliation measure, though we ask that you keep in mind that changes proposed in the reconciliation bill are still subject to change. We also have a chart we developed some time ago showing the implementation timeline differences between the House and Senate bills, though only the Senate bill applies now. Again, subject to what happens in the Senate with the reconciliation measure, there may be some changes in the Senate bill timeline based on what is included in the final reconciliation language. Feel free to share these documents with your clients or others who may find them helpful in understanding how to prepare for upcoming changes.

Finally, I want to assure you that even though we are not pleased that this bill passed, it is much better than what was originally proposed. It includes many positive improvements suggested by NAHU, including expanded agent/broker provisions, and it does not include a public plan option. One of the very positive items included in the Senate bill was that significant authority was given to the NAIC in a number of areas to develop uniform guidelines relative to market reform. We have worked closely with the NAIC for many years and expect to be included in their development of these guidelines. The magnitude of the legislation will also require extensive regulatory action from the Department of Health and Human Services, the Center for Medicare and Medicaid Services, the Department of Labor, and the Department of the Treasury. NAHU has always been very involved in the regulatory process and we will be working extensively with the agencies as they develop the ‘rules of the road’ for implementation.

If you have specific implementation questions, please e-mail them to reformimplementation@nahu.org. I would also like to ask that you identify any particular issues from a practical perspective that will make the timelines unworkable, or any other information relative to practical application of the new rules. This information will be especially valuable in our work with the NAIC and agencies as they develop regulations.

Thank you for your support of NAHU, and the invaluable contribution you make to your communities all over the United States. Your role in getting and keeping people insured is noticed by many in Congress, which is why you have been included as an important part of the process moving forward.

Please call your congressman to let them know how you feel about changing your Health Insurance benefits in Charlotte NC

BlueCross BlueShield of NC,Charlotte NC Health Insurance-Medical Insurance Charlotte NC.

terrystanley59 — Wed, 17 Mar 2010 20:11:02 +0000

Low-cost, high-quality private Health Insurance options in Charlotte, NC
Whether you’re looking for a traditional PPO or a high-deductible
health plan, Blue Advantage® and Blue Options HSASM,1 plans
offer choices to meet your needs and your budget. Both plans
offer protection against covered services that can be expensive.
And with either plan, you’re covered up to at least $5 million for
covered expenses over your lifetime. HSA plans have unlimited
lifetime benefits.

Preventive care coverage to keep you and
your family healthy2,3
Preventive care is important to your health. Whether it’s a routine
annual physical, a gynecological exam, or screenings for cervical
and prostate cancer, Blue Advantage and Blue Options HSA
plans provide you with coverage for a variety of preventive care
procedures. Mammography screenings, standard immunizations well-baby and well-child care are also included.

Extensive provider network for Health Insurance
Blue Advantage and Blue Options HSA plans offer access to an
extensive statewide provider network, which means many of
North Carolina’s best doctors and hospitals are at your fingertips.
With both plans, you have the freedom to receive care in or out
of network – and you don’t need a referral to see a specialist.5
When you’re traveling, you’re covered across the nation and in
more than 200 countries and territories worldwide through the
BlueCard® network

Commitment to quality… then, now, always
For over 75 years, North Carolinians have depended on
Blue Cross and Blue Shield of North Carolina for their health insurance
coverage. We have a tradition of providing plans and programs
that improve the health of our communities. And we remain
committed to being your plan for better health.

Life stage Is this you? Just starting out Since graduation, you’ve had a lot to think about – which job to take, where to live and how to keep up
with new living expenses. Among these important decisions should be which health insurance care plan will give
you the coverage you want at a price you can afford. So whether you’re used to your parents’ traditional
copayment plan but need lower premiums, or you’re in good health and ready for a high-deductible plan
with low premiums, we have options for quality coverage that will keep your budget on target.
Starting or
raising a family
Preventive care coverage is important to keep your family healthy. That’s why our plans cover standard
immunizations, well-baby care and well-child care.2,3 You’re also covered for a variety of preventive care
procedures and routine annual exams. You can choose a traditional PPO plan with low copayments, fast
and easy access to an extensive provider network, and access to specialists without a referral.5 Or, you
can choose a high-deductible health plan that covers 100% of certain preventive care services3 even
before you meet the deductible

Self-employed or
on your own
Maybe you’re self-employed or working for a company that doesn’t offer private health insurance coverage in Charlotte NC. Or, maybe
you’re recently divorced and are no longer covered by your spouse’s health plan. Whatever your life’s
challenges, we have a variety of traditional PPO and high-deductible plans that empower you to make
good decisions about your health insurance coverage in Charlotte NC, your budget and your future

Retiring early You worked hard. You played smart. Now you’re ready to retire early. You earned it, so you deserve
health coverage options that will protect your health and your investments. Blue Options HSA offers a
tax-free way to help you pay for current or future out-of-pocket health care expenses.7 And annual out of-
pocket maximums mean your savings can be protected from high-dollar covered services.8 So, when
you’re ready to do the traveling you’ve always dreamed about, you can keep your mind on the road, not
on your health insurance coverage.

Blue Options HSA pairs our most popular health plan design, the PPO,
with a high-deductible health plan. Before your deductible is met, you
pay the total cost of your care – and you receive a discount when you
visit an in-network provider, except for certain preventive care services.
After your deductible is met, you pay coinsurance until you reach your
total out-of-pocket maximum amount

Offers lower premiums typical of high-deductible health plans.
With Blue Options HSA plan premiums, you could save as much as
56% off Blue Advantage premiums.10

Deductibles as low as $1,200 for an Individual plan,
$2,400 for a Family plan

Offers 100% coverage for most preventive care services before your
deductible is met.

Offers coverage for prescription drugs. Discounts available in network. After
you meet your deductible, you pay your coinsurance amount. Meanwhile,
both medical and pharmacy claims apply to the same deductible.
Offers an option for a maternity rider for adult female subscribers or enrolled spouses (age 18 and over) at an additional cost to your plan premium

Easy to use with no claims to file in network. HSA funds are easy to
access with a convenient debit card or checks. Online access 24/7 to
Member Services and “Manage my HSA” online account management.

HSA contributions are tax deductible.13 Withdrawals and interest are
tax free.7 HSA funds spent on qualified medical expenses are tax free.7
Account balances roll over every year and can be invested.

Benefit type Benefit description
Office visits – in network Primary doctors and specialists, including surgery, lab work, therapy and
radiology performed by the same doctor on the same day in office.
You pay:15 $15 copayment for primary physicians,16
$30 copayment for specialists
Preventive care Routine physical exams, including gynecological exam; well-child and
well-baby care, including periodic assessments and immunizations.
You pay:2,16 $15 copayment for primary physicians,16
$30 copayment for specialists
Prescription drugs No annual limit for generic drugs. A $2,000 maximum for brand-name
drugs per person, per benefit period.
You pay:4 $10 copayment for generics, $35 or $50 for
brand-name, 25% coinsurance for specialty brand
Deductible The amount you pay during the benefit period for some services before
BCBSNC pays its portion.
Deductible options: $250, $500, $1,000 or $2,500
Benefits vary depending on the deductible selected
Coinsurance The percentage of covered medical expenses that you pay after
you’ve paid your deductible.
You pay: After deductible, 20%, 0%
(0% coinsurance is not available on the $2,500
deductible option)
Coinsurance maximum The total amount of coinsurance you’re required to pay for covered
services in a year. Once you reach the coinsurance maximum, you
will not have to pay any more for coinsurance for covered medical
expenses for the remainder of the year.
Individual: $0 for 0% coinsurance plans;
$2,000 for 20% for coinsurance plans;
Family: $0 for 0% coinsurance plans;
$4,000 per family for 20% for coinsurance plans
Out-of-pocket expenses The total amount of money you pay out of pocket in a
benefit period.
You pay: Deductible(s), coinsurance (up to the
maximum) and copayment(s)
Lifetime maximum The maximum amount BCBSNC will pay per member for
covered services. Unlimited Hospital Inpatient and outpatient facility services, drugs, blood, supplies, medical
care, surgical care, therapy services, diagnostic tests, X-rays, lab work
and well-baby care (including periodic assessments and immunizations).
Inpatient, you pay: Coinsurance after deductible Outpatient laboratory tests and mammograms performed alone. Outpatient, you pay: 0% with no deductible (May require pre-authorization.)
Urgent care centers Provide services for a sudden or unexpected condition requiring
prompt diagnosis or treatment to prevent chronic illness, prolonged
impairment or a more hazardous treatment. Examples: sprains, some
lacerations and dizziness.
You pay: $30 copayment Emergency room services Services for the sudden onset of a condition that a person could
reasonably expect the absence of immediate medical attention to result
in placing one’s health at risk.
You pay: $150 copayment17 Ambulatory surgery centers A licensed or certified non-hospital facility which has permanent
facilities and equipment for the primary purpose of performing
surgical procedures on an outpatient basis and does not provide
inpatient accommodations.
You pay: Coinsurance after deductible Mental health and
substance abuse
Inpatient and outpatient professionals. A $2,000 benefit period
maximum and a $10,000 lifetime maximum per member. You pay: 50% after deductible Vision Routine eye exam. You pay: $15 copayment Other services* Durable medical equipment, home health care, home infusion therapy,
hospice care, private duty nursing, ambulance services, skilled nursing
facilities (to 60 days per year) and dental accident.
You pay: Coinsurance after deductible Maternity rider Pre- and post-natal coverage. Rider available. You pay coinsurance after deductible. Child-only coverage Coverage for children 18 years of age and younger. No full-time
student requirement. Available *High-tech diagnostic imaging scans, such as CT scans, MRIs, MRAs and PET scans, are subject to deductible and coinsurance payments regardless of where service is provided

Common terms
and definitions
Knowing the definitions of some common
terms associated with health insurance may
help you make better decisions about which
plan is right for you.

Premium
A periodic payment made to BCBSNC to keep your health
insurance policy active. Premiums are separate from other costs,
like copayments, deductibles and coinsurance.
Copayment
A fixed dollar amount that you pay to a provider at the time certain
Blue Advantage-covered services are provided. For example, the
price you pay for an office visit or a prescription medication

Deductible
The amount you pay your insurance provider each benefit period
for certain covered services before your health insurance begins
paying toward those future covered services. An example would
be medical care or prescription medications

Family deductible (For Blue Advantage)
A family deductible for Blue Advantage is met once three members
on a family policy each meet their individual deductibles.

Family aggregate deductible
(For Blue Options HSA)
A family deductible for Blue Options HSA is a deductible that has
to be met before any benefits are payable for any given member
in a family. Under a family aggregate deductible, services for all
family members who are covered under the plan get applied to
the same deductible

Coinsurance (For Blue Advantage)
The percentage of covered medical expenses that you pay
after you’ve paid your deductible. Coinsurance is usually listed
as a percentage. So if BCBSNC lists coinsurance at 20% of
covered medical expenses after you’ve met your deductible,
then BCBSNC pays 80% and you pay 20% until you reach your
coinsurance maximum.

Coinsurance maximum (For Blue Advantage)
The total amount of coinsurance that you’re required to pay
for covered medical services in a year. Once you reach the
coinsurance maximum, BCBSNC covers 100% of all covered
services for the remainder of the benefit period. You may
continue to pay copayments for covered services

Preferred provider organization (PPO)
A health plan that contracts with various physicians and
hospitals. PPO members are offered a financial incentive to use
providers on a preferred list, but some use out-of-network
providers at a higher cost.

Total out-of-pocket maximum
(For Blue Options HSA)
The total amount of money you will pay out of pocket during a
benefit period. Once you reach the total out-of-pocket
maximum, BCBSNC covers 100% of all covered services for the
remainder of the benefit period. Total out-of-pocket maximum
includes deductible and coinsurance that you pay, and is
determined whether you have individual or family coverage.

Health savings account (HSA)
An HSA is a tax-free way to help pay for current or future out-ofpocket
health care expenses.7 To be eligible to open an HSA and
begin saving money for medical expenses tax-free, you must be
covered by a high-deductible health plan. BCBSNC will set up
an HSA for you when you purchase a Blue Options HSA health
plan. Then you will be able to make contributions to this account.
Dollars that are not used in a given year roll over into the next
year and are completely portable should you change jobs or
switch health care coverage.High-deductible health plan (HDHP)
A high-deductible health plan is a health plan product that, when
combined with an HSA, provides insurance coverage and a
tax-advantaged way to help save for future medical expenses.
An HDHP typically has a lower premium with a higher annual
deductible than a traditional health plan and must meet other
specific federal guidelines. With the exception of preventive care,
members covered under high-deductible health plans do not
have benefits for any coverage prior to meeting the deductible.
That means the member pays for covered services such as office
visits, emergency room visits and prescription drugs out of pocket
until the deductible is reachedCommon questions
about health insurance
If you’re looking for health insurance, chances are you
have a lot of questions. Take a look at some of the
most common health insurance questions we receive.

If I apply online for an insurance plan,
am I obligated to buy?
No. You’re under no obligation to buy a health insurance plan.
Once you’ve received a final decision after applying, you’ll be
given the option to review the original plan you selected, as well
as other plan options available to you.

What’s the difference between in-network
and out-of-network providers?
In-network providers are contracted with BCBSNC to provide
services to members at discounted rates. Out-of-network
providers aren’t contracted, so their services usually cost more
for members. Plus, BCBSNC generally pays a lower percentage
for these services, which also may increase member out-ofnetwork
provider costs

What’s a pre-existing condition and how does
it affect my plan if I have one?
A pre-existing condition is a condition, disease, illness or injury
for which medical advice, diagnosis, care or treatment was
received or recommended within the 12-month period prior to
the effective date of your health insurance plan.18 If you have a
pre-existing condition, any medications, doctor visits or surgeries
related to this condition won’t be covered until 12 months after
the policy’s effective date. If you had other coverage before
enrolling in a plan, without a lapse of 63 days or more, your
waiting period for pre-existing conditions will be reduced by the
number of days that you had prior coverage.

How much do I have to pay if I get really sick?
With all of our plans, there are maximum limits you’ll pay for your
covered services each year that help protect you from endless
medical bills. Blue Advantage plans have coinsurance maximums
and Blue Options HSA plans have total out-of-pocket maximums.
See page 11 for more detailed definitions

Do I have to meet the deductible before I pay
copayments for my doctor visits?
No. Deductibles and copayments work separately. For each
covered service provided, you may be charged a copayment
or a deductible, not both. Generally, copayments are a fixeddollar
amount paid at the time of service – like for an office
visit or a prescription – whereas deductibles go towards paying
for covered services before your health insurance begins
paying toward those expenses. Some prescription plans have
a separate deductible that’s required before prescription drug
copayments begin Do copayments count toward the deductible?
No. Copayments don’t count toward deductibles. They’re a flat
rate fee separate from your deductible costs.What is an HSA?
An HSA is a health savings account that allows you to save
money to pay for future medical expenses on an income-tax-free
basis. The HSA is connected to a high-deductible health plan
that doesn’t have copayments. You pay out of pocket until your
deductible is met for all services, excluding a predefined list of
preventive services that are covered at 100% (no cost to you)
each year.

What does “coinsurance after the benefit
period deductible” mean with a health
savings account (HSA)?
Since there are no copayments with a Blue Options HSA, you
pay the total cost of your care until your deductible is met –
even for doctor’s visits, unless it is for preventive care.3 After
that, you pay coinsurance for covered medical expenses until
you reach your total out-of-pocket maximum. Once the total
out-of-pocket maximum is met, BCBSNC pays 100% of covered
medical expenses.
What if I only need insurance for my child
and not for myself – how do I purchase it?
You can purchase a Blue Advantage or Blue Options HSA policy to
cover your child or adopted/foster child without being covered by
the policy yourself. Your child will receive full Blue Advantage or
Blue Options HSA benefits, including immunization, well-child and
well-baby care coverage. When you apply, be sure to enter
your child’s information (name, gender and birth date) as the
primary applicant. If you plan to cover multiple children, each
child must have his or her own policy, so you’ll need to apply
for each policy separately. Multiple children may be covered on
the same Blue Advantage or Blue Options HSA policy, as long
as the parent is covered by the same policy.
You can cover children up to age 26 on your policy, as long as
they are your legal dependents. However, children under age
18 are not eligible to have their own health savings account.
Children under age 18 are subject to certain tax guidelines.
Consult a tax professional for more information.

What are my options for a maternity rider?
For an extra charge, a maternity rider is available when you
first purchase your Blue Advantage or Blue Options HSA policy,
renew your policy (if the policy has been in effect for at least six
months) or if you have a family status change, such as marriage.11
A maternity rider is available only for adult females age 18 and
over (subscribers or spouses) who are not pregnant at the time
a maternity rider is selected and are not on a child-only policy.
Services are subject to deductible and coinsurance.

How do I get dental coverage with my plan?
Dental coverage is available through Dental Blue for
IndividualsSM, a separate plan that provides dental-only coverage
at an additional cost to your health plan premium,12 and it’s
available with or without the purchase of a health plan. Dental
Blue for Individuals covers two (2) preventive care visits at 100%
each year. Basic services and major services are covered (in part)
after you meet your dental deductible

If I get a Blue Options HSA health plan, do I have
to worry about finding and setting up the HSA?
No. BCBSNC sets up an HSA automatically when you purchase
a Blue Options HSA health plan. You must be 18 or older to be
eligible for an HSA. Then you can make contributions into an
FDIC-insured checking account, administered by Mellon Trust of
New England, N.A.1 Once you’ve registered your signature, you
can use your HSA checkbook or debit card to pay for provider
services. Simply show the provider your BCBSNC ID card and
pay, either at the time of service or later when you receive a bill.
See

Offers preventive care coverage for a variety of services important
to your good health

Limitations & Exclusions
Like most health care plans, Blue Advantage and Blue Options
HSA have some limitations and exclusions. You must qualify
medically. If your application is approved, you will receive a
Member Guide. It will contain detailed information about plan
benefits, exclusions and limitations.

~~HSA~~

Regular preventive care can help you stay in better overall health.
Make sure you understand how your preventive care benefits work,
and be sure to take advantage of them.

A cost-saving plan
with maximum employee engagement and
tax-advantaged savings

Regular preventive care can help you stay in better overall health.
Make sure you understand how your preventive care benefits work,
and be sure to take advantage of them

Medical-Health Insurance Charlotte NC-Medicare Supplement, NC

terrystanley59 — Wed, 17 Mar 2010 16:16:05 +0000

Compare plans

We want to help you choose the
Blue Medicare Supplement plan that’s
right for you. First, take a look at the
benefits listed in the chart and determine which ones are most important to you.
Then, select the plan that includes those benefits. Premiums for each plan are
listed at the bottom of the chart.

A wide selection
of plans
Largest market share*
Local company
you’ve trusted for
over 75 years
Value-added
programs¥

Members have the freedom to choose their own doctor without a referral and can visit any
Medicare-participating hospital. And in most cases, we handle Part A and Part B Medicare
claims and supplemental claims automatically

Quality supplemental coverage

Wide selection of plans We offer eleven Blue Medicare Supplement plans to fit individual health care needs and budgets.
Blue Medicare Supplement may help take care of costs that Original Medicare doesn’t cover, so
members won’t have to worry about their health-related expenses.Locked in entry-age1 forever
For our entry-age plans, when members enroll in a Blue Medicare Supplement plan within
the first six months of enrolling in Medicare Part B, they lock in their entry-age forever.1
Rate adjustments will be made only due to medical inflation or overall claims experience.

No waiting periods for
pre-existing conditions18
Members who enroll early may be eligible for a Blue Medicare Supplement plan without
medical underwriting and waiting periods for pre-existing conditions

Choice of doctors with
virtually no claims to file
Members have the freedom to choose their own doctor without a referral and can visit any
Medicare-participating hospital. And in most cases, we handle Part A and Part B Medicare
claims and supplemental claims automatically.

+ They enroll within 6 months of enrolling in Medicare Part B
+ They are not covered by certain Medicaid programs
+ They are a resident of North Carolina

Benefits covered by
Blue Medicare Supplement
(Original Medicare does not cover the following benefits3)

Compare plans
Benefits covered by
Blue Medicare Supplement
(Original Medicare does not cover the following benefits3)
Part A (Hospitalization)
$1,100 Inpatient hospital deductible each benefit period
$275 a day copayment for days 61-90 in a hospital
$550 a day copayment for days 91-150 (lifetime reserve4)
100% of Medicare allowable expenses for additional
365 days after Medicare hospital benefits stop completely
First 3 pints of blood per calendar year5
$137.50 per day for days 21-100 in a skilled nursing facility6
Hospice care copayment/coinsurance
Part B (Physician and medical services)
$155 Part B deductible
Generally, 20% of Medicare-approved amount
(Part B coinsurance) after Part B deductible is met
100% of Medicare Part B excess charges7
Additional benefits not covered by Medicare
Benefits for medically necessary emergency care
received in a foreign country8
Blue Medicare Supplement monthly rates9
Age Under 65
Age 65
66–69
70–74
75 and over
1)With our entry-age plan, members enroll and lock in their entry-age forever, as long as they stay in the Medicare supplement plan that they initially chose. Any rate adjustments will only be due to medical inflation or overall claims experience. Any change in their rate will be preceded by a 30-day notice and is guaranteed for 12 months. Rates are subject to change June 1 of each year, but members alone will
not be singled out for premium increases based on their health or age. 2)When you enroll in an attained-age plan, your initial rate may be lower than the rate of an entry-age rated plan, and your rates will increase as you age, due to your age. Compare entry-age and attained-age plans to see which plans offer the best cost for you. 3)This is only a summary of benefits describing the policies’ most important features. The policy is the insurance contract. You must read the policy itself to understand all the rights and duties of both you and your insurance company. These policies may not fully cover all of your medical costs. Neither BCBSNC nor its agents are affiliated with Medicare. 4) After 90 days of hospitalization, Medicare benefits are paid from a one- time, lifetime reserve of 60 additional days, which are not renewable each benefit period. 5) If blood is donated to replace what you use, there is no charge. 6) You must have been in a hospital for at least three days and enter a Medicare-approved facility generally within 30 days after hospital discharge, no benefits after 100 days. 7) On all plans offered except PLANS F, High Ded F and G, members may be responsible for charges higher than the amount approved by Medicare unless the provider agrees to accept Medicare’s approved amount as full payment. These plans are covered at 100% for these charges. 80% of medically necessary emergency care services beginning during the first 60 days of trip outside of USA, after $250 annual deductible, up to $50,000
We want to help you choose the
Blue Medicare Supplement plan that’s
right for you. First, take a look at the
benefits listed in the chart and determine which ones are most important to you.
Then, select the plan that includes those benefits. Premiums for each plan are
listed at the bottom of the chart.
Entry-age and attained-age plans
We offer Blue Medicare Supplement plans with entry-age rates or attained-age rates. When you enroll in an entry-age plan, you lock in your entry-age. Your plan’s rates won’t increase due to age.1 So, if you purchase an entry-age plan at age 65,
you’ll always pay the rate of a 65-year old, even as you age, provided you remain in
the entry-age plan.
We also offer attained-age plans that feature lower initial rates than the initial rate of entry-age plans, but these rates increase due to age. You can compare entry-age and attained-age plans to see which one best meets your needs.

Benefits covered by
Blue Medicare Supplement
(Original Medicare does not cover the following benefits3)
Part A (Hospitalization)
$1,100 Inpatient hospital deductible each benefit period
$275 a day copayment for days 61-90 in a hospital
$550 a day copayment for days 91-150 (lifetime reserve4)
100% of Medicare allowable expenses for additional
365 days after Medicare hospital benefits stop completely
First 3 pints of blood per calendar year5
$137.50 per day for days 21-100 in a skilled nursing facility6
Hospice care copayment/coinsurance
Part B (Physician and medical services)
$155 Part B deductible
Generally, 20% of Medicare-approved amount
(Part B coinsurance) after Part B deductible is met
100% of Medicare Part B excess charges7
Additional benefits not covered by Medicare
Benefits for medically necessary emergency care
received in a foreign country8

Early enrollment means guaranteed acceptance
Enrollees cannot be turned down for Blue Medicare Supplement
coverage with BCBSNC if they meet all of the following
requirements:
+ They are age 65 or older and eligible for Medicare or under
age 65 and are eligible for Medicare by reason of disability
(Plans A, and C)
+ They enroll within 6 months of enrolling in Medicare Part B
+ They are not covered by certain Medicaid programs
+ They are a resident of North Carolina

* Based on “2008 Medicare Supplement Insurance Experience Exhibits”, published in 2009 by
the National Association of Insurance Commissioners (NAIC), as supplied by Mark Farrah.
¥ These value-added programs may change or be discontinued at any time. BCBSNC does not
profit from this program. BCBSNC provides these programs for member convenience and is
not liable in any way for the goods and services received. These programs are not part of a
member’s policy or benefits, but are value-added discounts available for their use.
18 Pre-existing conditions are conditions for which medical advice was given or treatment was
recommended by or received from a physician within six months before the effective date of
coverage. If enrollees wait until after the deadline to enroll, they may have a waiting period for preexisting
conditions and may have to complete a medical questionnaire

Individual Medical-Health Insurance Charlotte NC—Charlotte NC Private HSA Medical Health Insurance

terrystanley59 — Tue, 16 Mar 2010 16:56:42 +0000

Colorectal cancer screening
• Covered once per benefit period
As with other preventive services, colorectal screenings must
be performed in the physician’s office, not in an outpatient
clinic or hospital, to be covered as preventive. Should your
physician perform additional services during the procedure,
such as the removal of identified polyps, the service is subject
to your deductible and coinsurance.
Things you should know
• If you receive more than one of these services per
benefit period, the additional service may be subject to
your deductible and coinsurance.
• Services that are not delivered in an in-network, officebased
setting or stand-alone clinic filing as an office
visit will be subject to your deductible and coinsurance.
• Services that include additional procedures or
diagnostic services will also be subject to your
deductible and coinsurance.
• During routine preventive visits, your health care
provider may order additional screenings not listed here.
These are subject to your deductible and coinsurance.
• Save on out-of-pocket costs. Ask your health care
provider to send your routine lab work to a contracted
BCBSNC reference lab.
Immunizations (adult and child)2
Covered:
• Diphtheria – Pertussis – Tetanus Toxoid (DPT)
• Polio
• Influenza
• Measles – Mumps – Rubella (MMR)
• Pneumococcal vaccine
• HiB
• Hepatitis B
• HPV (girls and women ages nine to 26)
• Meningococcal vaccine
• Chicken pox
• Herpes Zoster (Shingles)
Not covered:
• Immunizations required for occupational hazard
• Immunizations required for international travel
Mammogram
• Covered once per benefit period
Routine, preventive mammograms are paid at 100 percent of
the allowed amount when performed in an in-network, officebased
setting or stand-alone clinic and filed as an office visit.
Should your physician perform additional services during the
procedure, such as the removal of breast tissue for biopsy,
the service is subject to your deductible and coinsurance.

Screening tests that involve additional diagnostic services
are subject to your deductible and coinsurance.
Well baby and well child care2
• Children up to age three: Routine office visits
• Children ages three through 18: One routine office
visit per benefit period
Adult preventive care
• One routine office visit per benefit period is
covered for adults age 19 and above.
Obesity evaluation and management
• One office visit per benefit period is covered.
Additional obesity evaluation visits are subject to your
deductible, coinsurance and a four-visit limit.
How your preventive care benefits work
Preventive care services are generally covered at
100 percent of the allowed amount when they meet
the following conditions:
• The service is delivered by an in-network provider.
• The service is performed in an in-network, office-based
setting or stand-alone clinic and filed as an office visit.
• The service is received only once per benefit period.
• The service does not include any additional procedures.
Your covered preventive care services
Screening tests (adult and child)
Each of these services is covered once per benefit period:
• Pap smear
• Routine pelvic exam
• Chlamydia screening
• Clinical breast exam
• Cholesterol
• Lipid screening
• Hemoglobin
• Prostate specific antigen
• Digital rectal exam
• Osteoporosis screening
Understand your
preventive care benefits
Regular preventive care can help you stay in better overall health.
Make sure you understand how your preventive care benefits work,
and be sure to take advantage of them.1
PAGE

charlotte NC health insurance

terrystanley59 — Mon, 15 Mar 2010 18:49:15 +0000

You can purchase a Blue Advantage or Blue Options HSA policy to
cover your child or adopted/foster child without being covered by
the policy yourself. Your child will receive full Blue Advantage or
Blue Options HSA benefits, including immunization, well-child and
well-baby care coverage. When you apply, be sure to enter
your child’s information (name, gender and birth date) as the
primary applicant. If you plan to cover multiple children, each
child must have his or her own policy, so you’ll need to apply
for each policy separately. Multiple children may be covered on
the same Blue Advantage or Blue Options HSA policy, as long
as the parent is covered by the same policy.
You can cover children up to age 26 on your policy, as long as
they are your legal dependents. However, children under age
18 are not eligible to have their own health savings account.
Children under age 18 are subject to certain tax guidelines.
Consult a tax professional for more information

Individual Health Insurance Charlotte NC, Charlotte NC Private Medical- Health Insurance

terrystanley59 — Fri, 12 Mar 2010 17:50:46 +0000

Offers convenient copayments for most prescription drugs
purchased at a network pharmacy.4 (A separate prescription
deductible may apply.)
Blue Options HSA pairs our most popular Individual health in Charlotte NC plan design, the PPO,
with a high-deductible private health insurance plan in NC. Before your deductible is met, you
pay the total cost of your care – and you receive a discount when you
visit an in-network provider, except for certain preventive care services.
After your deductible is met, you pay coinsurance until you reach your
total out-of-pocket maximum amount.
Offers low-cost premium options to fit most budgets. Offers lower premiums typical of high-deductible health plans.
With Blue Options HSA plan premiums, you could save as much as
56% off Blue Advantage premiums.10
Deductibles as low as $250 per person. Deductibles as low as $1,200 for an Individual plan,
$2,400 for a Family plan.8
Offers preventive care coverage for a variety of services important
to your good health.2
Offers 100% coverage for most preventive care services before your
deductible is met.3
Offers convenient copayments for most prescription drugs
purchased at a network pharmacy.4 (A separate prescription
deductible may apply.)
Offers coverage for prescription drugs. Discounts available in network. After
you meet your deductible, you pay your coinsurance amount. Meanwhile,
both medical and pharmacy claims apply to the same deductible.
Offers an option for a maternity rider for adult female subscribers or enrolled spouses (age 18 and over) at an additional cost to your plan premium.11
You can choose to purchase Dental Blue for Individuals SM , a separate plan that provides dental-only coverage at an additional cost to
your health plan premium.12
Offers separate coverage for dependent children without you having to cover yourself. Child-only HSA policies are not eligible to receive tax advantages.
Easy to use with no claims to file in network. Online access 24/7 to
Member Services.
Easy to use with no claims to file in network. HSA funds are easy to
access with a convenient debit card or checks. Online access 24/7 to
Member Services and “Manage my HSA” online account management.
None. HSA contributions are tax deductible.13 Withdrawals and interest are
tax free.7 HSA funds spent on qualified medical expenses are tax free.7
Account balances roll over every year and can be invested.14
Our traditional PPO plan Our high-deductible health plan with
a tax-advantaged savings account for
qualified medical expenses7

Self-employed or
on your own
Maybe you’re self-employed or working for a company that doesn’t offer health insurance coverage in Charlotte NC. Or, maybe
you’re recently divorced and are no longer covered by your spouse’s health insurance plan. Whatever your life’s
challenges, we have a variety of traditional PPO and high-deductible plans that empower you to make
good decisions about your health insurance coverage in Charlotte NC, your budget and your future

Between jobs For a variety of reasons, planned or unplanned, people find themselves changing jobs or suddenly
between jobs. That’s why we offer low-premium options for traditional PPO plans or high-deductible
health plans that can get you covered within 15 days of application. Child-only
coverage
When you need coverage just for your child, our Blue Advantage and Blue Options HSA plans can
provide health coverage to protect your most important priority. Select from a variety of premium levels
with options for copayment and deductible amounts.
!

Offers low-cost premium options to fit most budgets.

Deductibles as low as $250 per person

Offers preventive care coverage for a variety of services important
to your good health

Offers convenient copayments for most prescription drugs
purchased at a network pharmacy.4 (A separate prescription
deductible may apply.)

Easy to use with no claims to file in network. Online access 24/7 to
Member Services

HSA Plan

Our high-deductible health plan with
a tax-advantaged savings account for
qualified medical expenses7

Offers lower premiums typical of high-deductible health plans.
With Blue Options HSA plan premiums, you could save as much as
56% off Blue Advantage premiums

Deductibles as low as $1,200 for an Individual plan,
$2,400 for a Family plan.8

Offers 100% coverage for most preventive care services before your
deductible is met

Regular preventive care can help you stay in better overall health.
Make sure you understand how your preventive care benefits work,
and be sure to take advantage of them.

HSA contributions are tax deductible.13 Withdrawals and interest are
tax free.7 HSA funds spent on qualified medical expenses are tax free.7
Account balances roll over every year and can be invested

Common terms
and definitions
Knowing the definitions of some common
terms associated with health insurance may
help you make better decisions about which
plan is right for you