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.
STEP
1
Life

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

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

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