What if I only need health 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
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 reached