Blue Advantage® FAQ
1. Are there any eligibility requirements for coverage under Blue Advantage®?A: The applicant must be a North Carolina resident, under 65 years of age, and not qualifying for Medicare.
2. Does the Blue Advantage® policy provide for out-of-state services?
A: Services are considered in-network if the provider is a participant with that respective state's Blue Cross plan. Otherwise; services are paid as out-of-network charges.
3. When do the calendar year deductibles apply?
A. Typically, deductibles apply to hospital admissions, hospital-based out-patient procedures and other services such as ambulatory surgical centers, home health care & lab/x-rays performed outside a physicians' office visit.
4. Is maternity included?
A: Maternity benefits are considered optional and are available for additional premium when you first apply for a policy, at renewal, or when you have a family status change, such as marriage.
5. If I am pregnant, can I still apply for the maternity option?
A: No; you or your spouse cannot be pregnant when applying.
6. How are prescription drugs covered under the Blue Advantage® Plan?
A: The 4 Tier Drug Formulary separates prescription drugs into four co-payment categories based on usage, cost and effectiveness. Generic drugs have the lowest copay, while brand name drugs require a higher copay. When available, always ask for the generic option in order to minimize your out-of-pocket costs. There is a calendar year benefit of $2,000 and no claims to file. And, with Plan A, there is no deductible. To guarantee you receive the negotiated discounts, you must show your Blue Cross NC ID card at any participating Blue Advantage pharmacy.
7. How is coinsurance applied?
A: Coinsurance is the sharing of covered services costs between you & BCBSNC®. It's applicable after the satisfaction of the calendar year deductible.
8. When can I make benefit changes like deductibles?
A: You are allowed to make benefit reductions anytime during the plan year; however, any benefit upgrade must be done during the open enrollment period of November each year. All benefit enhancements require the completion of a Blue Advantage® application with updated health information. Additionally, you must be covered at least 6 months prior to open enrollment in order to be eligible for benefit upgrades.
9. Can I pick the effective (start) date of my Blue Advantage® policy?
A: Effective dates are either the 1st or 15th of the month and your application must be signed & dated at least 30 days prior to the requested effective date.
10. How do I renew my Blue Advantage® policy?
A: Your Blue Advantage® policy automatically renews each January 1st as long as premiums are paid when due.
11. When do premiums change & what causes the rate adjustment?
A: Premiums adjust as you age, add/remove dependents and/or change residences. Premiums may also change each January 1st.
12. How can I pay for my Blue Advantage® policy?
A: There are 3 ways to pay your Blue Advantage premiums. You may set up a bank draft by attaching a cancelled check to your Blue Advantage® application. You can pay your 1st month's premium by credit card and then be billed monthly. And lastly, you can opt to be billed monthly by BCBSNC®.
