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Health Plans for
Individuals and Families

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*Le estamos enviando a HealthSherpa para comprar su program de seguro médico de Blueish Cantankerous and Blueish Shield of Northward Carolina (Blue Cross NC). HealthSherpa es united nations vendedor certificado por los Centros de Servicios de Medicare y Medicaid (CMS, en inglés) que Blue Cross NC ha seleccionado para facilitar el proceso de inscripción. Tenga en cuenta que estará saliendo de BlueCrossNC.com y el sitio spider web de Blueish Cross NC. HealthSherpa se hace responsable por el sitio al cual le estamos enviando, incluidas las políticas de privacidad que gobiernan el sitio.

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Choose Wisely. Cull Blueish℠.

Benefits of buying a Bluish Cross and Bluish Shield of North Carolina (Blueish Cross NC) wellness plan include:

100% preventive care coverage
including annual health visits^ane

Health and well-existence
programs like telehealth

No referrals needed
to see a specialist

3 gratis primary care provider visits
and 3 free mental health visits²

Motherhood, newborn
and pediatric care

Online tools to help yous find doctors,
compare costs — and more

DID YOU KNOW?

More than half of our members with a subsidy paid $0 per month in 2021!

Source: Internal Blue Cantankerous NC data, 2021.

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ACA 101: How It All Works

How to Shop for a Health Plan

When yous're shopping for a wellness plan, here are some things to call back about:

Subsidies

To assistance brand health insurance more than affordable, the federal government offers financial assist, also called subsidies, to individuals and families who qualify based on their income and household size. There are two types of subsidies available: Advanced Premium Tax Credit (APTC) and Price Sharing Reductions (CSRs).

To qualify for a subsidy nether health intendance reform, you must:

Accept income higher up 100% Federal Poverty Level (FPL)
Non be eligible for public coverage, such as Medicaid, the Children'southward Wellness Insurance Program (CHIP), Medicare or coverage through the Armed forces
Not take affordable access to insurance through an employer ("affordable" is defined yearly past the federal Market based on the per centum of premium an employee is responsible for)

Use this online figurer to estimate the subsidy amount you lot could potentially qualify for from the federal government.

Subsidy Figurer

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ACA 101: Subsidies and Cost Sharing Reductions

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Network

Each Blue Cross NC health plan has its ain network of covered health care providers. The larger the network, the more in-network options you lot have for doctors, hospitals and other facilities. Merely plans with a larger network typically have a higher monthly premium. Plans with a wellness arrangement-specific network are often less expensive and assistance you get coordinated intendance, but ordinarily only the doctors and facilities of one major health organization are in-network.

And then, it's of import to counterbalance access versus cost when choosing your plan. While we besides offer out-of-network coverage, you tin save the most money by only seeing providers that are in your plan'southward network.

In the side by side section, you lot'll come across the wellness plans available in your canton. Use the Find an In-Network Doctor button to await up providers and hospitals that are covered by that plan's network.

Wellness Plan Options

We have new lower-cost plans for 2022. Enter your canton to see which health plans are available in your area:

Prescription Coverage

Our Affordable Care Act (ACA) plans utilise the same formulary (a list of covered medications) and pharmacy network.

Utilize the Find a Drug button to run across which medicines are covered and which tier they fall into. Tier 1 is often the least expensive, while Tiers 5 and 6 are the highest-toll.

Use the Find a Pharmacy push button to search for in-network pharmacies.

ACA 101: Plans and Benefits

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Copayments, Deductibles and Coinsurance

When shopping for your health plan, you'll cull between two types: Copayment plans and deductible/coinsurance plans. The type you select affects how y'all'll pay for care at the doc, chemist's shop or infirmary.

Copayments

A copayment is a fixed dollar amount you pay for a covered service at the fourth dimension yous receive it.

For instance, you may have a programme that charges a $20 copay for an in-network doctor visit. All yous'll demand to pay is your $20 copay. Plans with copays tend to be more expensive. But, you'll know the price of the visit before you become.

Deductibles

A deductible is the amount you lot owe for covered health care before your health insurance company starts to pay.

For example, let's say you take a $3,000 deductible and y'all've paid $2,000 toward information technology. Yous just had an MRI that costs $1,500. You'll have to pay $1,000 to reach your deductible. Later that, yous'll only pay part of the remaining $500 based on your coinsurance percentage.

If your program has an integrated deductible that means your medical costs and pharmacy costs both utilise toward the same deductible and out-of-pocket maximum.

Coinsurance

Coinsurance is your share of costs for health care expenses based on a percentage of those costs.

Afterward y'all've met your deductible, yous may be charged coinsurance for health care services. The cost of the service will exist split between yous and your insurance company.

So, if you lot get a $100 neb for a chest X-ray and yous take a 30% coinsurance amount, you'll need to pay $30, and your insurance company will pay the residual.

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ACA 101: Copayments, Deductibles and Coinsurance

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Metallic Levels

Our ACA health plans are available in three metallic levels: Bronze, Silver and Gilded. These levels were created by the ACA to show the value of coverage within a plan. They vary by how much of your medical costs a program will pay on average. This tin can help yous easily compare plans.

Statuary plans pay 60% of medical costs on boilerplate, and y'all pay 40%. ³

Skillful if you want protection from worst-case medical scenarios, similar serious sickness or injury. While the monthly premium is lower, you'll have to pay for most routine intendance yourself.

Silverish plans pay 70% of medical costs on average, and y'all pay 30%. ⁱⁱⁱ

Good if y'all are willing to pay a higher monthly premium than Bronze to have more of your routine intendance covered.

Gold plans pay eighty% of medical costs on boilerplate, and you pay 20%. ³

Good if you use a lot of care and are willing to pay more than in monthly premiums to accept more costs covered when you go medical handling.

Health and Well-Beingness

Every bit a Blue Cross NC fellow member, you'll savor benefits and programs that can assist you improve your wellness and experience your best.

Telehealth

24/7 telehealth care options for behavioral and physical wellness (available in English and Castilian).⁴

Blue365^®

Grab discounts on products tied to fitness, personal care, good for you eating, wellness, financial wellness, lifestyle and more.^v

Support

Get access to programs to aid you lot control blazon two diabetes and quit smoking.⁶

ACA 101: Vision and Dental

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Catastrophic Health Plans

Are you nether 30 or authorize for a hardship through the federal government? You may exist eligible for catastrophic coverage.^vii These plans have a high deductible, but your monthly payments volition exist lower than near other plans.

Benefits include:

100% preventive care coverageⁱ
$35 copays for outset three non-preventive primary care provider visits
Essential wellness benefits covered after deductible is met
Plans run into ACA Bronze-level requirements

All Blue Cross NC individual ACA plans may be purchased through the Health Insurance Marketplace as a Qualified Health Plan (QHP) or through other sources, such every bit directly from Bluish Cross NC. Advanced Premium Tax Credits (APTC) and Price Sharing Reductions are only available when plans are purchased through the Health Insurance Marketplace. If you apply through Blue Cantankerous NC, you lot'll be able to go to the Health Insurance Market to get any APTC or Cost Sharing Reductions you're eligible for. The Health Insurance Market displays all QHPs available for sale in a given state past all issuers and may contain more than QHPs than displayed on this site. The Wellness Insurance Marketplace allows individuals to employ via its website, in person or by phone.

This website is operated by Blueish Cantankerous and Blue Shield of North Carolina and is not the Health Insurance Market place website. This website does not display all QHPs available through the Health Insurance Market place website. To see all available QHP options, go to the Health Insurance Market place website at HealthCare.gov. All information discussed on this page pertains to Blue Cross NC individual-marketplace, medical health insurance plans that are eligible for sale in 2022 and meet ACA guidelines. The information contained does non apply to plans that are transitional, grouping, dental-only or other programme types. All details regarding program benefits and pattern independent herein are for advisory purposes only. Delight see the production benefit booklet for all terms and conditions that utilize.

Your coverage volition automatically renew. Your coverage may be canceled by Blue Cantankerous NC for fraud or intentional misrepresentation of material fact on your awarding or for nonpayment of premiums. Coverage for dependent children ends at the end of the month they become historic period 26. Members will be notified thirty days in advance of any change in coverage. To be eligible for a catastrophic health plan, you must be nether xxx years of age when the plan begins or qualify for a hardship exemption through the federal government.

The policy form number for Bluish Habitation^SM with Novant Wellness and Bluish Domicile^SM with UNC Wellness Brotherhood, Blue Local^SM with Atrium Health, Blue Local^SM with Wake Forest Baptist Wellness and Blue Value^SM is ACAPOS-I, 5/21. The policy form number for Blue Advantage^® is NGFPPO-I, v/21. All plans may not be available in all geographic areas. This webpage contains information only. It is not your insurance policy. Your policy and application are your contract. If there is any difference between this webpage and the policy, the provisions of the policy will control.

Bluish Cross NC has collaborated with Novant Health to bring you Blue Home with Novant Health. Blue Home with Novant Health is a health insurance program offered by Blue Cross NC that provides access to a limited network of providers. Novant Health is an contained company that is solely responsible for the physicians and medical facilities it owns and operates. Novant Health does not offer Blue Cross or Blue Shield products or services.

Blue Cross NC has collaborated with UNC Health to bring yous Blue Habitation with UNC Wellness Brotherhood. Blueish Home with UNC Health Alliance is a health insurance programme offered by Blue Cantankerous NC that provides access to a express network of providers. UNC Health is an independent company that is solely responsible for the physicians and medical facilities it owns and operates. UNC Wellness does not offering Blueish Cross or Blue Shield products or services.

Bluish Cantankerous NC has collaborated with Atrium Health to bring you Blue Local with Atrium Health. Blue Local with Atrium Wellness is a health insurance programme offered by Blue Cantankerous NC that provides access to a express network of providers. Atrium Health is an independent company that is solely responsible for the physicians and medical facilities it owns and operates. Atrium Health does not offering Bluish Cross or Blue Shield products or services.

Blue Cross NC offers several decision back up tools, such as Discover a Doctor, to aid members in making decisions around their health care feel. These tools are offered for member convenience and should be used only every bit reference tools. Members should consult their own legal counsel, tax advisor or personal physician equally applicative throughout their health care experience.

The federal government determines eligibility and subsidy corporeality for health insurance plans purchased on the federally facilitated Market place. Details can exist found at HealthCare.gov.
Prime Therapeutics is an independent company that is solely responsible for the services it provides. It does not offering Blueish Cross or Blue Shield products or services.
1

Preventive intendance services as divers by recent federal regulations are covered at no accuse to you lot in-network. Federal and land-mandated preventive services are available out-of-network, for which members will pay deductible and coinsurance, plus charges over the allowed amount. Visit BlueCrossNC.com/Preventive for examples of preventive care services.
ii

Available on select plans in select counties.
3
4

Telehealth benefits available to all plans either from Blue Cross NC or through the provider network. Blue Cross NC provides the telehealth program for your convenience and is non liable in any way for the goods or services received. Blue Cross NC reserves the right to discontinue or modify the program at any time without prior notice. Decisions regarding your care should exist fabricated with the advice of a doctor. Depending on your program, selected programs may not exist available to you at this time. Check with Blue Cross NC Client Service to make up one's mind your eligibility. Blueish Cantankerous NC has contracted with a third-party vendor independent from Blue Cross NC to bring you telehealth benefits.
5

Blue365 offers access to savings on items that members may purchase directly from independent vendors, which are different from items that are covered under the policies with Blueish Cross NC. Blue Cross and Blue Shield Association (BCBSA) may receive payments from Blue365 vendors. Neither Blue Cantankerous NC nor BCBSA recommends, endorses, warrants or guarantees any specific Blue365 vendor or item. This program may be modified or discontinued at any time without prior detect. Visit www.blue365deals.com/terms-use for complete terms of use.
6

Blue Cross NC provides tobacco cessation and diabetes reversal programs for your convenience. Blue Cross NC is not liable in any way for the goods or services received through the respective vendors. Blue Cross NC reserves the right to discontinue or change the plan at any time without prior notification. Decisions regarding your care should exist made with the communication of your dr.. Bank check with Blue Cross NC Customer Service to determine your eligibility. Blue Cross NC has contracted with a third-party vendor independent from Blue Cross NC to bring yous these offerings.
7

Concluding decision of hardship eligibility for catastrophic health plans can only be obtained through the Wellness Insurance Market place atHealthCare.gov.
All other merchandise names are the property of their respective owners.
U21561, 12/21

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Source: https://www.bluecrossnc.com/shop-plans/individual-and-family-plans

Insurance for Just One Person of the Family Through Aca

Health Plans for
Individuals and Families

Choose Wisely. Cull Blueish℠.