Plan is a Preferred Provider Organization (PPO) plan administered by
Blue Cross and Blue Shield of North Carolina (BCBSNC). A PPO plan offers
freedom of choice among in-network providers, lower out-of-pocket costs
(copay only for most in-network office visits) and a strong emphasis on
preventive health. Affordable Care Act preventive services and
medications will require the applicable copay under this plan.
2018 Uniform Summary of Coverage
Members indicated as 50% or 100% contributory notes the percentage of the premium for which they are responsible.
Benefits Booklet provides a good overview of what services and products
are available to you under the PPO plans, the medical policies provide
detailed information around the circumstances under which certain
services and products are and are not covered. Medical policies can be
found here on the Blue Cross and Blue Shield website*.
* If any of
the State Health Plan medical policies conflict with the Blue Cross and
Blue Shield of North Carolina medical policies, the State Health Plan
medical policies will prevail.
Certain services require prior review and certification before they can be covered by your health insurance plan. Click here for more information.
If you disagree
with the way a claim has been handled, you can request an appeal or
grievance review. For the complete appeals process, please click here.
State Health Plan Enrollment Exceptions and Appeals
State Health Plan Policy on Arrears