Important: The information on this page is for current (2017) plan members enrolled in the 80/20 Plan for Active Members. To view information on 2018 plans including rates and what’s new for Active Members, please click the Learn More button.
The 80/20 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)
A strong emphasis on preventive
Additionally, members in this plan have the ability to lower the
employee-only monthly premium by completing wellness activities.
Care Act (ACA) Preventive Services performed by an in-network provider
are covered at 100% in this plan, which means there is no charge to
2017 Affordable Care Act (ACA) Preventive Medications List
2017 Uniform Summary of Coverage - Enhanced 80/20 Plan
2017 80/20 Benefits Booklet
2017 Plan Comparison Chart
2017 80/20 Preventive Services Summary
Although your 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
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.