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My Plan Benefits

80_20_family275.jpgThe 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 health

Additionally, members in this plan have the ability to lower the employee​-only monthly premium by completing wellness activities.

Affordable 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 you.  

80/20 Important Documents

80/20 Plan Rate Sheets (2017)

Medical Policies

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 prevail.

Prior Authorization

Certain services require prior review and certification before they can be covered by your health insurance plan. Click here​ for more information.

Appeals

​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 Policies