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My Plan Benefits


80/20 Plan for Non-Medicare Retirees
80/20 Plan Overview

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) and 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

 

 

Members indicated as 50% or 100% contributory notes the percentage of the premium for which they are responsible.

 

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.

Formulary Exclusion Exception Process

Formulary Exclusion Exception Process

2018 Drug Cost Lookup and Pharmacy Locator Tools

 

CVS Caremark is the State Health Plan’s Pharmacy Benefit Manager. Click below to access the Drug Cost Lookup and Pharmacy Locator tools.

The Plan’s Pharmacy Benefit Manager, CVS Caremark, is another valuable resource as you navigate through your decisions. CVS Customer Service can be reached at 888-321-3124, or you can log in to your own account at www.caremark.com. Remember to always discuss your prescription options with your health care provider to find the most cost-effective therapy.

Please note: If a drug is not covered, the following advisory will appear under Plan Notes: “Not covered: Ask your doctor about alternatives.”

 
 
 
 
 
 

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​.

Blue Connect

 

Visit the Enroll Now/Access Benefits page to access Blue Connect. From there, you will log into eEnroll, the Plan's enrollment system, through the appropriate portal. Once you're logged into eEnroll, you will see a Blue Connect Quick Link on the left side of your screen. Blue Connect​ is your online resource that can help you manage costs, make more informed health decisions and reach personal health goals anytime.