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.