General Coverage Information

What happens to my coverage if I move out of the area?

Answers vary according to your plan. For better information, please visit the Help section and FAQs on your plan's member page.

What happens to my coverage if I quit my job or I'm laid off or fired?

If your employment ends, you may have certain options such as continuing health insurance under this health benefit plan or purchasing a nongroup conversion policy. Contact your employer or group administrator to learn about the options available.

Continuation of Coverage Under COBRA
Under a federal law known as COBRA, covered employees and their dependent(s) of employers with 20 or more employees can elect to continue coverage for up to 18 months by paying applicable fees to their employer in the following circumstances:

Your employment is terminated (unless the termination is the result of gross misconduct)
Your hours worked are reduced, causing you to be ineligible for coverage

For more information about your coverage options under COBRA, contact your group administrator or refer to your Member Guide.

Continuation of Coverage Under State Law
Under state law, employees and their dependent(s) of any size group have the option to continue group coverage for 18 months from the date that they cease to be eligible for coverage under the health benefit plan. Employees are not eligible for continuation under state law if:

The employee is currently eligible for COBRA coverage
The employee's insurance is terminated because they failed to pay the appropriate contribution
The employee or their dependent(s) requesting continuation are eligible for another group health plan
The employee was covered less than three consecutive months prior to termination.

You must notify the group of your intention to continue coverage and pay the applicable fees before your period of eligibility has ended. The state law benefits run concurrently and not in addition to any applicable federal continuation rights.

For more information about your coverage options under state law, contact your group administrator or refer to your Member Guide.

Purchasing a Non-Group Conversion Policy
If you would like more information about purchasing a non-group policy, please contact Customer Service at 1-877-258-3334 or visit the Plans for Individuals section of our site.

What happens to my coverage when I turn 65?

When you reach age 65, you may be eligible for Medicare Part A hospital and Medicare Part B medical benefits. If you become eligible for Medicare and you remain actively employed with your current employer, your health plan will coordinate with Medicare and pay either primary or secondary benefits. Just before either you or your spouse turns 65, you should contact the nearest Social Security office and apply for Medicare benefits. They can tell you what Medicare benefits are available.

What happens to my coverage if I retire?

You may be eligible to continue your coverage under your group health plan for a certain period of time after you retire. Your group administrator will advise you about continuation of coverage under your health benefit plan.

What if I become disabled?

If you become temporarily disabled, you would first exhaust short term/long term disability periods with your company and retain coverage under your group plan as long as you are employed.

In the event that you become permanently disabled, contact the nearest Social Security office and apply for Medicare benefits. They can tell you what Medicare benefits are available. You should also supply Blue Cross NC with a copy of your Social Security card as evidence of your disability and our Group Membership Services Department will document your status.

Your employment is terminated (unless the termination is the result of gross misconduct)
Your hours worked are reduced, causing you to be ineligible for coverage

For more information about your coverage options under COBRA, contact your group administrator or refer to your Member Guide.

The employee is currently eligible for COBRA coverage
The employee's insurance is terminated because they failed to pay the appropriate contribution
The employee or their dependent(s) requesting continuation are eligible for another group health plan
The employee was covered less than three consecutive months prior to termination.

For more information about your coverage options under state law, contact your group administrator or refer to your Member Guide.

If you become disabled while you are on a continuation plan, the following principle applies: Employees or their dependent(s) who are determined to be disabled under the Social Security Act within the first 60 days of continuation of coverage are eligible to extend their 18 months of continuation to 29 months. Your group administrator will advise you about continuation of coverage under your health benefit plan.

What if my spouse and I divorce?

If you divorce, your spouse's eligibility under your group health benefit plan will end. However, if eligible, a spouse may continue coverage under COBRA or under state law. For more information about your coverage options under COBRA, contact your group administrator or refer to your Member Guide. Your group administrator will advise you about continuation of coverage under your health benefit plan.

Continuation of Coverage Under State Law. You must notify your group of your intention to continue coverage and pay the applicable fees before the period of eligibility has ended. The state law benefits run concurrently and not in addition to any applicable federal continuation rights.

Is my child covered while in college?

Yes. A dependent child is eligible for coverage until their 26th birthday, regardless of whether or not they are in college. Please review your Member Guide or consult your employer regarding dependent eligibility requirements.

Do I have coverage for pre-existing conditions?

Review your Member Guide. Most employer groups require a 12-month waiting period for pre-existing conditions. However, the waiting period for pre-existing conditions is reduced by the amount of time spent on prior coverage if your prior coverage was terminated within 63 days of your new enrollment date. If you or your dependent(s) have such prior insurance, remember to include the effective termination dates of your previous coverage on your application. Please refer to your Member Guide for specific information about your policy. Your group administrator can also advise you about the length of your waiting period for pre-existing conditions, if applicable.