Local Group Health, Dental and
Vision Plans for Businesses

Plans and Programs Designed to
Fit Your Employees’ Needs

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Local Group: Companies with 50 or fewer full-time employees

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Local Group Plan Type and Network

The larger the network, the more doctors and pharmacies there are in that network. Larger networks tend to have fewer limits when you need to find a doctor or prescription drugs.

You’ll save the most money when you see a doctor or visit a pharmacy in your plan’s network.

 

Blue Options® and Blue Options® 1-2-3℠

  • Largest provider network
  • Integrated prescription drug benefit
  • Available in all 100 counties

Available in a 1-2-3 benefit tiering featuring:

  • Copayments for primary care, urgent care and telehealth1
  • Cost sharing for the other services
  • Increases employee engagement

 

network map for Blue Options

Our reach goes way beyond North Carolina, too. With the BlueCard® program, your coverage extends worldwide,
which means you have coverage at home and when you travel.2

Blue High Performance Network℠ (BlueHPN℠)

 

  • Significant savings over our industry-leading PPO*
  • Carefully selected network of doctors and hospitals consistently delivering higher-quality care at lower costs
  • Engagement tools and decision support for employees

     

 

Available to residents of the Charlotte-Concord-Gastonia-York, Hickory-Statesville, Raleigh-Durham-Chapel Hill and Winston-Salem-Greensboro-High Point regions of the Carolinas*

network map for Blue Options

Plus seamless in-network only access across 65+ major U.S. markets*

network map for BlueHPN

* Price position is an average based on a comparison of 1Q 2022 rates across a representative sample of plans with comparable plan designs. Actual price positions will vary depending on plan design and policy effective date. Results are subject to change due to issuer rate revisions. Market footprint for 1/1/2023. Urgent and emergent care benefits in non-BlueHPN markets. Market footprint subject to change. In the North Carolina market, BlueHPN available as of 1/1/2023 to employees who live in one of these counties: Alexander; Anson; Cabarrus; Caswell; Catawba; Chatham; Cleveland; Davidson; Davie; Durham; Forsyth; Gaston; Granville; Guilford; Iredell; Lincoln; Mecklenburg; Orange; Person; Randolph; Rowan; Stanly; Stokes; Union; Wake; Wilkes; Yadkin; York County, SC.

No Commission Plans

We offer no commission plans for groups who are not using the service of an agent. These offer a more affordable option when choosing a medical plan.

  • Lower-cost plans for the same high-quality care
  • Dedicated account management and service
  • Various network options available – from our Blue Options full statewide network to BlueHPN offering additional savings
  • On-demand access to the employer service portal for plan information and updates – plus online tools to put you in control of your account, including the employee roster, enrollment maintenance and detailed monthly billing statements

network map for Blue Options

“The large network of providers means my employees have a wide selection of doctors to take care of them and their families. Also, when I have questions about our coverage, my Blue Cross NC rep responds so quickly. It’s amazing to have a team supporting me and my business.”

– ONUG Communications, Inc.

Local Group Plan Options

Dual-Option Plans

No matter the size of your group, you may offer your employees the ability to choose between two health plans3 for the benefits that best suit their needs. All you have to do is establish your base plan and choose another plan from our many options. Employers often choose a base and a buy-up option for those who want to spend less or need more benefits.

  • Employer contribution – Set your contribution to your premium as a fixed dollar amount or fixed percentage for the base plan. Employees who want the richer benefit plan option can choose to buy-up to that plan. Your cost stays the same.
  • Broad choice of plan designs – You’ll be able to adjust your plans on an annual basis as your business needs change.

Health Savings Accounts (HSAs)

Our unique relationship with HealthEquity® allows us to offer tax-favorable HSAs that are fully integrated with a member’s health plan.

Benefits:

  • Pair with any eligible high-deductible health plan on any network
  • Employer and/or employee funds the account with pre-tax dollars up to limits set by the IRS
  • Funds may be used for qualified medical expenses4
  • Unused amounts roll over to the next year without penalty

Balanced Funding

The balanced funding5 option offers groups with at least 20 eligible employees the advantages of a self-funding plan with the financial protection and predictable monthly payments of a fully insured plan.

Benefits:

  • Potential savings that can come from self-funding
  • Predictable monthly rates, similar to a fully insured plan
  • Integrated stop-loss coverage for protection against high-dollar claims
  • Money-back opportunity – with balanced funding, Blue Cross NC will refund a portion of your claims surplus if you renew your coverage6

Total Health Bundling

Make the most of your health care budget with Total Health Bundling from Blue Cross NC. When you combine your Blue Cross NC medical plan with our dental, vision or select ancillary coverage through Mosaic Group℠, we’ll give you a credit on your monthly bill.7

Don’t Forget Dental and Vision

Employees get a simplified experience with a single member ID card and portal – helping them create a total health connection.

Dental Makes a Difference

Proper oral health affects our overall health and well-being. That’s why Blue Cross NC takes an integrated approach to dental and medical coverage. From taking care of your total health to lowering costs, integrating with us is a clear win-win for you and your employees. With each of our flexible plans, you get:

  • One combined bill and one member ID card
  • A dedicated account management support team
  • Broad local and national networks
  • One portal with access to all Blue Cross NC medical, dental and vision plans through Blue ConnectSM
  • Dental care gap reminders for medical members with certain health conditions
  • Options for rollover benefits, preventive not applying to the annual maximum, orthodontia with no age limit and more

Along with easy administration and access, we look out for your employees by offering these features as standard:

  • Periodontal maintenance covered under basic services
  • Composite (white) fillings covered on all teeth
  • No missing tooth exclusion or limitation
  • Sustained release therapeutic injections to minimize the need for opioid prescriptions
Dental Blue® PreferredSM (PPO)
  • Saves money for you and your employees with lower premiums and higher benefits for staying in-network*
  • Three cleanings and exams come standard – unique to Dental Blue Preferred
  • Preventive Only and Preventive & Basic Only plans available
  • Options available with no annual maximum on preventive services
Dental Blue®
  • Indemnity-like plan with same benefit level at any provider
  • Your employees can save on out-of-pocket expenses by using participating providers*
  • Preventive Only and Preventive & Basic Only plans available
  • Options available with no annual maximum on preventive services
Dental Blue® SelectSM (shelf-rated)
  • Indemnity-like plan with reliable, steady rates because it’s community (shelf) rated
  • Three plans from standard to enhanced, including options with implants and orthodontia
  • Lifetime deductible your members only need to meet once

* Non-participating providers may bill members the balance for amounts higher than what is allowed for out-of-network.

Dental Care Resource Center

The Dental Care Resource Center has the information and tools you need to get a healthy smile. Read helpful articles, get tips for good dental health, check symptoms or find answers to frequently asked questions.

Visit Our Dental Care Resource Center

Vision Plans

Blue 20/20℠ Vision Plans to Meet Your Employees’ Needs

Our Blue 20/20 plans offer your employees a wide network of vision providers. They can choose from independent eye doctors or retail chains and online vision products. Each of our plans has unique features along with great coverage for both in- and out-of-network benefits.

You can choose between employer-paid or voluntary coverage. And, if you purchase with a medical plan, you’ll get one combined bill and one enrollment to save you time!

 

Choose from Four Flexible Plan Options:

Blue 20/20 Exam Only Blue 20/20 Exam Plus

Blue 20/20 Lens & Frame Only

Blue 20/20 Lens & Frame Plus
A comprehensive eye exam benefit A comprehensive eye exam with allowance or copay benefits for materials An easy-to-use materials allowance An easy-to-use materials allowance paired with a routine comprehensive eye exams
Coverage for routine comprehensive eye exams Coverage for routine comprehensive eye exams Routine comprehensive eye exams NOT COVERED Coverage for routine comprehensive eye exams
  Allowance for frames AND a choice of a copayment for lenses OR an allowance for contact lenses  Flat dollar allowance for prescription eyeglasses or contact lenses Flat dollar allowance for prescription eyeglasses or contact lenses
Additional In-Network Savings*
An average of 35% off complete pairs of prescription eyeglasses and prescription sunglasses on initial purchase, and additional pair discount of 40% off 40% off additional complete sets of prescription eyeglasses and prescription sunglasses 40% off additional complete sets of prescription eyeglasses and prescription sunglasses 40% off additional complete sets of prescription eyeglasses and prescription sunglasses
15% off conventional contact lenses
Discounts of 15% off retail or 5% off promo price for LASIK or PRK
20% off select non-covered items, including non-prescription sunglasses
Special offers on Blue Connect for discounts on frames and lenses, contacts and other vision services and items

* No discounts for Out-of-Network 

“A rare and almost universally fatal pediatric ailment is a parent’s worst nightmare. Issues with insurance coverage is the last thing one should be considering in such a scenario, albeit such is often the case. Despite no facility in North Carolina being able to provide the needed care, our first choice of a leading out-of-state facility was happily in-network. They had her treatment plan approved in a matter of 24-48 hours with our insurance. We can’t know what tomorrow holds, but thankfully in our recent circumstance I had top-tier coverage from Blue Cross NC.”

– Dave P.

Local Group Health and Wellness8

Blue Connect
Member Site

Log in or register on Blue Connect

Blue Connect is your personal guide to the tools9 you need to manage your health plan and health care. You can:

  • View your deductible, claims and benefits in an instant
  • Access important documents like your digital member ID card no matter where you are
  • Get health tips, articles and videos on everything from weight loss to prescription costs to dental health
     

Log In or Register

Blue Rewards℠
Program

Our Wellness Programs - pdf

Our Blue Rewards program10 encourages participation in activities that can improve your employees’ health and well-being. Rewards come in the form of gift cards for activities like registering for Blue Connect, sharing contact preferences or participating in a condition care or care management program.

 




 

Blue365® Health & Wellness Discounts

Learn more about Blue365

Blue365 gives you access to savings across all aspects of your life – including 20% off on Fitbit® devices; over $800 off LASIK; discounts on healthy, organic meal delivery services like Sunbasket; and much more!11






 

Blue365

Preventive Care
Covered Services

Our Preventive Care Services

Our Preventive Care Services list shows you which services and prescriptions are considered preventive and covered at 100%.


Preventive Care Services

Health Line Blue℠
Nurse Line

Learn more about Health Line Blue

Health Line Blue connects you to a trained nurse, 24/7, to get your health questions answered.12

Health Line Blue

Prime Therapeutics® Prescriptions by Mail

Prime Mail Overview - pdf

Prime Therapeutics13 (Prime) Prescriptions by Mail delivers a 90-day supply of medications by mail. No driving. No waiting.

Prime Overview

Request a Quote

We’d like to help you make the right choice for your business.

Please fill out the following form​ if you have 1-50 Full-Time Employees.

 

Dental B, 6/22; Dental B Select, 6/22; Dental B PPO, 6/22; VIS-EO, 6/22; VIS-EP, 6/22; VIS-LFO, 6/22; VIS-LFP, 6/22; SG BHPN, 5/22; SGBOptions, 5/22.

U40244, 11/22

  • This is a partial list of services not covered by your dental benefits plan. Refer to the member booklet for a full list of exclusions: Not clinically necessary services, Hospitalization for any dental procedure, Dental procedure solely for cosmetic or aesthetic reasons, Dental procedures not directly associated with dental disease, Procedures not performed in a dental setting, Procedures that are considered experimental, Drugs or medications obtainable with or without a prescription, unless they’re dispensed and utilized in the dental office during the patient visit, Services related to temporomandibular joint (TMJ), Services received prior to member’s effective date, Oral orthotic devices, palatal expanders and orthodontics, except as specifically covered by your dental benefit plan.

  • This is a partial list of services not covered by your vision benefits plan. Refer to the member booklet for a full list of exclusions: Orthoptic or vision training, subnormal vision aids and any associated supplemental testing, Aniseikonic lenses, Medical and/or surgical treatment of the eye, eyes or supporting structures, Any eye or vision examination, or any corrective eyewear required by a policyholder as a condition of employment, Safety eyewear, Services provided as a result of any workers’ compensation law, or similar legislation, or required by any governmental agency or program whether federal, state or subdivisions thereof, Plano (non-prescription) lenses and/or contact lenses, Non-prescription sunglasses, Two pairs of glasses in lieu of bifocals, Services rendered after the date an insured person ceases to be covered under the policy, except when vision materials ordered before coverage ended are delivered, and the services rendered to the insured person are within 31 days from the date of such order, Services or materials provided by any other group benefit plan providing vision care, Lost or broken lenses, frames, glasses or contact lenses will not be replaced except in the next benefit frequency when vision materials would next become available.

  • HealthEquity, Mosaic Group, Fitbit and Sunbasket are independent companies that are solely responsible for the services they provide. They do not offer Blue Cross or Blue Shield products or services.

  • All other trade names are the property of their respective owners.

  • 1

    Telehealth benefits are available on all plans either from Blue Cross NC or through the provider network. Blue Cross NC provides the telehealth program for your convenience and is not liable in any way for the goods or services received. Blue Cross NC reserves the right to discontinue or change the program at any time without prior notice. Decisions regarding your care should be made with the advice of a doctor. Depending on your plan, selected programs may not be available to you at this time. Check with Blue Cross NC Customer Service to determine your eligibility. Blue Cross NC has contracted with a third-party vendor independent from BlueCross NC to bring you telehealth benefits.

  • 2

    Blue Cross Blue Shield Association (BCBSA), www.bcbs.com/learn/glossary#B (Accessed August 2022). BlueCard coverage varies for each BCBS Plan. For more complete details, including benefits, limitations and exclusions, please refer to your certificate of coverage.

  • 3

    No restriction on dual-option plans based on group size, but some restrictions may apply based on health plan options. Talk to your Blue Cross NC representative for full details.

  • 4

    Withdrawals are tax-free only if used for qualified medical expenses. See irs.gov for a detailed description of qualified expenses. Consult your own legal counsel/tax advisor for any legal/tax questions.

  • 5

    Special conditions apply. Please contact us at small.business@bcbsnc.com for more details.

  • 6

    The refund only occurs if the group renews with Blue Cross NC. Refunds may not be guaranteed or may not exist depending upon claims liability.

  • 7

    Groups and agents may contact their Blue Cross NC sales representative for program eligibility details. Total Health Bundling is generally available to new and qualified renewing fully insured 1-50 ACA medical groups who add new ancillary lines of coverage. The medical and ancillary plans must have the same group number and the same effective date. Not all groups may qualify. Blue Cross NC has the sole discretion to offer this program, and it may be subject to change or termination at any time.

  • 8

    Blue Cross NC offers wellness programs as a convenience to aid members in improving their health; results are not guaranteed. Blue Cross NC may contract with independent third-party vendors for the provision of certain aspects of our wellness programs and is not liable in any way for goods or services received from them. These vendors do not offer Blue Cross or Blue Shield products or services. Blue Cross NC reserves the right to discontinue or change our wellness programs at any time. These programs are educational in nature. They are intended to help members make informed decisions about their health and comply with their doctor’s plan of care. Decisions regarding care should be made with the advice of a doctor.

  • 9

    Blue Cross NC offers several decision support tools, such as Find a Doctor and Find Medical Cost, to aid members in making decisions around their health care experience. These tools are offered for member convenience and should be used only as reference tools. Members should consult their own legal counsel, tax advisor or personal physician as applicable throughout their health care experience.

  • 10

    Your chance to earn Blue Rewards may be available for a limited time only. Please note that it may take time for activities to show as completed in the Blue Connect℠ Activity Center and for you to receive the certificate to redeem your gift card. All federal, state and local taxes on gift cards, if applicable, are the sole responsibility of the member. Members should consult their tax professional for any advice on whether or not gift cards are considered reportable income. Rally Health is an independent company that is solely responsible for the gift card services it is providing. Rally Health does not offer Blue Cross or Blue Shield products or services. Must be at least 18 years old to participate. Participation restrictions apply based on plan type, and rewardable activities are not available for all plan types. Visit the Activity Center on Blue Connect for activities currently available to you. Blue Cross NC reserves the right to change or discontinue Blue Rewards at any time, including changing dollar amounts and available rewards, without prior notification. Visit BlueCrossNC.com/BlueRewards for full program terms and conditions. Consult with your benefits administrator or contact Blue Cross NC Customer Service for questions or support.

  • 11

    Blue365 offers access to savings on items that members may purchase directly from independent vendors, which are different from items that are covered under the policies with Blue Cross NC. The Blue Cross and Blue Shield Association (BCBSA) may receive payments from Blue365 vendors. Neither Blue Cross NC nor the Blue Cross Blue Shield Association recommends, endorses, warrants or guarantees any specific Blue365 vendor or item. This program may be modified or discontinued at any time without prior notice. This program is provided by BCBSA and not Blue Cross NC.

  • 12

    Blue Cross NC provides Health Line Blue for your convenience and is not liable in any way for services received. Decisions regarding your care should be made with the advice of a doctor. Blue Cross NC has contracted with an independent third-party vendor to bring you Health Line Blue — and reserves the right to discontinue or change the program at any time.

  • 13

    Prime Therapeutics is an independent company that is solely responsible for providing pharmacy benefit management services. Prime Therapeutics does not offer Blue Cross or Blue Shield products or services.