Individual & Family Insurance

Blue Cross® and Blue Shield® of North Carolina offers many different types of health care plans for individuals under the age of 65 and their families. Opting for any of Blue Cross® and Blue Shield® of North Carolina’s health care plans will help you to avoid the Individual Mandate Penalty, as all plans meet ACA requirements. Though all plans have similarities and are high quality, the plans have differences that can help you to optimize your insurance for your needs.

Preferred Provider Organization Plans

Preferred Provider Organization Plans (PPOs) allow you to see any doctor or visit any medical facility that is in-network inside of the U.S. without a referral from a primary physician. Out-of-network doctors and offices are also typically covered but at a lower rate. Blue Cross NC’s PPO plan, Blue Advantage®, offers many options for doctors, specialists, and hospitals with flexibility in how much you pay for doctor visits and prescriptions.

Health Maintenance Organization Plans

Health Maintenance Organization plans (HMOs) require you to select a primary care physician that will then refer you to any specialists or hospitals that are in-network as necessary. HMO plans generally don’t cover out-of-network services except in the case of true emergencies. However, HMOs are lower in cost than alternative insurance plans. Blue Cross NC’s HMO plan, Blue Value℠, provides a large network of providers at some of the lowest costs of all the plans.

Point of Service Plans

Point of Service Plans (POSs) offer a compromise between HMOs and PPOs. Policyholders are required to select a primary care physician, who then makes referrals as necessary. Greater coverage is allowed, at a lower cost, but within a more limited network. Out-of-network physicians may be covered, but policyholders are required to track receipts and file paperwork to receive insurance benefits. Blue Cross NC’s POS, Blue Select®, offers policyholders a tiered plan with flexible copays based on the facility of choice.

Local-Major Medical Plans

Local-Major Medical Plans allow you to see doctors and visit facilities within a local area. Blue Cross NC’s Local-Major Medical Plan, Blue Local℠ with Atrium Health, offers huge savings and the convenience of high-quality care within one coordinated health care system in certain counties. Preventative care is covered at 100 percent and policy holders may choose from four different levels that have different premiums and copays. Blue Local℠ with Atrium Health plans can also be linked to HSAs.

Health Savings Account Plans

Health Savings Account Plans (HSAs) allow you to contribute money to a savings account that is available for you if you need to pay for medical costs. HSAs are tax-deductible and roll over from year to year, so you keep all of the money that you put in. HSAs can be used to supplement insurance plans with high deductibles, so that you have the money to cover the deductible in the case of a medical emergency.

Catastrophic Coverage Health Plans

Catastrophic Coverage Health plans meet all of the requirements of the ACA, but cover only three primary care visits a year before the deductible is met. The premiums for these plans are lower than other health care plans, but the out-of-pocket expenses for medical care may be higher. To qualify for a Catastrophic Coverage Health plan, you must be under 30 years old.

Child Only Coverage

Child Only health care coverage is insurance that covers children under the age of 18 that do not have a parent covered by insurance. This type of insurance is ideal for families that can’t afford to pay for insurance for parents, but wish to cover children so that they may receive regular health care services. Child Only Coverage covers immunizations, check-ups, and medications, as well as a portion of costs for emergencies and some major medical events.

Short Term Insurance

Short Term Insurance is health insurance that can be purchased for a term of a certain number of days or months that is decided upon by the insurance company and the policy holder. Short Term Insurance is meant to be a temporary solution until policy holders can establish a more permanent health care solution. Short term insurance is not considered minimum essential coverage under the ACA, so it is important to attain appropriate coverage in order to avoid the Individual Mandate Penalty.


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