Blue Advantage® Summary
- You pay convenient copayments or coinsurance for things like primary care visits, specialist office visits and prescription drugs.
- Costs as low as $15 for copayments and $10 for generic prescription drugs.
- Offers low-cost premium options to fit most budgets.
- Easy to use with no claims to file in network.
Blue Options HSA (SM) Summary
- Offers lower premiums typical of high-deductible health plans.
- Offers 100% coverage for most preventative care services before your deductible is met.
- Offers coverage for prescription drugs. Discounts available in network.
- HSA contributions are tax deductible.
With Dental Blue, members don’t pay a deductible for check-ups or diagnostic and preventive services.
Check-ups and cleanings are covered twice per benefit period. Plus, members can visit any licensed dentist they choose. There are no “in-network” restrictions.
Members pay a $75 annual deductible and 50 percent coinsurance and are covered for both basic services like routine fillings and extractions, and major services including crowns, bridges and dentures.
Applicants can choose Dental Blue coverage for themselves, their children or the entire family. There are three convenient payment options: monthly bank draft, semiannual payment or annual payment.
| Type of Coverage | Plan Benefits1 |
| Preventive Services Routine oral exams Adult & child cleaning Bitewing x–rays Pulp testing Annual fluoride cleaning (members through 18–years–old only) Palliative emergency treatment & emergency oral examinations Other diagnostic & preventive services Sealants (members 5-15 years old only) |
100% |
| Basic Services Routine fillings Space maintainers (members under 16–years–old) Endodontics Simple extractions Stainless Steel Crowns Oral surgery Other basic services |
60% |
| Major Services Gingival curettage Gingivectomy and gingivoplasty Periodontal maintenance Inlays and onlays (once per 5 years) Porcelain Crowns Dentures Bridges Other major services |
50% |
| Deductible, basic and major services | $75 |
| Annual maximum, all services2 | $1,000 |
1. Based on allowed amount, as determined by BCBSNC. The allowed amount may be substantially less than the provider’s actual charge. You will be responsible for the charges above the allowed amount, in addition to any deductible and coinsurance applied.
2. Annual maximum on all services is $1,000 (includes diagnostic and preventive, basic and major services).