Medical Plan

Wake Forest offers two comprehensive medical plans to meet the diverse needs of our benefit-eligible faculty and staff members and their eligible dependents:

  • The High Plan
  • The Low Plan

Both plans are Preferred Provider Organization (PPO) plans. The High Plan has higher paycheck premiums, with a lower deductible and out-of-pocket maximum. The Low Plan offers lower paycheck premiums, with a larger deductible and out-of-pocket maximum.

Both plans offer BlueCross BlueShield of North Carolina (BCBSNC) medical coverage, OptumRx prescription drug coverage and Carolina Behavioral Health Alliance (CBHA) mental health coverage. To receive care through CBHA, please contact them directly at 1.800.475.7900 to set up an initial appointment with a provider.

ID cards are issued for BCBSNC and OptumRx. You may request a new BCBS ID card by calling 877.275.9787.

2016/2017 Summary of Benefits Coverage for the High and Low Plans.

Preventive Care listing of services covered at 100% per Health Care Reform.

Plan Details

Below is a brief overview of the two medical plans. Please refer to the High Medical Plan Guidebook and Low Medical Plan Guidebook for a complete overview.

The plans run on a fiscal year (July 1 – June 30), but the plan benefits, deductibles and out-of-pocket maximums run on a calendar year.

 Plan Feature
Low Plan   High Plan  
Co-insurance Coverage
(after deductible, plan pays)
Out-of-Pocket Maximum (deductible, co-insurance, co-pays, excluding CBHA services; there is an additional $1,000 OOP maximum for CBHA services)
Routine Office Visit Co-pay$25Subject to deductible & co-insurance$25Subject to deductible & co-insurance
Specialist Office Visit Co-pay$40 Subject to deductible & co-insurance$40 Subject to deductible & co-insurance

The above information is intended as a benefit summary only. It does not include all of the benefit provisions, limitations and qualifications. If this information conflicts in any way with the contract, the contract will prevail. Any services rendered under the CBHA benefit do not apply towards the BCBS annual deductible or co-insurance.

Important Notification regarding in-network labs effective July 15, 2015.