Wake Forest offers two comprehensive medical plans to meet the diverse needs of our benefits-eligible faculty and staff members and their eligible dependents:
- Low Plan: lower premiums, with a larger deductible and out-of-pocket maximum.
- High Plan: higher premiums, with a lower deductible and out-of pocket maximum.
Both plans offer medical coverage through BCBS, prescription drug coverage through OptumRX, and behavioral health coverage through Carolina Behavioral Health Alliance (CBHA). To receive care through CBHA, contact them directly at 1.800.475.7900 to set up an initial appointment with a provider.
Annual Deductible, Coinsurance, Out-of-Pocket Maximums, and Copayment Details
Low Plan High Plan
In-Network Out-of-Network In-Network Out-of-Network
Individual $1,000 $2,500 $500 $1,250
Family* $2,500 $6,250 $1,250 $3,125
(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)
Individual $4,000 $10,000 $2,500 $6,250
Family $10,000 $25,000 $6,250 $15,625
Routine Office Visit Co-pay $25 Subject to deductible & co-insurance $25 Subject 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.
BCBS medical ID cards maybe be requested by calling 877.275.9787 (plan number 009335).
OptumRx prescription ID cards may be requested by calling 844.265.1875 (plan number 009335).
Preventive Care listing of services covered at 100% per Health Care Reform.
Summary of Benefits and Coverage
Medical Plan Guidebooks
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.
Important Notification regarding in-network labs effective July 15, 2015.
Network Information and Verification
It is recommended that you verify network status for providers and facilities, as the network is evaluated and updated each January. To verify network status in the Blue Value Network:
- Got to BCBS
- Click Find a Doctor (top right screen)*
- Click the box, Individuals, Families & Groups
- Go to “Choose a plan to search”
- In the drop down box, select Blue Value
- Click Search
- Click Find a Doctor or Facility
- Follow the prompts to narrow your search
*You may also log into your BCBS account and then search for a provider or facility.
Members may still utilize the out-of-network providers or facilities, however the out-of-network charges will apply (deductible, copayments, coinsurance, and out-of-pocket maximums).