Medical Plan

July 1, 2017 Highlights:

  • Medical plans moved from the BlueCross BlueShield (BCBS) Blue Options to the BCBS Blue Value network for North Carolina providers. The Blue Value Network is a narrower network to drive utilization to high-quality providers offering deeper discounts. Services outside North Carolina will continue to be provided through the BCBS Blue Options PPO network.
  • Autism benefits have been expanded to include Adaptive Behavioral Treatment (ABT) with an annual maximum of $40,000 per member per year. ABT is covered under the medical plan, and will be administered through Carolina Behavioral Health Alliance (CBHA). Members can access ABT services by calling CBHA at 800.475.7900.

Medical Plans

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

 Plan Feature
Low Plan   High Plan  
In-NetworkOut-of-NetworkIn-NetworkOut-of-Network
Deductible
Individual$1,000$2,500$500$1,250
Family*$2,500$6,250$1,250$3,125
Co-insurance Coverage
(after deductible, plan pays)
80%
60%
90%
70%
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$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.

 

ID Cards

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

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

Summary of Benefits and Coverage

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

Medical Plan Guidebooks

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.

Important Notifications

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:

  1. Got to BCBS
  2. Click Find a Doctor (top right screen)*
  3. Click the box, Individuals, Families & Groups
  4. Go to “Choose a plan to search”
  5. In the drop down box, select Blue Value
  6. Click Search
  7. Click Find a Doctor or Facility
  8. 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).