Both plans offer Prescription and Behavioral health coverage.
Information about behavioral health plan administrator (CBHA) data incident.
Deductible
Low Plan:
Individual: $1,250 in-network, $3,125 out-of-network; Family: $3,125 in-network, $7,800 out-of-network
High Plan:
Individual: $750 in-network, $1,875 out-of-network; Family: $1,875 in-network, $4,675 out-of-network
Out-of-Pocket Maximum
Low Plan:
Individual: $4,000 in-network, $10,000 out-of-network; Family: $10,000 in-network, $25,000 out-of-network
High Plan:
Individual: $3,000 in-network, $7,500 out-of-network; Family: $7,500 in-network, $18,750 out-of-network
TELEHEALTH SERVICES
Wake Forest University offers a telehealth option with Teledoc through BlueCross and BlueShield of North Carolina for
both medical plans. These secure video consults, at a $10 copay, are a good option for minor health issues when you cannot see your regular doctor. You can register online or call 1-800-Teladoc, (1-800-835-2362). Learn more about Teledoc by reviewing this flyer and FAQs.
Enrolling or Making Changes
New Hires
- Enrollment is completed in Workday during the onboarding process.
- If adding a spouse and/or dependent child, submit the required dependent verification documentation.
- You will receive an ID card from BCBSNC.
Throughout the Year
- Log into Workday to elect coverage throughout the year following a qualifying event.
- Provide supplemental documentation for the event.
- If adding a spouse and/or dependent child, submit the required dependent verification documentation via Workday within 30 days of the event, or by the Annual Benefits Enrollment deadline.
- If you need a replacement ID card, call BCBSNC at (877) 275-9787.
Resources
- Premiums
- BCBSNC Medical Claim Form
- Preventive Care
(Services covered at 100% per Health Care Reform) - Machine Readable Files
- Spousal Surcharge
- Tobacco Cessation
Low Plan
- Low Plan Member Guide
- Low Plan Member Guide (Charlotte Version)
- Summary of Benefits and Coverage – Low
- Summary of Benefits and Coverage – Low (Charlotte Version)
High Plan
Prescription
If you have elected medical coverage through Wake Forest, you are automatically enrolled in the prescription drug plan. The Low and High Plans offer the following in-network copayments for prescription drugs:
- Generic brand: $15
- Preferred brand: $30
- Non-preferred brand: $60
- Specialty: 10%, minimum of $50, maximum of $100
Provider
OptumRx
(Website includes Diabetic Sense Program Information, Drug Cost Calculator, Covered Drug Lists, Drug Dictionary and Drug Interaction Tool, Pharmacy Locator, and Copayment Information)
Mail Order
Cost savings
Convenient ordering
Expedited shipping
Delivery tracking
Flexible payment options
Refill reminders
Mobile app
Find more information on the OptumRx website.
Preferred Network*
Walgreens
Rite Aid
Walmart
Sam’s
Publix
Kroger
Harris Teeter
*Non-preferred pharmacies will apply a $5 additional copayment. Non-preferred pharmacies include but are not limited to Novant Health and Target. Pharmacy network status is subject to change; contact OptumRX with any questions regarding the network status of your pharmacy.
Enrolling
- If you have elected Wake Forest medical coverage, you are automatically enrolled in the prescription drug plan at no additional cost.
- You will receive a separate ID card, and you may request a new copy by calling OptumRx at (888) 869-4600.
Behavioral
If you have elected medical coverage through Wake Forest, you are automatically enrolled in the behavioral health plan. Licensed clinical case managers will connect you or your covered family members with in-network providers, specializing in mental health and substance abuse issues. The behavioral health plan includes coverage for Adaptive Behavioral Treatment (ABT). There is a separate $1,000 out-of-pocket maximum for both in- and out-of-network providers, which includes office visit copays and coinsurance amounts associated with mental health and substance abuse services coordinate through CBHA.
Provider
Carolina Behavioral Health Alliance (CBHA)
Contact CBHA at 1 (800) 475-7900 (located on the back of your medical ID card) for a confidential assessment and service.
Inpatient Care
Low Plan: 100% covered in-network, 60% covered out-of-network
High Plan: 100% covered in-network, 70% covered out-of-network
Outpatient Care
Low Plan: $30 copayment in-network, 60% covered out-of-network
High Plan: $30 copayment in-network, 70% covered out-of-network
Enrolling
- If you have elected Wake Forest University medical coverage, you are automatically enrolled in the behavioral health plan at no additional cost.
- You will not receive a separate ID card.
- You can access Adaptive Behavioral Treatment services by calling CBHA at (800) 475-7900. A clinician will help determine the services needed, the diagnosis, treatment planning, or therapy, and will direct you to an in-network provider.
Resources
- CBHA Website (Provider Search, Disease Management Program, Alcohol Assessment, Opiates Assessment, Depression Assessment, Information on support groups and community resources, Articles and e-Books about alcohol, depression, and drug abuse)
- Summary Plan Description
Guidebook
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.
Wake Forest University Human Resources
2598 Reynolda Rd, Winston-Salem, NC 27106 | P.O. Box 7424
AskHR@wfu.edu | P (336) 758-4700 | F (336) 758-6127
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