Medical

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Wake Forest University offers two Preferred Provider Plan (PPO) medical options:

  • Low Plan: Lower premiums, larger deductible and out-of-pocket maximum.
  • High Plan: Higher premiums, lower deductible and out-of pocket maximum.

Both plans offer Prescription and Behavioral health coverage.


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Deductible

Low Plan: 
Individual: $1,000 in-network, $2,500 out-of-network; Family: $2,500 in-network, $6,250 out-of-network

High Plan:
Individual: $500 in-network, $1,250 out-of-network; Family: $1,250 in-network, $3,125 out-of-network

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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: $2,500 in-network, $6,250 out-of-network; Family: $6,250 in-network, $15,625 out-of-network


Enrolling or Making Changes

New Hires

  1. Enrollment is completed in Workday during the onboarding process.
  2. If adding a spouse and/or dependent child, submit the required dependent verification documentation.
  3. You will receive an ID card from BCBSNC.

Throughout the Year

  1. Log into Workday to elect coverage throughout the year following a qualifying event.
  2. Provide supplemental documentation for the event.
  3. 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.
  4. If you need a replacement ID card, call BCBSNC at (877) 275-9787.

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

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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)

BriovaRx
(Specialty Pharmacy)

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Mail Order

Cost savings
Convenient ordering
Expedited shipping
Delivery tracking
Flexible payment options
Refill reminders
Mobile app

Find more information on the OptumRx website.

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Preferred Network*

Walgreens
Rite Aid
Walmart
Sam’s
Publix
Kroger
Harris Teeter

*An additional $5 copay will be required at non-preferred pharmacies.


Enrolling

  1. If you have elected Wake Forest medical coverage, you are automatically enrolled in the prescription drug plan at no additional cost.
  2. 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 has been expanded to include coverage for Adaptive Behavioral Treatment (ABT), up to $40,000 per member per year.

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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.

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Inpatient Care

Low Plan:  100% covered in-network, 60% covered out-of-network

High Plan: 100% covered in-network, 70% covered out-of-network

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Outpatient Care

Low Plan:  $25 copayment in-network, 60% covered out-of-network

High Plan: $25 copayment in-network, 70% covered out-of-network


Enrolling

  1. If you have elected Wake Forest University medical coverage, you are automatically enrolled in the behavioral health plan at no additional cost.
  2. You will not receive a separate ID card.
  3. 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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