News from Blue Cross NC

August 30, 2018


Blue Cross and Blue Shield of North Carolina (Blue Cross NC) announced several changes recently that could affect your members.

Blue Cross NC Opioid Epidemic Resource Website
Blue Cross NC has launched a website to help you and your members become more knowledgeable about the opioid epidemic in NC. The site was created to educate and collaborate with providers, provide outreach and engagement to members, and increase awareness while removing the stigma of addiction.

Pharmacy Changes Effective October 1, 2018
New Blue Cross NC Pharmacy Utilization Management changes will be effective October 1. Letters will be mailed to affected members the week of August 28th; this will include members who have received any of the affected medications in the past four months.

Members can find more information about prescription coverage and costs on the Blue Cross NC website.

Changes to Blue Cross NC Medical Plans – Routine Eye Exams
Starting January 1, 2019 in the major group market (100+), Blue Cross NC will be removing routine eye exams embedded within medical plans. This applies to non-grandfathered groups effective January 1, 2019 with renewal. In addition to their Large Group business (100+), this also applies to Small Group (26+) self-funded and 51+ fully insured group medical plans. This will take place effective January 1, 2019 and upon renewal.

Blue Cross NC Files to Lower ACA Rates
At the end of July, Blue Cross NC announced that they had filed an overall average rate decrease of 4.1 percent for 2019 Affordable Care Act (ACA) individual plans.

  • Rates are being reduced in the Triangle due to a new agreement with UNC Health Alliance, which will be the exclusive in-network provider for Blue Cross NC ACA plans in the Triangle
  • Blue Cross NC will no longer offer its Blue Local with Duke Health and WakeMed
  • Blue Cross NC mailed letters and sent emails to customers in early August.

TeleHealth (Self-Insured plans only)
If you are an employer with 250 members or more, starting with effective dates January 1, 2019 and after, you will have additional options with regards to Telehealth services through your Blue Cross NC medical plan. Services can include a Standard plan, Audio Only care, or telehealth that includes Behavioral Health and Dermatology.