Retiree Information

2015 BCBSNC Health Benefit Highlights 

  BCBSNC - PPO 75 BCBSNC - PPO 85
Benefits In-Network Out-of-Network In-Network Out-of-Network
Deductible (Single/Family) $1500/$3000 $3000/$6000 $750 / $1500 $1250 / $2500
Out-of-Pocket Maximum (includes deductible) $4400/$8800 $8800/$17600 $3700/$7400 $7400/$14800
Office Visits - PCP $30 Copay 55% after deductible $20 Copay 65% after deductible
Office Visits - Specialist $45 Copay 55% after deductible $35 Copay 65% after deductible
Preventive Care 100% 55% after deductible 100% 65% after deductible
Urgent Care $45 Copay $45 Copay $35 Copay $35 Copay
Chiropractic Care - 24 days max per cal yr $45 Copay 55% after deductible $35 Copay 65% after deductible
Emergency Room $300 copay, then 75% after deductible (copay waived if admitted) $300 copay, then 75% after deductible (copay waived if admitted) $300 copay, then 85% after deductible (copay waived if admitted) $300 copay, then 85% after deductible (copay waived if admitted)
Copay for Inpatient Hospital (per Admission)  $200 $200 $200 $200
Inpatient Hospital 75% after deductible 55% after deductible 85% after deductible 65% after deductible
Outpatient Hospital 75% after deductible 55% after deductible 85% after deductible 65% after deductible
Skilled Nursing Facility 75% after deductible 55% after deductible 85% after deductible 65% after deductible
Home Health Care - 60 (16 hr day) max days per cal yr 75% after deductible 55% after deductible 85% after deductible 65% after deductible
Hospice 75% after deductible 55% after deductible 85% after deductible 65% after deductible
Durable Medical Supplies 75% after deductible 55% after deductible 85% after deductible 65% after deductible
Short-Term Rehabilitative Therapy* - 30 days max per cal yr $45 Copay 55% after deductible $35 Copay 65% after deductible
Bariatric Surgery (Covered at Blue Distinction Center only) 75% after deductible N/A 85% after deductible N/A
Maternity        
Initial office visit to confirm pregnancy (applicable lab work will be coinsurance after deductible) $30 Copay (if OB/GYN is PCP) 55% after deductible $20 Copay (if OB/GYN is PCP) 65% after deductible
Hospital Services 75% after deductible 55% after deductible 85% after deductible 65% after deductible
Professional Services 75% after deductible 55% after deductible 85% after deductible 65% after deductible
Vision** - one routine eye exam per cal yr, including refraction 100% 55% after deductible 100% 65% after deductible
Inpatient Mental Health/Substance Abuse 75% after deductible 55% after deductible 85% after deductible 65% after deductible
Outpatient Mental Health/Substance Abuse 75% after deductible 55% after deductible 85% after deductible 65% after deductible
Office Visit Mental Health/Substance Abuse $30 Copay 55% after deductible $20 Copay 65% after deductible
*Physical Therapy, Speech Therapy, Occupational Therapy, Pulmonary Rehabilitation, Cognitive Therapy
**Hardware (lenses, frames, contacts) not included

 

 

 Contact:

Blue Cross Blue Shield
1-877-275-9787
www.bcbsnc.com

 2015 OptumRx Pharmacy Benefit Highlights

Prescription Drugs - Retail                                           30 Day Supply 90 Day Supply Maintenance Drug Program (Retail & Mail Service)  90 Day Supply Maintenance Drug Program (Retail & Mail Service)
Generic (30 Day Supply) 20% up to $50 max  Generic Brand (90 Day Supply) 20% up to $125 max
Preferred Brand (30 Day Supply) 35% up to $100 max  Preferred Brand (90 Day Supply) 35% up to $250 max
Non-Preferred Brand (30 Day Supply) 50% up to $150 max Non-Preferred Brand (90 Day Supply)  50% up to $300 max

 

Please click documents below for information about 2015 Retiree Benefits.

2015 Retiree Rate Sheet.doc2015 Retiree Rate Sheet

2015 Medical and Rx Plan highlights-Retirees.xlsx2015 Medical and Rx Plan Highlights

 

2015 Member Guides

Pre 65 PPO 75 - Wake County Government Member Guide.pdfPre 65 PPO 75 - Wake County Government Member Guide.pdf

Pre 65 PPO 85 - Wake County Government - 2015 Member Guide.pdfPre 65 PPO 85 - Wake County Government - 2015 Member Guide.pdf

Post 65 PPO75 - Wake County Government Member Guide.pdfPost 65 PPO75 - Wake County Government Member Guide.pdf

Post 65 PPO85 - Wake County Government Member Guide.pdfPost 65 PPO85 - Wake County Government Member Guide.pdf

 

2015 Summaries of Benefits and Coverage

Group health plans are required to provide employees with an easy-to-understand summary about a health plan’s benefits and coverage. The new regulation is designed to help you better understand and evaluate your health insurance choices. 

 Wake Co Gov_SBC_PPO 75_120114.pdfWake County Gov SBC PPO 75 Plan  

Wake County Gov _SBC_PPO 85_120114.pdfWake County Gov SBC PPO 85 Plan 

 

  Know Your Numbers
kyn.jpgKnow Your Numbers is an annual wellness initiative that is linked to your health insurance plan. Employees, pre-65 retirees and spouses enrolled in Wake County’s health insurance are being asked to get an annual biometric screening before October 31 of each year. Children are exempt from the program.

 

        KYN Verification form  2015.pdfKYN Verification form 2015

The program consists of a biometric screening designed to help employees identify and begin to manage health risks factors that could lead to chronic diseases such as diabetes, hypertension, heart disease and obesity.

To ensure the complete biometric screening is performed and that your provider codes the blood draw appropriately, please download the letter below.

A biometric screening includes a blood draw to check your blood sugar and cholesterol. The screening also includes a blood pressure check. You can request a biometric screening during a routine office visit with your doctor. You can also receive one during your annual physical.

Each month, the County will receive a report from BCBSNC that identifies everyone who had their biometric screening during the program period. If you have completed your screening and wish to confirm if your name is on the BCBSNC report, please send an email to wakebenefitsandwellness@wakegov.com (please wait to inquire at least 45 days after your screening is completed.)

The County will NOT know yourpersonal health information. They will only know whether or not you participated in the program. The County will not be gathering personal health information from participants, nor will the County use this information to penalize individuals or groups of individuals with chronic health conditions. 

Biometric screenings are covered at 100 percent if you use a doctor in the BCBSNC network.

The timeframe to complete your 2015 screening is November 1, 2014, through October 31, 2015. If a biometric screening is not completed, your insurance premium will increase beginning January 1, 2016. This will be in addition to any other insurance increases.

The premium increases will be:

  • $20 per month for retiree
  • Additional $20 per month if spouse is covered





Contacts

NC Supplemental Retirement Plans - 401(k)
(administered by Prudential Retirement)
1-866-627-5267
www.nc401k.prudential.com

ICMA
(457 Deferred Compensation Plan)
1-800-669-7400
www.icmarc.org

Local Governmental Employees'
Retirement System Division
919-733-4191
www.nctreasurer.com

Local Government Federal Credit Union
919-839-5331
www.lgfcu.org

Ceridian
(Third Party COBRA Administrator)
1-800-877-7994
www.ceridian-benefits.com

Long-term Care Insurance
Unum
1-800-227-4165
www.unum.com

Wake County Human Resources
9

19-856-6090

 

 

 

Questions?

We have answers! Email the Wake County Benefits staff at wakebenefits@wakegov.com or call Human Resources at 919-856-6090.