Wake County Retiree Information

 

2016 BCBSNC Health Benefit Highlights

Blue Cross Blue Shield
1-877-275-9787
www.bcbsnc.com
 
2016 Member Guides
 

  BCBSNC - PPO 75 BCBSNC - PPO 85
Benefits In-Network In-Network
​Provider Tier ​Tier 1/Tier 2 ​Tier 1/Tier 2
Deductible (Single/Family) $1,500 Single
$3,000 Family
$750 Single
$1,500 Family
Out-of-Pocket Maximum (includes deductible) $4,400 Single
$8,800 Family
$3,700 Single
$7,400 Family
Office Visits - PCP $30 Copay $20 Copay
Office Visits - Specialist Tier 1 / Tier 2 $45 Copay / $65 Copay $35 Copay / $55 Copay
Preventive Care 100% 100%
Urgent Care $45 Copay $35 Copay
Chiropractic Care - 24 days max per cal yr $45 Copay $35 Copay
Emergency Room $300 copay, then 75% after deductible (copay waived if admitted) ​$300 copay, then 85% after deductible (copay waived if admitted)
Inpatient Hospital Copay (per Admission) - Tier 1 / Tier 2 $0 / $200 ​$0 / $200
Inpatient Hospital - Tier 1 / Tier 2

75% after deductible /
55% after deductible

85% after deductible /
65% after deductible
Outpatient Hospital Based -
Tier 1 / Tier 2
75% after deductible /
55% after deductible
​85% after deductible /
65% after deductible
Outpatient Non-Hospital Based 75% after deductible 85% after deductible
Skilled Nursing Facility 75% after deductible 85% after deductible
Home Health Care - 60 (16 hr day) max days per cal yr 75% after deductible 85% after deductible
Hospice 75% after deductible 85% after deductible
Durable Medical Supplies 75% after deductible 85% after deductible
Short-Term Rehabilitative Therapy* - 60 days max per cal yr $45 Copay $35 Copay
Bariatric Surgery (Covered only at Blue Distinction Center) 75% after deductible 85% after deductible
Maternity    
Initial office visit to confirm pregnancy (applicable lab work will be coinsurance after deductible) $30 Copay (if OB/GYN is PCP) $20 Copay (if OB/GYN is PCP)
Hospital Services Tier 1 / Tier 2

75% after deductible /
55% after deductible

85% after deductible /
65% after deductible
Vision** - one routine eye exam per cal yr, including refraction 100% 100%
Inpatient Mental Health/Substance Abuse
Tier 1 / Tier 2
75% after deductible /
55% after deductible
85% after deductible /
65% after deductible
Outpatient Hospital Based Mental Health/Substance Abuse
Tier 1 / Tier 2
75% after deductible /
55% after deductible
85% after deductible /
65% after deductible
Outpatient Non-Hospital Based Mental Health/Substance Abuse
Tier 1 / Tier 2
75% after deductible 85% after deductible
Office Visit Mental Health/Substance Abuse $30 Copay $20 Copay
*Physical Therapy, Speech Therapy, Occupational Therapy, Pulmonary Rehabilitation, Cognitive Therapy
**Hardware (lenses, frames, contacts) not included
 
    

CVS/Caremark Prescription Drug Benefit Schedule

  
 
CVS/Caremark Prescription Drug benefits for prescription drugs and related supplies are provided by participating pharmacies as shown in this Schedule of Benefits. To receive prescription drug benefits, you and your dependents may be required to pay a portion of the covered expenses for prescription drugs and related supplies for each 30-day or 90-day supply if applicable at a retail pharmacy or each 90-day supply at a retail pharmacy or mail order.
Please note: Your prescription drug (Retail and Mail Order) costs will apply to the total medical out-of-pocket maximum.
 
 
 
Prescription Drugs - Retail                                           30-Day Supply 90-Day Supply
Generic 20% up to $50 max  20% up to $125 max
Preferred Brand 35% up to $100 max  35% up to $250 max
Non-Preferred Brand 50% up to $150 max 50% up to $300 max
Specialty Brand 50% up to $200 max N/A

Preauthorization is required for compounded prescription drugs if cost of prescription is $150 or more

 
 

2016 Retiree Rates

 
 
 

Download a PDF version

 

2016 Retiree Monthly Insurance Rates

Effective January 1, 2016–December 31, 2016

 

RETIREES WHO ARE ELIGIBLE FOR 100% COUNTY-PAID BENEFIT*

 

BCBSNC ​PPO85

 

 

County
Cost

 

Retiree
Cost

 

Total
Cost

 

Retiree only

 

$541.80

 

$60.00

 

$601.80

 

Retiree/child(ren)

 

$670.98

 

$190.00

 

$860.98

 

Retiree/spouse

 

$751.54

 

$380.00

 

$1,131.54

 

Retiree/family

 

$847.05

 

$550.00

 

$1,397.05

BCBSNC P​PO75

 

 

County
Cost

 

Retiree
Cost

 

Total
Cost

 

Retiree only

 

$481.44

 

    $0.00

 

$481.44

 

Retiree/child(ren)

 

$568.79

 

$120.00

 

$688.79

 

Retiree/spouse

 

$655.23

 

$250.00

 

$905.23

 

Retiree/family

 

$717.63

 

$400.00

 

$1,117.63

 









 

*Note:  Rates are for Retirees who receive County-paid coverage. If you pay 50%, then you must pay 50% of the County cost plus the retiree premium associated with the coverage tier for plan options listed above. If you pay the en​​tire premium, then you must pay the amount shown above under the Total column.​

Required Notices

 

 
 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.
 
 
 

 

 
      
The program consists of two parts - a health risk assessment and biometric screening - both designed to help members 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.

 
 

The County will NOT know your personal 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 2016 screening is November 1, 2015, through October 31, 2016. If a biometric screening is not completed, your insurance premium will increase beginning January 1, 2017. 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





 


 

 

 

 

Questions?

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