Overview of PPO Plans
Benefits Booklet
Listed below are links to plan summaries and benefits booklets for each of the plans.
Medical Policies
Although your Benefits Booklet provides a good overview of what services and products are available to you under the PPO plans, the medical policies provide detailed information around the circumstances under which certain services and products are and are not covered. For behavioral health and prescription policies click here. All other medical policies can be found here on the Blue Cross Blue Shield website*. Please check both areas for more information.
In addition, you can find a list of upcoming medical policy changes by clicking here.
Prior Authorization
Certain services require prior review and certification before they can be covered by your health insurance plan. Click here for more information.
Appeals
If you disagree with the way a claim has been handled, you can request an appeal or grievance review. For the complete appeals process, please click here.
Health Plan Frequently Asked Questions (FAQs)
* If any of the State Health Plan medical policies conflict with the Blue Cross and Blue Shield of North Carolina medical policies, the State Health Plan medical policies will prevail.
