DEPARTMENT OF
  Human Resources

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Medical Insurance

What type of plan is it?

  • Self-insured, comprehensive health management benefits that includes coverage for routine and wellness, prescription drugs, vision, chiropractic, mental health, and substance abuse.
  • It is an open access plan that offers "in-network benefits" through the Blue Cross/Blue Shield of NC Blue Options network. (Note: Blue Cross/Blue Shield of NC will be referred to as BCBSNC throughout remaining text.)
  • Out-of-network benefits are also available (subject to a deductible and coinsurance) when obtaining services or treatment from a provider that is not in the BCBSNC network.
  • Please note -- wellness/preventive services such as routine physicals and immunizations are not covered out-of-network.
  • See the BCBSNC Member Guides :

Who would an employee call with questions about the plan?

What is the breakdown of medical benefits and co-payments for each plan option?

  • See BCBSNC Insurance Summary Sheets:
  • In-Network Copays are also listed on your Blue Options card.

      • Are routine exams and annual physicals covered by the Health Insurance plan?

      • Yes. An important focus of our health plan is to encourage prevention and for all covered employees and family members to visit their primary care physician at least once each year for routine care and tests according to the BCBSNC Preventive Care Guidelines for all age groups.
      • There is no co-pay for preventive care which is also noted on your BCBSNC Member ID health insurance card. Make sure that your primary care physician's office is made aware of this feature of our health plan by presenting your card at the time of the routine exam appointment.

      Are there any other benefits to the Health Insurance Plan?

      How can I find a provider and/or health facility that is in the network?

      Where is the list of preferred and non-preferred prescription drugs and the Medco Prescription Drug Reimbursement Form?

      • It is recommended that employees register to use the Medco website to look up information about drug category and tier (generic, brand, non-preferred, or specialty) and additional information about any prescription drug you have been prescribed. Or you may wish to call RxBenefits Member Services at 1-800-334-8134.
      • After logging in to the Medco website, click on the link to "Drug information" found in the banner on the left side of the page under the heading of Planning and reference.
      • If you need assistance with logging in to the Medco website or with information about a prescription drug, contact Rx Benefits member services toll free at 1-800-334-8134. If you are calling after normal hours, you will be redirected to Medco member services available 24/7.
      • Medco Prescription Drug Reimbursement Form
      • List of Maintenance Drugs Included in the Preferred Medco Mail Order Program

            What are the costs associated with my health insurance for paycheck eductions, 
            co-payments, and prescription drugs?

      • Each plan level has different paycheck deduction amounts, co-payments, etc. See the Triple Plan Option Health Summary for full-time employees, employees working 30-35 hours, and employees working 20-29 hours.
      • Note: Rates for regular part-time employees are prorated depending on the number of hours worked per week.
      • Health and dental deductions are from 26 paychecks.

      When would an employee and/or his/her family be eligible for coverage?

      • You and your dependents are eligible for coverage effective your first day of employment.
      • You would enroll during the Employee Benefits Enrollment session generally within 10 business days of your start date.
      • Newborn coverage -- The covered employee should contact their HR Assistant when the child is born, and they can process the paperwork over the telephone. Then a copy of the birth certificate the mother receives in the hospital must be submitted to HR no later than 30 days after the birth of the child for the child to be officially enrolled in the plan. The birth certificate may be faxed to HR - 319-4567.
      • Eligible dependents -- employee's spouse and children or stepchildren until the dependent's 26th birth date, if they do not have access to coverage under another group plan.
      • Dependent children age 26 and older are not eligible for coverage.

      What happens if an employee doesn't need to be covered by the Town's plan?

      • Employees may waive their medical coverage if they have proof of other comparable coverage. Contact your HR Assistant for additional information.
      • Note: Employees who waive their medical coverage are not eligible for dental coverage.

      How does an employee add or drop a spouse, dependents, or self to/from the health plan?

      • Because insurance premiums are deducted "pre tax," the plans are governed by IRS guidelines that provide an "Open Enrollment" period one time per benefit year. This Open Enrollment period allows you to add or drop yourself and/or dependents. Announcements regarding this period are made in advance of the event.
      • Exceptions to having to wait until the "Open Enrollment" period are known as "qualifying events"; i.e., birth of a child, marriage, divorce, loss of coverage under spouse's plan, spouse's open enrollment, etc. You have 30 days from the date of the event to join the plan. Proof of the qualifying event is required. Contact your HR Assistant for additional information on what is considered a qualifying event.The "Open Enrollment" period will be advertised on the C-Net Events/Training Calendar

      What if an employee needs to see a specialist?

      • No referral is needed to access a specialist.

              What are an employee's out-of-pocket expenses?

     What if an employee's doctor(s) is not on the Provider list for BCBSNC Blue Options Network?

    • You are free to use a health care provider who is not a part of the Blue Options Network, and you'll still be covered - although you'll pay a higher share of the costs.
    • You will need to make arrangements to pay the physician's office and then submit a Claim Form to BCBSNC. The address is on the claim form.
    • Your out-of-network deductibles coinsurance and out-of-pocket maximums are dependent upon your level of coverage and plan type (Basic, Core, or Premium).

    Are all services covered if an employee uses an out-of-network physician?

    • No. Wellness/preventive services such as routine physicals and immunizations are not covered out-of-network.

     

    The employee benefits information posted on this website is intended to provide details and helpful information regarding benefits available to current employees of the Town of Cary. These benefits are also described in detail in contracts with the Town of Cary and/or in Town policy. The provisions of the contracts and Town policies are controlling and subject to change. None of the conditions or limitations thereof are waived or modified by reason of omission or misstatement on this website.