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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.
What is the breakdown of medical benefits and co-payments for each plan option? 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? What are the costs associated with my health insurance for paycheck deductions, co-payments, and prescription drugs?
  • Each plan level has different paycheck deduction amounts, co-payments, etc. SSee the Triple Plan Option Health Summary for full-time employees (HTML), employees working 30-35 hours (HTML), and employees working 20-29 hours (HTML).
  • 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 unmarried children or stepchildren birth through age 18*.
  • *An unmarried dependent child who attends a licensed or accredited school (vocational, technical college or university) will continue to be covered from age 19 to their 26th birthday.
  • Student coverage continues only between semesters/quarters if the student is enrolled in the next regular semester/quarter.
  • Students 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? Who would an employee call with questions about the plan?
  • Any questions that you have about the plan, claims questions, lost ID cards, etc. can be directed to BCBSNC Customer Service by calling 1-877-258-3334, or by going to www.bcbsnc.com/members/index.cfm?lob=ppo1. Your unique subscriber ID number and Group number (052108) are found on your BCBS ID.
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.
Are there any other benefits to the Health Insurance Plan?
  • Several health insurance/wellness programs are available under the Town's plan. Information about these programs is being compiled and will be provided at a later date.

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.