Hi-Lo Flex for small groups
Maximum flexibility, maximum choice
With Hi-Lo Flex from Blue Cross and Blue Shield
of North Carolina (BCBSNC), you can:
+ Retain quality employees with quality
health coverage
+ Provide your employees with the health care
coverage choices to meet their needs
+ Work with the most trusted insurer in
North Carolina2
1
With Hi-Lo Flex
Employees have the chance to choose
No matter what kind of small business you have, BCBSNC’s
Hi-Lo Flex has you covered. When it comes to health care
coverage, employees’ preferences and needs are different.
You have younger and older employees; single people and
families; perhaps even employees with chronic conditions.
Some need a plan with lower premiums. Others want a
comprehensive plan offering richer benefits. Hi-Lo Flex
provides the choice and flexibility to meet the needs of
all your employees.
A wide spread means a wide range of choice
Hi-Lo Flex has a pricing spread of as much as 27% between the
more robust plan and the base plan – which gives employees a
clear choice and great flexibility.5
Remember, as a small business, you can now offer your
employees two plans – one you establish as a base plan and
one that your employees can pay extra for if they need or want
the added benefits.
The benefits of Hi-Lo Flex
Fixed contribution
You can set your contribution at a fixed dollar amount or fixed
percentage of the low option, and make the basic plan available
at a cost that works for you and your employees.3 Employees
can then choose to “buy up” to the high option – your more
robust coverage plan. Your cost stays the same.
Getting started with Hi-Lo Flex
+ First, set the amount you want to pay for your health
care coverage
+Second, select the type of network. You can choose
between:
Flexibility for your diverse employees
With Hi-Lo Flex, you can offer your employees two plans –
the base plan and the richer “buy-up” plan. So employees
can choose the plan that’s best for them – whatever their
preference or needs.
Make changes in your coverage as the needs of your workforce
change. Maybe you start with two similar preferred provider
organization (PPO) products – a smaller price spread between
your high and low options. And you can increase the price
spread by offering a PPO and an HSA plan. Hi-Lo Flex lets
you customize your coverage annually.
O
ur traditional full network that extends throughout
all 100 North Carolina counties.
n
n
n
Changing benefits without changing insurers
T
he tiered network of Blue Select plans which offers
two tiers of in-network benefits in addition to out-ofnetwork coverage.
T
he smaller, more streamlined network of providers
available through our Blue Value offering, a lower-cost
plan that offers quality, cost-effective coverage.
+Third, select a “high” option. This is the plan with richer
benefits – the plan that your employees can pay extra
for, if they want the added benefits. Choose from the 13
plans grouped in three different levels based on network
accessibility. (See the chart below)
Health Reimbursement Account (HRA)
An HRA gives you the chance to save by introducing a medical
plan with a higher deductible and lower premiums.4 The reduced
premiums help everyone save. And because you help fund
the HRA (with 100% tax-deductible contributions) to cover the
higher deductible, the level of your employees’ overall costs
can remain low.
+ Finally, select a “low” option from among the plans available
for pairing with your high option. This is your basic, more
price-conscious plan – the base plan that all employees
receive unless they indicate otherwise.
Full network of providers and hospitals
Tier 1 in-network benefits
Tier 2 in-network benefits
Smaller, streamlined network
Choose the network that best meets employee needs and budgets.
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HOW IT
WORKS
FOR
YOU
The plans that power Hi-Lo Flex
Hi-Lo Flex offers you the ability to choose from the following products including Blue Value and Blue Select! In addition, we
provide an array of pharmacy options for non-HSA plans; HSA plans offer an integrated pharmacy benefit. The bottom line?
You can customize your Hi-Lo Flex plan to better meet the needs of you and your employees.
(New!)
(New!)
Blue Options is a traditional
PPO plan. It’s the easiest
health plan for employers
to manage and administer,
with a familiar plan design
comfortable for employees.
Blue Select is our new, tiered benefit
plan that offers the kind of high-quality,
cost-effective coverage companies and
their employees have been asking for.
This plan demonstrates our commitment
to making health care available to all
North Carolinians.
Blue Value is a lower-cost plan
that offers quality, cost-effective
coverage for groups of all sizes. We’ve
collaborated with providers across
the state to create a plan that lets you
trade full access for a smaller, more
streamlined network of providers.
Blue Options HSA pairs a
high-deductible PPO plan
with a tax-advantaged health
savings account (HSA)
employees use to pay for
qualified medical expenses.10, 11
Blue Options offers
Blue Select offers
Blue Value offers
Blue Options HSA
+ Copayments for
routine primary and
specialist care6
+ The freedom to see
providers outside
the network7
+ 100% coverage for
a wide range of
preventive services6, 7
+ No referrals to
see specialists
+ Multiple prescription
drug coverage options
+ Preferred Provider Organization (PPO) plan
that offers two tiers of in-network benefits
in addition to out-of-network coverage.
+ A smaller, more streamlined pharmacy
network to encourage the use of lower cost
alternatives. So, every time your employees
purchase a generic drug or use an innetwork pharmacy, they save.
+ Businesses will find it an effective way to
cut costs – as much as 5%8 – while
covering employees all across the state.
+ The plan will cover employees all across
the state, giving them plenty of ways to
manage their cost of care. They can choose
by provider, by price or by proximity –
whatever they feel is most important.
+ T
he quality coverage you’ve come to
expect from BCBSNC,with access to
many quality, cost-effective providers
+ Helps you manage bottom-line costs
while providing your employees with
quality coverage. As much as 9%
savings in targeted areas.9
+ A smaller, more streamlined
pharmacy network to encourage the
use of lower cost alternatives. So,
every time your employees purchase
a generic drug or use an in-network
pharmacy, they save.
+ Premium savings up to
22% compared to our
most popular PPO plan12
+ The opportunity to make
tax-free employer
contributions to employees’
HSA accounts
+ Tax savings for employees
of up to 35% for out-ofpocket costs13
+ 100% coverage for
a wide range of
preventive services7
Pair with an HRA
Pair with an HRA
Pair with an HRA
Cannot be paired with an HRA
at this time
Get the best of BCBSNC with any Hi-Lo Flex combination!
Blue Cross and Blue Shield of North Carolina –
Leading the way in quality coverage for
small businesses
Small businesses create jobs, drive innovation – and have their
eye on the bottom line. BCBSNC is committed to helping small
businesses offer high-quality health care coverage at the right
price. It’s why we offer health plans designed to give you and
your employees the choice and flexibility you need.
BCBSNC is proud to be the #1 choice of small businesses in
North Carolina14 – in fact, we’ve earned the trust of more
North Carolinians than any other health insurer.15
The company your employees trust
With BCBSNC, you’ll be giving your employees health coverage
from a company they know and trust: BCBSNC is the most trusted
health insurer in North Carolina.2 Your employees will feel
confident and valued – because they’re getting coverage from
a North Carolina company with over 80 years of experience.
And an extensive network in North Carolina
BCBSNC also gives you and your employees access to our extensive
statewide network of doctors and hospitals – and the savings that
come with it. Over 91% of physicians and 99% of hospitals in
North Carolina are in our network.16 Your employees can also rest
assured they’re covered wherever they go – in every state across
the U.S. and in more than 200 countries and territories worldwide.17
PAGE 3 of 4
Your total benefit solution
Visit
Strengthen your employee benefits package. Add
coverage options that give your employees greater
protection, while still saving you money.
– Dental coverage can be added to your medical plan or purchased
as a stand-alone offering. Combine dental with your group medical plan and get the
convenience of one source covering your insurance needs. You pay only one bill, and
your employees keep track of one card.
Round out your benefits – Mosaic Group is a full-service authorized agency of
BCBSNC that offers additional benefit options, so you can provide your employees
a comprehensive benefit package. Short-term and long-term disability, life, AD&D,
supplemental hospital coverage and critical illness policies are all available.18
bcbsnc.com/smallbusiness
Now available to more small
groups than ever before
If your company has 10‑50 enrolled subscribers, you can take advantage of
Hi-Lo Flex. Offer your employees a choice of two high-quality health plans –
a base plan and a more robust plan they can “buy up” to for extra benefits.
HOW
CAN WE
HELP?
You want your employees to have the best health care coverage at
the right price. Call your BCBSNC representative today to see how
Hi-Lo Flex can work for you.
For costs and further details of the coverage, including exclusions, reductions or limitations and terms under which the policy
may be continued in force, see your agent.
®, SM Marks of the Blue Cross and Blue Shield Association.
Blue Cross and Blue Shield of North Carolina is an independent
licensee of the Blue Cross and Blue Shield Association.
U8027, 11/13
1) Groups with 10–50 enrolled subscribers. 2) BCBSNC Brand Tracking Study; Prophet; March 2013. 3) Groups are required to
meet underwriting guidelines and minimum contribution requirements. 4) BCBSNC is the HRA administrator and contracts
with HealthEquity, Inc. to perform certain HRA administrative services. The HRA Fund offered by BCBSNC cannot be paired
with the following products: Health Savings Accounts (HSA), Blue Care HMO, Comprehensive Major Medical (CMM) plans,
and Exclusive Provider Organization (EPO) plans. HSAs cannot be paired with HRAs at this time. For Small Groups with 50
Full-Time Equivalents (FTEs) or less, HRA contribution limits will apply. Members may combine rollover HRA funds with their
annual contribution amount as long as the combined total does not exceed annual contribution limits for the current benefit
period. In addition, plans with deductibles below $1,000 are not eligible for HRAs. 5) Based on rate comparison between
the small group plans approved for 2014 offering the richest benefits and the least rich. The savings percentage is for the
same member comparing these two plans, and is independent of the member’s geography and demographic status. 6) Some
services and supplies received by members in an office setting or in connection with an office visit are in fact outpatient
hospital-based services provided by hospital-owned or operated practices. These services and supplies may be subject
to deductible and coinsurance. Please see the BCBSNC provider list to identify these providers. 7) Certain preventive care
services are limited to in-network benefits. 8) BCBSNC Internal Data; Represents 2014 product premium savings assuming
no change in levels of member cost sharing. Actual savings will depend on geography and plan design(s) selected by group.
Blue Select offers two tiers of benefits in addition to out-of network coverage. Tier 2 providers may not have met one or
more of the standards necessary for inclusion in Tier 1. 9) BCBSNC Internal Data; Represents 2014 product premium savings
assuming no change in levels of member cost sharing. Actual savings will depend on geography and plan design(s) selected
by group. 10) Blue Options HSA combines a high-deductible health plan and a health savings account (HSA). BCBSNC does
not administer the HSA and is not affiliated with your HSA custodian or administrator. An HSA is offered for your convenience
through BenefitWallet™, a Xerox Solution. 11) Withdrawals are tax-free only if used for qualified medical expenses. Specific
regulations and a list of qualified medical expenses can be found in IRS publication 502, available at www.irs.gov. 12) BCBSNC
Internal data 2012. Based on copayment plans that include a $2,000 coinsurance max and $10/$25/$40 copayment
structure for prescription drugs. Based on data for Blue Options underwritten groups as of 8/1/2012 with 5 to 20 subscribers.
Pricing is for a single male age 45-49 residing in Durham. 13) Visit www.irs.gov for complete tax bracket information.
14) NAIC 2012 Supplemental Health Care Exhibit Report. 15) BCBSNC Brand Tracking Study; Prophet; March 2013. 16) CHP
MarketQuest, Network Compare, April 2013. 17) Blue Cross and Blue Shield Association, www.bcbs.com/shop-for-healthinsurance/coverage-home-and-away.html (accessed August 2013). 18) USAble Life underwrites Short-Term and Long-Term
Disability, Life, AD&D, supplemental hospital coverage and critical illness. USAble Life does not offer BCBSNC products
or services. USAble Life and BCBSNC are not affiliated companies. Mosaic Group is an authorized agency of BCBSNC and
USAble Life.
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