My Pharmacy Benefits

Overview of PPO Plans

2015 Benefits Booklets

Listed below are links to plan summaries and benefits booklets for each of the plans.

2015 Summaries of Coverage

Listed below are links to Summary of Coverage documents for each plan:

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. Medical policies can be found here on the Blue Cross and Blue Shield website*.

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.


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)

Archived Documents

Archived rate sheets, Benefits Booklets and other materials can be found by clicking here.

* 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.

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