2021-2022 Comparison of Benefits- All Plans

	Blue Options PPO Plan 1	Blue Options PPO Plan 2	Blue Options PPO Plan 3	Blue Options PPO Plan 4	Blue Options PPO Plan 5	Blue Options HDHP Plan 10 HSA Eligible	Blue Options HDHP Plan 15 HSA Eligible	Blue Options HDHP Plan 20 HSA Eligible
Statement of Benefits Covered:	SBC Plan 1	SBC Plan 2	SBC Plan 3	SBC Plan 4	SBC Plan 5	SBC Plan 10	SBC Plan 15	SBC Plan 20
Member Guide:	NCBA PPO Plan 1	NCBA PPO Plan 2	NCBA PPO Plan 3	NCBA PPO Plan 4	NCBA PPO Plan 5	NCBA HBT HSA Plan 10	NCBA HBT HSA Plan 15	NCBA HBT HSA Plan 20

FORMS

Enrollment Application or Change to Existing Participant

Initial Rejection of Coverage for New Employee Declining Coverage

Coverage Cancellation for Employees Continuing Employment but Terminating Coverage

Beneficiary Change Form

Request/Reject Continuation of Health Coverage for Terminating Employees

HEALTH PLAN GENERAL INFORMATION

HSA Contribution Limits

State Continuation Pamphlet

Preventive Care

Federal Healthcare Transparency Requirement *

* https://www.bluecrossnc.com/about-us/policies-and-best-practices/transparencycoverage-mrf#.

HEALTH PLAN GENERAL INFORMATION

NCBA Health Benefit Trust and Life Insurance Plan Summary Annual Reports

FEES AND PPACA

ACA Fees paid for firms that are members of the NCBA Health Benefit Trust.
2020 PCORI Fee Extension