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2010 BlueOptionsHSA preferred tier monthly rates, good through 12/31/10
CHARLOTTE AREA
(Individual Rates)

INSTRUCTIONS FOR USING THE RATE TABLES:
(Note: Actual rates may change based on medical underwriting review. Rates are effective from 1/1/10 through 12/31/10)

Step One:
Find the appropriate rate table for the county of residence.

 Step Two:
Use the appropriate table to determine the plan, the deductible and it's corresponding rates for the applicant, and his/her spouse and dependents if applying for coverage.
   Step Three:
Add the Optional Maternity Benefit if applicable (use the deductible that corresponds to the deductible selected in
Step Two above).

Step Four:
Sum the rates.

Blue Advantage
BlueOptionsHSA
DentalBlue
Blue Medicare Supplement

Traditional insurance with
co-pays. Still BCBSNC®'s most
popular health plan.*

  

High Deductible, Tax
Advantaged Insurance. Is a
health savings account
(HSA) right for you?

 

Affordable coverage
with the best dental plan
in North Carolina.

  

For beneficiaries enrolled
in Medicare Part B.
*BCBSNC® internal data, 2006

Triangle Planning Services, Inc. is an independent authorized producer/agency licensed to sell and promote products from Blue Cross
and Blue Shield of North Carolina® (BCBSNC®). The content contained in this site is maintained by Triangle Planning Services, Inc.
Blue Cross and Blue Shield of North Carolina® is an independent licensee of the Blue Cross and Blue Shield Association.®, SM Marks
of the Blue Cross and Blue Shield Association. SM1 Mark of Blue Cross and Blue Shield of North Carolina.

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