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BlueCross of Northeastern PA

Blue Cross of Northeastern Pennsylvania® (BCNEPA) is headquartered in Wilkes-Barre, and offers coverage to nearly 550,000 residents in 13 counties in the north and central parts of the state. As a nonprofit health insurer and independent licensee of the Blue Cross and Blue Shield Association, Blue Cross of Northeastern Pennsylvania is community-centered and focused on health and wellness for all members and residents. Since being established in 1938, BCNEPA has been actively involved in serving the people in its counties of operation, whether struck by natural disaster or in need of health insurance. They insure a large portion of north and central Pennsylvania businesses, seniors, families and individuals, and have provided many public health services for the uninsured, such as the adultBasic insurance program, which currently covers 5,000 people.

BCNEPA offers individuals and families a variety of coverage options through a PPO network. Their BlueCare Direct plans include comprehensive coverage, low cost with upfront benefits, high deductibles, and HSA-qualified plans. They have even added a fifth plan, Direct Simplicity, to keep coverage affordable and beneficial for the 2013 plan year.┬á In addition to the PPOs, BCNEPA offers Medicare plans for individuals age 65 or older, and individual HMO and EPO plans. BCNEPA also provides the Children’s Health Insurance Program and Special Care for young people in north and central Pennsylvania. Individual and family PPOs are underwritten by First Priority Life Insurance Company, and HMOs are administered through First Priority Health.

Coverage is offered in Bradford, Clinton, Lycoming, Lackawanna, Luzerne, Tioga, Sullivan, Susquehanna, Wyoming, Carbon, Monroe, Wayne and Pike Counties.


Blue Cross of Northeastern Pennsylvania


BlueCare Individual Plans

BlueCare Individual Brochure

BlueCare Direct

These plans provide low out of pocket costs with in-network providers with a range of deductibles to give you the best coverage possible. When you meet the $200 prescription deductible, generics are free, whether using mail order or retail services and other tiers are covered at copay. The first four office visits are covered for a copay, as well, specialist and primary care combined, and emergency room visits are $150. In network coinsurance in 20 percent after deductible, making these an affordable yet protective plan to have.

BlueCare Direct Benefits


BlueCare Direct Select

The most comprehensive Blue Cross PPO plan in the region, Direct Select plans offer unlimited office visits and access to all tiers of prescriptions immediately for a copay. These plans cover 80 or 90 percent of major medical care after deductible, including hospital services, diagnostic work, and therapies. Deductibles range from zero (like an HMO with more freedom – all services offered upfront) to $1,500, giving you the ability to use the Blue PPO network as soon as you need care. Maternity coverage is also included in part.

BlueCare Direct Select Benefits


BlueCare Direct Simplicity

The newest plan from BCNEPA, Direct Simplicity plans include a variety of benefits in an easy to understand package. Ideal for young adults, these plans have two very low deductibles to choose from and cover 80 percent after deductible for eligible services. There is no separate pharmacy deductible, and copays are offered on many services, including office visits, physical therapy, diagnostic testing, emergency care, and hospital care. For less out of pocket costs to worry about, Simplicity plans make obtaining care much more efficient.

BlueCare Direct Simplicity Benefits


BlueCare Direct Essentials

With a very low premium, these plans offer three deductible options and 75 percent coverage. Pay nothing for your first six office visits, and a low copay for any kind of prescription. Emergency room visits are covered with a $100 copay, and several other services are included at coinsurance. These plans have a few less benefits than other BCNEPA plans, though members still receive immediate access to high quality Blue Cross network care at a reasonable cost.

BlueCare Direct Essentials Benefits


BlueCare Direct Advantage

An HSA-compatible plan with a high deductible gives you the ability to open a health savings account to pay for your medical care. Staying in-network provides discounted rates, and you can meet your deductible sooner. Though you pay out of pocket for all covered services until the deductible is met, preventive care and wellness programs with special discounts and incentives are available throughout your plan year. Prescriptions are included in the annual deductible, along with office visits and hospital care.

BlueCare Direct Advantage Benefits


BlueCare Assure

Offering an affordable monthly premium and many deductibles to choose from, these high deductible PPO plans do not include the upfront benefits and copays of many other BCNEPA choices, but still give members access to the same great network. Preventive care is included at no cost, and tiered prescription coverage is available after a $500 deductible. Coinsurance applies to nearly every covered service, and is either 20 or 30 percent after deductible depending on your plan.

BlueCare Assure Benefits


BlueCare HMO Direct

Benefit from the personal attention and cost savings of managed care. BlueCare HMO Direct plans offer a majority of services for a copay, including diagnostic tests, office visits, therapy, mental health, emergency care, and much more. While there are three deductibles to choose from, each of these plans offers enough services upfront to provide you with very low cost sharing. Prescriptions are included with a $250 deductible, and coinsurance is either 10 or 20 percent depending on your plan.

BlueCare HMO Direct Benefits


Find out more about BlueCross of Northeastern Pennsylvania and get personally tailored rates with a quick health insurance quote. Get more information and speak with an agent about your healthcare and insurance needs at 888 803 5917.