Member resources

Access helpful materials to learn more about Healthy Blue Care Together.

Member Handbooks

 

Explore more information on policies, enrollment, contact information and other useful materials.

 

 Member handbook - English

 

 Member handbook - Spanish

 

 

Member Services

 

For any questions about any information you cannot locate on our site or in your handbook, please contact our Member Services team.

 

 833-777-3611 (TTY 711)

Pharmacy and prescription drug benefits

 

Your benefits include a wide range of prescription and over-the-counter (OTC) medicines. You can even have your medicines delivered to your home. We work with CarelonRx to provide these benefits.

  • The Preferred Drug List (PDL) is the list of drugs that your doctor will use first when prescribing you medicine. These drugs have been chosen for their quality and effectiveness. Your doctor can prescribe most of these medicines to you without getting preapproval, or an "OK," from us. The PDL is updated frequently.

 

Preferred drug list 

 

  • The searchable formulary is a list of all brand-name and generic drugs available in your plan. It lists all the drugs found on the PDL, plus others. All drugs on the formulary are covered, but many require preapproval before the prescription can be filled.

 

Search formulary 

NC CarePoints Connect

 

NC CarePoints Connect is a secure and no-cost web-based application. It offers tools and resources to improve health outcomes and allows members to redeem their extra benefits and healthy rewards. NC CarePoints Connect helps share vital information, such as medical records, screenings, medicines, trauma assessments and care plans. Users access it by selecting "Register with NC CarePoints Connect" and completing the short registration process.

 

Register with NC CarePoints Connect 

Member programs

 

Our member programs offer support to Healthy Blue Care Together enrollees across their whole health journey.

Statewide and regional trainings

 

Wherever you are located in North Carolina, we have training opportunities for you and your family. These topics help promote social, physical and mental health for our Healthy Blue Care Together members.

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Ombudsman support

 

The NC Medicaid Ombudsman is a resource you can use when you have been unable to resolve issues with Healthy Blue Care Together or doctors. It is an independently operated, nonprofit organization. The NC Medicaid Ombudsman:

  • Resolves issues
  • Provides education and advocacy
  • Ensures individuals and families under NC Medicaid Managed Care get access to the care they need

 

To contact the NC Medicaid Ombudsman, please call 877-201-3750 or visit ncmedicaidombudsman.org.

Appeals, grievances and State Fair Hearing policies

 

As a Healthy Blue Care Together member, you have the right to ask us to reconsider decisions we have made and to make complaints. These are called appeals and grievances. If you would like support in filing an appeal and/or grievance, please contact Member Services at 833-777-3611 (TTY 711).

 

Once filed, we have 30 days to finish your appeal. You may also ask for an appeal by:

  • Mail: Fill out the appeal request form in the notice you receive about our decision
  • Fax: Fill out, sign and fax the appeal request form in the notice you received about our decision
  • Phone: Call 833-777-3611 (TTY 711) and ask for an appeal


You may ask for a State Fair Hearing by:

  • Mail: Fill out and sign the State Fair Hearing request form that comes with your notice
  • Fax: Fill out, sign and fax the State Fair Hearing request form that comes with your notice
  • Phone: Call NC Office of Administrative Hearing (OAH) at 984-236-1860 and ask for a State Fair Hearing


If you ever have a complaint (grievance) you can contact us by phone, mail or email:


To learn more about appeals, grievances, and state fair hearings, check your member handbook.

Healthy Blue Care Together policies

 

Utilization Management Policy - Coming soon

 

*Heathy Blue Care Together policy updates may be made at any time if we are notified of a mandated change or due to a Healthy Blue Care Together business decision. We reserve the right to review and revise our policies when necessary. When there is an update, we will publish the most current policies on our site.