State Health Plan
The State Health Plan is administered by Blue Cross, Blue Shield of North Carolina. Employees may choose between three plan options – the Traditional 70/30 Plan, the Enhanced 80/20 Plan and the Consumer-Directed Health Plan (CDHP). The cost of individual coverage varies depending upon which plan is chosen and, in the case of the CDHP and Enhanced 80/20 Plan, how many wellness activities are completed. The employee-only premium of the Traditional 70/30 Plan is covered 100% by the College. Employees are responsible for the cost of dependent premiums. The State Health Plan runs on a calendar year.
To make changes to your State Health Plan outside of open enrollment, employees must have a qualifying event. Examples of qualifying events include birth, marriage, divorce, loss or gain of other coverage, and death. In order to make changes to your coverage, visit the eEnroll website and create an account.
Traditional 70/30 Plan
Under this plan, employees have a $39 co-pay for a physician visit, an $92 co-pay for a specialist and an $98 co-pay for an urgent care visit. If the employee has hospital-related services, he/she is responsible for a $1,054 deductible as well as 30% of the bill after the deductible has been met. Prescription medicine is charged according to tier and will be either a $15, $46 or $72 co-pay.
Click to see the rate sheet for 2016 Traditional 70/30 Plan
Enhanced 80/20 Plan
Under this plan, employees have a $30 co-pay for a physician visit, a $70 co-pay for a specialist and an $87 co-pay for an urgent care visit. If the employee has hospital-related services, he/she is responsible for a $700 deductible as well as 20% of the bill after the deductible has been met. Prescription medicine is charged according to tier and will be either a $12, $40 or $64 co-pay.
Additionally, the Enhanced 80/20 Plan offers reductions in both premiums and co-pays if an employee completes additional steps, including filling out a Health Assessment, attesting that he/she (and spouse) are non-smokers (or willing to enroll in a cessation program), and selecting a Primary Care Provider (PCP) to be listed on the insurance card. Any time the employee visits the designated PCP, the co-pay will be $15 instead of $30. This plan also offers Affordable Care Act preventive services and preventive medication at no cost and co-pay discounts for BCBS designated specialists and hospitals.
Consumer-Directed Health Plan (CDHP)
The CDHP does not have any associated co-pays. Instead, individual employees are responsible for the full cost of medical services and prescription medicine until a $1500 deductible has been met. In order to offset some of this cost, the State Health Plan pays for the first $600 worth of services/medicine through a Health Reimbursement Account (HRA). After the employee has met the deductible, he/she will be responsible for 15% of all future bills for that plan year.
Like the Enhanced 80/20 Plan, the CDHP employee-only premium may be reduced by completing wellness incentives. Additionally, PCP visits, BCBS designated specialist visits and BCBS designated hospital visits result in additional funds added to the employee’s HRA. ACA preventive services and preventive medication are also covered 100% under this plan, and the CDHP also provides a list of CDHP preventive medications that are subject to a charge of 15% only, even if the employee has not yet met his/her deductible.
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