State Health Plan

In order to enroll in the State Health Plan, you must be within 30 calendar days of your hire date or must enroll during the open enrollment period, held in October of each year with a January 1 effective date.

The State Health Plan is administered by Blue Cross, Blue Shield of North Carolina. Employees may choose between two plan options – the 70/30 Plan and the 80/20 Plan. The cost of individual coverage varies depending upon which plan is chosen and if a tobacco wellness premium credit is completed. Employees are responsible for the full cost of dependent premiums. The State Health Plan runs on a calendar year.

Dependent Eligibility Verification: documentation must be submitted online to verify any dependents you cover on your health plan. Eligible Dependents include:

• Legally married spouse including same and opposite gender spouses
• Biological child of the subscriber under age 26
• Adopted child under age 26
• Foster child under age 26
• Stepchild under age 26
• Child under age 26 for whom the subscriber is the court-appointed guardian or for whom the plan as reviewed a QMCSO

To make changes to your State Health Plan outside of Annual Open Enrollment, employees must do so within 30 calendar days of a Qualifying Life Event as established by the IRS. Examples of qualifying events include birth, marriage, divorce, loss or gain of other coverage, and death.

Health Insurance SmartNC

Health Claim denied? If you or someone you know has been denied medical services, contact the North Carolina Department of Insurance’s Health Insurance SmartNC Program . SmartNC can assist you with:

• Understanding the appeals process and your rights under NC state law
• Filing your medical appeal with the State Health Plan
• Request an external review if your health insurance claim was denied

Medical Appeals Tool Kit

SmartNC
North Carolina Department of Insurance
325 N. Salisbury St.
Raleigh, NC 27603
855-408-1212
919-807-6865 (fax)