Member Services
The following FAQs address some common issues concerning doctor visits.
Can I order an ID card online?
No, this service is not available at this time for members enrolled in the Indemnity Plan.
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Can I obtain claim information online?
No, this service is not available at this time for members enrolled in the Indemnity Plan.
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Is there anyone in my office who can help me with health benefit questions?
Each employing unit (school district, state agency, etc.) has a designated employee or Health Benefit Representative (HBR) who is responsible for administering the Plan for its employees. The HBR, among other duties, enrolls new employees, reports changes, explains benefits, reconciles group statements and remits group fees. The HBR serves as a liaison between the Plan and members.
The State Retirement System serves as the HBR for retired members.
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Does the State Health Plan subrogate?
The State Health Plan intends to exercise its right of recovery as set out in NCGS 135-40.13 (g) and pursue all subrogation rights allowed by North Carolina law.
NCGS 135-40.13 Coordination of Benefits provides:
(g) Right of Recovery. - Whenever payments have been made by the Claims Processor with respect to covered services in a total amount which is, at any time, in excess of the maximum amount of payment necessary at that time to satisfy the intent of this provision, irrespective of to whom paid, the Claims Processor shall have the right to recover such payments, to the extent of such excess, from among one or more of the following, as the Claims Processor shall determine: any persons to or for or with respect to whom such payments were made, any insurance companies, or any other organizations.
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What is the policy for paying out-of-state hospitals and doctors?
The State Health Plan's out-of-state provider network for the Indemnity Plan is managed by Private Healthcare Systems. To locate a provider outside of North Carolina, use the PHCS online Provider Search (under "Choose Your Network," be sure to select "Healthy Directions").
If you receive care from a participating provider in the PHCS Healthy Directions network, you will not be held responsible for amounts above the allowance for covered services. Plan members will be responsible for any deductibles, copays, coinsurance and non-covered charges. Mental Health and Chemical Dependency Benefits/Visits do not apply to the PHCS network.
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Note: The information contained in these Frequently Asked Questions does not include all the benefits or everything you need to know about the State Health Plan. Please check your Benefit Booklet for further details. For more information click on the appropriate Benefits Book for your health plan: NC SmartChoice Basic PPO, NC SmartChoice Standard PPO, NC SmartChoice Plus PPO and the Indemnity Plan. We encourage you to call if you have questions about any of your health plan benefits. For the contact information, consult our Contact Us page.
- Can I order an ID card online?
- Can I obtain claim information online?
- Is there anyone in my office who can help me with health benefit questions?
- Does the State Health Plan subrogate?
- What is the policy for paying out-of-state hospitals and doctors?
Can I order an ID card online?
No, this service is not available at this time for members enrolled in the Indemnity Plan.
Back To Top
Can I obtain claim information online?
No, this service is not available at this time for members enrolled in the Indemnity Plan.
Back To Top
Is there anyone in my office who can help me with health benefit questions?
Each employing unit (school district, state agency, etc.) has a designated employee or Health Benefit Representative (HBR) who is responsible for administering the Plan for its employees. The HBR, among other duties, enrolls new employees, reports changes, explains benefits, reconciles group statements and remits group fees. The HBR serves as a liaison between the Plan and members.
The State Retirement System serves as the HBR for retired members.
Back To Top
Does the State Health Plan subrogate?
The State Health Plan intends to exercise its right of recovery as set out in NCGS 135-40.13 (g) and pursue all subrogation rights allowed by North Carolina law.
NCGS 135-40.13 Coordination of Benefits provides:
(g) Right of Recovery. - Whenever payments have been made by the Claims Processor with respect to covered services in a total amount which is, at any time, in excess of the maximum amount of payment necessary at that time to satisfy the intent of this provision, irrespective of to whom paid, the Claims Processor shall have the right to recover such payments, to the extent of such excess, from among one or more of the following, as the Claims Processor shall determine: any persons to or for or with respect to whom such payments were made, any insurance companies, or any other organizations.
Back To Top
What is the policy for paying out-of-state hospitals and doctors?
The State Health Plan's out-of-state provider network for the Indemnity Plan is managed by Private Healthcare Systems. To locate a provider outside of North Carolina, use the PHCS online Provider Search (under "Choose Your Network," be sure to select "Healthy Directions").
If you receive care from a participating provider in the PHCS Healthy Directions network, you will not be held responsible for amounts above the allowance for covered services. Plan members will be responsible for any deductibles, copays, coinsurance and non-covered charges. Mental Health and Chemical Dependency Benefits/Visits do not apply to the PHCS network.
Back To Top
Note: The information contained in these Frequently Asked Questions does not include all the benefits or everything you need to know about the State Health Plan. Please check your Benefit Booklet for further details. For more information click on the appropriate Benefits Book for your health plan: NC SmartChoice Basic PPO, NC SmartChoice Standard PPO, NC SmartChoice Plus PPO and the Indemnity Plan. We encourage you to call if you have questions about any of your health plan benefits. For the contact information, consult our Contact Us page.
