My Pharmacy Benefits

Welcome to the State Health Plan

The State Health Plan offers health benefits to all eligible teachers, state employees, retirees and other individuals identified in the North Carolina General Statutes. The Plan's mission is to improve the health and health care of North Carolina teachers, state employees, retirees, and their dependents, in a financially sustainable manner, thereby serving as a model to the people of North Carolina for improving their health and well-being.

The Plan offers three Preferred Provider Organization (PPO) plans. PPO plans offer the freedom of choice among in-network providers, lower out-of-pocket costs and a strong emphasis on preventive health. Two of the plans, the Consumer-Directed Health Plan (CDHP) and the Enhanced 80/20 Plan, offer financial incentives for taking steps to improve your health. Listed below is the Plan information for the 2014 benefit year (Jan. 1-Dec. 31, 2014). To view Plan information for the 2015 benefit year (Jan. 1-Dec. 31, 2015), click here. To enroll in a 2015 Plan click here.

Consumer-Directed Health Plan (CDHP)

This is a high deductible health plan that is accompanied by a Health Reimbursement Account (HRA), which is set up for you by the State Health Plan. This plan includes the ability to lower your monthly premium by completing wellness activities. For a short video of how the CDHP works click here. For a list of covered Preventative Services click here.

For a list of Blue Options Designated Hospitals, click here.

Members who elect the CDHP receive ACA preventive medications at no charge with a prescription and CDHP preventive medications at 15% coinsurance with no deductible.

2014 Uniform Summary of Coverage

Enhanced 80/20 Plan

This plan has higher premiums in exchange for lower copays, coinsurance and deductibles. This plan includes the ability to lower your monthly premium by completing wellness activities. For a list of covered Preventative Services click here.

For a list of Blue Options Designated Hospitals, click here.

Members who elect this plan receive Affordable Care Act (ACA) medications covered at no charge with a prescription.

2014 Uniform Summary of Coverage

Traditional 70/30 Plan

This plan has lower premiums in exchange for higher copays, coinsurance and deductibles. Affordable Care Act preventive services and medications will require the applicable copay under this plan.

2014 Uniform Summary of Coverage

By choosing one of these plans, you have access to Member Services, a protected online resource for help in maximizing your benefits, and to NC HealthSmart, a protected online resource for help in managing your health.

Once you've identified the plan that is right for you, click here to learn how to enroll in a plan.

Wellness Premium Credits

You can lower your monthly premium for the Consumer-Directed Health Plan and the Enhanced 80/20 Plan by completing the wellness activities listed below. Wellness premium credits apply only to the employee-only premium. In order to receive the wellness premium credits, you must complete your wellness activities within 30 days of your hire date. For more information contact your Health Benefits Representative or call Customer Service at 855-859-0966.

Enhanced 80/20 Wellness Activities Wellness Premium Credits
Attest that you and your covered spouse (if applicable) are non-smokers or commit to a smoking cessation program $20 per month
Complete a confidential Health Assessment $15 per month
Select a Primary Care Provider for yourself and each covered dependent (if applicable) $15 per month
Total wellness premium credits $50 per month
Consumer-Directed Health Plan Wellness Activities Wellness Premium Credits
Attest that you and your covered spouse (if applicable) are non-smokers or commit to a smoking cessation program $20 per month
Complete a confidential Health Assessment $10 per month
Select a Primary Care Provider for yourself and each covered dependent (if applicable) $10 per month
Total wellness premium credits $40 per month

The smoker attestation and selecting a Primary Care Provider can be completed through BEACON or eEnroll. You can complete your Health Assessment through your enrollment system or by logging into your Personal Health Portal, which is available via the State Health Plan website or by telephone by calling 800-817-7044.

Additional Wellness Incentives

Additional wellness incentives are available in the Consumer-Directed Health Plan and the Enhanced 80/20 Plan that lower your out-of-pocket costs for various health care services you receive throughout the year.

Rate Comparison

January 1, 2014 – December 31, 2014

Plan Comparison

January 1, 2014 – December 31, 2014

Reduction in Force (RIF) and Health Coverage

Learn more about health coverage for employees who lose their jobs due to a reduction in force.

High Deductible Health Plan (HDHP) for Newly Eligibles

The North Carolina General Assembly recently approved legislation to create a new health benefit to comply with the federal Affordable Care Act (ACA). The HDHP benefit option is available only to employees eligible for coverage under G.S. §135 48.40(e).

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