Benefit Changes to State Health Plan
August 15, 2005
The new state budget brings changes to many North Carolina agencies, schools, colleges and citizens and the State Health Plan is no different. We feel that the changes that will negatively impact our members are much smaller than they could have been and one of the benefits even increased!
Following is a summary of the changes:
The new state budget brings changes to many North Carolina agencies, schools, colleges and citizens and the State Health Plan is no different. We feel that the changes that will negatively impact our members are much smaller than they could have been and one of the benefits even increased!
Following is a summary of the changes:
- There is a premium increase of about 12.3% effective 10/1/05. This will not change again for two years. The industry standard for premium increases is 12-15% annually.
- There is NO benefit change to the annual deductible or for the physician office co-pay.
- The wellness benefit has been EXPANDED to include a yearly mammogram for women age 40 and over covered at 100% of allowable charges. The maximum amount payable at 100% of allowable charges for wellness benefits is $150 per Plan year. Any charges over $150 are subject to the deductible and coinsurance requirements.
- Prescription drug co-pays for generics and preferred brand drugs remain the same. A brand with generic available and non-preferred drug co-pays will increase. The increase will take effect August 20, 2005. The drug co-pays will not be retroactive.
- Emergency room visit co-pays have increased effective July 1, 2005.
- Other costs for hospital inpatient and outpatient stays/services have increased effective July 1, 2005.
