2021 Benefit Information: Active Members

CLEAR PRICING PROJECT PROVIDER COPAY COMPARISON CHART

Provider

80/20 Plan

70/30 Plan

Primary Care Provider (PCP)

$0 for Clear Pricing Project (CPP) PCP on ID card;

$10 for non-CPP PCP on ID card;

$25 for any other PCP

$0 for Clear Pricing Project (CPP) PCP on ID card;  

$30 for non-CPP PCP on ID card;

$45 for any other PCP

Specialist

$40 for CPP Specialist;

$80 for other Specialists

$47 for CPP Specialist;

$94 for other Specialists

Speech, Occupational, Chiropractor and Physical Therapy

$26 for CPP Providers;

$52 for other Providers

$36 for CPP Providers;

$72 for other Providers

To locate a CPP PCP visit the Find a Doctor tool or visit the Clear Pricing Project page.

Earn Down Your Premium by Completing the Tobacco Attestation

Tobacco users can attend a tobacco cessation counseling session at a CVS MinuteClinic or Primary Care Provider’s (PCP) office for FREE to earn a lower premium for 2021! You have until November 30, 2020, to take action. (If you combine your tobacco cessation visit with another service, there may be a copay.)

Before your cessation counseling visit, go to the Plan’s tobacco user attestation page and print off instructions for your provider to ensure your visit is billed correctly and is FREE.

CVS MinuteClinic is now able to conduct virtual tobacco attestation counseling sessions in North Carolina! Subscribers interested in this service should click here to request a virtual session. This only applies to subscribers that attested during Open Enrollment that they were tobacco users who wanted to earn a premium credit.

At Time of Enrollment

Subscriber-Only Monthly Premium

80/20 PLAN

70/30 PLAN

$110

$85

*Attest to being a non-tobacco user or agree to visit a CVS MinuteClinic or Primary Care Provider (by Nov. 30, 2020) for at least one cessation counseling session to earn a monthly premium credit of $60. Print the tobacco cessation coding instructions and provide them to your provider to ensure the claims are submitted correctly.

-$60

-$60

Total Monthly Employee-Only Premium

(With Credit)

$50

$25

Pharmacy Resources

*The prescription medications listed or their tier placement may change from time to time due to a change in cost and/or classification of medication.

CVS Caremark is the State Health Plan’s Pharmacy Benefit Manager.

The State Health Plan utilizes a custom, closed formulary (drug list). The formulary indicates which drugs are excluded from the formulary and not covered by the Plan. All other drugs that are on the formulary are grouped into tiers. Your medication’s tier determines your portion of the drug cost.

Pharmacy icon

FAQs - Clear Pricing Project and Primary Care Providers

What is the Clear Pricing Project?

What is the Clear Pricing Project?

Under the Clear Pricing Project (CPP), more than 25,000 providers partnered with the State Health Plan for transparent and affordable health care. These provider partners are included in the North Carolina State Health Plan Network, which is made up of providers who signed up for the Plan's Clear Pricing Project, and Blue Cross NC's Blue Options network.

  • CPP providers have agreed to no secret contracts and more affordable health care. The goal is to ensure that members have this valuable benefit for years to come, while bringing transparency to health care expenses and addressing rising health costs. To support members and CPP providers, the Plan is offering reduced copays beginning January 1, 2021.
  • If you select a Clear Pricing Project provider as your Primary Care Provider listed on your ID card, your visits are free!
  • If you visit a Clear Pricing Project specialist, 80/20 Plan members will pay only $40 for a CPP specialist ($80 for a non-CPP specialist), and 70/30 Plan members will pay $47 for a CPP specialist ($94 for a non-CPP specialist).
How do I search for a CPP Provider?

How do I search for a CPP Provider?

There are two ways members can search for a CPP Provider. Click here for instructions.

What if there aren't any CPP providers in our area?

What if there aren't any CPP providers in our area?

Members still have access to in-network providers if there aren’t any Clear Pricing Project (CPP) providers in their area.

If I already have a Primary Care Provider selected, will I need to choose that provider again?

If I already have a Primary Care Provider selected, will I need to choose that provider again?

No, you do not need to re-select. It is a good idea to verify when you’re going through the online enrollment process to ensure you have a PCP selected. Remember, in order to receive the CPP reduced copayment, the PCP you select will need to be a CPP Provider. To find a CPP Provider, visit the Find a Doctor tool.

If a provider recently signed up for CPP and is not showing up in my search, what should I do?

If a provider recently signed up for CPP and is not showing up in my search, what should I do?

Providers who signed up recently may not appear on the list of CPP providers until January 1, 2021. You will need to log into eBenefits after January 1, 2021, to re-select that PCP. A new ID card will be generated for you. Please keep in mind it takes 5-7 days for your new cards to generate.

Can you select a different CPP provider for your dependents?

Can you select a different CPP provider for your dependents?

Yes, each dependent can have a different PCP, which will be listed on their ID card.

If a new member recently completed a tobacco cessation counseling session, do they have to complete another session for Open Enrollment for 2021?

If a new member recently completed a tobacco cessation counseling session, do they have to complete another session for Open Enrollment for 2021?

New employees who completed a tobacco cessation counseling session between July 1, 2020, and November 30, 2020, will not need to complete another tobacco cessation session in order to earn their 2021 premium credit. December 2020 new hires will also only need to complete one tobacco cessation counseling session but will have 60 days to complete it. 2020 new hires do need to complete the 2021 attestation to earn the 2021 credit.

Do members have to visit the PCP listed on their ID card for the tobacco cessation counseling session to be free?

Do members have to visit the PCP listed on their ID card for the tobacco cessation counseling session to be free?

No, they can go to any network provider that provides the service. Visit the Plan’s website and print out the instructions for providers to ensure they receive the visit at no cost. If the visit is combined with another reason, there may be a copay.

Can the tobacco cessation counseling visit with a PCP be virtual?

Can the tobacco cessation counseling visit with a PCP be virtual?

Yes, as long as the provider is offering that service virtually.

Nicotine lozenges and patches are not mentioned in the Tobacco Attestation Survey question. Are they included as tobacco use?

Nicotine lozenges and patches are not mentioned in the Tobacco Attestation Survey question. Are they included as tobacco use?

No.

If a member waived/declined insurance for 2020, will they need to log on and waive/decline it again?

If a member waived/declined insurance for 2020, will they need to log on and waive/decline it again?

No. Members who declined 2020 coverage will not have to log in to decline 2021 coverage.

If a member participates in Open Enrollment early in the period, but then decides to make a change before the OE ends, will the change be allowed?

If a member participates in Open Enrollment early in the period, but then decides to make a change before the OE ends, will the change be allowed?

Yes.

Does dependent verification documentation have to be uploaded within the two-week Open Enrollment time frame? Or do we have 30 days from the beginning of Open Enrollment?

Does dependent verification documentation have to be uploaded within the two-week Open Enrollment time frame? Or do we have 30 days from the beginning of Open Enrollment?

Members have 30 days from the date of enrollment to upload dependent verification documents, which is the same time frame they have to enroll.