2022 Open Enrollment Information: Individual Members

2022 Open Enrollment Information: Individual Members

For 2022, the State Health Plan will continue to offer two Preferred Provider Organization (PPO) plans administered through Blue Cross and Blue Shield of North Carolina (Blue Cross NC). They are the 70/30 PPO Plan and the 80/20 PPO Plan. 

All members will be automatically enrolled in the 70/30 PPO Plan. You can reduce your premium by completing the tobacco attestation during Open Enrollment.

Members who wish to enroll in the 80/20 PPO Plan or who wish to reduce their monthly premium in either the 80/20 PPO Plan or the 70/30 PPO Plan by completing the tobacco attestation will need to TAKE ACTION during Open Enrollment.

Open Enrollment is October 11-29, 2021. Members are encouraged to not wait until the last minute to enroll, in case you have questions or documents to gather.

Open Enrollment Instructions

Important Highlights About Your 2022 Benefits

  • There are no significant benefit changes for 2022. The formulary (drug list), which determines what medications are covered and what tier they fall under, changes on a quarterly basis, so there is a possibility that you will have changes in your prescription coverage in 2022.
  • Members who select a Clear Pricing Project Provider as their Primary Care Provider will continue to enjoy a $0 copay!
  • Members will continue to enjoy a reduced copay when visiting a Clear Pricing Project Specialist!
  • Preferred and non-preferred insulin continues to have a $0 copay for a 30-day supply!
  • Preventive Services remain free – no copay or deductible – on either plan!

CLEAR PRICING PROJECT PROVIDER COPAY COMPARISON CHART

Provider

80/20 PPO Plan

70/30 PPO 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

Behavioral Health Provider

$0 for CPP Provider;

$25 for other Providers

$0 for CPP Provider;

$45 for other Providers

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

    Tobacco Attestation Premium Credit

    Tobacco users can attend a tobacco cessation counseling session at a CVS MinuteClinic or Primary Care Provider’s (PCP) office for FREE to receive a lower premium for 2022! You have until November 30, 2021, to take action.

    Please Note: The rates below are for 100% Contributory Members.

     

    At Time of Enrollment

    Subscriber-Only Monthly Premium

    80/20 PPO PLAN

    70/30 PPO PLAN

    $642.36

    $617.36

    *Attest to being a non-tobacco user or agree to visit a CVS MinuteClinic or Primary Care Provider (by Nov. 30, 2021) for at least one cessation counseling session to earn a monthly premium credit of $60.

     

     

    -$60

     

     

    -$60

    Total Monthly Employee-Only Premium

    (With Credit)

     

    $582.36

     

    $557.36

    • If you combine your tobacco cessation visit with another service, there may be a copay.
    • Since members can see a PCP for the tobacco cessation counseling session, waivers will no longer be given to members who live more than 25 miles away from a CVS MinuteClinic.
    • Even if you completed the tobacco attestation during last year’s Open Enrollment, you must make a new attestation during this year’s Open Enrollment period to receive the $60 premium credit for the 2022 Plan benefit year.
    • After you visit a CVS MinuteClinic or a PCP for your tobacco cessation session, the provider will submit a claim on your behalf. To ensure you receive credit for your visit, you should upload your office visit summary to the “Document Center” located in eBenefits, the Plan’s enrollment system. Make sure to request a copy of your visit summary during your counseling session.

    Pharmacy Resources

    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.

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

    *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. These tools include information based on the 2021 formulary and are subject to change prior to January 1, 2022.

    Open Enrollment Webinars

    Register today for a convenient webinar to learn more about Open Enrollment!

    WEBINAR DATES

    WEBINAR TIMES

    Sept. 23

    12:30pm & 4:00pm

    Sept. 28

    10:00am & 4:00pm

    Oct. 4

    11:30am & 4:00pm

    Oct. 8

    2:00pm

    Oct. 14

    12:00pm

    Oct. 18

    12:30pm & 4:00pm

    Oct. 21

    10:30am

    Oct. 25

    4:00pm

    Forgot Password for eBenefits?

    For members that log in directly to eBenefits (not through an employer portal) you can reset your password yourself and DO NOT need to call the Eligibility and Enrollment Support Center to reset your password.

    If you are having issues logging into eBenefits, do not continue to attempt to log in or you will lock your account. Instead you have the option to reset your password. Simply click “Reset your account” on the log-in page, and then click “I can’t remember my password." From there, you will be prompted to a screen that will ask you to enter your username, so a passcode can be sent to the email address you have in eBenefits.

    Click here to go to the eBenefits page