2023 Benefit Information: Non-Medicare Members

2023 Benefit Information: Non-Medicare Members

For 2023, 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 Base PPO Plan (70/30) and the Enhanced PPO Plan (80/20). 

All members will be automatically enrolled in the Base PPO Plan (70/30), which remains premium free for eligible retirees. Members who wish to enroll and reduce their premium in the Enhanced PPO Plan (80/20) by completing the tobacco attestation will need to TAKE ACTION during Open Enrollment, which will be held October 10-28, 2022.

Please note: Although the 80/20 and 70/30 plan names have changed, these are still the same plans offered previously to State Health Plan members.

2023 Open Enrollment for Non-Medicare Members

Important Highlights About Your 2023 Benefits

  • No premium increases for the 5th year in a row!
  • 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 2023. Please refer to your benefit booklet for full coverage details.
  • 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!
  • Joint replacement bundle pricing for eligible members!
  • 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!
  • To learn more about the Clear Pricing Project, click here.

    Tobacco Attestation Premium Credit

    Tobacco users can attend a tobacco cessation counseling session at a provider's office for FREE to receive a lower premium for 2023! You have until November 30, 2022, to take action. **The Base PPO Plan (70/30) remains premium-free for eligible retirees and this action is not necessary to reduce premiums in that plan.**


    At Time of Enrollment

    Subscriber-Only Monthly Premium

    Enhanced PPO Plan (80/20)


    *Attest to being a non-tobacco user or agree to visit a provider (by Nov. 30, 2022) for at least one cessation counseling session to earn a monthly premium credit of $60.




    Total Monthly Employee-Only Premium

    (With Credit)



      • If you combine your tobacco cessation visit with another service, there may be a copay.
      • 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 2023 Plan benefit year.
      • After you visit a provider 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

      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.

      These documents and tools include information based on the 2022 formulary and are subject to change prior to January 1, 2023.

      Open Enrollment Webinars

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



      Oct. 5


      Oct. 6

      12:30pm & 4:00pm

      Oct. 11


      Oct. 13

      10:00am & 4:00pm

      Oct. 18


      Oct. 20

      12:30pm & 4:00pm

      Oct. 25


      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