2023 Open Enrollment Information: Individual Members

2023 Open Enrollment Information: Individual 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). You can reduce your premium by completing the tobacco attestation during Open Enrollment.

Members who wish to enroll in the Enhanced PPO Plan (80/20) or who wish to reduce their monthly premium in either the Enhanced PPO Plan (80/20) or the Base PPO Plan (70/30) 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.

Important Highlights About Your 2023 Benefits

  • 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 Benefits Booklet for complete 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.

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

 

At Time of Enrollment

Subscriber-Only Monthly Premium

Enhanced PPO Plan (80/20)

Base PPO Plan (70/30)

$694.96

$669.96

*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.

 

 

-$60

 

 

-$60

Total Monthly Employee-Only Premium

(With Credit)

 

$634.96

 

$609.96

  • 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!

WEBINAR DATES

WEBINAR TIMES

Oct. 5

10:00am

Oct. 6

12:30pm & 4:00pm

Oct. 11

10:00am

Oct. 13

10:00am & 4:00pm

Oct. 18

4:00pm

Oct. 20

12:30pm & 4:00pm

Oct. 25

11:00am

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