2024 Benefit Information: Individual Members
2024 Benefit Information: Individual Members
For 2024, 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 9-27, 2023.
2024 Rate Sheets
- 70/30 & 80/20 Plan for 100% Contributory Subscribers
- 70/30 & 80/20 Plan for Active Subscribers Who Are Medicare Primary Due to Upcoming Retirement
- 80/20 & 70/30 Plan for 12-Month RIF Subscribers
- 70/30 & 80/20 Plan for Active Subscribers Who Are Medicare Primary Due to ESRD
- 70/30 & 80/20 Plan for Active Subscribers Whose Dependent is Medicare Primary Due to ESRD
- 70/30 & 80/20 Plan for Active Subscribers Who Are Medicare Primary Due to ESRD and Have an ESRD Medicare Primary Dependent
- Medicare Primary Plans 100% Contributory Medicare Primary Subscribers who are in the Direct Bill & Sponsored Dependent Groups
- Medicare Primary Plans 100% Contributory Medicare Primary Subscribers who are in COBRA
Important Highlights About Your 2024 Benefits
- No premium increases for the 6th year in a row with no increase in copays or deductibles!
- 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 2024. 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!
- You will not receive a new ID card unless you change your plans. You will continue to use your 2023 ID card in 2024.
- To learn more about the Clear Pricing Project, click here.
Tobacco Attestation Premium Credit
|
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, 2023) 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 |
- Tobacco users can attend a tobacco cessation counseling session at a provider's office for FREE to receive a lower premium for 2024! You have until November 30, 2023, to take action. Please Note: The rates are for 100% Contributory Members.
- 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 2024 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 2023 formulary and are subject to change prior to January 1, 2024.
Open Enrollment Webinars
Register today for a convenient webinar to learn more about Open Enrollment! Click a date and time below to register.
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WEBINAR DATES |
WEBINAR TIMES |
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Sept. 26 |
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Sept. 28 |
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Oct. 4 |
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Oct. 10 |
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Oct. 12 |
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Oct. 17 |
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Oct. 19 |
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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.