2025 Transition to Aetna as TPA
State Health Plan Third-Party Administrator Switch to Aetna in 2025
This page serves as the official State Health Plan information source for members seeking details regarding the recently announced Third-Party Administrator (TPA) Services Contract award to Aetna, which will take place on January 1, 2025. This page will provide the most accurate, up-to-date information regarding this transition.
2025 Third-Party Administrator Transition to Aetna
The State Health Plan is transitioning its third-party administrator from Blue Cross NC to Aetna® beginning Jan. 1, 2025. This short video gives you a brief overview about this change and answers some questions you may have. We’re here to help you navigate through this change and make it as seamless as possible!
2025 TPA Transition Information Video
Frequently Asked Questions
In 2022, after an open, competitive bid process, the Board of Trustees awarded the third-party administrator services (TPA) contract to Aetna®. The change is expected to save North Carolina taxpayers approximately $140 million.
Aetna will become the Plan’s new TPA on Jan. 1, 2025.
This change applies to members enrolled in the Base PPO Plan (70/30), Enhanced PPO Plan (80/20) and the High Deductible Health Plan. This change does NOT impact members enrolled in the Humana Medicare Advantage plans.
Plan options, including the Base PPO Plan (70/30) and the Enhanced PPO Plan (80/20), will remain in place and will continue to be offered. Copays, deductibles and premiums are not impacted by this change.
Your pharmacy benefit administrator, or PBM, is NOT changing, so this change does not affect your pharmacy benefits. Your PBM is currently CVS Caremark.
Your coverage is not changing, but the services available to you are expanding at no additional cost. The State Health Plan’s partnership with Aetna® means even more benefit offerings for members, including:
- Aetna Health Concierge services
- Teladoc Health services
- A 24/7 nurse line
- Expanded disease and case management services to support all of your unique health needs
Look for more information about these new services in the coming months.
Aetna has an extensive national and in-state provider network. Aetna reviewed millions of State Health Plan claims processed over an entire year, and about 99% of those claims came from providers already in the Aetna network.
Even so, providers don’t have to wait to make sure they continue to serve Plan members, if they’re already not in Aetna’s network, they can join now. The Clear Pricing Project (CPP) will continue in 2025, but current CPP providers need to rejoin through Aetna. Talk to your provider!
Should I do anything now?
Stay updated on the TPA transition and all plan benefits news on the Plan’s website, in the Plan’s monthly e-newsletter and on Facebook. It’s easy! To ensure you receive announcements and messages about this change, please see this handy checklist!
🗹 Make sure you have your correct mailing address, email address and phone number in eBenefits, the Plan’s enrollment system. Click here to access eBenefits.
🗹 Make sure your employer has the correct address, as well. If you're a retiree, your personal information needs to be current in ORBIT and eBenefits as the two systems do not coordinate.
🗹 Sign up for the Plan’s monthly e-newsletter, Member Focus.
🗹 Follow the State Health Plan on social media! Visit Facebook.com/SHPNC and Instagram.com/nchealthplan.