What is a TPA?
A TPA, or Third-Party Administrator, provides a comprehensive network of health care providers – including doctors and specialists – and processes claims for the Plan. The Plan has always had a TPA. Taxpayers like you pay the claims, not the TPA. The Plan’s Board of Trustees sets Plan benefits and premiums, not the TPA.
- The State Health Plan recently announced the award of the Third-Party Administrative (TPA) Services Contract to Aetna. This award was unanimously approved by your Board of Trustees.
- Blue Cross NC currently provides this service to our members on the Base PPO Plan (70/30) and the Enhanced PPO Plan (80/20).
- This does not impact members enrolled in the Humana Group 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.
- Aetna has a national network. Aetna has already begun a robust effort to recruit even more providers, which will only continue over the next two years.
- Providers don’t have to wait to make sure that they’re going to continue to serve Plan members if they’re not already in-network with Aetna. They can sign up now if they choose.
- Aetna will become the Plan’s new TPA on Jan. 1, 2025. Over the next two years, the Plan and Aetna will work to create a smooth process and make the transition as seamless as possible for our members.
- During the 2025 Open Enrollment period, which will take place in the fall of 2024, members will begin to receive additional information.
- Be aware of misinformation.
- A group called affordablecarenc.com is collecting email addresses of Plan members and promising to provide information on the TPA transition. That is not an official source of information and appears to be associated with a vendor that lost the Plan’s business in the procurement process that wishes to distribute misinformation.
- There are also targeted advertising efforts taking place across the state that are not from the State Health Plan. These efforts are deliberately meant to confuse you, so please do not take any action as a result of these advertisements.