Be a State Health Plan Watchdog

Why do we need members to become a State Health Plan Watchdog?

The sustainability of this State Health Plan benefit is at risk and its fate is in the hands of our members.

  • For 40 years, no money has been set aside for the State Health Plan to pay for future retiree health care.
  • This lack of savings has placed us $34 billion in debt. This debt is often called an unfunded liability.
  • The cost of health care is increasing, but funding for the State Health Plan has not kept pace.
  • Not addressing this funding crisis puts the State Health Plan on an unsustainable path.

It’s a benefit worth protecting. Remember that you are a valued Plan member – and your State Health Plan is a valuable benefit!

How do you become a Watchdog?

Making more informed decisions about your healthcare spending can help as we try to drive down costs. It’s one way to tackle the debt and help you save money, but we need your help. The Watchdog initiative will equip you with the knowledge and information you need to work with us on driving down the cost of health care.  Here are some ways you can help!

  • Report any suspected waste, fraud and abuse to 800-324-4963.
  • Maintain your best health. Don’t forget your annual physical and age-appropriate health screenings. They are key to maintaining your good health.
  • Review your Explanation of Benefits (EOB). These EOBs – mailed to your home and available online – help you understand how your benefits are applied. The EOB has been redesigned to make it easier to read!
  • Use transparency tools. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) and CVS Caremark have online tools that let you search for estimated out-of-pocket costs. The location of a service can drive the price, so shop around and save!
    • For Blue Cross NC, log into eBenefits and look for the Blue Connect link on the left-hand menu.
    • For CVS Caremark, log into eBenefits and look for the CVS Caremark link on the left-hand menu.

With these resources, you can make sure that you’re using your health benefit most cost-effectively, you’re billed correctly for services, and you’re guarding against waste, fraud and abuse.

Did You Know?

  • If you are an active employee, your employer pays 82% of your Plan costs with your employer contributing nearly $500 to your health benefits each month.
     
  • You and taxpayers like you pay your medical bills – not Blue Cross NC. They only process your claims and provide a network of medical providers for the State Health Plan.
     
  • Your pharmacy benefits are paid for by you and taxpayers like you. CVS Caremark is the State Health Plan’s Pharmacy Benefit Manager, but your pharmacy benefits are paid for by taxpayers.