The North Carolina General Assembly approved legislation to create a new health benefit to comply with the federal Affordable Care Act (ACA). The High Deductible Health Plan (HDHP) benefit option is available only to employees eligible for coverage under G.S. §135 48.40(e).
The High Deductible Health Plan is administered by Blue Cross and Blue Shield of North Carolina (Blue Cross NC) and utilizes the Blue Options Network. Preventive services performed by an in-network provider are covered at 100% in this plan, which means there is no charge to you.
The State Health Plan’s Clear Pricing Project (CPP) helps members control health care costs and protects the Plan’s financial future. Learn how you can save money in 2024 by visiting a CPP provider!
The Pharmacy Benefit Manager for this plan is CVS Caremark. This does NOT mean members have to go to a CVS pharmacy location for their prescriptions. CVS Caremark has a broad pharmacy network, which can be found using the tools below. For questions about the Pharmacy benefit, call CVS Customer Service at 888-321-3124.
The copay for preferred and non-preferred insulin has been waived for 30-day supply of insulin. This means regardless of the formulary tier, any covered insulin or insulin approved through the Formulary Exceptions (medical necessity) process will have a $0 coinsurance for you.
If you choose to enroll in this plan, you will be billed monthly for your premiums by the State Health Plan's direct billing administrator, iTEDIUM. This is a pre-paid plan; therefore, you will be billed a month in advance. For instance, you will receive a bill in December for January coverage. You will be responsible for paying your bill in a timely manner, and failure to do so will lead to termination of coverage.
Enrollment for this plan will be available online only, through eBenefits, the Plan's enrollment system. You will need to log into eBenefits through one of the portals listed to get started and will need to register as a first-time user.
During your enrollment period you are able to enroll yourself and any eligible dependents in the State Health Plan.
An eligible dependent of a covered employee includes:
Children up to age 26, including natural, legally adopted, foster children, children for which the employee has legal guardianship and stepchildren of the employee;
This includes coverage for such children (described above) who are covered by the Plan when they turn age 26 to the extent that they are disabled on the date that they turn age 26. A child is disabled if they are incapable of earning a living due to a mental or physical condition. Coverage continues for such children as long as the disability exists or the date coverage would otherwise end, whichever is earlier.
Please remember that when adding dependents to your benefit plan, you may be asked to provide documentation of dependent eligibility under the State Health Plan. Outside of your enrollment period you may not add or remove dependents or disenroll from the State Health Plan unless you experience a qualifying life event, such as marriage, birth, death or retirement.
For questions about enrollment, call the Eligibility and Enrollment Support Center at 855-859-0966