High Deductible Health Plan
High Deductible Health Plan (HDHP)
Use the resources below to understand the HDHP for your eligible employees.
|HDHP Benefit Booklet||This is the benefit booklet for those employees enrolled in the HDHP.|
|HDHP Enrollment Guide||This is the enrollment guide that HBRs can use for those eligible for the HDHP.|
|HDHP Quick Guide||The State Health Plan has created the HDHP Quick Guide to assist HBRs with questions on the eligibility, enrollment, policies and procedures for the High Deductible Health Plan.|
|A Reference Guide for non-BEACON Employing Units to the Pay or Play Rules under the Affordable Care Act||The State Health Plan has created a Reference Guide to provide additional guidance to assist employing units in navigating through the HDHP eligibility requirements. This guide can be used as a reference tool; however, you will need to seek guidance regarding your specific needs with your employing unit's legal counsel.|
Retiree Termination Process
- Effective January 1, 2016, employing units had to make the decision to offer the High Deductible Health Plan (HDHP) or the benefits traditionally offered to active employees (70/30 PPO Plan and 80/20 PPO Plan) to a rehired retiree that meets the eligibility requirements of a non-permanent full-time employee. While the rehired retiree is not required to enroll in a plan, the retiree is no longer eligible for the State Health Plan retiree group coverage under the Retirement System as required by NC General Statute 135-48.41(j). Therefore, the Plan will terminate the retiree from the State Health Plan retiree group coverage under the Retirement System.
- To document the offer, you must update eBenefits with the retiree's information.
- To notify the Plan, HBRs will need to complete the retiree termination of coverage process using the Exception Form. Click here for Step-by-Step instructions.
- Once the online exception form is completed and received by the Plan, the Plan will terminate the retiree’s coverage under the Retirement System and notify the HBR via email. The rehired retiree has 30 days to elect coverage once he/she becomes eligible under the employing unit. The HBR is responsible for relaying this process to the rehired retiree as no notice will be sent to them regarding termination of coverage.
- If you are offering the HDHP, the 70/30 PPO Plan or the 80/20 PPO Plan, you will need to add the rehired retiree to eBenefits as a new employee or rehired employee. If you need assistance adding the rehired retiree, please call the HBR Support Line at 800-422-5249, create a case via One Place 365, or reach out to your Account Manager, if you have one assigned.
High Deductible Health Plan FAQs
Yes, members enrolled in this plan are eligible for COBRA.
Yes, all eligible employees should be loaded into the system to allow for them to enroll or waive coverage. Those who do not enroll within the appropriate timeframes will not be eligible to enroll until the next Open Enrollment.
Premium payments are due by the first of the effective month. Members who do not pay by the end of the effective month will be terminated the first of the following month.
Employers will be able to pay online and paper checks will also be accepted.
Yes, charter schools are required to participate.
Initial enrollment can by uploaded from a file or loaded manually one by one. Please contact the State Health Plan at firstname.lastname@example.org if you are interested in utilizing EDI for ongoing enrollment maintenance.
Yes, they are able to decline coverage.
If an employee qualifies for this coverage, they are no longer eligible for Plan coverage under the Retirement Systems.
Providing a direct bill for these employees will be the standard approach. Groups interested in using payroll deductions for their members may contact the Plan at HBRInquiries@nctreasurer.com for an exception.
No, an email address will not be required for a member to enroll online.
Yes, you will have to approve an employee’s activity in the eBenefits enrollment system.
No, iTEDIUM, the Plan’s billing administrator, will be billing the members monthly. Employers will not have to bill employees for this plan.
Employing units will be able to log into the portal and view their invoice. You will be able to submit payment via ACH or by check.
HBRs must approve any qualifying life event changes. Additionally, HBRs have access to various employee reports and can view the employees’ records.
The bill will be as current as the enrollment entered the day before the bill run.
Any employee who meets the definition of a full-time employee under the Internal Revenue Code, i.e., an employee with 30 hours of service or more per week during a month or with 130 service hours in a month, is eligible for coverage. This could include employees acting as substitute teachers or filling other positions on a temporary basis.
Any employee who meets the definition of a full-time employee under the Internal Revenue Code, i.e., an employee with 30 hours of service or more per week in a month or with 130 service hours in a month, is eligible for coverage.
Yes, in order to avoid IRS penalties, you must identify any common law employee – regardless of how classified (permanent or otherwise) – and offer those employees coverage that is affordable and has minimum value. Keep in mind that permanent full-time employees, those employed in permanent job 5 positions on a recurring basis who work 30 or more hours per week for nine or more months per calendar year, are eligible for other coverage with the State Health Plan and not the HDHP.
The process will be the same and you will use the same exception form.
Various banks and credit unions offer an HSA. Eligible members are responsible for setting up their own Health Savings Account.
Enrollment is only available online. Members without computer access are able to call to enroll.
Yes, HBRs will be responsible for uploading information on eligible employees.
Yes. The Employing Unit has to show that it made the offer of coverage and so it is important to capture when an employee declines coverage.
The department census shows all employees (and dependents, if selected) that are actively enrolled in benefits. If an employee has waived coverage they will show on this report as well. The enrollment report will show all pending enrollments for employees and dependents, as well as the pending benefit the employee has selected.
There is no required length of coverage if offering coverage on a month-to-month basis. If an employee does not have the required number of hours of service in a month, they are not eligible for coverage. Thus, if they have 130 hours in January, they would need to be offered coverage for January. If they then have 115 hours in February, they would not have to be offered coverage but they would be eligible for COBRA. The termination should be completed within the effective month of the termination. This intermittent offering of coverage will be difficult to administer and is not recommended.
Yes. If the retiree is not eligible for coverage as a full-time employee of an employing unit, then the retiree remains eligible for health benefits as a retiree through the Retirement Systems.