Training and Development

The State Health Plan recognizes the value in providing HBRs with ongoing training opportunities to assist in carrying out duties as they relate to the Plan. Below is a list of resources available to you as an HBR. We know how important you are to our members, and we’re here to help you learn what you need to know! 

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Resource Guides

There are additional resource guides specific to eBenefits for HBRs located in eBenefits under Resources. 

Presentations

HBR Webinars

2025 Open Enrollment Training

2025 Open Enrollment will be held Sept. 30-Oct. 25, 2024. With the Aetna transition, it’s vital for Health Benefit Representatives (HBRs) to stay informed and updated! Let us help you get ready! The State Health Plan is holding Open Enrollment trainings for HBRs in July. Trainings will cover important information regarding 2025. These trainings will be offered as webinars, so you may join us from the comfort of your own desk. 

Reserve your spot to ensure you have the information you need to best serve your employees! Click below to register for one of the 10 trainings that best fits your schedule. 

HBR webinars are offered on as as-needed basis. Please check HBR Update, our free monthly e-newsletter, each month to see when a webinar is scheduled. You can access previous HBR webinars by clicking here.

Additional Resource Information

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QLE Training #1

The Patient Protection and Affordable Care Act (PPACA) was enacted on March 23, 2010 and then amended on March 30, 2010 by the Heath Care and Education Reconciliation Act. The final version of the law is often referred to as the ACA.

The ACA requires every employer with 50 or more Fulltime Equivalents, referred to as an Applicable Large Employer or an ALE, to offer affordable health coverage to Qualified Fulltime Employees.  This coverage offering must meet or exceed minimum effective coverage and minimum value standards.

If an ALE fails to offer or chooses not to offer affordable coverage meeting these standards to at least 95% of their qualified fulltime employees, they are subject to paying an Employee Shared Responsibility Payment (ESRP). Or, if a fulltime employee successfully meets the criteria to obtain coverage via the healthcare exchange (healthcare.gov) and successfully qualifies for a government subsidy, the ALE would also be subject to an ESRP.

A fulltime employee would only qualify for a government subsidy if they were not offered coverage, or the coverage they were offered was not affordable or did not provide minimum value or minimum effective coverage. By statute, all State Health Plan offerings for qualified fulltime employees meet or exceed the ACA thresholds. By following the Plan's coverage guidelines, employers will be ACA compliant, given that they adequately identify their qualified fulltime employees and offer them coverage.

To monitor compliance with the ACA, the IRS code was modified to require ALE’s to report their coverage offerings on forms 1094-C and 1095-C each calendar year. This information is sent to both the IRS and the qualifying fulltime employee.  The IRS receives both forms while the employee receives the 1095-C.

The ACA also requires the IRS to collect information from Providers of Minimum Essential Coverage regarding coverage they provide to their members, and for the Providers to report this information to their members.  This coverage information is reported on forms 1094-B and 1095-B.  The IRS receives both forms while the member receives the 1095-B.  This is an annual reporting requirement for coverage providers.

Self-insured employers are considered the Coverage Provider for their employees.  Therefore, self-insured employers are responsible for the 1094-B and 1095-B reporting.  A self-insured employer who is also an ALE is required to report both as an ALE and as a Provider.  To make the reporting easier, the IRS added a section to the 1095-C where the self-insured ALE can honor their reporting responsibility as a Provider.  This is Part III of the form and it eliminates the need for the self-insured ALE to create both the 1095-C and 1095-B.  The 1094-C also serves both purposes.

All employers offering State Health Plan coverage are self-insured.  This means that all State Health Plan employers must report to the IRS using either forms 1095-B or 1095-C each calendar year.  If you are an ALE, you use form 1095-C, otherwise you use form 1095-B. The appropriate 1094 form is also required.

New Health Insurance Marketplace Coverage Options and Your Health Coverage Template

A complete list of the benefit package tiers and rates for employing units are available below.

For e-billing, download the e-billing guide. Click here to access the eBilling Quarterly HBR Training presentation.

The North Carolina State Health Plan (Plan) is committed to safeguarding Protected Health Information (PHI) and providing quality services to all our members. We would like to remind every employing unit that when information regarding Plan members received from the Plan or its vendors is stored, accessed, or transmitted by the employing unit and its employees (including the Health Benefit Representative), that information is subject to the protections and regulations of HIPAA.

The HIPAA Privacy Rule is a federal regulation issued by the U.S. Department of Health and Human Services (HHS) which governs the use and disclosure of PHI in health care treatment, payment, and operations by Covered Entities and their partners. Group health plans like the Plan are considered Covered Entities and are subject to the requirements of HIPAA and the Privacy Rule. Anyone with whom the Plan shares information in the course of business is also required to protect that information.

The Privacy Rule protects all individually identifiable health information held or transmitted by a Covered Entity, in any form or media, whether electronic, paper, or oral. Individually identifiable health information is information that (1) identifies an individual person, and (2) relates to:

  • an individual’s past, present, or future physical or mental health or condition;
  • the provision of health care to an individual; or
  • the past, present, or future payment for the provision of health care to an individual.

When the Plan and its vendors, such as Benefitfocus and iTEDIUM, transmit data containing an employee’s eligibility, premiums, or other individually identifiable information to an employing unit or HBR (i.e., on daily, weekly or monthly data files or via a secure portal), that data is considered PHI, and must be protected by the employing unit according to the requirements of HIPAA.

Consult your legal department, as well as your IT security, to ensure you have the necessary processes, security, and controls in place to adequately protect any such information received from the Plan or its vendors regarding Plan members that you store, access, or transmit.