Directly Invoiced Members Overview
Individual members are a special category under the State Health Plan that includes surviving spouses, surviving dependents, Reduction in Force (RIF) members and former legislators. These members are not part of an employment group and must enroll, make payments and maintain coverage status individually. See below for details on plan options, rates and billing.
Health Plan Options
Individual members are eligible for the following two health plans. Click each link for more information:
When members elect and pay to continue coverage, they are enrolled and billed to a current date. Subsequently, members are billed on a monthly basis, 20 days prior to the period for which premiums are due.
When members are in a status that requires them to receive an invoice directly, an invoice is generated immediately to reflect all charges through the end of the current billing period. Subsequently, members are billed on a monthly basis, 20 days prior to the period for which premiums are due.
Although your Benefits Booklet provides a good overview of what services and products are available to you under the PPO plans, the medical policies provide detailed information around the circumstances under which certain services and products are and are not covered. Medical policies can be found here on the Blue Cross and Blue Shield website*.
* If any of the State Health Plan medical policies conflict with the Blue Cross and Blue Shield of North Carolina medical policies, the State Health Plan medical policies will prevail.
Certain services require prior review and certification before they can be covered by your health insurance plan. Click here for more information.
If you disagree with the way a claim has been handled, you can request an appeal or grievance review. For the complete appeals process, please click here.