Skip to main content
NC State Health Plan logo NC State Health Plan

Topical Navigation

  • Home
  • Employee Benefits
    Employee Benefits
    • 70/30 PPO Plan for Employees
    • 80/20 PPO Plan for Employees
    • High Deductible Health Plan
    • Subrogation and Recovery
    • Understanding Disability
    • Important Forms
    • Joint Replacement Program
  • Retiree Benefits
    Retiree Benefits
    • Non-Medicare Retirees 70/30 PPO Plan
    • Non-Medicare Retirees 80/20 PPO Plan
    • Medicare Retirees 70/30 PPO Plan
    • Humana Group Medicare Advantage Base Plan (90/10)
    • Humana Group Medicare Advantage Enhanced Plan (90/10)
    • Understanding Disability
    • Important Forms
    • Planning for Retirement
  • Individual Members
    Individual Members
    • COBRA Plan Overview
    • Directly Invoiced Members
    • Subrogation and Recovery
    • Important Forms
  • Wellness
    Wellness
    • Your Health Resources
    • Preventive Care
    • Diabetes Resource Center
    • Opioid Resource Center
    • High Blood Pressure Resource Center
    • Behavioral Health Resource Center
    • Worksite Wellness
    • Wellness Champions
  • HBRs
  • Contact Us
  • eBenefits
  • About
  • Find a Doctor
  • New Employees
NC State Health Plan »   Retiree Benefits »   Medicare Retirees 70/30 PPO Plan

70/30 PPO Plan for Medicare Retirees

70/30 PPO Plan for Medicare Retirees Overview

The 70/30 PPO Plan is a Preferred Provider Organization (PPO) plan administered by Blue Cross and Blue Shield of North Carolina (Blue Cross NC).

A PPO plan offers:

  • freedom of choice among in-network providers and lower out-of-pocket costs (copay only for most in-network office visits)
  • strong emphasis on preventive health
  • preventive services and medications covered at 100% on this plan
  • ability to lower your copay by selecting and visiting the Primary Care Provider (PCP) listed on your ID card or another provider in the same practice (you can find instructions on updating your PCP here)

For Medicare retirees, the 70/30 PPO Plan serves as secondary coverage to Medicare. 

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 2022 by visiting a CPP provider!

70/30 PPO Plan Important Documents

  • 2022 70/30 PPO Plan Benefits Booklet
  • 2022 Plan Comparison Chart
  • 2022 Uniform Summary of Coverage
  • 2022 Preventive Services Summary
  • 2022 Comprehensive Formulary Drug List
  • 2022 Preferred Drug List
  • 2022 Preventive Medications List

70/30 PPO Plan Rate Sheets

  • Medicare Primary Plans for Medicare Subscribers
  • Medicare Primary Plans for 50% Contributory Medicare Subscribers
  • Medicare Primary Plans for 100% Contributory Medicare Subscribers

Members indicated as 50% or 100% contributory notes the percentage of the premium for which they are responsible.

Formulary Exclusion Exception Process

A formulary exclusion exception process is available for Plan members who, per their provider, have a medical necessity to remain on an excluded, or non-covered, medication. If a member is approved for the excluded drug, that drug will be placed into Tier 3 or Tier 6.

Formulary Exclusion Exception Process

Medical Policies

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.

Prior Authorization

Certain services require prior review and certification before they can be covered by your health insurance plan. Click here for more information.

Appeals

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.

Blue Connect

Visit the eBenefits page to access Blue Connect. From there, you will log into eBenefits, the Plan's enrollment system, through the appropriate portal. Once you're logged into eEnroll, you will see a Blue Connect Quick Link on the left side of your screen. Blue Connect is your online resource that can help you manage costs, make more informed health decisions and reach personal health goals anytime.

Retiree Benefits

  • Non-Medicare Retirees 70/30 PPO Plan
  • Non-Medicare Retirees 80/20 PPO Plan
  • Medicare Retirees 70/30 PPO Plan
    • Pharmacy Benefits
    • Appeals Information
    • Important Forms
  • Humana Group Medicare Advantage Base Plan (90/10)
  • Humana Group Medicare Advantage Enhanced Plan (90/10)
  • Understanding Disability
  • Important Forms
  • Planning for Retirement

Share this page:

  • Facebook
  • Twitter
  • Email

How can we make this page better for you?

Back to top

About Us

Who We Are

Board of Trustees

Board of Trustees Meeting Materials

Pharmacy and Therapeutics Committee

State Health Plan Policies and Procedures

State Health Plan Contracted Vendors

Contact Us

North Carolina State Health Plan
3200 Atlantic Ave
Raleigh, NC 27604 Map It
ppo.inquiries@nctreasurer.com
855-859-0966

Follow Us

  • Facebook
  • YouTube
  • SHP Privacy Policy
  • Accessibility
  • Terms of Use
  • Privacy Policy
  • Open Budget
https://www.shpnc.org/retiree-benefits/7030-ppo-plan-medicare-retirees