State Health Plan Clear Pricing Project

What is the State Health Plan's Clear Pricing Project?

Under the Clear Pricing Project, the State Health Plan sought to change how the Plan paid providers by setting our own rates instead of paying providers rates set under confidential contracts.

The Clear Pricing Project recently concluded its provider signup period for the new network, with thousands of new providers partnering with the Plan for transparent and affordable health care.

However, the State Health Plan realizes that its members need more hospitals and providers to meet needs in accessing statewide quality health care starting in 2020.

To meet that need, the Plan recently decided to combine the new North Carolina State Health Plan Network with the existing broad, statewide network that exists today, which is the Blue Options network administered by Blue Cross NC.

What does it mean to members on the 70/30, 80/20, and High Deductible Health Plans specifically?

For 2020, members will have access to the SAME broad, statewide network that they do today, which is the Blue Options network administered by Blue Cross NC.

Because of the success of the Clear Pricing Project, this network will now include even more providers that are supportive of transparent and lower pricing.

What does this mean for retirees?

For retirees on either the 80/20 Plan or the 70/30 Plan, this means that they will have access to the SAME broad, statewide network that they do today, which is the Blue Options network administered by Blue Cross NC. This does not impact retirees on the UHC Medicare Advantage Plans.

What about members on UnitedHealthcare (UHC) Medicare Advantage Plans?

This does not affect members on the UHC Medicare Advantage Plans.

Why did the State Health Plan do this?

The goal of this effort was to promote transparency, control rising health care costs and protect the Plan’s long-term financial health. The State Health Plan has a duty to its more than 727,000 members and dependents to ensure that the Plan isn’t being overcharged.

The Plan will continue its mission to fight for transparency in health care on behalf of our members.

Is my hospital in-network?

For 2020, members will have access to the SAME broad, statewide network of hospitals that they do today, which is the Blue Options network administered by Blue Cross NC.

Visit the Find a Doctor tool on the Plan’s website to search for providers you have access to today.

Is my doctor in-network?

For 2020, members will have access to the SAME broad, statewide network of doctors and other providers that they do today, which is the Blue Options network administered by Blue Cross NC.

Visit the Find a Doctor tool on the Plan’s website to search for providers you have access to today.

What if my provider didn't sign on to the Clear Pricing Project?

If your provider didn’t sign on to the Clear Pricing Project, they will still be considered in-network for 2020 if they are currently in the Blue Options network, which is the network members have access to today.

What are the rates going to be for 2020?

Premium rates for 2020 have not yet been set. Rates are based on the state budget which has not yet been passed by the General Assembly.

When is Open Enrollment?

Open Enrollment for the 2020 benefit year will be held later in the fall at a date that will be announced soon.

What does this mean for my prescriptions?

This does not impact your pharmacy benefits with the State Health Plan.