State Health Plan Clear Pricing Project

Clear Pricing Project and 2020 State Health Plan Network

The State Health Plan’s Clear Pricing Project was developed to secure the Plan’s financial future and to promote quality, accessible health care. The goal of this effort was to ensure that members have this valuable benefit for years to come, while bringing transparency to health care expenses and addressing the rising health costs that you and your family face every day.

This effort resulted in more than 25,000 providers partnering with the Plan for transparent and affordable health care. Click here to view a list of the providers that signed on to the Clear Pricing Project.

The Plan's final proposal increased payments to medical providers, on average, from 182 to 196 percent of Medicare. State taxpayers would have saved $166 million and Plan members an additional $34 million in reduced costs. Additionally, the Plan twice extended the enrollment period for hospitals to sign on. However, due to opposition from major hospitals, the Plan did not realize these savings resulting in the inability to lower family premiums for 2020.

As a reminder, members on the 70/30 Plan, 80/20 Plan and High Deductible Health Plan have access to the SAME statewide network that was available to you in 2019, in addition to those providers that committed to transparent pricing.

Additionally, this does not affect members on the UnitedHealthcare Medicare Advantage plans.

Please view this Press Release for more information.

Frequently Asked Questions

What is the State Health Plan's 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 same existing broad, statewide network as in 2019, 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?

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 as in 2019, 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?

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 as in 2019, 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?

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?

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?

Is my hospital in-network?

For 2020, members will have access to the SAME broad, statewide network of hospitals as in 2019, 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?

Is my doctor in-network?

For 2020, members will have access to the SAME broad, statewide network of doctors and other providers as in 2019, 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?

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 are still 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?

What are the rates going to be for 2020?

Premium rates for 2020 can be found under the Employee Benefits page. Click on your plan, then look for "Rate Sheets."

What does this mean for my prescriptions?

What does this mean for my prescriptions?

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