State Health Plan Clear Pricing Project
The Clear Pricing Project
This page includes details about this effort and how it will impact members in 2020.
The Clear Pricing Project and the 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. In the future the Plan will be highlighting providers who support non-secret contracts and transparency. 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.
To ensure members continue to have access to a broad, statewide provider network, the decision was made that members will continue to have access to the SAME network available to you today, in addition to those providers that committed to transparent pricing.
Here is what members need to know:
- 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.
- As a reminder, this does not affect members on the UnitedHealthcare Medicare Advantage plans.
Press Releases
- 8/8/2019 - NC State Health Plan Announces Network for 2020
- 7/23/2019 - CaroMont Health Joins NC State Health Plan Network
- 7/22/2019 - NC State Health Plan Network Increases Payments to Hospitals and Reopens Sign-Up Period
- 7/16/2019 - 27,000 Medical Providers Join NC State Health Plan Network
- 7/1/2019 - UNC Health Care Attempts to Distract from Its Dark Money Scandal
In The News
- 7/27/19- "Dale Folwell: Secret contracts drive up health care costs"
- 7/25/19 - "NC State Health Plan network reopens sign-up period"
- 7/4/2019 - "Can this plan reduce health care prices?" Former CEO at Randolph Healthcare shares his thoughts on the Clear Pricing Project
- 5/23/2019 - Charlotte medical group agrees to SHP contracts
- 5/13/2019 - State Health Plan reimbursement contracts made available; RAND report shows Folwell's initiative has merit
Frequently Asked Questions
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.