State Health Plan Clear Pricing Project

As a State Health Plan member, you have access to the North Carolina State Health Plan Network, which is made up of providers who signed up for the Plan’s Clear Pricing Project (CPP), and Aetna's POS II Network. CPP providers have agreed to transparent pricing. In an effort to lower health care costs for members and to support CPP providers, the Plan offers significant copay reductions for members who visit a CPP provider. The CPP is applicable to members on the Base PPO Plan (70/30) and Enhanced PPO Plan (80/20).

This does not impact members on the Medicare Advantage plans. This would only be applicable to Medicare-eligible members on the 70/30 Plan.

The CPP is only applicable to North Carolina providers, including Primary Care Provider (PCP) offices, specialist offices, participating hospitals and urgent care facilities. Outside of North Carolina, you would still have access to in-network providers in Aetna's POS II Network.

You can go to any CPP Specialist, Chiropractor, Speech or Occupational Therapist to receive a copay reduction. To qualify for the $0  CPP PCP copay, you must have selected a CPP PCP which appears on your State Health Plan ID card and then see that PCP for your office visit. Here's how to select or update your Primary Care Provider!

You are able select a new provider any time during the year – CPP or non-CPP – by using eBenefits, the Plan’s enrollment system. Here's how to select or update your Primary Care Provider!

To locate a CPP Provider, follow the steps below:

• Visit www.shpnc.org. Click the Find a Doctor link at the top of the home page.
• Scroll down to select your health plan to access your Find a Doctor Tool.
• The Find a Doctor Tool opens. Select the plan type by clicking the Individuals, Families, & Groups button.
• Choose North Carolina State Health Plan in the drop-down box and click Submit.
• Click the Find a Doctor or Facility button.
• From there, you can search by Category or by Name.
• CPP providers will say “Clear Pricing Project Provider” next to their name. Note: You cannot specifically search for a CPP provider by that designation.

You can change your provider anytime throughout the benefit year, so you will be able to select another provider.  You can also research a new provider by using the Find a Doctor tool or contacting the provider’s office to see if they are accepting new patients.  

CPP providers and specialists within a practice joined the CPP via the practice level. This means you can see any provider within that practice and still have the copay reduction. Please note that the address is very important. When selecting your provider, make sure you intend to see the provider at the address reflected for that provider. Not all practices that your provider may be affiliated with joined the CPP. 

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

No. There can only be one provider reflected on your ID card as your PCP.

No. As long as the provider is part of Aetna's POS II Network, provider will not be considered out-of-network. You will have the normal copayment applied. For emergency situations, service at the nearest hospital would be processed at an in-network benefit.

If your provider didn’t sign on to the Clear Pricing Project, they are still considered in-network for the benefit year, if they are currently in Aetna's POS II Network, but the CPP copay reductions would not apply.

Using a CPP provider will lower your out-of-pocket amount for your copayment, which is applied to your out-of-pocket maximum, but it does not impact your deductible.