State Health Plan Clear Pricing Project

Clear Pricing Project and the N.C. State Health Plan Network

The State Health Plan’s Clear Pricing Project (CPP) was developed to secure the Plan’s financial future and to promote quality, accessible health care. The goal is 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 26,000 providers partnering with the Plan for transparent and affordable health care. These provider partners are included in the North Carolina State Health Plan Network, which is made up of providers who signed up for the Plan’s Clear Pricing Project, and Blue Cross NC’s Blue Options network.

As of January 1, 2021:

  • If you select a Clear Pricing Project provider as your Primary Care Provider listed on your ID card, your visits are free!
  • If you visit a CPP behavioral health provider, your visits are free!
  • If you visit a Clear Pricing Project specialist, 80/20 Plan members will pay only $40 for a CPP specialist ($80 for a non-CPP specialist), and 70/30 Plan members will pay $47 for a CPP specialist ($94 for a non-CPP specialist).

Compare the difference and check out the savings!

CLEAR PRICING PROJECT PROVIDER COPAY COMPARISON CHART

Provider

80/20 Plan

70/30 Plan

Primary Care Provider (PCP)

$0 for Clear Pricing Project (CPP) PCP on ID card;

$10 for non-CPP PCP on ID card;

$25 for any other PCP

$0 for Clear Pricing Project (CPP) PCP on ID card;  

$30 for non-CPP PCP on ID card;

$45 for any other PCP

Behavioral Health Provider $0 for CPP Specialist $0 for CPP Specialist

Specialist

$40 for CPP Specialist;

$80 for other Specialists

$47 for CPP Specialist;

$94 for other Specialists

Speech, Occupational, Chiropractor and Physical Therapy

$26 for CPP Providers;

$52 for other Providers

$36 for CPP Providers;

$72 for other Providers

Please note the following:

  • The Clear Pricing Project does not affect members on Medicare Advantage plans.
  • The NC State Health Plan Network is composed of CPP providers and Blue Options providers. There is an indicator in the Find A Doctor tool that identifies CPP providers. That CPP designation DOES need to be noted in the Find a Doctor tool for the provider to be a CPP Primary Care Provider (PCP).
  • Providers joined the CPP at the practice level, so members should be able to see any provider in that listed CPP practice. However, a lot of providers practice at multiple locations and different practices. If members see their CPP PCP at a NON-CPP practice, the member will not receive the $0 copay. Members are encouraged to check with their provider on their CPP status.

 

Frequently Asked Questions