The State Health Plan Prepares for Follow-up Enrollment
June 10, 2011 - Health benefits for teachers and state employees are determined by the North Carolina General Assembly. Senate Bill 323 became law May 23 and House Bill 578 was signed into law by Governor Perdue May 26, making changes to premiums, copays and deductibles. Please read the details below carefully, as they affect your health benefits.
Due to changes in premiums, copays and deductibles, which will go into effect September 1, 2011, it is necessary for the State Health Plan to conduct a Follow-up Enrollment, which will be held July 18-29, 2011. During this period, members will have the opportunity to change their plan elections and add eligible dependents.
Along with other changes, the Comprehensive Wellness Initiative (CWI) has been eliminated. Therefore, effective September 1, 2011, the tobacco and weight management component will no longer determine the plan in which members may enroll. If members previously elected to enroll in the 70/30 Basic plan due to CWI, they will now have the opportunity to enroll in the 80/20 Standard plan.
Members who wish to remain on the plan in which they enrolled during Annual Enrollment will not need to do anything during the second enrollment period.
For the first time, effective September 1, 2011, active and retired employees who wish to enroll in the 80/20 Standard plan will be required to pay a premium for subscriber only coverage. However, there will be a premium-free option for the 70/30 Basic plan for employees and retirees. In addition to these changes, there will be a 5.3 percent increase in dependent premiums for the 2011/2012 benefit plan year, beginning September 1, 2011. Below is a plan comparison rate chart for the 70/30 Basic and 80/20 Standard plans.
Member incurred medical expenses that are applicable to their deductible and coinsurance maximum for dates of service between July 1, 2011 and August 31, 2011, will be applied to the adjusted deductible and coinsurance maximum going forward under the new benefit package. These changes will also go into effect September 1, 2011.
Members can expect to receive new identification cards by July 1, 2011, which will reflect benefit changes selected during Annual Enrollment, which concluded June 8. Members will also receive new identifications cards by September 1 reflecting the changes summarized below.
Premium Rates |
|
70/30 |
80/20 |
Employee/Non-Medicare Eligible or Medicare Secondary Contribution |
$0.00 |
$21.62 |
Retiree/Non-Medicare Eligible Contribution |
$0.00 |
$21.62 |
Medicare Eligible Retiree Contribution |
$0.00 |
$10.00 |
Below are the changes to coinsurance, deductibles and copays effective September 1, 2011:
| Medical |
Pharmacy (Prices for a 30-day supply) |
| |
70/30 |
80/20 |
Generic Drugs |
$ 12 |
| Deductible |
$ 933 |
$ 700 |
Preferred Brand |
$ 40 |
| Coinsurance Max |
$3,793 |
$3,210 |
Non–Preferred Brand |
$ 64 |
| Urgent Care |
$ 87 |
$ 87 |
Specialty Drugs |
25% coinsurance up to $100 |
| Primary Care Copay |
$ 35 |
$ 30 |
For brand name drugs with an available generic, members will be required to pay the generic copay, plus the difference between the Plan's cost of the brand name drug and the Plan's cost of the generic drug.
|
| Specialist Copay |
$ 81 |
$ 70 |
| PT/OT/ST - MH/SA |
$ 64 |
$ 52 |
| ER/Inpatient Copay |
$ 291 |
$ 233 |
For a more detailed plan comparison click here.
Plan members can expect to receive additional information regarding the Follow-up Enrollment via mail. Plan members can click here for enrollment information and materials. Plan members with questions should call Customer Service at 888-234-2416.
