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NC Treasurer Folwell backs a risky switch in who runs the State Health Plan | Opinion, Vote to fire Blue Cross as health plan administrator was unanimous, NC treasurer says, State Health Plan ousts longtime insurer Blue Cross NC, signs new contract with Aetna. Copyright 2023 Jerry Ballard & Associates, Inc. All rights reserved. While Aetna may have negotiated prices that are different from those of Blue Cross NC, state employees will likely not see a difference in what they pay out-of-pocket. About Blue Cross and Blue Shield of North Carolina: Blue Cross and Blue Shield of North Carolina (Blue Cross NC), the leading not-for-profit health plan in North Carolina, is committed to making health care more affordable, easier to navigate and accessible for all. Not only does our Agency offer outstanding service, we also provide the technological sophistication you need to obtain quick and accurate information via our website, www.nchealthplans.com. Blue Cross NC, in a protest filed Thursday. A silent period in place until appeals are exhausted prevents their disclosure, according to the legal staff at the state treasurers office. Bid Process Failed to Deliver Lowest Cost and Best Access to Health Care. She covers health care, including mental health and Medicaid expansion; higher education; hurricane recovery efforts and lobbying.Luciana previously worked as a Roy W. Howard Fellow at Searchlight New Mexico, an investigative news organization. Members will continue to enjoy a reduced copay when visiting a Clear Pricing Project Specialist! The NDA requirement was first reported by The North Carolina Tribune, which also quoted Treasurers office spokesman Frank Lester as stating that the announcement delay was done to avoid any member confusion prior to a new benefit year starting on Jan. 1, Lester said. Members who do not have a commercial plan can find more information about their telehealth coverage below. Resource Center | NC State Health Plan In recognition of the difficulties related to the Facets implementation, Blue Cross NC gave the State Health Plan a $1 million credit on administrative fees and paid out over $900,000 for failing to meet performance guarantees, according to Lester. Folwell said the state will save an estimated $140 million throughout the course of the three-year contract, which begins in January 2025. We encourage members to speak with their primary care provider about the COVID-19 vaccine and staying current on recommendations. The silent period remains in effect and an accounting of the closed session minutes of the Dec. 14 meeting will be released once it is lifted and the minutes are approved by the board, according to information shared by legal staff at the treasurers office. North Carolina State Health Plan. Blue Cross NC offered the lowest total cost by more than $17 million as well as the broadest Blue Cross NC is disappointed that the State Health Plan has not disclosed any documents about its RFP process, despite our public records requests a month ago. An earlier version of this story described its role incorrectly. The vacuum of information has been filled with questions from state employees and few clear answers from those in charge of the health plan. Helping you understand COVID-19, your coverage and support. Blue Cross NC also offers State Health Plan members and their families the broadest statewide network, allowing them to keep the doctors they know and trust. Lang said that when transitioning large data sets to a new software, it is not unusual to experience issues and that Blue Cross had worked closely and transparently with the state plan to address these challenges. Learn more about our coverage options including health, Medicare, dental and vision options for you, your family or your employees. COVID-19 vaccines are now available to everyone 6 months and older. We encourage everyone to get vaccinated. Fraud and Abuse. What happens if Aetna is state health plan administrator? | Raleigh However, he added that it matters what types of services are included in the 2% of claims out of Aetnas network. They could also have different requirements for prior authorizations, which require patients to get approval from a health plan before undergoing a procedure or getting a healthcare service. Learn More Register Now Telehealth - when care can't wait Members enjoy easy-to-access virtual doctor's appointments from the comfort of home. Folwell referenced a 2011 state auditors report that said the plans auditors did not have access to BCBSNC contracts and could not independently verify that the plan received the proper discounts from the provider network. Visit Blue Cross NC online atwww.bluecrossnc.com. This includes ongoing reviews of clinical information about Can I use my HSA, FSA, or HRA to cover the cost of a COVID-19 OTC test? Learn more about our non-discrimination policy and no-cost services available to you. Access the tools you need: rate quotes, applications, forms, the latest industry news, marketing materials and more. Login Page CORRECTION: Aetna has been chosen to replace Blue Cross NC as the administrator of the states health plan. North Carolina State Health Plan. 2023 Blue Cross and Blue Shield of North Carolina. It has been our experience that the Plans leadership has the interests of state employees and retirees at heart, Watkins said in a statement. Testing No cost-sharing for COVID-19 testing Coverage and treatment The North Carolina State Health Plan for Teachers and State Employees also falls under the North Carolina Treasurers Office. The N&O maintains full editorial control of the work. For this, the state pays a fixed per-member cost. A smaller network could result in a significant number of teachers and state employees across the state to change doctors theyve built relationships with for years and travel farther for in-network care. The investment over three years will allow kids to have access to primary care onsite without Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. COVID-19 treatment is covered with no cost-sharing for Healthy Blue members through September 30, 2024. Learn more about our non-discrimination policy and no-cost services available to you. As a North Carolina not-for-profit company, Blue Cross NC is headquartered in the state, supports North Carolina jobs and does not have shareholders. Since 1933, the health insurer has created programs and initiatives to provide North Carolinians the opportunity to be healthy. A leader in the industry, Jerry Ballard has been the #1 top producing independent insurance agent for Blue Cross Blue Shield of North Carolina in individual sales for 11 consecutive years. 2023 Blue Cross and Blue Shield of North Carolina. From there, you will be prompted to a screen that will ask you to enter your username, so a passcode can be sent to the email address you have in eBenefits. Go to the State Health Plan website at www.shpnc.org and click on eBenefits at the top of the page. Aetna would begin with a three-year contract, with the option afterward for two agreements that would last one year each. Asked whether he agreed with the decision, Folwell said he was comfortable with what the board unanimously decided. Folwell said he was confident Aetna would bring more transparency and lower costs and higher quality health care for those that teach, protect and serve.. Privacy Policy 1998 - 2023 Nexstar Media Inc. | All Rights Reserved. Virtual (or telehealth) visits can be used with your primary care doctors, specialists, and behavioral health providers. Aetna will replace Blue Cross Blue Shield of North Carolina as the administrator for the states health plan, State Treasurer Dale Folwell announced Wednesday. Meanwhile, Blue Cross NC, in a protest filed Thursday appealing the states decision to replace it with Aetna, wrote that its statewide network of total provider locations appears to be 38% larger than Aetnas. A spokesperson for Blue Cross NC said the company will appeal the decision and will request public records to learn more about the decision. How do providers code the COVID-19 vaccine? What comes next? Preferred and non-preferred insulin continues to have a $0 copay for a 30-day supply! To learn more about the Clear Pricing Project. Plan. The board suggested that legislatively mandated reference-based pricing which establishes a set price for each health care service instead of negotiating prices with providers could partially resolve the problem. eBenefits is used to enroll in your State Health Plan and NC Flex benefits Stay on top of your health care with member resources from Blue Cross and Blue Shield of North Carolina (Blue Cross NC). She graduated from UCLA with a bachelors degree in psychobiology. See the latest information onCOVID-19 vaccines, treatments and more in the Point of Blue blog. Pat Ryan, a spokesperson for Aetna, wrote that most insurance carriers have very similar prior authorization policies and that Aetna will work with the state plan to see if there are policies it would like to have customized. Claims paid out by the state to the administrator are different from the prices paid by state plan members, who pay the rates fixed by the state. Blue Cross NC is an independent licensee of the Blue Cross and Blue Shield Association. Only CMM (including State Health Plan), HMO and PPO lines of business have fee schedules in Bue e. Real-time updates and all local stories you want right in the palm of your hand. For 2024, the State Health Plan will continue to offer two Preferred Provider Organization (PPO) plans administered through Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Watkins said even more cost savings are needed in the coming years to prevent expenses from falling increasingly on plan members. That was true at our founding, and it will be true on Jan. 1, 2025, when we formally assume health insurance responsibility for those who teach, protect, and serve North Carolina, he wrote. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. This story was originally published January 15, 2023, 6:00 AM. 3200 Atlantic AveRaleigh, NC 27604 Map Itppo.inquiries@nctreasurer.com855-859-0966, State Health Plan Policies and Procedures, An official website of the State of North Carolina, *Attest to being a non-tobacco user or agree to visit a provider (by Nov. 30, 2023) for at least one. Learn more about our non-discrimination policy and no-cost services available to you. Ryan wrote that the state plan had spent all of last year trying to resolve disruptions caused by Blue Cross, so no, customers will not be getting the same level of customer care from Aetna that level of care is what prompted the State Health Plan to pursue a new procurement process in the first place, he wrote. Secure websites use HTTPS certificates. Information in other languages: Espaol Ting Vit Franais Hmoob Tagalog Deutsch . Blue Cross NC is currently covering telehealth services for behavioral health, primary care and outpatient visits, which accounted for more than 97% of telehealth claims received during the last two years. August 20, 2022 RFP issued by State Health Plan, September 26, 2022 Deadline set by RFP for vendors to submit responses to certain minimum requirements, November 7, 2022 Blue Cross NC, Aetna, and United Healthcare submitted proposals, December 14, 2022 State Health Plan notified Blue Cross NC that Aetna was selected as Third-Party Administrator, December 15, 2022 Blue Cross NC submitted first public records request, December 16, 2022 Post-award meeting with State Health Plan, December 20, 2022 Blue Cross NC submitted second public records request, January 4, 2023 Treasurer announced selection of Third-Party Administrator, January 12, 2023 Blue Cross NC submitted protest letter. To find COVID-19 medications, go to the Department of Health and Human Services medication location tool. State Health Plan 's 80 /20. Tobacco users can attend a tobacco cessation counseling session at a provider's office for FREE to receive a lower premium for 2024! If theyre especially high-cost or high-value services that cant be easily obtained elsewhere, then enrollees might still care quite a lot even though the number of claims is small, he said. Learn more about our non-discrimination policy and no-cost services available to you. State Retirement System (ORBIT) OSC Integrated HR-Payroll System (formerly BEACON) Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. For example, every response to a technical requirement was treated as identical in importance. DURHAM, N.C. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) filed a legal challenge on Thursday to the North Carolina State Health Plans decision to award the 2025-2027 contract for third-party administrative services to Aetna. The chair only votes to break ties, according to state law. No. are covered by the state plan administered by Humana, The North Carolina Tribune, which also quoted, Durham pushes vote on new development rules to after the election during chaotic meeting. . Blue Cross fights back: Its appealing NCs pick of Aetna for health plan. Our goal is to provide the highest level of service to our customers while offering the convenience of handling your health insurance needs from the comfort of your own home. One Atlantic storm moves ashore, 4 others jockey over the ocean. It also wrote that without price considerations from providers, annual appropriations will need to grow from the current $2.6 billion to $3.9 billion by 2028. Will he get life-saving heart care? We have done a gillion things over the last five years to keep the plan going.. Q&A: What does the Blue Cross NC ouster mean for State Health Plan members? It could take up to several weeks for the State Health Plan to decide on the appeal. Click a date and time below to register. If you are part of one of the groups below, please click the appropriate link. A lock icon or https:// means youve safely connected to the official website. Are COVID-19 vaccines and boosters covered when given at a retail pharmacy? This plan will not be available once Aetna takes over. The plans board of trustees, across multiple meetings, cited many problems with this software, NC Tribune reported, including complaints that claims and vendors were not being paid on time and that physicians were dropped at random from Blue Crosss system.