State Health Plan Major Medical
The State Health Plan's Preferred Provider Organization (PPO) plans offer freedom of choice among in-network providers, lower out-of-pocket costs and a strong emphasis on preventive health. There are two levels of PPO coverage.
Plan summaries and benefits booklets:
All permanent full-time employees who work 30 or more hours per week are eligible for coverage. Employees selecting the Standard plan will pay an additional monthly premium for employee only coverage. Spouses and legally dependent children up to age 26 (if not eligible for their own or their spouse's employer sponsored health coverage or be in the military) are also eligible for coverage under both plans at group rates.
To receive the maximum coverage under the PPO plan, you must see in-network providers. The State Health Plan's local provider network for the PPO is managed by Blue Cross and Blue Shield of North Carolina. To locate a doctor or hospital near you, use SHNPC Find a Doctor BCBSNC PPO Plan Provider Search.
Generally, there are three times when you can enroll in or may be able to change your benefits elections at the University:
- As a newly hired or newly eligible faculty or staff member after experiencing a qualified job or family status change during annual enrollment
- You have a 30 day window from the date of your event (i.e. new hire, job or qualified family status change) to enroll, unless specified otherwise. It is to your advantage to enroll in each benefit plan as soon as you are eligible.
If you are newly hired, you will make your benefits elections online, which is accessed by logging onto the University's Enrollment Website's (see links below for State Health Plan and NCFlex). If you are enrolling in any of the University Benefit Plans, print and complete the forms and return them to Benefits Services.
If you are a current employee and have experienced a life event or job status change, please review the Life Events section of our Web site for information about benefit plan changes and other things to consider.
Effective Date of Your Benefit Elections
For the following benefits plans, coverage begins on the first of the month following your hire date or change in job/family status, if you enroll within 30 days of that date.
Please note: There have been changes to Plan enrollment following the ratification of House Bill 1085 on June 29, 2012. Most importantly, there was a change clarifying the rules under which members can enroll in the Plan.
Members who do not elect to enroll themselves or dependents on the Plan when first eligible within 30 days of hire will not be allowed to enroll in the Plan unless they experience a qualifying event or during Annual Enrollment.
There will be no exceptions to this rule. Please remember, whether employees enroll through BEACON or eBenefitsNow, they are encouraged to print the confirmation page upon completion of enrollment. This rule emphasizes the importance of new hires enrolling in a timely manner and the consequences that will follow with failure to elect coverage within 30 days (possible gap in coverage, unable to enroll in the Plan until the next Annual Enrollment period, etc.).
You may add or drop dependents during the annual enrollment period or within 30 days of a change in family status. Examples of a change in family status are:
- Change in job status for your spouse
- Other Changes as defined by the State
If you have a change in family status, you must contact the Benefits Department in Human Resources or complete the change on the Benefit Focus within 30 days of the family status change (i.e. within 30 days of the date of birth, marriage, etc.).
If you do not call HR or complete change on Benefit Focus within 30 days of the change in family status, you will have to wait until the next annual enrollment period to add or drop your dependent.
The Annual Enrollment Period will be announced each year.
If you cannot afford the dependent premiums for the State Health Plans offered, there is another alternative for children.
Families who make too much money to qualify for Medicaid but too little to afford the State Plans may qualify for free or low cost health care for their children. The plan "NC Health Choice for Children" is the same as coverage provided by the State Health Plan's Comprehensive Major Medical Plan, plus vision, hearing and dental benefits.
Under Federal Law, the Consolidated Omnibus Budget Reconciliation Act (COBRA) allows a member the option of continuing health coverage under certain qualifying events. Under COBRA, you or your eligible dependents continue to have the same health coverage as before the qualifying event. The rates for coverage are 2% higher than normal group rates. You must pay the entire cost of coverage.