The State Health Plan offers health benefits to all eligible teachers, state employees, retirees and other individuals identified in the North Carolina General Statutes. The Plan’s mission is to provide quality health care products and services for the health and well being of the members.

The State Health Plan offers two health plan designs for its members.

The two PPO options are the SmartChoice Basic Blue Options (70/30) and SmartChoice Standard Blue Options (80/20).

• The PPO options are based on different levels of physician office visit “co-pays” different levels of “co-insurance” and different levels of the “deductible.” The amount of money that employees pay out-of-pocket for PPO premiums will differ based on the option that employees select.
• Employees pay no premiums for SmartChoice Basic Blue Options and SmartChoice Standard Blue Options employee-only coverage.
• There is an employee/spouse coverage type.
• Employees who opt for the PPO health insurance will have “in-network” access to the BCBSNC “Blue Options” PPO network. Go to the provider search web page to verify that any medical care provider that you use is in the network.

To learn detailed information on specific plans or if you are trying to decide which plan is best for you, visit the plan comparison page.

The State Health Plan has implemented the Comprehensive Wellness Initiative (CWI) as legislated by Senate Bill 287 (Session Law 2009-16) developed to help members succeed in quitting tobacco use, achieve and maintain a healthy weight and to lower the costs associated with the treatment of health conditions caused or complicated by smoking and obesity.

• Tobacco cessation component starts July 1, 2010
• Weight management component starts July 1, 2011

Beginning July 1, 2010, members will be enrolled in the 70/30 Plan. Members can qualify for the 80/20 Plan if they and their dependents:

For Plan years beginning in 2010

• Do not use tobacco
• Are actively trying to quit tobacco

Beginning July 1, 2011, members will be enrolled in the 70/30 plan and the weight management component will be added to the requirements for the 80/20 Standard Plan. Members can qualify for the 80/20 Plan if they and their dependents:

• Do not use tobacco products, AND
• Have a Body Mass Index (BMI) less than 40 kg/m²; OR
• Qualify for exemption due to participation in a weight management and/or tobacco cessation program, or have a physician-certified medical condition that prevents the attainment of the required BMI.

Beginning July 1, 2012, members must have a BMI of less than 35 kg/m2 to enroll in the 80/20 Standard Plan. All other program requirements and processes will remain the same.

For more information on the Comprehensive Wellness Initiative, go to the State Health Plan Website.

Who is eligible to enroll in the PPO State Health Plan options?

All permanent full-time state employees and permanent part-time eligible state employees (who work 20-30 hours per week) and their dependents are able to participate in the State Health Plan. Re-employed retirees, who work 30 or more hours per week and are "in a position that would require the employer to pay hospital-medical benefits if the individual had not been retired", are required to enroll in the State Health Plan. Permanent part-time state employees pay full cost for their insurance—the amount the employer contributes towards the cost of employees' health insurance premiums plus the employees' cost.

What do I need to do to enroll in a plan since the State Health Plan has implemented the Comprehensive Wellness Initiative?

If you wish enroll in the 70/30 Basic Plan, you do not need to complete an Attestation Form. If you wish to enroll or remain in the 80/20 Standard Plan, you must complete an Attestation Form EACH Plan year. If requesting an exemption, you must obtain a completed Physician Certification Form each year to enroll in the 80/20 Standard Plan.

How do I enroll in the State Health Plan?

You may enroll online using the Employee Self-Service (ESS) Portal in BEACON or submit the State Health Plan Enrollment Form and Attestation Form if you wish to enroll in the 80/20 plan. If you have an NCID user ID, do not submit a paper enrollment form and attestation form. For more information on how to enroll, please contact your Health Benefits Representative.

As a new employee, when can I enroll in the State Health Plan and when does it become effective?

As a new employee, you must enroll within 30 days of your start date.

The effective date of coverage is either the first day of the month following the date of hire or the first day of the second month. The employee selects the date that coverage begins. For example, a new employee hired on October 15 may begin coverage on either November 1 or December 1.

When are insurance premiums payroll deducted?

Insurance premiums are deducted one month in advance of the coverage effective date. For example, if coverage begins on November 1, payroll deduction will begin with the October payroll.

Are my insurance premiums pre-tax or post-tax deducted?

Generally, your premiums are deducted on a pre-tax basis but you may elect for your premiums to be deducted on a post-tax basis instead.

What is an Attestation Form?

An Attestation Form is a legally binding document that members must complete each year to enroll in the 80/20 Standard Plan. For the 2010 Plan Year, members are eligible to enroll in the 80/20 Standard Plan if they declare on the Attestation Form that they and their covered dependents do not use tobacco products and for the 2011 Plan Year, that they and their covered dependents have a BMI less than 40 kg/m2 to pass the test, or that they qualify for exemption due to participation in a tobacco cessation program and/or participation in a weight management program. Members will be attesting that they understand they may be randomly selected to participate in a tobacco use/weight management verification test at their worksite.

What is a Physician Certification Form?

Members who attest to qualifying for an exemption at enrollment must obtain a Physician Certification Form. The form will permit members to claim an exemption for member participation in a weight management program and/or for a medical condition that prevents them from attaining the required BMI, in addition to the tobacco cessation program exemption. A completed form must include a dated physician, nurse practitioner or physician assistant’s signature, as well as the tobacco cessation and/or weight management program start date(s). Members should keep the original, completed certification form for their records, as the Plan may request it at any time. Upon the Plan’s request, the member will have fifteen (15) business days to submit the completed form to maintain their eligibility for enrollment in the 80/20 Standard Plan.

Who will be eligible for testing for tobacco use and/or BMI?

The Plan reserves the right to test any non-Medicare primary Plan member who is eligible for the Comprehensive Wellness Initiative and enrolled in the 80/20 plan.

Will members be made aware of testing ahead of time?

The Plan has not yet determined the details of the testing process but members and, if applicable, their covered spouses, who attest that they do not use tobacco and/or have a BMI less than 40 kg/m2 to enroll in the 80/20 Standard plan may be randomly selected to participate in a tobacco use/weight management verification test at their worksite. Once a testing vendor has been confirmed, additional information will be provided regarding the testing process.

What are the consequences if I fail to submit the Physician Certification Form within fifteen (15) business days, refuse testing, and/or fail the random test?

Members will be moved to the 70/30 Basic Plan for the rest of the Plan year. The move to the 70/30 Basic Plan will include all covered family members. Those members will forfeit any coinsurance and deductible(s) already paid under the 80/20 Standard Plan and members will only be eligible to enroll in the 70/30 Basic Plan for the following Plan year. Members may not appeal the stated consequences if they do not submit a Physician Certification Form within fifteen (15) business days of the Plan’s request. Members may appeal the stated consequences based on test results. Instructions on the appeal process will be provided to the member at the time of testing.

What happens if a member chooses not to participate in verification testing?

Members who are offered the verification testing, and refuse to take the verification test, will be moved to the 70/30 plan for the remainder of the benefit year. They will also be subject to additional consequences.

Return to the Forms List page.

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If you have completed all forms and read all of the policies, go on to the next section.

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Don't forget to complete the short online evaluation after you complete the orientation program.

Last updated: April 27, 2010