Wednesday, January 4, 2023
North Carolina’s Treasurer announced on Wednesday, January 4 the award of the Third-Party Administrative (TPA) Services Contract to Aetna. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is the current TPA for the Plan and has been the TPA for more than 40 years.
The three-year initial service period for the contract begins January 1, 2025, and continues through December 31, 2027, with the option to renew for two, one-year terms.
This change will not impact our members who are enrolled in the Humana Group Medicare Advantage Plans. It will only impact members on the Base PPO Plan (70/30) and the Enhanced PPO Plan (80/20) which are currently being administered by Blue Cross NC.
Plan members will start receiving more information regarding the changes in 2024 prior to our Open Enrollment Period for the 2025 benefit year.
The administrative contract, awarded by the State Health Plan Board of Trustees, oversees health care spending of more than $17.5 billion over five years. The new contract reflects a partnership that focuses on transparency and lower costs, with the potential administrative cost savings over the course of the contract equaling $140 million.
The award is the result of a Request for Proposals, a competitive bid process in which the Plan solicited and selected industry-leading partners providing exceptional customer service, technological resources and professional support. The services under the contract include processing claims and offering a comprehensive network of health care providers. Aetna was one of three companies bidding for the contract. Blue Cross NC and UMR, Inc. also submitted proposals.
The State Health Plan, a division of the Department of State Treasurer, provides health care coverage to nearly 740,000 teachers, state employees, retirees, current and former lawmakers, state university and community college personnel, and their dependents.