State Health Plan Open Enrollment Begins September 30

The State Health Plan’s (Plan) 2025 Open Enrollment period is under way and ends Oct. 25, 2024.

By now, you should have received your decision guide in the mail and have heard about the Plan’s third-party
administrator (TPA) transition from Blue Cross NC to Aetna effective Jan. 1, 2025. The TPA transition affects
Plan members on the Base PPO Plan (70/30), Enhanced PPO Plan (80/20), and the High-Deductible Health Plan.
It does not affect members on Humana Medicare Advantage Plans.

NON-MEDICARE RETIREES:
For 2025, the Plan will continue to offer two preferred provider organization (PPO) plans administered by Aetna. Your two options are the Enhanced PPO Plan (80/20) and the Base PPO Plan (70/30).

All members will be automatically enrolled in the Base PPO Plan (70/30), which for eligible members will remain premium-free for subscriber-only coverage. Members who wish to enroll in the Enhanced PPO Plan (80/20) or who wish to reduce their monthly premium in the Enhanced PPO Plan (80/20) by completing the tobacco attestation MUST TAKE ACTION during open enrollment.

During open enrollment, all members will need to RE-SELECT a primary care provider (PCP) to continue to enjoy lower copays when visiting that provider in 2025. Members will do this during the open enrollment online process in eBenefits, the Plan’s enrollment system.

MEDICARE-ELIGIBLE RETIREES:
As a Medicare-eligible member, you continue to have three plan options to choose from for 2025:

• Humana Group Medicare Advantage (PPO) Base Plan (90/10)*
• Humana Group Medicare Advantage (PPO) Enhanced Plan (90/10)*
• The Base PPO Plan (70/30), administered by Aetna

* Humana Group Medicare Advantage Plans have a benefit value equivalent to a 90/10 plan.

For the 2025 benefit year, members in the Humana Medicare Advantage Base and Enhanced plans will remain in that plan unless you would like to enroll in a different plan during open enrollment.

Medicare members enrolled in the Base PPO Plan (70/30) will be moved to the Humana Base Plan unless they enroll in the Base PPO Plan (70/30) during open enrollment.

You will need to take action during open enrollment if you want to be enrolled in a different plan option or if you need to make any changes regarding your dependents.

If you have non-Medicare primary dependents on your plan, they have different options: the Enhanced PPO Plan (80/20) and the Base PPO Plan (70/30). If they are currently enrolled in the Enhanced PPO Plan (80/20), they will be moved to the Base PPO Plan (70/30) for the 2025 benefit year. You will need to take action during open enrollment if your non-Medicare primary dependents want to be enrolled in the Enhanced PPO Plan (80/20) for the 2025 benefit year.

MEMBER OUTREACH
As part of the Plan’s 2025 open enrollment member outreach, the Plan, Humana, and Aetna are holding in-person events, webinars, and telephone town halls to review your options and answer questions. These events began in late August and will continue through late October.

Dates and times are posted on the Plan’s website at SHPNC.org. We encourage you to stay engaged and social with your State Health Plan!

Here’s how:

• Sign up for the Plan’s monthly Member Focus e-newsletter for details regarding open enrollment by visiting SHPNC.org.
• Follow the State Health Plan on Facebook (Facebook.com/SHPNC) and Instagram (@nchealthplan).
• Make sure your address is correct in eBenefits, the Plan’s enrollment system, and that your address is correct in ORBIT!