Duke Health joins new State Health Plan provider tier

Duke Health will become an Access Provider on Jan. 1, 2027, affecting coverage options for nearly 750,000 State Health Plan members.

RALEIGH, N.C. — Duke Health will participate in the North Carolina State Health Plan’s new provider network as an Access Provider beginning Jan. 1, 2027, the Department of State Treasurer announced Wednesday.

The agreement means State Health Plan members who receive care through Duke Health will have the same or lower member costs than they currently pay, according to the department.

The State Health Plan provides coverage to nearly 750,000 teachers, state employees, retirees, current and former lawmakers, university and community college personnel and their dependents.

Access Provider is one of four designations in the tiered provider network scheduled to take effect in 2027. The other categories are Preferred, Non-Preferred and Out-of-Network.

Members will generally pay the lowest deductibles, copayments and out-of-pocket maximums when using Preferred Providers. Access Providers are intended to maintain affordable care in areas where preferred networks may be limited.

The plan previously announced Preferred Provider agreements with UNC Health and Novant Health. Duke Health’s designation means members will have access to two of the Triangle’s three major hospital systems at the same or lower member costs than under the current plan, the treasurer’s office said.

State Treasurer Brad Briner, who chairs the State Health Plan Board of Trustees, said the agreement reflects efforts to lower costs while preserving access to major medical systems.

The plan’s network and benefit changes are part of a broader attempt to address rising medical expenses and the long-term financial condition of the State Health Plan.

Members who use Non-Preferred Providers beginning in 2027 may face substantially higher out-of-pocket expenses. Out-of-network coverage will generally continue to operate as it does under the current plan.

The State Health Plan said updated provider directories and educational materials will be available before open enrollment, scheduled for Oct. 12 through Oct. 30.

Members will need to review how their physicians, hospitals and other providers are classified before selecting coverage and scheduling care for 2027.

Editor’s note: This article was drafted with the assistance of artificial intelligence and was reviewed and fact-checked by a member of the NC Political News editorial team before publication.