NC State Health Plan approves Blue Cross contracts and 2027 benefit changes
The State Health Plan Board approved new administrative and pharmacy contracts, a tiered provider network and 2027 premium and benefit changes affecting nearly 750,000 members.
RALEIGH, N.C. — The North Carolina State Health Plan Board of Trustees has approved a series of changes to the health plan serving nearly 750,000 teachers, state employees, retirees and other members, including new administrative and pharmacy contracts and a tiered provider network scheduled to begin in 2027.
The board approved Blue Cross NC for third-party administrative services and as part of the plan's pharmacy benefit management arrangement. Both contracts are scheduled to take effect Jan. 1, 2028, and run through the end of 2031, with two optional one-year renewals.
According to the Department of State Treasurer, Blue Cross NC's administrative services proposal could provide up to $1 billion in savings over the life of the contract through provider discounts and value-based payment arrangements. Aetna also submitted a bid for third-party administrative services.
The board also approved preferred provider agreements with UNC Health and Novant Health beginning Jan. 1, 2027. The health systems will receive preferred status in the plan's new tiered network in exchange for discounted rates and participation in efforts intended to lower the total cost of care.
Beginning in 2027, providers will be categorized as Preferred, Access, Non-Preferred or Out-of-Network. Members using preferred providers will have lower deductibles, out-of-pocket maximums and copays, according to the Treasurer's Office.
Access providers are intended to preserve options in rural and underserved communities. Benefits for those providers will generally remain at current levels or, in some cases, have lower out-of-pocket costs.
Members who use non-preferred providers will face higher out-of-pocket costs.
The board also approved 2027 premium rates and benefit changes. The Treasurer's Office said some copays will decrease under the new network structure. The Lantern Surgical Benefit, which covers certain procedures at no cost when members use participating providers, will continue.
"This is a monumental step in the right direction for the Plan and the people we serve," State Treasurer Brad Briner said in the department's announcement.
The State Health Plan plans to provide members with additional information before open enrollment, scheduled for Oct. 12 through Oct. 30.
The plan covers teachers, state employees, retirees, university and community college employees, current and former lawmakers and eligible dependents.
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.
