NC State Health Plan overhauls insurer, hospital network and premiums. What to know

North Carolina’s State Health Plan approved sweeping changes Friday that will reshape coverage for hundreds of thousands of state employees, teachers, retirees and their families. The plan’s board picked a new benefits administrator, named preferred hospital systems and approved another round of premium increases.

Here are key takeaways:

• Blue Cross Blue Shield of North Carolina will take over as the plan’s third-party administrator starting Jan. 1, 2028, replacing Aetna. Blue Cross NC will also handle pharmacy benefits, replacing CVS Caremark, under contracts running through Dec. 31, 2030.
• State Treasurer Brad Briner said the plan expects to trend toward more than a billion dollars in savings over the contract term, calling the bidding process decisive. Plan officials said the total value of the contract to the plan over three years will exceed $12 billion.
• The board approved a flat 5% premium increase for 2027 for most members, citing the need to cut costs. Monthly increases range from about $1.76 for the lowest-earning employees with individual coverage to more than $42 for family coverage among the highest earners.
• UNC Health and Novant Health were named “preferred” providers under a new four-tier network, while WakeMed, Atrium Health, Granville Health and some Duke LifePoint facilities were designated “non-preferred.” Members using preferred providers will pay the lowest copays, deductibles and out-of-pocket costs.
• Maternity, cancer care and transplant benefits will remain unchanged for at least the first year after the new network takes effect in 2027, and emergency care at any hospital will be covered at a middle, “access-tier” level regardless of network designation.

The summary points above were compiled with the help of AI tools and edited by journalists, including politics editor Jordan Schrader. The source reporting referenced above was written and edited entirely by journalists.

Luciana Perez Uribe Guinassi

The News & Observer

Luciana Perez Uribe Guinassi is a politics reporter for the News & Observer. She reports on health care, including mental health and Medicaid expansion, hurricane recovery efforts and lobbying. Luciana previously worked as a Roy W. Howard Fellow at Searchlight New Mexico, an investigative news organization.