North Carolina State Retirees Health Insurance


What Does The Nc State Retiree Lawsuit Allege

North Carolina state employees could see health care costs go up

The lawsuit states that, upon employment, retirement health benefits were contractually guaranteed to all state employees who participate in the Teachers and State Employees Retirement System of North Carolina, and who were hired before October 1, 2006 and completed five years of service.

The suit alleges that the state breached that contract in April, 2009, when the North Carolina General Assembly passed Session Law 2009-16 that eliminated the optional 90/10 health insurance plan. Another breach occurred in May of 2011, when they passed Session Laws 2011-85 and 2011-96, which required retirees to pay a premium to receive the 80/20 plan they had been promised.

Plaintiffs contend that these retirement health benefits were promised to state employees in exchange for working for the state for a certain number of years. The suit alleges that after these employees had met their part of the contract and eventually retired, the state pulled an abrupt 180-degree turn, and began overcharging retirees.

Insurer Participation In North Carolinas Exchange: 2014

In 2014, plans were only available through two carriers in North Carolinas exchange: Blue Cross Blue Shield of North Carolina and Coventry Health Care of the Carolinas . But nearly two-thirds of the states 100 counties had only Blue Cross Blue Shield as an option, because Coventry only offered plans in 39 counties.

United Healthcare joined the individual health insurance exchange in North Carolina in 2015 , and the three insurers continued to offer plans in the exchange in 2016 as well. BCBSNC plans were available statewide, Uniteds plans were available in 77 counties, and Aetnas plans were available in 39 counties

UnitedHealthcare exited the individual market entirely in North Carolina at the end of 2016, as was the case in the majority of the states where United offered exchange plans in 2016. Aetna also exited the exchange in North Carolina, along with most of the other states where they were participating in the exchanges.

North Carolina Insurance Commissioner, Wayne Goodwin, expressed his dismay at Aetnas announcement, saying I am shocked and disappointed that Aetna and its executives have chosen to abandon their Exchange members. We at NCDOI were in the middle of reviewing Aetnas rate requests for 2017. Never during the review did the company indicate any concern that the requested rates would not solve. I am angered by the impact Aetnas decision will have on Tar Heel families and our market.

Postdoc Medical Insurance Plan


Health insurance benefits exist for all eligible postdocs. Eligible Postdocs must be classified as either a Postdoc Research Associate or a Postdoc Research Trainee and temporary full-time in the UNC Payroll system. Monthly health insurance premiums for individual postdocs are covered by the institution , NOT by the postdoc. Postdocs are responsible for covering monthly premiums for spouses and children. The Postdoc Medical Insurance Plan is underwritten by Blue Cross and Blue Shield of North Carolina . A waiver form must be signed if the postdoctoral scholar decides he/she does not want to enroll for health coverage benefits.

How much does it cost?

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With Grandfathered Bcbsnc Plans Needed To Transition To Aca

Blue Cross Blue Shield of North Carolina announced in August 2017 that they would terminate their remaining grandfathered plans at the end of 2017. The insurer noted that while they initially had 330,000 grandfathered plan members in 2010, enrollment had dropped to 50,000 in 2017. And since nobody was able to join the insurance pool for those plans since the ACA was enacted in 2010, the risk pool got older and sicker and thus more expensive over the ensuing seven years.

Members with BCBSNC grandfathered plans were able to select from all of the available ACA-compliant plans in their area during open enrollment, including on and off-exchange plans. And while open enrollment ended on December 15, there was a special enrollment period that continued through March 1, 2018 for anyone whose plan was terminated on December 31, 2017. The special enrollment period allowed former BCBSNC grandfathered plan members to enroll in a replacement plan on or off-exchange.

Age 65 And Still Working

North Carolina Teachers and State Employees Retirement ...

If you are age 65 and still working full-time at NC State, you may only need to enroll in Medicare Part A. Part A covers hospitalization and there is no cost to you for this coverage. While working full-time, Medicare Part A acts as secondary coverage to your State Health Plan. You do not need Medicare Part B or D unless you want to give up your State Health Plan benefit. You will be able to elect Medicare Part B at retirement with no penalty. By enrolling in Medicare Part A when you turn age 65, you can reduce your out of pocket cost for hospitalizations since this plan will pay as a secondary coverage to the State Health Plan. Click on the button below to review the guide from the State Retirement about Medicare and retiree health.

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North Carolina Health Insurance Exchange Links

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Exchange History And Legislation

North Carolinas path towards ACA implementation was a complicated one that covered all bases. The state took official actions toward each one of the options for a health insurance marketplace: state-run, partnership, and federally operated. In June 2011, North Carolina passed a law stating an intention to develop a state-run health insurance exchange.

The House at one point authorized a state-run exchange, but the Senate did not. Outgoing Gov. Bev Perdue announced in November 2012 that the state would partner with the federal government to run the marketplace. Finally, new Gov. Pat McCrory announced in February 2013 that North Carolina would default to the federal marketplace.

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Over Age 65 And Retiring

If you retire at age 65 or older, you will need to enroll in Medicare Part B effective the month in which you retire. In retirement you will have three different health plans to choose from . You will not need to enroll in Medicare Part D as the retiree health plans all have prescription drug coverage. Click on the button below to review the guide from the State Retirement about Medicare and retiree health.

If retiring, contact your HR Benefits Consultant about 90 days prior to your retirement. Your consultant will meet with you and help you through all the steps in the retirement process.

For help with enrolling in Medicare Part B, click on the button below.

How Will Premiums In North Carolina’s Individual Market Change For 2022

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There will be ten insurers offering plans in North Carolinas marketplace for 2022. The six insurers that offer plans in the marketplace in 2021 have proposed the following average rate changes for 2022 :

  • Blue Cross Blue Shield of North Carolina: Average proposed rate increase of 9.43%
  • Cigna: Average proposed rate increase of 6.46%
  • Ambetter/Centene: Average proposed rate of 5.1%
  • Bright Health: Average proposed rate increase of 8.23%
  • Oscar: Average proposed rate of 2%
  • UnitedHealthcare: Average proposed rate of 6.06%
  • Aetna CVS Health: New for 2022, so no applicable rate change
  • Friday Health Plans: New for 2022, so no applicable rate change
  • AmeriHealth Caritas: New for 2022, so no applicable rate change
  • Celtic/WellCare: New for 2022, so no applicable rate change

The proposed rates are under review by the North Carolina Department of Insurance, and will be finalized by the fall of 2021. Open enrollment for 2022 health coverage will begin November 1, 2021.

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/30 Ppo Plan For Medicare Retirees Overview

The 70/30 PPO Plan is a Preferred Provider Organization plan administered by Blue Cross and Blue Shield of North Carolina .

A PPO plan offers:

  • freedom of choice among in-network providers and lower out-of-pocket costs
  • strong emphasis on preventive health
  • preventive services and medications covered at 100% on this plan
  • ability to lower your copay by selecting and visiting the Primary Care Provider listed on your ID card or another provider in the same practice

For Medicare retirees, the 70/30 PPO Plan serves as secondary coverage to Medicare.

The State Health Plans Clear Pricing Project helps members control health care costs and protects the Plans financial future. Learn how you can save money in 2021 by visiting a CPP provider!

Health Care Obligations For Nc Retirees Before Supreme Court

This Friday, Sept. 3, 2021, photo shows the Supreme Court in Washington. The Supreme Court term that begins next week is already full of contentious cases, including fights over abortion and guns. But the justices still have a lot of blank space on their calendar, with four more months of arguments left to fill.

RALEIGH, N.C. North Carolinas highest court weighed Monday whether the legislatures decision 10 years ago to begin charging some retired state government workers and teachers a premium for health insurance violated an agreement the state made with these workers.

The courts didnt immediately rule following oral arguments in the case, which could affect hundreds of thousands of retirees and cost the state over $100 million in premium refunds, as well as expenses to cover additional retiree benefits.

Retired employees sued the State Health Plan in 2012, saying the state was contractually obligated to offer them premium-free benefits through a plan in which they paid 20 percent of their co-insurance. The plaintiffs included retired Chief Justice Beverly Lake Jr., who died in September 2019.

The legislature and ultimately the State Health Plan initiated the premium requirement in 2011 for workers and retirees with the most generous plans to close spending shortfalls.

The legal class impacted by the case would include almost all retirees eligible for health coverage as of September 2016.

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New Law Expands Ahps In North Carolina But Some Provisions Depend On Federal Ahp Lawsuit

North Carolina lawmakers passed S.B.86 by a wide margin in 2019, and although Governor Roy Cooper did not sign it, the bill became law without his signature. .

The NC legislation essentially mirrors the federal guidelines for association health plans that the Trump administration finalized in 2018, allowing small businesses to join together and obtain large-group health insurance based on either a common industry or a common geographical area . The legislation also calls for allowing sole proprietors to join AHPs, as is the case under the federal guidelines.

In March 2019, a federal judge blocked some provisions of the federal AHP rules, calling the regulations an end-run around the ACA. Specifically, the judge overturned the provisions that allow sole proprietors to join AHPs, as well as the provision that allowed unrelated small businesses that share only a geographical location to join AHPs. The Trump administration appealed the decision in April 2019 oral arguments were heard by the U.S. Court of Appeals, DC Circuit, in November 2019, but a ruling had not yet been issued as of February 2021, when the Biden administration asked the court to stay the appeal, and the court agreed.

Humana Group Medicare Advantage Base Plan

North Carolina state employees could see health care ...

State Health Plan Medicare retirees have several options for health plan coverage. One of these options is the Humana Group Medicare Advantage PPO Base Plan *, which includes Medicare prescription drug coverage.

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

Below are resources for members enrolled in the Humana Base Plan.

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High Deductible Health Plan


Both UNC and the enrolled employee share the monthly cost of coverage. The enrolled employee will receive a monthly bill for his/her portion of the monthly cost.

Please contact to see if you are eligible for this plan.

How Much Does it Cost?

When does Coverage Begin/End?

How to Enroll or Make Changes

Health Plan enrollment and changes are made through ConnectCarolina Self Service or call the Benefits and Eligibility Hotline at: 855-859-0966.

Class Action Grows To 220000 Plaintiffs

Four years later, in 2016, the case was certified as a class action, and there are now more than 220,000 plaintiffs. If you meet the following criteria, you could be part of this class action lawsuit automatically and there would be no need for action on your part. You should have already been contacted via mail if you meet these criteria.

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Formulary Exclusion Exception Process

A formulary exclusion exception process is available for Plan members who, per their provider, have a medical necessity to remain on an excluded, or non-covered, medication. If a member is approved for the excluded drug, that drug will be placed into Tier 3 or Tier 6.

Shp Coverage At Retirement For Members Hired On Or After October 1 2006

North Carolina state worker healthcare plan in jeopardy

If you were first hired on or after October 1, 2006, your cost at retirement for individual coverage under the SHP 70/30 or Medicare Advantage Base Plan is based upon the following retirement service credit requirements:

  • You must retire with 20 or more years of creditable service to receive individual coverage under the 70/30 or Medicare Advantage Base Plan at no charge.
  • If you retire with 10 years or more, but less than 20 years, of creditable service, you will have to pay 50 percent of the cost for your 70/30 or Medicare Advantage Base Plan coverage.
  • If you retire with five years of membership service, but less than 10 years of creditable service, you will have to pay the full cost for your 70/30 or Medicare Advantage Base Plan coverage.

Individual coverage under other SHP plans is available for an additional monthly fee. In all cases, the full cost of dependent coverage, if elected, must be paid by you.

If you were first hired by the state on or after October 1, 2006, the required 20 years of creditable service must include at least five years of TSERS membership service in order to receive free SHP coverage under the 70/30 or Medicare Advantage Base Plan. The remaining years of creditable service may include any combination of the following types of service:

  • Membership

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State Health Plan Enrollment Process For Eligible Retiring Employees

If you are retiring under TSERS and are eligible for State Health Plan retiree group coverage, you will be auto-enrolled into a health plan after you have submitted, and the Retirement System has processed, your online retirement application or have submitted a Form 6E, Choosing Your Retirement Payment Option. Many of your health coverage options are limited if you wait too close to your retirement date to submit your retirement paperwork.

State Health Plan retiree group coverage begins on the first day of the month after your effective date of retirement.

  • If under 65 , you will be automatically enrolled in the health plan you were enrolled in as an active employee along with any covered dependents.
  • If you did not have coverage in the State Health Plan as an active employee, you will be automatically enrolled in the Traditional 70/30 Plan retiree-only coverage.
  • You can change your auto-enrollment plan or coverage up to 30 days after your coverage effective date.

NOTE: If you do not take action within the specified time period to change coverage, you will remain, unless you drop coverage, in the assigned auto-enrolled retiree group health plan and pay the applicable premiums until the next State Health Plan Open Enrollment . You do not need a qualifying event or to be within the open enrollment period to drop coverage for yourself and/or your covered dependents.

All of the conditions described below are based upon current law .

Unitedhealthcare And Oscar Joined North Carolinas Marketplace For 2021

UnitedHealthcare, which previously offered coverage in North Carolinas marketplace but exited after the end of 2016, returned to the state as of 2021 . UnitedHealthcares plans are only sold on-exchange, and are available in all of rating areas 2, 7, 9, and 13, plus parts of rating areas 1, 11, and 15 .

Oscar also joined the North Carolina marketplace for 2021, with plans available in the Asheville area.

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Plaintiffs In Lake Et Al V State Health Plan Et Al

Attorney Gary Jackson has been working with a team of attorneys on a class action lawsuit in efforts to restore retirement health benefits to more than 220,000 North Carolina state retirees. The class action alleges that as former employees of the state of North Carolina, these retirees were contractually promised health benefits, only to have them subsequently taken away.

Major Changes To State Health Plan Announced

Numerous North Carolina Health Care Employees ...

Elizabeth Yelverton | NCASA Legal Affairs and Policy Manager

North Carolina State Treasurer Dale R. Folwell recently announced significant changes to the State Health Plan, a division of the N.C. Department of the State Treasurer, which may affect individual healthcare options for many Plan members. The Plan will be changing its reimbursement strategy from commercial-based pricing to reference-based pricing, beginning January 1, 2020.

The State Health Plan provides health care coverage to more than 727,000 teachers, current and former lawmakers, state university and community college personnel, retirees and their dependents, according to the Plans website. For decades, State Health Plan members have been able to obtain medical services from Blue Cross and Blue Shield of North Carolinas commercial network of providers. These providers consider the costs of services within the network to be confidential, meaning the fees charged for medical services are not actually provided to the Plan or its members. As a result, the State Health Plan has continued to reimburse these providers without knowing the specific costs of treatment, making it hard to predict how much it will pay out to providers each year.

The State Health Plan has already sent letters to providers announcing their new reimbursement rates, and will be collecting data from providers regarding their interest in participating in the new rate strategy.

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