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State Health Plan OKs premium hikes, preferred providers

On Friday, the North Carolina State Plan Board of Trustees (SHP) voted on what are being called monumental changes to the Plan over the next few years, including preferred provider hospital systems, benefit changes, and premiums for 2027, and the announcement of a Third Party Administrator (TPA) and Pharmacy Benefit Manager (PBM) for 2028, in an effort to make improvements and reduce overall costs for the nearly 750,000 members covered by the Plan.

Theresa Opeka
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State Health Plan board votes on benefit restructuring strategies

On Tuesday, the North Carolina State Health Plan Board of Trustees voted unanimously at its meeting to approve the implementation of a three-tier provider network for 2027 that will strengthen the Preferred Provider Program (PPP), which will steer members toward providers at a cost savings for both the member and the State Health Plan (SHP), while delivering a volume of patients to preferred providers.

Theresa Opeka
News

Duke–Aetna dispute could raise premiums, cut coverage for NC’s state employees

The clock is ticking on negotiations between health insurance company Aetna and Duke Health, which says that unless Aetna raises its reimbursement rates, many patients will lose in-network coverage to Duke’s doctors, hospitals, clinics, and services on Oct. 20, including over 750,000 state employees covered under the State Health Plan (SHP).

Theresa Opeka

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State Supreme Court rules government retirees had contractual health care right

The N.C. Supreme Court has ruled, 4-2, that 220,000 state government retirees had a contractual right to premium-free health care benefits that had been promised to them. Now a trial court will have to determine whether state changes to those benefits a decade ago violated the contract. The decision reverses the state Court of Appeals,...

CJ Staff
News

Folwell hopeful medical providers will join new State Health Plan network

Fresh off N.C. Department of Insurance approval of cost-reducing reforms, Treasurer Dale Folwell is optimistic doctors and hospitals will join a new State Health Plan provider network. Contracts were set to go out late last week. The Insurance Department green light was the last regulatory hurdle to implement his Clear Pricing Project and change the...

Dan Way
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