State Health Plan Update

Prepared by Marge Foreman, 9/21/09

1. Maintained free premiums for active employees and retirees.
2. Led the charge for $250 million to be used from “Rainy Day Fund” to offset costs (if not used, premiums would have been 38% higher).
3. New premiums increased by only 8.9%, while national average in health care increases is close to 12%.
4. Eye exams still available in the State Health Plan with only a co-pay ($30 in 70/30 plan and $25 in 80/20 plan) until January 1, 2010. 
5. Slight increase ($5 above last year’s specialist visit co-pay) in therapy co-pays for office visits ($50 to $55 in 70/30 plan and $40 to $45 in 80/20 plan).
6. There are certain generic drugs that can be mail ordered from Medco, the State Health Plan’s third-party prescription drug administrator, costing only $10 for a three-month supply.  Go to http://www.shpnc.org/pdf/PreferredPrescList.pdf to see the complete list.
7. Effective October 1, 2009, certain nasal steroid allergy medications will require a coverage review.  Go to http://www.shpnc.org/pharm-nasal-steroid.html to see a list of prescription drugs affected.
8. State Health Plan members will be charged the same cash price for prescription drugs as the general public ($13 million savings to members).  In some cases, pharmacists charged plan members higher co-pays than the general public.
9. The State Health Plan bill, Senate Bill 287, now requires transparency in all contracts between the Plan and third party administrators.
10. The State Health Plan bill also requires a comprehensive, independent audit of the Plan. A Request for Proposals (RFP) has been sent out from the Executive Administrator.  If fraud is found in any area, refunds must be made to Plan members in the form of reduced premiums and co-pays. 
11. The State Health Plan’s Executive Administrator is also required to inform Plan members of the requirements for compliance and consequences for non-compliance on the Comprehensive Wellness Initiatives (smoking cessation and weight management) prior to October 1, 2009.  The requirements also include education and training to assist members in complying with healthy lifestyle initiatives.  The Plan’s Executive Administrator will also offer patches for smoking cessation, along with a “quit smoking” helpline.  Please review in detail information regarding what is being offered to assist members with compliance at http://www.shpnc.org/comp-wellness.html.
12. Creation of a Blue Ribbon Task Force to conduct a comprehensive review of the State Health Plan’s benefits structure, premium rates, contracts, administrative fees, etc.  An NCAE member will serve on the Community.

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