Employees Can Get a Head Start on Open Enrollment

Employees who are tobacco users and want to earn their monthly premium credit for 2025 don’t have to wait until Open Enrollment this fall. They can take action now to save money throughout 2025!

Starting July 1, 2024, tobacco users can attend a tobacco cessation counseling session at their Primary Care Provider’s (PCP) office for FREE to earn a lower premium for 2025. They have until November 30, 2024, to take action. (Note: If employees combine their tobacco cessation visit with another service, there may be a copay.) This convenient employee option means there’s no need to wait for Open Enrollment in October to secure their monthly premium credit for 2025.

How it works:

• After employees visit a PCP for their tobacco cessation session, the provider will submit a claim on their behalf. To ensure they receive credit for their visit, employees can upload their office visit summary to the “Document Center” located in eBenefits, the State Health Plan’s enrollment system. They should make sure to request a copy of their summary during their visit.
• This action is ONLY for tobacco users who want to reduce their monthly premium by $60 per month in 2025. If employees are NOT tobacco users, they will simply attest to that online during Open Enrollment, Sept. 30 - Oct. 25, 2024.
• During Open Enrollment, they will need to attest during the online enrollment process. This step is critical to ensure employees receive the lower premium for 2025.
• Employees who took no action on tobacco attestation last year will receive a postcard reminder regarding 2025 Open Enrollment.

Clear Pricing Project Providers Need to Take Action for 2025

(Base PPO (70/30) & Enhanced PPO (80/20) Plan Members)

The Clear Pricing Project (CPP) will still be offered in 2025 when the State Health Plan transitions from Blue Cross NC to Aetna as the new third-party administrator (TPA) effective January 1, 2025.

As a reminder, the transition to Aetna applies to members in the Base PPO Plan (70/30), the Enhanced PPO Plan (80/20), and the High Deductible Health Plan. This change does not impact members enrolled in the Humana Medicare Advantage plans. 

CPP Providers will need to take action if they want to continue being a CPP Provider in 2025. Members are encouraged to talk with your CPP Providers regarding their plans for 2025. Providers need to re-sign up with Aetna by May 31, 2024, if they want to be a CPP Provider in 2025.

If CPP Providers choose not to re-sign up, members will not receive the lower copays in 2025 for those specific providers.

For more details, see the Plan’s TPA transition page.

State Health Plan Program:

The State Health Plan put multiple temporary benefit provisions in place to assist Plan members during the COVID-19 public health emergency.  The federal government announced that the COVID-19 public health emergency ended on May 11, 2023.  Here's what it means to employees regarding coverage as it relates to COVID-19:

• The Plan will continue to cover both the cost of the COVID-19 vaccine and vaccine administration at 100% when employees receive the vaccine at an in-network provider as part of the Plan’s preventive care benefits. If employees receive any other service during the visit, the visit may be subject to a copay. This is true for all other vaccines the Plan covers.
• The Plan will cover COVID-19 tests that are administered by a provider. If members receive any other service during the visit, the visit may be subject to a copay.
• The Plan will no longer cover the cost of over-the-counter (OTC) COVID-19 tests. Members will be responsible for the cost.
• The State Health Plan will no longer cover the cost of COVID testing as it relates to return to work. This means if you have to test negative before returning to work or if a place of employment requires regular testing.

The Plan continues to cover telehealth. Members should always ask their provider if they offer telehealth services. The Plan implemented a new telehealth policy effective January 1, 2023. Below are the services that will no longer be covered at the same copay as in-person care (if a person receives these services via a telehealth appointment). The services below will continue to be covered, but members will have to pay the appropriate copay.

• Dialysis services
• Physical Therapy/Occupational Therapy evaluations
• COVID testing services
• Emergency Department Evaluation and Management Services
• Hospitalization Evaluation and Management Services
• Extended Office Visits
• New Patient Preventative/Annual Wellness Exams

Please call Customer Service at 888-234-2416 if you have any questions about your telehealth benefits.