Health Insurance Changes

NC State employees will see changes in health insurance benefits and rates for 2009-10 and 2010-11. Here is a summary of the changes from Senate Bill 287, signed into law April 23 by Gov. Bev Perdue.

Rate Increases

• On July 1, there will be an 8.9 percent premium increase on all coverage tiers.
• On July 1, 2010 there will be another 8.9 percent premium increase on all coverage tiers.

Benefit Changes

• The 90/10 Plus plan will no longer be offered as of July 1. Currently enrolled employees will have the choice of moving to the PPO Basic (70/30) or PPO Standard (80/20) during annual enrollment, scheduled for May 6-29. To change options, you must complete an annual enrollment change form, which will be posted on the benefits homepage by Monday, May 4. If a PPO Plus (90/10) participant does not submit a completed form by May 29, he or she and covered dependents will automatically default to the PPO Standard plan (80/20) effective July 1. Employees who switch or are moved to the 80/20 plan will no longer have to pay for employee-only coverage, effective July 1. Premium changes for dependents will occur in June payroll with coverage effective July 1.
• At this time, no changes will be allowed in the contribution level of Medical Flexible Spending Accounts based on elimination of the PPO option, according to the NC Flex plan administrator. Universities in the UNC System have asked that the decision be reconsidered.
• Deductibles, copays and coinsurance maximums will increase, effective July 1. See the Benefit Changes Chart for details.
• As of Jan. 1, 2010, routine vision exams will no longer be covered under the PPO options. Annual enrollment for the NCFlex Vision Care Plan will be held in October for a Jan. 1, 2010 effective date.

Prescription Drug Coverage

• The number of days’ supply for one copayment will change from 34 days to 30 days, effective July 1.
• Prescription drug copays for preferred brand (without a generic available), and nonpreferred brand will each increase by $5, effective July 1.
• Beginning July 1, a 25 percent coinsurance will be charged for specialty prescription drugs up to $100 for each 30-day supply. If you are currently taking a specialty medication, you will receive additional information in the mail.
• The preferred brand copay tier (with generic available) will be eliminated effective July 1.

Beginning July 1, if a generic equivalent is available and you choose to have the brand name drug or your doctor prescribes “Dispense as Written,” you will be required to pay the difference between the actual cost of the brand name drug and the amount the plan would have paid for the generic equivalent, in addition to the generic copayment.

Health Initiatives

• Effective July 1, 2010, you must attest that you or your covered dependents do not use tobacco products. If not, you may only opt for the PPO Basic (70/30) plan.
• Effective July 1, 2011, you must attest that your weight and height ratios are within an evidence-based determined range. If not, you may only opt for the PPO Basic (70/30) plan.

Insurance Cards

Because of the shortened time frame, not all members who make changes will receive ID cards by July 1. Providers and pharmacies will accept your old ID cards in the meantime.