The mission of the State Health Plan is to improve the health and health care of North Carolina teachers, state employees, retirees, and their dependents, in a financially sustainable manner, thereby serving as a model to the people of North Carolina for improving their health and well-being.
The Plan provides health care coverage to over 714,000 teachers, state employees, retirees, current and former lawmakers, state university and community college personnel, and their dependents.
Our membership includes:
More than 492,000 active employees and dependents. Dependents include spouses and children up to age 26
More than 1,166 COBRA participants and their dependents.
More than 56,000 non-Medicare eligible retirees and their dependents.
More than 161,000 Medicare eligible retirees and their dependents.
The Plan is self-insured and exempt from the Employee Retirement Income Security Act as a government-sponsored plan. The Plan offers two Preferred Provider Organization (PPO) plans, the 70/30 and 80/20 Plans for active and Non-Medicare members. PPO plans offer the freedom of choice among in-network providers, lower out-of-pocket costs and a strong emphasis on preventive health.
The Plan also offers a High Deductible Health Plan for those who are deemed eligible by their employing agency.
For our retirees, the Plan offers three health plan options. These plans include two Group Medicare Advantage Plan options that feature benefits and services such as access to the SilverSneakers® Fitness Program, a nurse help line and disease and case management. Retirees may also choose the 70/30 Plan, which is the same plan available to active members.
Through healthy living initiatives, such as
NC HealthSmart, the Plan seeks to empower members to make healthier lifestyle choices and to become partners in addressing their health care needs.