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Skip Navigation LinksOpen Enrollment - Active Members

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Active Members
2018 Benefit Information

2018 Open Enrollment has ended. Click either of the buttons below to learn more about your 2018 benefits:

2018 Benefit Information At a Glance

Rate Sheets Enrollment Resources 

Tobacco Attestation Wellness Activity

By taking this simple step, you can save money in 2018! If you do not take action, you will pay a higher premium.


2018 Premium Credit Savings



​Employee-Only Monthly Premium




Attest during Open Enrollment (Sept. 30-Oct. 31, 2017)
in eEnroll to being tobacco-free OR enroll in QuitlineNC multi-call program between Sept. 30-Oct. 31*.

-$60 premium credit

-$60 premium credit

Total Monthly Employee-Only Premium (with credit)

​$50 $25
 * Even if you attested during last year’s Open Enrollment, you will need to re-attest during Open Enrollment! If you are a tobacco user, you must enroll in the QuitlineNC tobacco-cessation program to receive the wellness credit. You can enroll in QuitlineNC’s program any time between now and December 31, 2017.

80/20 Additional Wellness Incentives


Additional wellness incentives are available in the 80/20 Plan that lower your out-of-pocket costs for various health care
services you receive throughout the year.


Additional Wellness Activities


Visit the Primary Care Provider (PCP) listed on your ID card or another provider in the same practice


$10 copay

Visit a Blue Options Designated specialist*


$45 copay

Get inpatient care in a Blue Options Desig​nated hospital*


$0; copay not applied

* You can identify Blue Options Designated providers within the "Find a Doctor" tool by looking for this designation by their name: "Designated for Cost and Quality."


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Rate Sheets (January 1, 2018 - December 31, 2018) 


Active Subscriber Monthly Rates

70/30 & 80/20 Plan for Active Subscribers

70/30 & 80/20 Plan for 100% Contributory Leave of Absence Subscribers

70/30 & 80/20 Plan for 100% Contributory Non-Medicare COBRA and Other 100% Contributory Subscribers

70/30 & 80/20 Plan for Active Subscribers Whose Dependent is Medicare Primary Due to ESRD​

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Enrollment Resources


The following Open Enrollment resources help you make the best decision for you and your family. Please check back often as more resources are added. 

2018 Open Enrollment Member Outreach Presentation

2018 ACA Preventive Services Summary

2018 Pharmacy Resources

2018 Comprehensive Formulary List: a complete list of covered medications and their tier placement.

2018 Preferred Drug List: a list of preferred medications noting which drug requires any prior approvals.
2018 Specialty Pharmacy Drug List: a complete list of all medications available through CVS Specialty.
2018 ACA Preventive Medication List (80/20 Plan only): medications on this list are covered at 100%, which means there is no cost to you.

The tools listed above include information based on the 2017 formulary (drug list) and are subject to change prior to January 1, 2018.  The formulary is regularly updated throughout the year, on a quarterly basis, so there is always a possibility that the coverage status of your medication(s) could change, which may affect your out-of-pocket costs.

As a reminder, the State Health Plan continues to utilize a custom, closed formulary (drug list). The formulary indicates which drugs are excluded from the formulary and not covered by the Plan. All other drugs that are on the formulary are grouped into tiers. Your medication’s tier determines your portion of the drug cost. Copay amounts can be located on the 2018 Plan Comparison below.

2018 Pharmacy Locator Tool and Drug Cost Lookup Tool

CVS Caremark is the State Health Plan’s Pharmacy Benefit Manager. Click below to access the Drug Cost Lookup and Pharmacy Locator tools.

The Plan’s Pharmacy Benefit Manager, CVS Caremark, is another valuable resource as you navigate through your decisions. CVS Customer Service can be reached at 888-321-3124, or you can log in to your own account at Remember to always discuss your prescription options with your health care provider to find the most cost-effective therapy.

Please note: If a drug is not covered, the following advisory will appear under Plan Notes: “Not covered: Ask your doctor about alternatives.”

Benefit Booklets

70/30 Plan
80/20 Plan

Uniform Summary of Coverage

70/30 Plan
80/20 Plan