(For Newly Eligible Employees)
The North Carolina General Assembly approved legislation to create a new health benefit to comply with the federal Affordable Care Act (ACA). The HDHP benefit option is available only to employees eligible for coverage under G.S. §135 48.40(e). Please check with your employer's HR department to confirm your eligibility prior to enrolling in this plan. Once you are eligible for this plan, you will have 30 days to elect coverage.
Please note that this plan utilizes the MedCost PPO Network — not Blue Cross and Blue Shield of North Carolina — and does not include NC HealthSmart resources.
The High Deductible Health Plan is administered by MedCost. Affordable Care Act (ACA) Preventive Services performed by an in-network provider are covered at 100% in this plan, which means there is no charge to you. Important benefit documents are below.
Find a Provider in the MedCost Network
Go to Medcost.com and click "Locate a Provider" and select "MedCost/MedCost ULTRA
As of January 1, 2017, the new Pharmacy Benefit Manager for this plan is CVS Caremark. Members should also note that this change does NOT mean members will have to go to a CVS pharmacy location for their prescriptions. CVS Caremark has a broad pharmacy network, which can be found using the Pharmacy Locator Tool. For questions about the Pharmacy benefit, call CVS Customer Service at 888-321-3124.
2017 Drug Cost Lookup and Pharmacy Locator Tools
Click below to access the Drug Cost Lookup and Pharmacy Locator Tools.
Please note: If a drug is not covered by the State Health Plan, the following advisory will appear under Plan Notes: “Not covered: Ask your doctor about alternatives.”
If you choose to enroll in this plan, you will be billed monthly for your premiums by the State Health Plan's direct billing administrator, iTEDIUM (formerly COBRAGuard). This is a pre-paid plan; therefore, you will be billed a month in advance. For instance, you will receive a bill in December for January coverage. You will be responsible for paying your bill in a timely manner, and failure to do so will lead to termination of coverage. Click here for a sample of the bill you will receive.
How to Enroll
Enrollment for this plan will be available online only. You will need to register online at www.shphdhp.com. You will be prompted to create a user name and password. Once you have registered, you will be able to follow the necessary steps to complete your enrollment. Click here for instructions on how to enroll.
During your enrollment period you are able to:
An eligible dependent of a covered employee includes:
Children up to age 26, including natural, legally adopted, foster children, children for which the employee has legal guardianship and stepchildren of the employee;
This includes coverage for such children (described above) who are covered by the Plan when they turn age 26 to the extent that they are physically or mentally incapacitated on the date that they turn age 26. A child is physically or mentally incapacitated if they are incapable of earning a living due to a mental or physical condition. Coverage continues for such children as long as the incapacity exists or the date coverage would otherwise end, whichever is earlier.
Please remember that when adding dependents to your benefit plan, you may be asked to provide documentation of dependent eligibility under the State Health Plan.
Click here for a list of acceptable documentation. Outside of your enrollment period you may not add or remove dependents or disenroll from the State Health Plan unless you experience a qualifying life event, such as marriage, birth, death or retirement.
For questions about enrollment call the Enrollment and Billing Support Center at 855-442-6272.