State Health Plan offers PPO options

Open enrollment - May 22 to June 30

The North Carolina State Health Plan is offering three new preferred provider organization (PPO) health plan options during this year’s open enrollment. The new NC SmartChoice PPO plans will be offered along with the current Comprehensive Major Medical plan as a significantly more affordable choice for teachers, state employees and other eligible members effective Oct. 1.

1. You may choose to remain on your current plan, Comprehensive Major Medical (CMM), or
2. You may select one of three new PPO plan designs being offered.

The State Health Plan has contracted with Blue Cross and Blue Shield of North Carolina to use its Blue Options Network of preferred providers. The NC SmartChoice products offer:

An employee/spouse option – You no longer pay the family rate if you want only to cover your spouse.

• Reduced premium options if you cover more than just yourself.
• Lower out-of-pocket costs (office visit co-pays instead of deductibles and co-insurance).
• No annual dollar cap for wellness benefits.
• An extensive network of providers – 90 percent of the primary care physicians in the state participate and 97 percent of the hospitals participate.
• No referrals are required to see specialists, and you will still be able to see physicians out of the network—just at a higher cost.
• Any credit toward the Comprehensive Major Medical (CMM) plan deductible will be applied to the PPO plan deductible effective 10/1/06.

Open enrollment for the State Health Plan runs from May 22 to June 30.

• If you are a member in the State Health Plan, a packet with all the information you need to help you make the best choice for your family should have arrived at your home address in May.
• If you are not a member in the State Health Plan and would like more information on the NC SmartChoice PPO plans, contact your Human Resources office to obtain a packet.
• As you make your decision about whether to join the State Health Plan’s new NC SmartChoice, please remember that some in-network providers work in practices that are hospital-owned or operated. If you see an in-network provider whose practice is hospital-owned or operated, the services you receive may be subject to your in-network deductible and co-insurance. Call your physician or refer to the Provider Directory if you are not sure whether your physician works in a hospital-owned or operated practice.

Be sure to check the State Health Plan Web site at www.statehealthplan.state.nc.us for information on your health plan options and the Provider Directory. You may also talk with your Human Resources representative or you can call the new NC SmartChoice PPO Customer Service line at 1-888-234-2416.

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Last Modified: June 6, 2006