1. Open Enrollment Dates: Sept. 29-Oct. 31, 2018
2019 State Health Plan Open Enrollment
Open Enrollment Dates: Sept. 29-Oct. 31, 2018

2. Introducing the State Health Plan’s New Website
The new website has a new look and feel and is NOW mobile responsive!
Changes to note:
Name change of eEnroll to eBenefits
NC HealthSmart transition to Health and Wellness 2

3. Enrollment Overview

4. Action Required!
ALL members will be moved to the 70/30 Plan effective Jan. 1, 2019.
Subscribers will see this change when they log in to eBenefits in October.
Subscribers MUST take action to enroll in the 80/20 Plan and reduce their premium in either the 70/30 or 80/20 Plan.
Failure to take action by Oct. 31st will result in:
Remaining on the 70/30 Plan for 2019
Paying more for subscriber-only premium for failure to complete the tobacco attestation.

5. Plan Options 80/20 Plan 70/30 Plan
The State Health Plan will continue to offer two plan options to active employees for 2019:
80/20 Plan
Members pay a 20% coinsurance for eligible in-network services. For some services (i.e., office visits, urgent care or emergency room visits), members pay a copay. Affordable Care Act (ACA) Preventive Services performed by an in-network provider are covered at 100% by the Plan, at no cost to the member.
70/30 Plan
Services are subject to deductible and coinsurance maximum. Members pay 30% coinsurance for eligible in-network expenses. Similar to the 80/20, members pay a copay for some services (i.e., office visits, urgent care or emergency room visits). What is different on the 70/30 plan is that members also pay a copay for preventive office services. The deductible and coinsurance would apply to preventive services, like colonoscopies, performed in an outpatient setting.
Members can reduce their employee premium by completing the tobacco attestation in both plans!

6. Tobacco Attestation Change
By completing the tobacco attestation, employees can reduce employee-only premium by $60 on both the 80/20 & 70/30 plans.
New attestation language and required activity:
Employee must re-attest to not being a tobacco user or agree to visit a CVS Minute Clinic for at least one tobacco cessation counseling session within 90 days of Open Enrollment or risk losing their credit.
New hires enrolling during OE will be prompted to answer the tobacco attestation for 2018 and 2019 benefit year. While they need to answer the question twice, they can satisfy the requirement by completing either the QuitlineNC (2018) or the Minute Clinic (2019) tobacco cessation program.

7. How the CVS Minute Clinic Tobacco Cessation Program Works
During enrollment on the tobacco attestation screen, employee selects “I AM a tobacco user, BUT I agree to visit a CVS Minute Clinic for at least one tobacco cessation counseling session within 90 days after the last day of Open Enrollment or from your initial hire date.”
Employee will then receive a letter which will include a CVS Minute Clinic Tobacco Attestation Voucher that will cover an initial visit (a $45 savings) + one follow-up (a $35 savings) visit for face-to-face tobacco cessation counseling.
Employee will need to bring the voucher to each session and present their State Health Plan ID card in order for the visit to be covered at 100% by the Plan (no charge to the member).
The initial visit is the only requirement to keep the premium credit.
This will replace the QuitlineNC multi-call program enrollment requirement for the 2019 Plan benefit year. For subscribers that would like to utilize the Voucher Program after Jan. 1, 2019, they will need to call CVS Caremark at and a voucher will be mailed to them.

8. CVS Minute Clinic Tobacco Attestation Voucher
For locations and hours visit

9. Tobacco Attestation Savings
80/20 Plan
70/30 Plan
Total employee-only monthly premium without credit
$110
$85
Attest to being tobacco-free OR agree to visit a CVS Minute Clinic for at least one tobacco cessation counseling session, if a tobacco user.
$60
TOTAL employee-only monthly premium with credit
$50
$25

10. $10 (selected PCP)/$25 (non)
2019 Changes
Individual In-Network Benefit Design
70/30 Plan (no changes)
/20 Plan
/20 Plan
Deductible
$1,080
$1,250
Coinsurance Percentage
30%
20%
Preventive Coverage
Cost-Sharing Applies
100%
Medical OOP Max Pharmacy OOP Max Medical Coinsurance Max Overall OOP Max NA
$3,360
$4,388
N/A
$4,350
$2,500
$6,850
N/A N/A
$4,890
PCP Copay
$40
$10 (selected PCP)/$25 (non)
Chiro/Therapies
$72
$52
Specialist Copay
$94
$45 Designated/$85 (non)
$80
Inpatient Hospital
$337, then Ded/Coins.
$0 or $450, then Ded/Coins.
$300, then Ded/Coins.
Outpatient Hospital
Ded/Coins.
ER Copay
Urgent Care
$100
$70
Drugs
Tier 1
Tier 2
Tier 3
Tier 4
Tier 5
Tier 6
$16
$47
$74
10% up to $ % up to $ % up to $133 $5
$30
$250
Preferred Diabetic Supplies* (e.g. Test Strips, Lancets, Syringes, Needles)
Preferred Diabetic Supply brand is OneTouch
$10
*Non-preferred Diabetic
Supplies will be priced at Tier 3 16

11. 80/20 Plan Wellness Incentive
Additional Wellness Activity
Reduced Copay
Visit the Primary Care Provider (PCP) listed on your ID card or another provider in the same practice.
$10 copay
The Blue Options Designated Provider Program will not be offered in 2019.

12. Pharmacy Benefit Reminders
CVS Caremark is the Pharmacy Benefits Manager for the State Health Plan. Remember that the Plan continues to maintain a customized closed formulary, or drug list.
Closed Formulary – In a “closed” formulary, certain drugs are excluded.
The formulary is updated on a quarterly basis and members should always review it to see if there have been any coverage changes to their prescribed medications.
An exception process is available to providers who believe that, based on medical necessity, it is in the members’ best interest to remain on the excluded drug(s).
Excluded drugs approved for coverage through the exceptions process will be at the tier 3 or tier 6 member copay level.

13. Pharmacy Benefit Reminders
Individual In-Network Benefit Design
70/30 Plan
80/20 Plan
Drugs Tier 1
Tier 2
Tier 3
Tier 4
Tier 5
Tier 6
$16
$47
$74
10% up to $ % up to $ % up to $133 $5
$30
Ded/Coins.
$100
$250
Preferred Diabetic Supplies* (e.g. Test Strips, Lancets, Syringes, Needles). Preferred Diabetic Supply brand is OneTouch
$10
Tier 3 and Tier 6 medications do not have a defined copay, but are subject to a deductible/coinsurance. Employees will have to pay the full cost of the medication until they meet the deductible. Once the deductible is met, members will be responsible for the 20% coinsurance amount until the the out-of-pocket maximum is met. Medications that are subject to coinsurance in most cases will result in higher out-of-pocket costs to members.
As a reminder, if an exception is approved for an excluded drug, it is only approved for coverage at the Tier 3 or Tier 6 member copay level.

14. Premium Rates

15. 2019 Premium Rates (80/20 & 70/30 Plan)
Monthly Premium Rates
2019 Rates *
80/20 Plan
Subscriber Only
$50.00
Subscriber + Child(ren)
$305.00
Subscriber + Spouse
$700.00
Subscriber + Family
$720.00
70/30 Plan
$25.00
$218.00
$590.00
$598.00
*Assumes completion of tobacco attestation. The employee-only premium will be $60 higher per month if the tobacco attestation is not completed.
NOTE: 70/30 Plan for retiree-only coverage remains premium free.

16. Extended Call Center Hours
The Eligibility and Enrollment Support Center will have extended hours:
Monday – Friday, 8:00 a.m. – 10:00 p.m.
Saturday 8:00 a.m. – Noon.
Encourage your employees not to wait until the last minute! Longer hold times occur the first and last week of Open Enrollment.

17. Important Points
It is important to SAVE your choices at the end of the
enrollment process.
Many members overlook this vital, final step and therefore fail to complete enrollment!
Printing out their confirmation statement is also
recommended!
The choices you pick
Will NOT stick
Unless you SAVE them With a CLICK!

18. Dependent Eligibility Verification

19. Dependent Eligibility Reminder
Open Enrollment is the time to add/drop dependents and/or change plans
Outside of OE, there must be a QLE to add/drop dependents
Within 30 days of the event
Dependent verification documentation is required for all dependents.

20. New State Health Plan Member ID Cards for 2019
Current ID Card
All members will be receiving new ID cards this year. They will be mailed in late November/early December.
New & Improved ID Card

21. New Explanation of Benefits (EOB) Coming Soon!
These new and easier to read EOBs will be
launched in August (draft version shown).
Current EOB
New & Improved EOB

22. Any Questions? ELIGIBILITY AND ENROLLMENT
(Complete Open Enrollment by phone)
CVS CAREMARK
(PHARMACY BENEFITS)
BLUE CROSS AND BLUE SHIELD OF NC
(BENEFITS, CLAIMS)

23. Website Navigation

24. Member Home Page at Login
Click Get Started

25. Make any needed changes to your dependents, then click Next.
Adding Dependents
Make any needed changes to your dependents, then click Next.

26. Begin Enrollment
Click
Begin Enrollment

27. Select Open Enrollment
Reason for Change
Select Open Enrollment
Click Next to continue

28. Who do you want to cover?
Click
Next

29. Review options and click “Select plan” and “Next” to continue.
Plan Selection
Review options and click “Select plan” and “Next” to continue.
This HR note will display.

30. Tobacco Attestation and Premium Credit
Select
Answer, then click Next
Select Answer, then click Next

31. Medical Summary Page
Click “Edit” to modify tobacco survey answer if you need to.
Click “Edit” to update additional insurance if you need to.
Click “Edit” to add a Primary Care Provider if you need to.
Click Save
Other options to edit Premium Credit,Additional Insurance and Primary Care Provider will follow.

32. Click “Save changes” to complete enrollment process
Review Elections and Select Save!
Click “Save changes” to complete enrollment process

33. Confirmation Page Confirmation statement example.
Click to view and print Confirmation Statement
Confirmation statement example.