Changes to NC State Employees Health Insurance Shifts Costs


North Carolina State Treasurer Dale Folwell, CPA announced on October 22, 2018, unanimously passed a resolution changing the provider reimbursement schedule, effective January 1, 2020. (View resolution here: https://files.nc.gov/ncshp/documents/board-of-trustees/provider_reimbursement_strategy_resolution_-_approved_10.22.18.pdf)

Treasurer Folwell believes the new reimbursement schedule will “offer(ing) medical providers the opportunity to be compensated at an established, transparent rate plus a generous profit.” Read the entire announcement on the NC State Health Plan website here: https://www.shpnc.org/blog/2018-10-22/state-health-plan-board-trustees-unanimously-supports-provider-reimbursement

How will this change affect Plan participants?
• Provider reimbursement will align more to Medicare reimbursement rates, greatly reducing reimbursements in many areas even though other areas will see an increase. This will result in larger out of pocket costs for Plan participants.
• In Network providers now, may not be In Network with the new reimbursement schedule, depending if they accepted the new schedule.

While Treasurer Folwell predicts the proposed Plan savings will result in lower premiums that will make the plans more affordable. If costs are actually shifting, is the plan really more affordable?