Alyssa Lane
The State of North Carolina offers its employees full medical and pharmacy benefits through the State Health Plan. Retirees who are eligible for coverage will be auto-enrolled in a health plan after submitting their retirement application. The Base PPO Plan (70/30) is a Preferred Provider Organization (PPO) plan administered by Aetna and Blue Cross NC. This plan offers freedom of choice among in-network providers and lower out-of-pocket costs. The Enhanced PPO Plan (80/20) is also a PPO plan administered by Aetna, with added benefits such as a strong emphasis on preventive health. Additionally, retirees can opt for supplemental vision, dental insurance, and identity theft protection through Pierce Insurance Agency Inc. at discounted rates.
| Characteristics | Values |
|---|---|
| Plan Name | NC State Health Plan |
| Plan Administrator | Aetna |
| Plan Type | Preferred Provider Organization (PPO) |
| Plan Options | Base PPO Plan (70/30), Enhanced PPO Plan (80/20), Humana Group Medicare Advantage (PPO) Base Plan |
| Eligibility | Retirees with at least five years of TSERS membership service as a teacher or state employee |
| Cost | Retirees with less than 10 years of service pay the full cost; the state pays the majority for those with more service, with employees subsidizing dependent coverage |
| Enrollment | Automatic upon retirement; can change or opt out within 30 days of coverage effective date |
| Dependent Coverage | Available at full cost to the retiree |
| Supplemental Coverage | Optional vision, dental, and identity theft insurance available through Pierce Insurance Agency Inc. |
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What You'll Learn
- Retirees are auto-enrolled in the health plan they were in as an active employee
- Retirees must be enrolled in Medicare Parts A and B to be eligible for the Humana Group Medicare Advantage (PPO) Plans
- Retirees with five years of membership service pay full cost for Base PPO Plan (70/30)
- Retirees can opt for supplemental vision, dental insurance and identity theft protection
- The State Health Plan covers over 700,000 teachers, state employees, retirees and their dependents
Retirees are auto-enrolled in the health plan they were in as an active employee
In North Carolina, retirees are auto-enrolled in a health plan. If a retiree was enrolled in the State Health Plan as an active employee, they will continue to be enrolled in the same plan after retirement, along with any covered dependents. However, if a retiree did not have coverage under the State Health Plan as an active employee, they will be automatically enrolled in the Base PPO Plan (70/30) retiree-only coverage.
For those who are eligible for State Health Plan coverage, the type of plan they are auto-enrolled in depends on when their retirement paperwork is processed and approved by the State Retirement Systems. If eligible retirees submit their retirement paperwork less than 60 days before their coverage effective date, they will be automatically enrolled in the Base PPO Plan (70/30). They will have up to the day before their coverage effective date to elect a Medicare Advantage Plan. If they do not choose a Medicare Advantage Base Plan, they will remain in the Base PPO Plan until the next Open Enrollment period. During this time, their non-Medicare-eligible dependents will be enrolled in the health plan they were in when the retiree was an active employee.
If eligible retirees submit their retirement paperwork 60 days or more before their coverage effective date, they will be automatically enrolled in the Humana Group Medicare Advantage (PPO) Base Plan. They will have up to 30 days before their coverage effective date to change plans. If no action is taken, they will remain in their assigned Medicare Advantage Base Plan until the next Open Enrollment, and their non-Medicare-eligible dependents will be enrolled in the health plan they were in when the retiree was an active employee.
The Base PPO Plan (70/30) is a Preferred Provider Organization (PPO) plan administered by Blue Cross, NC. This plan offers freedom of choice among in-network providers and lower out-of-pocket costs. Preventive services and medications are covered at 100% under this plan. The Humana Group Medicare Advantage (PPO) Base Plan is also a PPO plan, administered by Humana. To be eligible for this plan, retirees must be enrolled in Medicare Parts A and B.
Retirees can also choose to purchase supplemental insurance, such as vision, dental, and identity theft protection, through the Pierce Insurance Agency Inc. Although retirees pay the full cost of these premiums, the rates are much lower than they would find elsewhere.
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Retirees must be enrolled in Medicare Parts A and B to be eligible for the Humana Group Medicare Advantage (PPO) Plans
In North Carolina, retirees have access to a range of health insurance options, including the Humana Group Medicare Advantage (PPO) Plans. This plan is specifically designed to meet the needs of retirees during their transition from active work into retirement and beyond.
To be eligible for the Humana Group Medicare Advantage (PPO) Plans, retirees must be enrolled in both Medicare Parts A and B. These two parts of Medicare are essential components of the overall program and offer distinct benefits. Part A covers hospital insurance, which includes inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care services. On the other hand, Part B, also known as medical insurance, covers outpatient care, medical supplies, and preventive services. By enrolling in both parts, retirees can ensure they have comprehensive coverage for a wide range of health services.
It is important to note that retirees in North Carolina have other options besides the Humana Group Medicare Advantage (PPO) Plans. The state offers a variety of health plans to cater to different needs and preferences. One such option is the Base PPO Plan (70/30), administered by Aetna. This plan offers freedom of choice among in-network providers and lower out-of-pocket costs. Additionally, preventive services and medications are covered at 100% under this plan. For retirees who are eligible for State Health Plan benefits under the State Retirement Systems, automatic enrolment into either the Humana Group Medicare Advantage (PPO) Base Plan or the Base PPO Plan (70/30) will occur, depending on when their retirement paperwork is processed and approved.
Furthermore, retirees in North Carolina have access to optional supplemental insurance plans. For instance, Pierce Insurance Agency Inc. offers supplemental vision and dental insurance, as well as identity theft coverage. While retirees pay the full cost of these premiums, the rates are significantly lower than they would find elsewhere, without any hidden fees or dues. This provides retirees with additional peace of mind and coverage for specific areas not typically included in standard health insurance plans.
In conclusion, while retirees in North Carolina must be enrolled in Medicare Parts A and B to be eligible for the Humana Group Medicare Advantage (PPO) Plans, there are alternative health insurance options available through the state and private insurers. It is important for retirees to carefully review their options, consider their specific needs, and make informed decisions regarding their healthcare coverage during retirement.
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Retirees with five years of membership service pay full cost for Base PPO Plan (70/30)
The State Health Plan offers retiree group coverage, with eligibility depending on the number of years of creditable service. If retirees have five years of membership service, but less than 10 years of creditable service, they will have to pay the full cost of their Base PPO Plan (70/30) or the Medicare Advantage Base Plan coverage. This plan is administered by Aetna and offers freedom of choice among in-network providers, lower out-of-pocket costs, and a strong emphasis on preventive health. Preventive services and medications are covered at 100% under this plan.
For those with 10 years or more of creditable service but less than 20, retirees will pay 50% of the cost of the Base PPO Plan (70/30) or the Medicare Advantage Base Plan. If retirees were "first hired" before October 1, 2006, and have five or more years of TSERS membership service, the state will pay all the costs for their individual coverage under the Base PPO Plan (70/30) or the Medicare Advantage Base Plan.
It is important to note that retirees who cancel their coverage for any reason will not be allowed to re-enroll unless they experience a qualifying life event or enroll during the next scheduled Open Enrollment. Additionally, employees hired on or after January 1, 2021, are not eligible to receive retiree health benefits.
For Medicare members, the Base PPO Plan (70/30) serves as secondary to Medicare. This plan is also available to retirees under 65 who are not Medicare-eligible, and they will be automatically enrolled in the health plan they had as an active employee.
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Retirees can opt for supplemental vision, dental insurance and identity theft protection
The NC State Health Plan offers retirees a Base PPO Plan (70/30) and an Enhanced PPO Plan (80/20), both administered by Aetna. These plans offer freedom of choice among in-network providers and lower out-of-pocket costs. However, it is unclear if these plans cover vision, dental, and identity theft protection.
Retirees can benefit from supplemental vision, dental insurance, and identity theft protection in several ways. Firstly, vision insurance can help offset the costs of routine eye exams, eyewear, and treatment for age-related eye conditions such as diabetic retinopathy, macular degeneration, cataracts, and glaucoma. While Original Medicare does not typically cover these expenses, Medicare Advantage plans often offer vision coverage, with about 99% of enrollees having access to it.
Dental insurance is another important consideration for retirees. As we age, we face increased dental challenges, including a higher risk of gum disease, dry mouth, and oral cancer. Dental insurance can help mitigate these issues by providing access to routine dental care and procedures, helping to maintain overall health and well-being.
Additionally, identity theft protection services can provide peace of mind for retirees. These services offer credit monitoring, real-time alerts for any changes to credit reports, identity theft insurance, and restoration services in the event of identity theft. They also include device protection and online privacy tools to safeguard digital data.
By opting for supplemental vision and dental insurance and identity theft protection, retirees can ensure they have comprehensive coverage to maintain their health, well-being, and financial security during retirement. These additional protections can provide valuable support and assistance in dealing with unforeseen circumstances and maintaining their quality of life.
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The State Health Plan covers over 700,000 teachers, state employees, retirees and their dependents
The State Health Plan (Plan) is a North Carolina government-funded initiative that provides medical and pharmacy benefits to teachers and state employees, as well as retirees and their dependents. The Plan covers more than 700,000 people and is designed to improve the health and well-being of its members in a financially sustainable manner.
The Plan offers two main options for retirees: the Base PPO Plan (70/30) and the Enhanced PPO Plan (80/20). Both plans are administered by Aetna and offer freedom of choice among in-network providers, with a focus on preventive health. The main difference is that the Enhanced PPO Plan offers lower out-of-pocket costs and higher coverage for preventive services and medications (100% covered).
To be eligible for retiree health coverage under the Plan, individuals must meet certain criteria. Those who have retired under TSERS (Teachers' and State Employees' Retirement System) must have at least five years of TSERS membership service. If retiring with five years of membership service but less than 10 years of creditable service, retirees will have to pay the full cost of their chosen plan. Additionally, members hired on or after January 1, 2021, are not eligible for retiree health benefits.
For those who are eligible, the process of enrolling in the Plan is straightforward. Retirees who are eligible for State Health Plan retiree group coverage will be automatically enrolled once their online retirement application has been processed. They can also choose their plan by submitting a Form 6E, "Choosing Your Retirement Payment Option." It is important to note that health coverage options may be limited if retirees wait too close to their retirement date to submit their paperwork.
The State Health Plan is a valuable resource for North Carolina's teachers, state employees, and retirees, offering comprehensive health coverage and peace of mind for them and their dependents.
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Frequently asked questions
State retirees in NC are offered health insurance through the State Health Plan. This includes the Base PPO Plan (70/30) and the Enhanced PPO Plan (80/20), both administered by Aetna. Additionally, retirees may be eligible for the Humana Group Medicare Advantage (PPO) Plans.
To be eligible for health coverage under the State Health Plan in NC, retirees must have at least five years of membership service. If retirees had been hired on or after October 1, 2006, they must have 20 years of creditable service, including at least five years of TSERS membership service, to receive free SHP coverage.
If you are retiring under TSERS and are eligible for State Health Plan coverage, you will be automatically enrolled in a health plan once your online retirement application has been processed. You can also submit a Form 6E, "Choosing Your Retirement Payment Option." It is recommended to submit retirement paperwork early to avoid limited coverage options.
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