The State Health Plan Board of Trustees met late in November to discuss future plan benefit changes. No formal recommendations have been adopted yet, but several are likely to be presented at the board’s January meeting, with votes coming a week or so later.

Though not finalized, those recommendations will likely include:

• An increase in co-pays and deductibles under the 70/30 plan for 2016
• The addition of wellness premium surcharges and activities to the 70/30 plan like those currently in the Enhanced 80/20 plan for 2016
• Additional wellness premium surcharges based on biometric screenings – such as body-mass index, cholesterol, blood glucose and blood pressure – for both the Enhanced 80/20 and the 70/30 plans for 2016. These requirements might also be imposed on retirees selecting Traditional Medicare, despite the fact that they are limited to the PPO 70/30 and not allowed to participate in the Enhanced PPO 80/20
• The addition of biometric screenings by primary care providers, as well as health literacy and health engagement programs to the Enhanced 80/20 plan for 2017
• The reduction of some member co-pays for generic prescriptions and primary care providers  with the completion of certain health activities for members on the Enhanced 80/20 plan for 2017

The board also heard a presentation on how North Carolina’s health insurance options and benefits for its state employees compare to those of surrounding states.  In general, the report found that the State Health Plan compares favorably for active employees.

For dependent coverage, however, North Carolina ranked last. According to the presentation, North Carolina pays only 39 to 47 percent of total family premium, compared to benchmarked states paying an average of 83 percent of family premiums.

Furthermore, other states also offer lower deductibles, out-of-pocket maximums, more favorable mail order benefits on prescription drugs and higher contributions to health reimbursement accounts. However, most of those other states also required some of the additional wellness activities mentioned above in order to be in the richer options such as the Enhanced PPO 80/20.

SEANC will be watching this debate closely and will be advocating for continuation of a premium-free option, improved family coverage and the elimination of the current punitive wellness surcharges. We agree with the goal of a healthier workforce, but believe there are better ways to achieve that than by punishing employees through additional cost shifting of reduced benefits and increased premium surcharges.

Any recommendations adopted by the State Health Plan Board of Trustees in January will have to be approved by the General Assembly.

If you have any questions or concerns, please contact SEANC’s State Health Plan expert Chuck Stone.