The State Health Plan Board of Trustees voted today to increase premiums by $2 to $8 per month for most members in 2027 and approved sweeping changes to how the plan pays for care — changes that will require every member to make more deliberate decisions about where they seek treatment. The board also voted to return to Blue Cross Blue Shield of North Carolina as the plan’s administrator starting in 2028.

SEANC Executive Director Ardis Watkins made clear before the votes what was at stake: the 3% average raise state employees received in this year’s budget “is not going to cover inflation for this year and much less the increase y’all gave them for their health plan last year, and then what I assume will be an increase for them all this year.”

What’s changing with premiums

The increase translates to modest dollar amounts for individual coverage — between $1.76 and $8.04 more per month, depending on your salary band — but family coverage increases are larger, ranging from roughly $26 to $42 more per month.

The bigger change: a four-tier provider network starting in 2027

Beginning Jan. 1, 2027, the plan moves to a four-tier network — preferred, access, non-preferred, and out-of-network. Where you go for care will now have a direct and significant impact on what you pay.

Members who use preferred providers will pay the lowest copays and deductibles. Access providers, which include hospitals and practices in rural areas where alternatives are limited, will largely remain cost-neutral. Non-preferred providers, however, will trigger sharply higher out-of-pocket costs. A specialist visit at a non-preferred provider, for example, means 30% coinsurance after meeting the deductible — compared to a $40 copay at a preferred provider on the Standard PPO Plan.

Which hospital systems are where

The board voted in closed session on preferred-provider contracts. When members emerged, the announcement was significant:

• UNC Health, Novant Health, and Iredell Health System — Preferred
• WakeMed or Duke (main system) — Access in the Triangle (still being finalized)
• Atrium Health, some Duke/LifePoint hospitals, and Granville Medical Center — Non-Preferred

That last point matters enormously. Atrium is the dominant health system for much of the Charlotte area and western North Carolina, and roughly 54% of members in the Charlotte-Mecklenburg area currently use Atrium. Taking advantage of the new preferred-provider savings will require many of them to seek care outside the preferred providers.

Negotiations with Duke Health and WakeMed about access-tier status in the Triangle are still ongoing.

Members who use preferred providers could actually pay less overall

The State Health Plan has noted — and it’s worth acknowledging — that the premium increase doesn’t tell the full story for every member. For those who receive care at preferred providers, out-of-pocket costs will drop significantly. The annual deductible for an individual on the Standard PPO Plan, for example, falls from $3,000 to $1,500 when using a preferred provider. For members who hit their deductible in a given year, that’s real savings that can more than offset the premium increase.

Plan Administrator Thomas Friedman put it directly: “The premiums are going up with inflation. There’s an opportunity for your costs to go down.”

That’s a fair point, and members who can access preferred providers and adjust their care accordingly stand to benefit. The challenge is that not every member has that flexibility — particularly those in the Charlotte area, those with established specialist relationships at non-preferred systems, and retirees on fixed incomes who are already absorbing steeper premium increases.

Emergency care is protected — any emergency department will be covered at the access level, regardless of the hospital’s tier. Members currently in treatment for maternity care, cancer, or transplants will also have transition of care protections for at least the first year.

Blue Cross is coming back

In what may be the most welcomed news of the day for many members, the board also voted to return to Blue Cross Blue Shield of North Carolina as the plan’s third-party administrator starting in 2028. Blue Cross managed the plan for decades before the board voted to switch to Aetna in 2023 — a contentious decision that sparked legal battles at the time. That Aetna contract runs through the end of 2027.

Many members have been vocal about their frustrations with Aetna’s claims handling, prior authorization processes, and customer service. The plan’s own member survey released today showed widespread dissatisfaction with Aetna’s administration as a recurring complaint. SEANC did not take a position on the TPA selection.

The transition back to Blue Cross could affect which providers are considered in-network, what services are covered, and what members pay — details that will become clearer as 2028 approaches. Aetna has indicated it may challenge the decision.

What you should do now

• Check whether your primary care provider and any specialists you see regularly are in the preferred network. The plan’s preferred provider tool is available at shpnc.gov.
• If you rely on Atrium Health or the Duke/LifePoint systems, start asking questions now. Negotiations are ongoing and could still change before 2027.
• Watch for more information as the Blue Cross transition details become clearer ahead of 2028.