Landmark Decisions by State Health Plan Board to Enhance Member Benefits
In a series of strategic moves aimed at benefiting nearly 750,000 members, the State Health Plan Board of Trustees has taken decisive action to enhance health care affordability, accessibility, and sustainability for North Carolina’s public workforce. These actions are set to provide significant improvements for teachers, state employees, and retirees under the Plan.
The board has made several key decisions:
- Blue Cross NC has been awarded the contract for Third-Party Administrative (TPA) Services, effective January 1, 2028.
- A Pharmacy Benefit Manager (PBM) contract was also awarded to Blue Cross NC, effective January 1, 2028.
- Preferred Provider contracts were approved with UNC Health and Novant Health, effective January 1, 2027.
- Premium rates for 2027 were set for all members.
- Benefit changes for 2027 were approved, including decreased copays within the new tiered provider network.
Treasurer Brad Briner expressed optimism, stating, “This is a monumental step in the right direction for the Plan and the people we serve. Our members deserve for us to fight for them. Affordability, improved access to high-quality care and more sustainability for Plan mean better health care and better health. These actions do just that. For decades, health care costs have risen faster than funding, creating increasing pressure on our public servants, taxpayers and the Plan itself.”
Contracts with Blue Cross NC
After a competitive Request for Proposals (RFP) process, Blue Cross NC was chosen to provide Third-Party Administrative Services, which include claims management and provider network services. The contract promises potential savings of up to $1 billion, thanks to enhanced discounts and value-based payment strategies.
Similarly, the Pharmacy Benefit Manager contract was awarded to Blue Cross NC. The selection process aimed to find a partner capable of managing prescription drug costs effectively. The contract terms run from January 1, 2028, to December 31, 2031, with potential extensions.
Preferred Provider Agreements
New agreements with UNC Health and Novant Health will take effect on January 1, 2027. These health systems will offer discounted rates and collaborate to enhance member health while lowering overall care costs. Members will benefit from reduced expenses when accessing services from these Preferred Providers.
Both UNC Health and Novant Health boast expansive networks, ensuring accessible, high-quality care across North Carolina.
2027 Benefit Modifications
Starting January 1, 2027, the Plan introduces a tiered provider network, classifying providers as Preferred, Access, Non-Preferred, or Out-of-Network. Members choosing Preferred Providers will experience lower deductibles and copays, while Non-Preferred Providers will incur higher out-of-pocket expenses.
Executive Administrator Tom Friedman highlighted the necessity of these changes, saying, “As we’ve witnessed, the status quo is not sustainable, we have to try something different. We decided to break the health care mold this year- and create competition for providers and incentives for members. The tiered network strategy we’re implementing places us on a more stable financial footing. The only alternative to thinking outside the box would entail across the board increases to everything and we really didn’t think our members could- or should- be burdened with such an increase.”
Members will continue to benefit from the Lantern Surgical Benefit for certain procedures at no cost with participating providers. Communication efforts, including updated directories and tools, will assist members in making informed decisions during Open Enrollment from October 12-30, 2026.
For more details, visit the board materials here.
The State Health Plan, under the Department of State Treasurer, serves nearly 750,000 individuals, including teachers, state employees, retirees, and their dependents.
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