State Health Plan
Blue Cross and Blue Shield of North Carolina
The NC State Health Plan is a "self-insured" plan that offers three preferred provider organization ("PPO") plans. PPO plans offer the freedom of choice among in-network providers, lower out-of-pocket costs, and a strong emphasis on preventive health. Two of the plans, the Consumer-Directed Health Plan ("CDHP") and the Enhanced 80/20 Plan, offer financial incentives for taking steps to improve your health.
- You are a timely enrollee if you apply for coverage and/or add dependents within a 30-day period following any of the qualified life events listed below.
- You are newly hired
- You get married or obtain a dependent through birth, adoption, placement in anticipation of adoption, or foster care placement of an eligible child
- You or your dependents lose coverage under another health benefit plan, and each of the following conditions is met:
- You and/or your dependents are otherwise eligible for coverage under the State Health Plan, and
- You and/or your dependents were covered under another health benefit plan at the time this coverage was previously offered and declined enrollment due to the other coverage, an
- You and/or your dependents lose coverage under another health benefit plan due to i) the exhaustion of the COBRA continuation period, or ii) the loss of eligibility for that coverage for reasons including, but not limited to, divorce, loss of dependent status, death of the employee, termination of employment, or reduction in the number of hours of employment, or iii) the termination of the other plan's coverage, or iv) the offered health benefit plan not providing benefits in your service area and no other health benefit plans are available, or v) the termination of employer contributions toward the cost of the other plan's coverage, or vi) meeting or exceeding the lifetime maximum, or vii) the discontinuance of the health benefit plan to similarly situated individuals.
- You or your dependents become Medicare eligible
- You or your dependents lose coverage due to loss of eligibility under Medicaid or the Children's Health Insurance Program (CHIP) and apply for coverage under this Plan within 60 days
- You or your dependents become eligible for premium assistance with respect to coverage under this Plan under Medicaid or CHIP and apply for coverage under this Plan within 60 days.
- Members of the General Assembly upon the convening of each Session of the General Assembly or within 30 days after the end of the term of office