Brad Briner

Blue Cross NC will return as the third-party administrator for North Carolina’s State Health Plan in 2028, replacing Aetna. The decision followed a $1 billion cost difference between proposals and a previous 2023 dispute over price transparency that led to Blue Cross being replaced by Aetna.

North Carolina State Health Plan members may face higher premiums but could save on care costs by using preferred providers like UNC Hospitals and Novant Health. The plan categorizes providers into preferred, access, and non-preferred tiers, with Atrium Health designated as non-preferred. A 5% premium increase was approved, sparking criticism from employee groups.

North Carolina state employees enrolled in the State Health Plan can access certain non-emergency surgeries at no cost through the Lantern Program. The program covers procedures like knee and hip replacements, bariatric surgeries, and spine surgeries with $0 out-of-pocket expenses. David Thompson, a school bus driver, benefited from the program after receiving a letter offering free care for his injury.

Retirees in North Carolina's State Health Plan will face higher copays and out-of-pocket maximums for Medicare Advantage coverage, while active state workers and teachers may save through lower costs at preferred providers. The Board of Trustees approved the changes, citing efforts to control medical costs and address reserve drains.