Open enrollment for the 2025 North Carolina State Health Plan (NCSHP) is just around the corner. This is your opportunity to enroll in or change your health insurance plan for the upcoming year. The NCSHP offers a variety of plans to choose from, so you can find one that meets your needs and budget. Additionally, the NCSHP provides financial assistance to help you pay for your health insurance premiums. However, if you miss the open enrollment period, you may have to wait until the next open enrollment period to enroll in or change your plan.
The NCSHP open enrollment period for 2025 runs from [start date] to [end date]. During this time, you can enroll in or change your health insurance plan for the upcoming year. If you are already enrolled in an NCSHP plan, you will receive a renewal notice in the mail. This notice will contain information about your current plan and the changes that will be made for the upcoming year. You can also use this notice to enroll in a different plan if you wish. Hence, if you are not currently enrolled in an NCSHP plan, you can apply for coverage during the open enrollment period.
There are a few things you need to do to enroll in or change your NCSHP plan. First, you need to gather your personal information, such as your name, address, and date of birth. Second, you need to choose a health insurance plan. Once you have chosen a plan, you will need to complete an application. You can apply for coverage online, by mail, or by phone. The NCSHP website has more information about how to apply for coverage. Besides that, you can also get help from a health insurance agent or broker.
Important Dates and Deadlines
Open Enrollment Period
The open enrollment period for the 2025 NC State Health Plan is from March 1st, 2025 to March 31st, 2025. During this period, current plan members can make changes to their coverage, while new members can enroll for the first time. It’s crucial to note that coverage changes made during this period will take effect on July 1st, 2025.
To help employees navigate the open enrollment process, a series of educational sessions will be hosted by the NC State Human Resources Department. These sessions will provide detailed information about plan options, premiums, and making informed coverage decisions. Employees are strongly encouraged to attend these sessions and utilize the available resources to make the best choices for their healthcare needs.
Below is a table summarizing key dates related to the open enrollment period:
| Date | Action |
|---|---|
| March 1st, 2025 | Open enrollment period begins |
| March 31st, 2025 | Open enrollment period ends |
| July 1st, 2025 | Coverage changes take effect |
Enrollment Options and Plans
Enrollment Options
During the open enrollment period, you can enroll in an NC State Health Plan through one of the following options:
- Online: Visit the NC State Health Plan website at www.ncshealthplan.org.
- Phone: Call the NC State Health Plan Member Services Call Center at 1-888-627-4777.
- In-person: Visit an NC State Health Plan Enrollment Center.
Plans
The NC State Health Plan offers a variety of health insurance plans to choose from, including:
- Health Maintenance Organizations (HMOs): HMOs provide coverage through a network of providers and hospitals.
- Preferred Provider Organizations (PPOs): PPOs offer coverage through a wider network of providers, with higher out-of-network costs.
- Exclusive Provider Organizations (EPOs): EPOs are similar to HMOs, but they offer coverage for emergency care outside of the network.
- Point-of-Service (POS) Plans: POS plans offer the flexibility of using both in-network and out-of-network providers.
- High-Deductible Health Plans (HDHPs): HDHPs have lower monthly premiums but require you to pay more for medical expenses until you reach your deductible.
Factors to Consider When Choosing a Plan
When choosing an NC State Health Plan, it’s important to consider the following factors:
| Factor | Description |
|---|---|
| Coverage | Make sure the plan covers the medical services and medications you need. |
| Cost | Compare the monthly premiums, deductibles, and copayments of different plans. |
| Network | Consider the network of providers and hospitals covered by the plan. |
| Convenience | Think about how convenient it is to use the plan’s providers and pharmacies. |
| Your health needs | Choose a plan that meets your current and future health needs. |
Premium Rates and Coverage Details
The premium rates for the NC State Health Plan in 2025 will vary depending on the plan you choose and your coverage level. The table below provides a summary of the premium rates for the different plans and coverage levels.
| Plan | Coverage Level | Monthly Premium |
|---|---|---|
| Standard Plan | Individual | $250 |
| Standard Plan | Family | $500 |
| High-Deductible Plan | Individual | $150 |
| High-Deductible Plan | Family | $300 |
Coverage Details
All NC State Health Plan members will have access to the following coverage:
- Preventive care, such as well-child visits and screenings
- Emergency care
- Hospitalization
- Outpatient care, such as doctor visits and physical therapy
- Prescription drug coverage
- Mental health and substance abuse coverage
In addition to the basic coverage, members can also choose to add optional coverage, such as dental and vision insurance.
Eligibility Criteria and Qualifiers
To be eligible for the NC State Health Plan, you must meet the following criteria:
1. Employment Status
You must be an active employee of the State of North Carolina.
2. Residency
You must reside in the State of North Carolina.
3. Age
You must be at least 18 years of age.
4. Income and Assets
Your income and assets must meet certain criteria to qualify for the plan. The following table outlines the income and asset limits for 2025:
| Income Limit | Asset Limit |
|---|---|
| $55,000 (for individuals) | $100,000 (for individuals) |
| $82,500 (for families) | $200,000 (for families) |
If your income or assets exceed these limits, you may still be eligible for the plan if you have high medical expenses or other qualifying circumstances.
Open Enrollment Process and Timeline
The NC State Health Plan (SHP) Open Enrollment period is the time when eligible employees and their dependents can make changes to their health insurance coverage for the upcoming plan year. This period typically runs from October 15th to November 15th each year.
Eligibility
All active State employees, retirees, and their eligible dependents are eligible to enroll in the SHP during Open Enrollment. Employees must be enrolled in the SHP in order to participate in other State-sponsored benefit programs, such as the flexible spending account (FSA) and the health savings account (HSA).
Enrollment Process
Employees can enroll in the SHP online, by mail, or by phone. The online enrollment system is the fastest and easiest way to enroll. Employees will need to create an account on the SHP website and enter their personal information and coverage preferences.
Coverage Options
The SHP offers a variety of health insurance plans, including:
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Point-of-Service (POS) plans
- High-Deductible Health Plans (HDHPs)
Each plan has different benefits, costs, and provider networks. Employees should carefully review the plan options and select the plan that best meets their needs and budget.
Timeline
The 2025 SHP Open Enrollment period will run from October 15th to November 15th. Employees are encouraged to enroll during this period in order to avoid missing out on coverage for the upcoming plan year.
The following table summarizes the key dates for the 2025 SHP Open Enrollment period:
| Date | Event |
|---|---|
| October 15th | Open Enrollment begins |
| November 15th | Open Enrollment ends |
| December 1st | New coverage begins |
Special Enrollment Periods and Exceptions
Special Enrollment Periods (SEPs) allow you to enroll in health insurance outside the Open Enrollment Period if you experience certain qualifying life events. These events include:
- Loss of coverage
- Marriage or divorce
- Birth or adoption of a child
- Moving to a new coverage area
- Gaining or losing eligibility for Medicaid or Medicare
You typically have 60 days from the qualifying event to enroll in a new plan through a SEP. Certain exceptions to the SEP deadlines may apply, such as:
Extension of SEP Deadline
You may be eligible for an extension of the SEP deadline if you were unable to enroll in a new plan due to:
- Circumstances beyond your control (e.g., natural disaster)
- Errors or delays by the insurance company
- Misinformation from an insurance agent or broker
To request an extension, you must contact the health insurance marketplace or insurance company within 30 days of the SEP deadline and provide documentation supporting your request.
The following table summarizes the extended SEP deadlines based on the type of qualifying event:
| Qualifying Event | Extended SEP Deadline |
|---|---|
| Loss of Coverage | Up to 63 days after the loss of coverage |
| Marriage/Divorce | Up to 60 days after the marriage/divorce date |
| Birth/Adoption of Child | Up to 60 days after the birth/adoption date |
| Move to New Coverage Area | Up to 60 days after the move date |
| Gaining/Losing Medicaid/Medicare | Up to 60 days after the change in eligibility |
Covered Services and Benefits
Medical and Surgical
The plan covers a wide range of medical and surgical expenses, including:
- Hospitalization
- Physician visits
- Emergency care
- Prescription drugs
- Diagnostic tests
- Rehabilitative services
Mental Health and Substance Abuse
The plan provides coverage for mental health and substance abuse services, including:
- Therapy
- Counseling
- Medication
- Inpatient and outpatient care
Dental and Vision
The plan offers dental and vision coverage, including:
- Cleanings and checkups
- Fillings and crowns
- Eye exams
- Glasses and contact lenses
Preventive Care
The plan encourages preventive care by covering services such as:
- Routine screenings
- Wellness exams
- Immunizations
- Tobacco cessation programs
Catastrophic Coverage
The plan provides catastrophic coverage to protect members from large medical expenses. This coverage includes a lifetime maximum benefit and a deductible that applies once the maximum is met.
Out-of-Pocket Expenses
Members are responsible for paying certain out-of-pocket expenses, including:
- Copays
- Deductibles
- Coinsurance
- Out-of-network services
Additional Benefits
The plan also offers a variety of additional benefits, such as:
| Benefit | Description |
|---|---|
| Health Savings Account (HSA) | A tax-advantaged account that allows members to save for healthcare expenses. |
| Wellness Program | Incentive programs that encourage members to engage in healthy activities. |
| Pharmacy Assistance | Discounts and assistance for prescription drugs. |
Provider Networks
The State Health Plan offers a wide range of provider networks to choose from, ensuring access to high-quality care across the state. Each network includes a variety of healthcare providers, including physicians, hospitals, and other facilities. By choosing a network plan, members can receive care from in-network providers within their network’s coverage area.
In-Network Coverage
In-network coverage refers to medical services and treatments received from providers within the member’s chosen network. When members receive care from in-network providers, they enjoy the benefits of:
*
Lower out-of-pocket costs, such as deductibles and copayments
*
Simplified claims processing, with no need to submit claims or file paperwork
*
Access to a broad network of providers, ensuring convenient and timely care
Out-of-Network Coverage
Out-of-network coverage applies to medical services and treatments received from providers outside the member’s chosen network. In general, out-of-network services are more expensive and require higher out-of-pocket costs. However, there are instances when out-of-network coverage may be necessary, such as:
- When the care needed is not available from an in-network provider
- When a member requires emergency medical care outside the network’s coverage area
Emergencies and Out-of-Area Care
In the case of emergencies or out-of-area care, members are covered for medically necessary services, regardless of whether the provider is in-network or out-of-network.
| In-Network | Out-of-Network | |
|---|---|---|
| Services covered | All medically necessary services | Medically necessary services |
| Out-of-pocket costs | Lower deductibles and copayments | Higher deductibles and copayments |
| Claims processing | Simplified, no paperwork required | Requires claims submission and payment |
Payment Options
The NC State Health Plan offers different payment options to make it easier for you to budget for your health insurance premiums. You can choose to pay your premiums monthly, quarterly, or annually. You can also choose to have your premiums automatically deducted from your paycheck. If you need to make a one-time payment, you can do so online or by mail.
Premium Assistance
If you have a low income, you may be eligible for premium assistance. Premium assistance is a subsidy that helps you pay for your health insurance premiums. The amount of premium assistance you receive will depend on your income and family size. To apply for premium assistance, you will need to complete an application form and provide proof of your income.
The premium assistance program will provide subsidies to help you pay for your health insurance premiums. The amount of the subsidy will depend on the program you are enrolled in.
State Health Plan Premium Assistance Program (SHPP)
SHPP is a program for state employees and their families. Employees must meet certain income guidelines and be enrolled in one of the available health plans.
NC Medicaid
NC Medicaid provides health coverage to low-income children, pregnant women, and people with disabilities. There are different programs within NC Medicaid, depending on your income and family size.
Affordable Care Act Premium Tax Credit
Under the Affordable Care Act, you may be eligible for premium tax credits to help pay for your health insurance premiums. The amount of the tax credit is based on your income and family size.
HCBS Premium Assistance Program
This program helps pay for health insurance premiums for people with disabilities who live in the community and receive certain long-term care services.
Department of Veterans Affairs (VA) Health Care Benefits
Veterans may be eligible for health care benefits through the VA. The VA provides health care to veterans who meet certain income and service requirements.
Contact Information and Resources
For assistance with NC State Health Plan Open Enrollment 2025, you can contact the following resources:
NC State Health Plan Service Center
Phone: (800) 662-7771
Hours: Monday – Friday, 7:30 AM – 5:00 PM ET
NC State Health Plan Website
Website: https://www.shpnc.org/
NC State Health Plan Enrollment Portal
Website: https://secure.shpnc.org/shpnc/
Benefits Navigator
Phone: (800) 776-7714
Hours: Monday – Friday, 7:30 AM – 5:00 PM ET
Benefits Specialist
Contact your HR department for the name and contact information of your designated Benefits Specialist.
Open Enrollment Dates
| Plan Year | Open Enrollment Dates |
|---|---|
| 2026 | October 17, 2025 – November 4, 2025 |
NC State Health Plan Open Enrollment 2025: What You Need to Know
The NC State Health Plan Open Enrollment period for 2025 will run from [Start Date] to [End Date]. During this time, state employees can make changes to their health insurance coverage for the upcoming year. This includes adding or dropping dependents, changing plans, or making other adjustments.
To make changes to your coverage, you will need to log in to the NC State Health Plan website and complete the online enrollment form. You can also contact the State Health Plan Customer Service Center at [Phone Number] for assistance.
It is important to note that any changes you make during Open Enrollment will not take effect until January 1, 2025. If you do not make any changes during Open Enrollment, your current coverage will continue into the new year.
People Also Ask About NC State Health Plan Open Enrollment 2025
What is the NC State Health Plan Open Enrollment period for 2025?
The NC State Health Plan Open Enrollment period for 2025 will run from [Start Date] to [End Date].
How can I make changes to my health insurance coverage during Open Enrollment?
To make changes to your health insurance coverage during Open Enrollment, you will need to log in to the NC State Health Plan website and complete the online enrollment form. You can also contact the State Health Plan Customer Service Center at [Phone Number] for assistance.
When will my changes to coverage take effect?
Any changes you make to your coverage during Open Enrollment will not take effect until January 1, 2025.
What if I do not make any changes during Open Enrollment?
If you do not make any changes during Open Enrollment, your current coverage will continue into the new year.
