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5 Things You Need to Know About the 2025 NC State Health Plan for Retirees

The NC State Health Plan for Retirees (SHPR) provides comprehensive health coverage to eligible retirees of the State of North Carolina. The plan is designed to meet the unique healthcare needs of retirees and their families, and it offers a wide range of benefits and services. In this article, we will provide an overview of the SHPR, including its benefits, eligibility requirements, and costs. We will also discuss some of the recent changes to the plan and what you can expect in the future.

The SHPR is a valuable benefit for state retirees. It provides peace of mind knowing that you and your family will have access to quality healthcare coverage. The plan is also affordable, with premiums that are comparable to other retiree health plans. If you are a state retiree, we encourage you to learn more about the SHPR and see if it is right for you. Enrolling in the SHPR is easy, and you can do so online or by calling the plan’s customer service center. We also recommend that you meet with a SHPR representative to discuss your specific needs and coverage options.

The SHPR is committed to providing quality healthcare coverage to state retirees. The plan is constantly evolving to meet the changing needs of retirees and their families. In recent years, the SHPR has made a number of changes to improve the plan’s benefits and services. These changes include adding new benefits, such as dental and vision coverage, and increasing the plan’s coverage limits. The SHPR is also working to make the plan more affordable for retirees. In 2023, the plan reduced premiums for many retirees. The SHPR is committed to continuing to make improvements to the plan in the future. We encourage you to stay informed about the latest changes to the plan by visiting the SHPR website or calling the plan’s customer service center.

Affordable Premiums

Retirees can choose from a variety of plans that offer affordable premiums to fit their budget. Premiums are based on factors such as age, coverage level, and tobacco use. The monthly premiums for 2025 are as follows:

Plan	Monthly Premium
Standard Plan	$250
Enhanced Plan	$300
Premium Plan	$350

Flexible Payment Plans

Retirees have the flexibility to choose from a variety of payment plans. They can pay their premiums monthly, quarterly, or annually. They can also set up automatic payments to ensure that their premiums are paid on time. Additionally, retirees who are experiencing financial hardship may be eligible for a premium waiver.

The following are some of the payment plans available to retirees:

Monthly Payment Plan

Retirees can choose to pay their premiums monthly. This is the most common payment plan and it allows retirees to budget their expenses more easily.

Quarterly Payment Plan

Retirees can also choose to pay their premiums quarterly. This can be a good option for retirees who want to reduce the number of payments they make each year.

Annual Payment Plan

Retirees can choose to pay their premiums annually. This can be the most cost-effective option, as retirees can often get a discount on their premiums if they pay annually.

Automatic Payment Plan

Retirees can set up automatic payments to ensure that their premiums are paid on time. This can be a good option for retirees who want to avoid the hassle of having to remember to make their premium payments.

Access to a Nationwide Network of Providers

As a retiree of North Carolina State University, you can enjoy the convenience and peace of mind that comes with access to a nationwide network of healthcare providers through our health plan. Our carefully curated network includes:

In-Network Providers

Our in-network providers are located throughout the United States, ensuring you have access to quality medical care wherever you are. These providers have agreed to provide services at negotiated rates, offering you affordable and predictable healthcare costs.

Out-of-Network Providers

While we encourage you to use in-network providers whenever possible, we understand that there may be times when you need to see an out-of-network provider. In these cases, you will still have access to coverage, but you may be responsible for higher out-of-pocket costs.

Out-of-State Coverage

Even if you relocate out of North Carolina, your health plan will continue to provide coverage for eligible medical expenses incurred anywhere in the United States. This ensures that you have access to quality healthcare no matter where you choose to live.

Network Type	Coverage
In-Network	Negotiated rates, lower out-of-pocket costs
Out-of-Network	Coverage available, higher out-of-pocket costs
Out-of-State	Coverage for eligible medical expenses incurred anywhere in the United States

Telehealth Services for Convenient Virtual Care

The NC State Health Plan offers a comprehensive range of telehealth services to retirees, providing convenient and accessible virtual healthcare.

Benefits of Telehealth

Telehealth services offer numerous benefits, including:

Convenience: Access to care from the comfort of home or office.
Accessibility: No travel or time constraints associated with in-person appointments.
Improved Health Outcomes: Early detection and diagnosis can lead to better health outcomes.
Reduced Healthcare Costs: Telehealth visits can be more cost-effective than in-person appointments.

Available Telehealth Services

Retirees have access to a wide variety of telehealth services, covering a range of health concerns:

Service	Description
Primary Care	Routine check-ups, medication management, and chronic disease management.
Behavioral Health	Therapy, counseling, and medication management for mental health concerns.
Dermatology	Skin examinations, acne treatment, and prescription management.
Wellness and Prevention	Nutrition counseling, smoking cessation support, and health screenings.

How to Access Telehealth Services

Accessing telehealth services is easy and convenient:

Contact your primary care provider or request a referral from your healthcare professional.
Schedule an appointment through the NC State Health Plan website or mobile app.
Connect with a healthcare provider remotely using a video or phone call.
Receive your care and prescriptions as prescribed.

Long-Term Care Planning for Peace of Mind

Long-term Care Insurance

This insurance helps cover the costs of long-term care services, such as nursing home or assisted living care.

Medicaid Planning

Medicaid is a government program that provides health coverage to low-income individuals. It can also help cover long-term care costs.

VA Benefits

Veterans may be eligible for long-term care benefits through the VA.

Life Insurance with Long-Term Care Rider

Some life insurance policies offer a long-term care rider that provides additional coverage for long-term care expenses.

Annuities with Long-Term Care Benefit

Annuities can provide a steady stream of income in retirement. Some annuities also offer a long-term care benefit that provides additional coverage for long-term care expenses.

Reverse Mortgages

Reverse mortgages allow homeowners to access the equity in their homes to pay for long-term care expenses. However, it is important to understand the risks involved before taking out a reverse mortgage.

Type of Long-Term Care Planning	Pros	Cons
Long-term Care Insurance	Provides comprehensive coverage for long-term care expenses	Can be expensive
Medicaid Planning	Can provide coverage for long-term care costs for low-income individuals	Can be complex to qualify for
VA Benefits	Can provide long-term care benefits to veterans	Eligibility requirements can be complex
Life Insurance with Long-Term Care Rider	Provides additional coverage for long-term care expenses	May increase the cost of life insurance
Annuities with Long-Term Care Benefit	Provides a steady stream of income in retirement and additional coverage for long-term care expenses	May have lower returns than other investments
Reverse Mortgages	Allows homeowners to access the equity in their homes to pay for long-term care expenses	Can be risky if the home value decreases

Support Services for Smooth Transitions and Assistance

The NC State Health Plan for Retirees 2025 offers a range of support services to ensure a smooth transition and ongoing assistance for retirees.

Pre-Retirement Counseling

Retirees can schedule one-on-one counseling sessions to discuss health plan options, enrollment requirements, and retirement planning.

Dedicated Support Team

A dedicated team of specialists is available to assist retirees with any questions or concerns regarding their health plan.

Online Resources

Retirees can access a wealth of information on the NC State Health Plan website, including plan details, enrollment forms, and contact information.

Personalized Plan Selection

Retirees can consult with a benefits advisor to determine the best health plan based on their individual needs and budget.

Flexible Enrollment Options

Retirees can enroll in the health plan during the open enrollment period or through special events, such as a qualifying life event.

Continued Support Services

Once enrolled, retirees can continue to receive support through customer service representatives, online account management, and online educational resources.

Access to Health Care Providers

The health plan provides access to a network of healthcare providers, including primary care physicians, specialists, and hospitals.

Cost-Effective Options

The health plan offers a variety of cost-effective options, including generic drug coverage, preferred provider networks, and wellness programs to help retirees save money on healthcare expenses.

Financial Planning Tools to Secure Your Retirement Health Expenses

Enroll in Medicare

Consider enrolling in Medicare Part A (hospital insurance) and Part B (medical insurance) to cover your health care expenses after you turn 65. Medicare premiums can vary depending on your income and enrollment status.

Estimate Your Health Care Costs

Estimate the potential costs of health care during retirement, including insurance premiums, out-of-pocket expenses, and long-term care expenses. This will help you determine how much you need to save.

Contribute to a Health Savings Account (HSA)

Contribute to an HSA, which offers tax-advantaged savings for qualified medical expenses. Withdrawals for non-medical expenses are subject to income tax and a 20% penalty.

Consider a Long-Term Care Insurance Policy

Purchase a long-term care insurance policy to cover the costs of long-term care services, such as assisted living, nursing home care, or home health care. Premiums can be high, but it can provide peace of mind in case of extended care needs.

Save through Employer-Sponsored Retirement Plans

Maximize contributions to employer-sponsored retirement plans, such as 401(k) or 403(b) plans, which offer tax-deferred savings that can be used to cover health care expenses in retirement.

Rebalance Your Investment Portfolio

As you approach retirement, consider rebalancing your investment portfolio to reduce risk and ensure it aligns with your health care expense projections.

Explore Government Assistance Programs

Research government assistance programs, such as Medicaid and Supplemental Security Income (SSI), that may provide financial assistance with health care costs for low-income individuals.

Consider Annuities

Consider purchasing an annuity, which provides a guaranteed income stream for a specific period or the rest of your life. This can help supplement your retirement income and cover health care expenses.

Long-Term Care Expenses

Type of Care	Average Annual Cost
Assisted Living	$51,600
Nursing Home	$92,378
Home Health Care	$51,480

Note: Costs may vary depending on location and level of care.

Innovative Health Solutions for a Brighter Future

Customized Healthcare Plans

Choose from a range of plans tailored to your specific needs and budget, including traditional PPOs, HMOs, and innovative consumer-directed options.

Telehealth and Digital Tools

Access convenient and affordable virtual healthcare services, including video consultations, online appointments, and health monitoring apps.

Wellness Programs and Incentives

Participate in personalized wellness programs that reward you for healthy lifestyle choices and help you manage chronic conditions.

Expanded Coverage Options

Enjoy comprehensive coverage for a wide range of services, including dental, vision, and prescription drugs, with flexible out-of-pocket costs.

Healthcare Navigation

Get personalized guidance from a dedicated healthcare navigator to help you understand your plan and access the care you need.

Community Partnerships

Collaborate with local healthcare providers and organizations to provide support services, screenings, and access to specialized care.

Innovative Therapies and Medications

Stay at the forefront of medical advancements with access to cutting-edge therapies, medications, and treatments.

Flexible Dental Plans

Choose from dental plans that offer affordable preventive care, comprehensive coverage, and access to experienced dentists.

Personalized Care Coordination

Work with a team of healthcare professionals who coordinate your care to ensure seamless transitions and optimal outcomes.

Financial Security

Enjoy the peace of mind knowing that your healthcare needs are covered in retirement, with plans designed to meet your financial constraints.

Plan Type	Deductible	Copay
PPO	$500	$25
HMO	$0	$15
CDHP	$1,500	$0 (with HSA)

NC State Health Plan for Retirees 2025

The NC State Health Plan for Retirees 2025 is a comprehensive health insurance plan that provides coverage for retirees of the State of North Carolina. The plan is designed to provide affordable and quality health care coverage for retirees and their families. The plan includes a variety of benefits, including medical, dental, vision, and prescription drug coverage.

The NC State Health Plan for Retirees 2025 is a valuable benefit for retirees of the State of North Carolina. The plan provides affordable and quality health care coverage that can help retirees stay healthy and active in their retirement years.

5 Things You Need to Know About the 2025 NC State Health Plan Open Enrollment

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.