State Health Plan emphasizing primary care to keep costs down

Published April 28, 2016

by Leyla Santiago, WRAL, April 28, 2016.

The board governing North Carolina's State Health Plan voted Wednesday to tweak one of its more popular insurance plans but reaffirmed that it has dropped an earlier proposal to scrap the plan.

Roughly 280,000 plan members use what's called the 80/20 option, which requires enrollees to pay 20 percent of their health costs up to a certain deductible limit.

In February, State Health Plan administrators floated the idea of eliminating 80/20 and leaving its roughly 691,000 members – teachers, state employees and retirees – to choose between a more costly 70/30 plan or an "employee-directed" plan that amounts to catastrophic coverage plus a health savings account.

Administrators said they have a legislative mandate to cut costs and build up a reserve fund. North Carolina taxpayers put $2.5 billion in the plan during fiscal 2014-15, which is more than 10 percent of the state budget.

Complaints from state workers led the State Health Plan board to back off the idea of dropping the 80/20 option, and the board on Wednesday lowered the co-pays for routine medical visits and some prescription drugs, starting in 2017.

State Treasurer Janet Cowell, whose office provides an administrative home for the health plan, said the changes provide an incentive for workers and their dependents to focus on wellness and primary care, which will help keep costs down.

"If you can't make it to primary care, go to your gynecologist. If you can't make it there, go to the urgent care. All of those costs have been lowered. Taking your meds, we're lowering the co-pay," Cowell said. "If you don't do all those things, then yes, you're then going to pay a higher price."

The State Employees Association of North Carolina said the changes are better than what was discussed in February, but they continue the trend of decreasing State Health Plan benefits.

"Ultimately, they are creating a situation where plan members will be forced to taking consumer-driven health plans as their options because, again, they're doing the same thing to the 80/20 that was done to the 70/30 – reduced the plan benefits," said Chuck Stone, director of operations for SEANC.

Stone said he also has concerns about premium increases. The board is waiting to see how much money is included in the 2016-17 state budget for the health plan before setting premiums for 2017.