Health Insurance

State Health Plan of North Carolina

Preferred Provider Organization Plans

Description

The State Health Plan offers two health plan options: The Enhanced PPO Plan (80/20) and the Base PPO Plan (70/30). Both plans are administered by Blue Cross and Blue Shield of North Carolina (Blue Cross NC), but benefits are paid by the state, not Blue Cross NC.

You can seek care from providers in the NC State Health Plan Network or go out-of-network. However, if you stay in-network, your deductibles, copays and coinsurance will be lower. Both plans cover the same medical and pharmacy services. However, the member cost share varies by each plan. CVS Caremark is the Plan’s pharmacy manager, but your pharmacy benefits are paid by the state. Members should note that this does NOT mean members will have to go to a CVS pharmacy location for their prescriptions.

Base PPO Plan (70/30): This plan has lower premiums in exchange for higher copays, coinsurance and deductibles.

Enhanced PPO Plan (80/20): This plan has higher premiums than the 70/30 Plan in exchange for lower copays, coinsurance and deductibles.

Costs

The cost to you depends on the plan you choose, who you cover and whether or not you completed your tobacco attestation to receive your wellness credit. View the current rate sheets on the State Health Plan website.

Eligibility

Permanent, full-time employees who work 30+ hours per week are eligbile for the State Health Plan.

Permanent, part-time employees working 20-29 hours per week are eligible for the State Health Plan. If they enroll, they are responsible for paying both employee and employer premiums, the 100% Contributory rate.

Enrollment Deadline and Effective Date

Enrollment Deadline: If you are a new hire or experience a qualifying life event, you must enroll 30 days from your hire date or your eligibility event date.

Effective Date of Coverage: If you are a new hire eligible for benefits, you have the choice to enroll with health coverage effective the first day of the month following your hire date, OR the first day of the second month of your hire date, for enrollments made within 30 days of hire. If you experience a qualifying life event, the effective date of coverage enrollment/change depends on the type of qualifying life event. Reference the plan’s Benefits Booklet on the State Health Plan’s website for more details. The coverage change request must occur within 30 days of the qualifying life event.

Insurance Cards

State Health Plan insurance cards are issued by the vendor. ID cards serve as both medical and prescription drug cards. If you have selected a primary care provider, they will be listed on your card. If needed, you may request a new ID card through Blue Connect.

The State Health Plan will only issue new ID cards to those participants who made a change to their medical coverage for the 2024 plan year.

If you need access to your State Health Plan ID card, or have made changes to your State Health Plan and are waiting for a new card to arrive in the mail, you can access your card and get a copy online through Blue Connect. More information can be found on the State Health Plan website.

Deduction Frequency

Deductions for health insurance occurs semi-monthly (month in advance of coverage).

How to Enroll or Make Changes

State Health plan enrollment and changes are made through eBenefits.

High Deductible Health Plan

Description

UNC Charlotte offers the High Deductible Health Plan (HDHP) through the State Health Plan to eligible temporary employees, adjunct faculty and student employees. The HDHP is administered by Blue Cross Blue Shield of North Carolina (Blue Cross NC) and uses the Blue Options Network. Preventive services performed by an in-network provider are covered at 100% in this plan, which means there is no charge to you.

Costs

The cost to you depends on the plan you choose and who you cover. If you choose to enroll in this plan, you will be billed monthly for your premiums by the State Health Plan’s direct billing administrator, iTEDIUM. This is a pre-paid plan; therefore, you will be billed a month in advance. For instance, you will receive a bill in December for January coverage. You will be responsible for paying your bill in a timely manner and failure to do so will lead to termination of coverage.

Eligibility

Any non-permanent employee hired to work 30 or more hours per week for three months or more (cumulative of all positions, and not designated as variable hour worker), must be offered the chance to enroll in the High Deductible Health Plan, within 30 days of their eligibility. Any non-permanent employee hired to work less than 30 hours per week (cumulative of all positions, or designated as variable hour worker – i.e. student workers) are measured during designated measurement periods. If they average 30 or more hours per week over a designated measurement period, they will be offered the chance to enroll in the High Deductible Health Plan, and will be notified of instructions.

*Special Notes Regarding Eligibility for the High Deductible Health Plan

  • Student workers: Hired and reported as part-time variable hour, to be measured during designated measurement periods to determine eligibility
  • Temporary faculty (FTE calculated – 3 work hours for every credit hour) FTE .75+ (cumulative of all jobs) or measured full-time, offered the high deductible health insurance
  • Temporary hourly workers (eligibility based on FTE, duration of more than 30 days) FTE .75+ (cumulative of all jobs) or measured full-time, offered the high deductible health insurance
  • Temporary salaried workers (regardless of the FTE, duration of more than 30 days) Reported as full-time & offered the high deductible health insurance

This webpage is an overview of benefits eligibility and does not contain all the terms and conditions of the various programs. The appropriate plan document governs the benefits eligibility of each plan.

Enrollment Deadline and Effective Date

30 days from hire/eligibility date.

Insurance Cards

State Health Plan insurance cards are issued by the vendor. ID cards serve as both medical and prescription drug cards. If you have selected a primary care provider, they will be listed on your card. Request an ID card through Blue Connect.

If you need access to your State Health Plan ID card, or have made changes to your State Health Plan and are waiting for a new card to arrive in the mail, you can access your card and get a copy online through Blue Connect. More information can be found on the State Health Plan website.

Billing Frequency

Monthly.

How to Enroll or Make Changes

Enrollment for this plan will be available online only through eBenefits, the Plan’s enrollment system. Eligible employees will receive detailed information through the Benefits Office via email. You will need to log into eBenefits to get started and will need to register as a first-time user.

Pharmacy Benefits

CVS Caremark is the pharmacy benefit manager. It utilizes a custom, closed formulary (drug list). The formulary indicates which drugs are excluded from the formulary and not covered by the Plan. All other drugs that are on the formulary are grouped into tiers. Call 888-321-3124 or visit caremark.com to file a claim for prescription drugs, locate pharmacies within network, or learn about the Plan’s preferred prescription drugs).

The State Health Plan utilizes a Pharmacy Benefit Manager (PBM), which administers the pharmacy benefit. The current PBM for the State Health Plan is CVS Caremark. This does NOT mean members have to go to a CVS pharmacy for prescriptions. CVS Caremark has a broad pharmacy network.

The State Health Plan utilizes a custom, closed formulary (drug list). The formulary indicates which drugs are excluded from the formulary and not covered by the Plan. All other drugs that are on the formulary are grouped into tiers. Your medication’s tier determines your portion of the drug cost.

Detailed information regarding your benefits is available in your Benefits Booklet or you can call CVS Caremark Customer Service at 888-321-3124, or visit Caremark.com.

The Affordable Care Act and UNC Charlotte

The ACA and UNC Charlotte

12-16-2020 Notice to Non-Full-Time Individuals Enrolled In Our Medical Plan

As a large employer, the Affordable Care Act requires us to prepare a Form 1095-C for all individuals enrolled in our employer sponsored self-insured medical plan. For the 2020 reporting year, the distribution requirements have changed, and we are no longer required to mail the form to any individual who is not a full-time employee for any month of the calendar year. However, if you were enrolled in our self-insured medical plan during the 2020 calendar year, you may request that a form be sent to you by contacting one of the following:

Email: Benefits@charlotte.edu

Mail: Human Resources Department – Benefits, 9201 University City Boulevard, Charlotte, NC 28223-0001

Please contact the benefits office at: 704-687-8134 or Benefits@charlotte.edu, if you have general ACA questions, or need specifics regarding employee eligibility for the High Deductible Health Plan. Note: The ACA information provided below on this webpage is under review, and subject to change.

Information about the Affordable Care Act (ACA) for those hiring temporary staff, faculty, and student workers:

  • Effective Jan. 1, 2015, the ACA requires that any non-permanent employee working an average of 30 or more hours per week over a 3 month time period be provided with employer-provided health insurance.
  • The ACA employer mandate means that we must look at temporary employees, student employees, graduate RA/TA’s, adjunct faculty, lecturers (essentially all non-permanent employees of the University). Many of these may not have been eligible in the past, but may be eligible now.
  • The State Health Plan’s High Deductible Health Plan is the health plan that will be offered to eligible temporary employees, adjunct faculty and students. It is important not to confuse this plan with the student health insurance, graduate support plans, etc. This ACA plan will be offered in addition to any other plans offered.
  • It is important to associate correct FTE (full-time equivalency) to job data in the HR System. The HR Benefits Office will be responsible for monitoring for eligible employees.
  • Temporary staff, faculty and student workers (with the exception of Federal Work Study students) hired prior to January 1, 2015:
    • The Affordable Care Act (ACA) provides that we measure the work hours of any non-permanent employee working for the University for a 12 month period to determine if they are averaging 30 hours or more per week. For example, if a temporary employee was hired on February 1, 2014, then at the beginning of February, 2015, we would determine if the temporary employee averaged 30 or more hours per week. If so, this person would be eligible to enroll in the ACA health plan.
  • Temporary staff, faculty and student workers (with the exception of Federal Work Study students) hired on or after January 1, 2015:
    • The Affordable Care Act (ACA) states that any non-permanent employee hired or rehired after January 1, 2015 working 30 or more hours per week for 3 months or more, must be offered the chance to enroll in the ACA health plan within their first 30 days of employment.
  • The General Assembly has enacted legislation that requires a rehired retiree to enroll in the High Deductible Health Plan and terminate their retiree health plan if they become eligible under the Affordable Care Act for the ACA High Deductible Health Plan. HR/Benefits recommends that rehired retirees work no more than 29 hours/week.

Work Hour Exceptions for Non-Permanent Student Employees

Students are limited to 20 hours or less during the academic year. During the summer, if the student is not enrolled in summer courses and the department wants to employ a student on a Student Temporary Wage appointment to work over 20 hours a week, an exception form will need to be completed, approved and submitted to HR.

Student Temporary Wage- For those working over 20 hours/week at any time during the year work hour exception form is required (see link below).

Graduate Assistants- For those working over 20 hours/week anytime in the year, a work hour exception form is required (see link below).

Work Hour Exception Form

The Student Work Hour Exception Form should be completed and signed by the Dean of the College or Vice Chancellor of the Division, then forwarded to Student Employment Office in HR.

The Summer GA (Graduate Assistant) Work Hour Exception Form should be completed and signed by the Dean of the College or Vice Chancellor of the Division, then forwarded to Julie Green in the Graduate School.

Work Hour Exception Form for Student Temporary Wage

Work Hour Exception Form for Summer GA

For guidance related to temporary faculty work hour standard and exceptions, please contact Lori McMahon at 704-687-5774.

New ACA Health Plan Offered by the North Carolina State Health Plan

Click here for information about the new health care plan that the State offers to those newly eligible under the Affordable Care Act.

Disclaimer: UNC Charlotte HR Benefits Office designs these pages to be as current as possible; however, the information contained on these pages is subject to change at any time. This information cannot alter, modify or otherwise change the prevailing laws in any way, nor can any right accrue by reason of any inclusion or omission of any statement on these web pages. The Benefits Office provides this information solely as a convenience to employees of the University. Nothing on this web page affirms actual eligibility for health insurance.

Forms 1095-C and 1095-B

Under the Affordable Care Act (ACA), when you complete your tax return, you will be required to indicate whether or not you (and your eligible dependents) had qualifying medical coverage for all of prior calendar year. The University will send you a tax form, Form 1095-C, which includes information about the health coverage offered to you by the University. In some instances, our insurance carriers will be sending you Form 1095-B. You may receive one or both of these forms.

It is not necessary for you to wait until you receive these forms to file your tax return. While the information on the forms may assist you in preparing your return, the forms are not required. Similar to last year, you can prepare and file your return using other information about your health insurance.

Note: If you are not considered a full-time employee under the ACA rules, you may not receive these forms, or you may only receive one form.

FAQS

What information does Form 1095-C contain?
Your name, Social Security number and address
Your Employer’s name, Employer Identification Number (EIN) and address, and
Information about health coverage that the University offered you and your dependents during the prior calendar year and that you were enrolled in during that year.
For an example form, click here.

What information does Form 1095-B contain?
Your name, Social Security number and address, as well as your dependent’s names and Social Security numbers or date of birth, and
Information about the health coverage you and your dependents, if applicable, were enrolled in during the prior calendar year.
For an example form, click here.

Who will receive a Form 1095-C or 1095-B?
The following individuals will receive a Form 1095-C from the University:

  • Employees eligible for health coverage under any of the following health plans offered by the University:
    • Enhanced 80/20 Plan
    • Traditional 70/30 Plan
    • High Deductible Health Plan
  • Former employees who were eligible and/or enrolled in University-sponsored health coverage during the prior calendar year, either as active employees and/or COBRA participants
  • Other employees determined to be a full-time employee under the ACA rules

The following individuals will receive a Form 1095-C from the State Health Plan:

  • Retirees under age 65 enrolled in the Enhanced 80/20 Plan, or Traditional 70/30 Plan
  • Retirees 65 or older enrolled in the Traditional 70/30 Plan

The following individuals will receive a Form 1095-B from another organization, not UNC:

  • Retirees enrolled in the State Health Plan Medicare Advantage Plan will receive a 1095-B from the Medicare Advantage Insurer (either Humana or United Health Care)
  • Students enrolled in the UNC Student Health Insurance Plan will receive a 1095-B from Blue Cross / Blue Shield of North Carolina

The following will receive a Form 1095-C from the University and a Form 1095-B from Blue Cross / Blue Shield of North Carolina:

  • Postdoctoral fellows eligible for health coverage under the UNC Postdoc Medical Insurance Plan

When will I receive the forms?
The form(s) will be mailed to your home address at the end of January.

What do I need to do?
When you receive the form(s), save them with your other important tax records. You will not need to attach or file the forms with your federal income tax return.

If you (and your eligible dependents) were enrolled in the health plan provided by the University for all of the prior calendar year, you can indicate on the appropriate line of the IRS Form 1040, 1040A or 1040EZ that you (and your eligible dependents) had qualifying medical coverage.

If you (or your eligible dependents) did not have health coverage for all of the prior calendar year, you may be assessed a tax penalty unless you qualify for an exemption.

Note: Under passage of tax reform legislation at the end of 2017, the requirement for each individual to obtain health coverage or pay a penalty will no longer be in effect beginning 2019. The individual mandate will continue to apply for 2017 and 2018.

If I cover my dependents under the health plan provided by the University, will they receive a separate Form 1095-C or 1095-B?
Generally no. Coverage for both you and your eligible dependents will be included on the form(s) sent to you.

Note: If your eligible dependents file separate tax returns, they will need to provide information about their medical coverage when completing their tax returns. You can provide a copy of the form(s) to your eligible dependents; however, they do not need the form(s) to complete their individual tax returns. They can prepare and file their returns using other information about their health insurance.

Questions?
More information on Forms 1095-C and 1095-B are available on the IRS website.

Contact Information and Resources:

Note: * General Statute 135-48.1(18) SL 2017-57 changed the eligibility for retiree health coverage. Members hired on or after Jan. 1, 2021 will not be eligible for retiree medical benefits. Click here for more details.