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North Carolina State Health Plan for Teachers and State Employees

North Carolina State Health Plan for Teachers and State Employees. New Charter Schools. January 28, 2013. Topics. Legislation Group Set-up Electronic Enrollment Eligibility Rates Plans Effective Dates Benefits Group Premiums. Legislation. § NCGS 135-48.54

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North Carolina State Health Plan for Teachers and State Employees

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  1. North Carolina State Health Plan for Teachers and State Employees New Charter Schools January 28, 2013

  2. Topics • Legislation • Group Set-up • Electronic Enrollment • Eligibility • Rates • Plans • Effective Dates • Benefits • Group Premiums

  3. Legislation • § NCGS 135-48.54 • Charter School Board of Directors must make election in writing • Election must be made no later than 30 days after charter signed • Sent to the SHP Executive Administrator and the State Board of Education • Election is irrevocable • Shall notify each employee of the election in writing • Each employee shall acknowledge receipt

  4. New Group Set Up • Complete group set-up form and submit to SHP • Address • Contact information including e-mail • Order new employee kits – requisition form • State Health Plan website www.shpnc.org • Electronic enrollment setup – free (required) • Benefitfocus – electronic enrollment vendor

  5. Electronic Enrollment • The State Health Plan is paperless and enrollment is only available electronically. • No paper applications are accepted • Following receipt of Group Set-up form, a Benefitfocus Representative will be assigned to implement the new group onto the eBenefitsNow system.

  6. Eligibility • Full-time employees – covered at 100% of premium on the 70/30 basic plan • 30 or more hours per week • Part-time employees – covered at 50% of premium • 20 – 30 hours per week • Dependents – employees pay 100% of premium • Legal spouse • Natural, stepchild, adopted, foster and legal guardian up to age 26

  7. Rates • Current Employee-Only Rate - $432.66 (Employing Unit currently pays 100% for 70/30 plan; employees pay $22.76 for the 80/20 plan) • 4-Tiers (emp-only, emp-spouse, emp-child(ren), emp-family) • Rates for dependent coverage are based on tier and plan • Current rate sheet attached

  8. Plans • Two PPO Plans offered – benefits are the same, cost sharing varies • 80/20 Standard Plan • 20% coinsurance • $30 office visit copay - primary • $700 deductible • Higher dependent premiums • Employee pays $22.76 per month • 70/30 Basic Plan • 30% coinsurance • $35 office visit copay – primary • $933 deductible • Lower dependent premiums • Employee pays $0 per month

  9. Effective Dates • Effective date is the first of the month or first of the second month following date of hire • Dependents must be added at time of hire or or due to a qualifying event • Dependents must be enrolled within 30 days of the qualifying event or added at annual enrollment

  10. Group Premiums • Prepaid Plan • Billed monthly for the next month • i.e., June bill is for July • Bills are generated in the middle of the month • Premium is due by the 5th of the next month and must be paid as billed • If premium is not paid by the due date, claims are held • Premiums not received by the fifteenth day of the month following the due date shall be charged 1 ½% interest of the amount due the Plan, per month beginning with the sixteenth day of the month following the due date. (NCGS 135-48.55)

  11. Thank You!

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