Contact: Brad Young (919) 814-3820
February 5, 2016

State Health Plan Board of Trustees Meeting Update

On Friday, February 5, the State Health Plan’s Board of Trustees voted on benefit changes for calendar year 2017.
  • The Board approved the following benefit plan changes for 2017, which will be effective January 1, 2017. Approval of the enrollment strategy for 2017. During the Open Enrollment period, active members and Non-Medicare retirees will be enrolled in the Traditional 70/30 Plan and required to take action during the Open Enrollment period to select either the Enhanced 80/20 Plan or the Consumer-Directed Health Plan. 
  • Approval of the addition of a new Pharmacy tier for identified Specialty medications. 
  • Approval of the transition of identified Specialty drugs from the medical benefit to the pharmacy benefit.
  • Approval of coverage regarding clinical trials consistent with federal Affordable Care Act requirements, which will be retroactive to January 1, 2016.
The Board of Trustees voted to delay a decision on the following:
  • Increasing cost-sharing amounts in the Enhanced 80/20 Plan and Traditional 70/30 Plan. Non-Medicare and Medicare retirees will still have the Traditional 70/30 Plan as a premium-free option for retiree-only coverage in 2017.
  • Increasing the base employee-only premium on the Enhanced 80/20 Plan and establishing a base premium on both the Traditional 70/30 Plan and the Consumer-Directed Health Plan. Active members and Non-Medicare retirees will still have the opportunity to reduce their monthly premium by completing certain wellness activities.
Further benefit changes beyond 2017, including the discussion regarding changes to the Enhanced 80/20 Plan, will be delayed until a later date. The removal of spousal coverage was also presented to the Board in January as a potential savings strategy. The Board does not have the authority to change eligibility and did not vote to request or recommend legislation to remove spousal coverage.

As a reminder, in the 2015 Budget the General Assembly required the State Health Plan to take steps to reduce the projected increase to the state contribution for the 2017-19 fiscal biennium while maintaining significant cash reserves. With this legislative directive in mind, the State Health Plan will continue to work through various scenarios beyond 2017 to increase member engagement in order to reduce costs over time while providing meaningful benefits in accordance with the Board’s strategic plan.