Treasurer State Health Plan Board Awards 2019 Third Party Administrator Contract to Blue Cross Blue Shield of North Carolina Three Year Contract to Serve More than 700,000 Members

RALEIGH – At a press conference today, State Treasurer Dale R. Folwell, CPA, announced that the State Health Plan Board of Trustees has awarded the Third Party Administrator (TPA) medical claims contract to Blue Cross Blue Shield of North Carolina (BCBSNC).

The TPA contract provides the State Health Plan (Plan) with a provider network, health care claims processing and related services. The current TPA contract, also with BCBSNC, expires December 31, 2018. BCBSNC is also able to provide Population Health Management services which has been previously provided under a separate contract by another vendor. The Plan currently spends $3.2 billion a year for member health care.

“As we move toward implementation, we will reset our relationship not just renew our vows,” said Treasurer Folwell. “As the largest direct purchaser of health care in North Carolina, we will work with Blue Cross Blue Shield of North Carolina and medical providers to reduce complexity and improve Plan affordability as well as increase access for our members and taxpayers.”

The Plan is self-funded and provides health care coverage for more than 700,000 teachers, state employees, retirees, current and former lawmakers, state university and community college personnel, and their dependents. The TPA negotiates contracts with health care providers as well as processes claims that are then paid using taxpayer funds. The BCBSNC proposal kept the potential administrative costs essentially flat.

The Request for Proposal (RFP) was issued on April 19, 2017, and technical proposals for all components were received on July 10, 2017. The RFP was designed to offer the Board of Trustees the flexibility to consider a variety of benefit plan options that will be in the best interest of Plan members and North Carolina taxpayers. 

Through this RFP process, the Plan solicited and selected a partner who is an industry leader equipped to provide exceptional customer service, technology and staff. The Plan also sought a TPA that would negotiate provider contracts focused on high quality services for members and value-based reimbursements to benefit both the Plan and its members. 

BCBSNC was one of four companies bidding for the contract. UnitedHealthcare (UHC), MedCost, and Aetna also submitted proposals. 

The contract will extend for three years to 2021, at which time the Plan will review the performance of BCBSNC and make a decision on issuing another RFP or extending the contract in one-year increments for a total of up to five years.

For a podcast of the press conference, please click here.