(Raleigh, N.C.) – State Treasurer Dale R. Folwell, CPA, and the State Health Plan (Plan) today released all documents related to the Plan’s Request for Proposal (RFP) process for its Third-Party Administrative (TPA) Services Contract that will process health claims for members two years from now. Earlier this year, the State Health Plan Board of Trustees voted unanimously to award the TPA contract to Aetna for a three-year initial service period beginning Jan. 1, 2025, through Dec. 31, 2027, with the option to renew for two, one-year terms. Blue Cross North Carolina will continue to be the Plan’s claims processor (TPA) for the next two years.
The award was the result of a competitive bid process in which the Plan solicited and selected industry-leading partners providing exceptional customer service, technological resources and professional support. The services under the contract include processing claims and offering a comprehensive network of health care providers. It also reflects a partnership that focuses on transparency and lower costs.
The new three-year claims processing contract was awarded after a standard, competitive and modernized bid process in which submissions were evaluated by an in-house team of subject matter experts and outside professionals, with scores assigned to various sections. The contract went to bid during the first year of an existing three-year contract to allow two years for transition if one was needed. Posting these documents online provides additional transparency into the analysis and allows others to see the unbiased nature of the process.
“We are the most transparent and open agency in state government,” Treasurer Folwell said. “I cannot be prouder of the work done by the staff of the State Health Plan and the bipartisan State Health Plan Board of Trustees. This contract doesn’t change the body or engine of the State Health Plan, it is just a modernization of the transmission. We look forward to Blue Cross finishing their current contract strong and facilitating a seamless transition to Aetna.”
The materials are available for public inspection on a transparency web page created specifically in keeping with Treasurer Folwell’s open government policies.
The documents on the website provide the complete story of the procurement process leading to the change in claims processors and include a media briefing presentation with links to key components of the transparency.
Aetna currently has more than 600 employees assigned to work on the transition for the next two years. They will be working diligently, in close collaboration with Plan staff and multiple vendors, to develop comprehensive plans and processes, systems and platforms to ensure members will enjoy a smooth transition when its services roll out.
Plan benefits including copays and deductibles are not determined by Aeta or, currently, Blue Cross NC. The State Health Plan Board of Trustees has sole authority to decide benefits, premiums and copays. The Plan will use Aetna’s network of providers.
The State Health Plan, a division of the Department of State Treasurer, provides health care coverage to nearly 740,000 teachers, state employees, retirees, current and former lawmakers, state university and community college personnel, and their dependents.