By admin 
RALEIGH, N.C. (WNCN) — More than 750,000 North Carolina state employees, retirees and their family members could soon learn how much they will pay for health insurance — and whether changing doctors could save them money — as leaders overseeing the State Health Plan prepare to vote Friday on a sweeping package of changes scheduled to take effect in 2027.
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The State Health Plan Board of Trustees is expected to consider and vote on 2027 premium rates, benefit changes, provider contracts and new contracts for the plan’s third-party administrator and pharmacy benefit manager during its meeting on Friday morning, according to the Friday meeting agenda.
N.C. State Treasurer Brad Briner underscored the significance of Friday’s meeting during the board’s June session, calling it “perhaps the most consequential meeting this board has ever had.”
Among the most significant proposals is a new provider network that would reward members who receive care from designated “preferred” hospitals, physician groups and clinics with lower deductibles, copays and other out-of-pocket costs. Members who continue receiving care from providers placed in a “non-preferred” tier could instead see their costs increase.
Briner has previously said the proposal is designed to reduce overall healthcare spending while encouraging providers to compete for State Health Plan members by offering lower prices. During the board’s June meeting, Briner estimated the changes could save the State Health Plan roughly $54 million while also lowering costs for many members who choose preferred providers.
“Every one of our active members on this plan should have the opportunity to save material amounts of money under this new strategy,” Briner said during the June meeting.
Under the proposed system, providers would fall into one of four categories:
- Preferred providers, offering members the lowest copays, deductibles and out-of-pocket costs.
- Access providers, where costs would generally remain similar to today’s benefit structure while maintaining access in rural communities and areas with fewer provider options.
- Non-preferred providers, where members would pay significantly more out of pocket.
- Out-of-network providers, where officials have said members would see relatively little change because of the State Health Plan’s broad national network through Aetna.
State Health Plan leaders have said every major health system in North Carolina was invited to participate in the preferred provider program.
Briner has said members who choose preferred providers could see substantial savings.
“By choosing preferred providers, you will be able to cut your out-of-pocket costs by a third or more,” he said.
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Officials have also said members undergoing cancer treatment, transplant care or pregnancy-related care would receive transition-of-care protections, allowing them to continue treatment without immediately losing their current benefit levels if their provider is placed outside the preferred tier.
“We want to be very, very careful about changing benefits on folks that are undergoing active cancer treatment, transplant treatment or pregnant,” Briner said during the June meeting.
Friday’s meeting is also expected to include a vote on 2027 premium rates and other benefit changes.
While trustees have not yet publicly approved final premium amounts, Briner has previously proposed tying premium increases for active employees to annual pay raises. Under that proposal, an employee paying $50 per month whose salary increased by 5% would see their monthly premium rise to $52.50.
The timing is notable because Gov. Josh Stein signed North Carolina’s new $34.4 billion state budget into law earlier this week. The budget includes salary increases for many state employees and teachers, making Friday’s discussion especially significant if trustees move forward with a premium structure linked to future pay raises.
State Health Plan officials have said the proposed changes are intended to improve the plan’s long-term financial sustainability as health care costs continue to rise, while reducing reliance on larger premium increases in future years.
In addition to premiums and benefits, trustees are expected to vote on provider contracts before considering contracts for the State Health Plan’s third-party administrator and pharmacy benefit manager, both of which are scheduled to begin in 2028.
The Board of Trustees is scheduled to convene at 9:30 a.m. Friday.
If approved, the premium, benefit and provider network changes would take effect in 2027.
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