State Health Plan

The State Health Plan offers eligible employees two Preferred Provider Organization (PPO) plan options, the 70/30 and 80/20. These plans offer coverage for both in-network and out-of-network providers. However, visiting an in-network provider lowers deductibles, copays, and coinsurance.

The State Health Plan also offers the High Deductible Health Plan (HDHP), which is a health plan to comply with the federal Affordable Care Act (ACA). This plan is only available to employees eligible for coverage under G.S. §135 48.40(e).

Blue Cross Blue Shield of North Carolina administers each of these plans but benefits are paid by the state. Under all plans, Affordable Care Act (ACA) preventive services and medications are covered at 100% for services performed by an in-network provider.

Notice to Non-Full-Time Individuals Enrolled In Our Medical Plan

As a large employer, the Affordable Care Act requires us to prepare a Form 1095-C for all individuals enrolled in our employer sponsored self-insured medical plan. For the 2023 reporting year, we are no longer required to mail the form to any individual who is not a full-time employee for any month of the calendar year. However, if you were enrolled in our self-insured medical plan during the 2023 calendar year, you may request that a form be sent to you by contacting Trina Baker in the Benefits HR office:

Email: bakekrtr@ecu.edu
Mail: 210 East 1st Street Greenville, NC 27858
Phone: 252-328-9889

 

Who’s Eligible?

Permanent or time-limited employees working 20 hours or more per week are eligible to enroll in coverage. However, the cost of coverage depends on an employee’s regularly scheduled hours worked per week.

Employees actively covered under the plan are also eligible to enroll their eligible dependents in coverage. To determine dependent eligibility and required documentation, click here.

 

How much does coverage cost?

The cost of coverage depends on the plan selected, employment status, hours worked per week, who’s covered, and completed wellness credits. Premiums are paid one month in advance and are deducted from an employee’s paycheck semi-monthly on a pre-tax basis.

 

Wellness Credits

An employee can earn a wellness premium credit by completing the tobacco attestation, which will reduce the monthly premium for both the 70/30 and 80/20 plan options. The wellness premium credit only applies to the employee premium. The tobacco attestation must be completed each year to receive the wellness premium credit. 

An employee can also save money under the 70/30 or 80/20 when visiting their selected Primary Care Provider (PCP). An employee can designate or update their selected PCP at any time by logging into their eBenefits enrollment site.

 

Coverage Rates

Permanent or time-limited employees in an active pay status working 30 hours or more per week are eligible for the employer share of the premium. See current premium rates here.

Part-time permanent or time-limited employees working 20-29 hours per week are eligible to enroll in coverage by paying the full premium (employee + employer portions). See current premium rates here.

Temporary and student employees working 30 hours or more per week may be eligible to enroll in the High Deductible Health Plan (HDHP). Those eligible will be contacted by the HR Benefits Office with an enrollment guide and the uniform summary of benefits within 30 days of the date eligibility is determined. See current plan premium rates here.

NOTE: Permanent or time-limited employees regularly scheduled to work 30 hours or more per week on a leave without pay for more than half of the workdays and holidays in a month, excluding those covered by the Family Medical Leave Act (FMLA) or Workers’ Compensation, will be responsible for paying the full premium (employee + employer portions).

 

When does coverage begin?

Eligible new-hires, or employees newly eligible for coverage due to an employment status change, have 30 calendar days starting from their hire or eligibility date to enroll in coverage. The coverage effective date would be the first day of the month following the month in which the hire date or status change date occurred.

If an existing employee is making changes during open enrollment, the changes made will take effect the beginning of the next plan year.

If an existing employee experiences a qualifying life event (QLE) within the plan year, the effective date of coverage will depend on the type of event and the event date. Supporting documentation is required and the change to benefits must take place within 30 days of the event date. Employees who have experienced a valid QLE must make any necessary changes and upload the required supporting documentation in eBenefits within 30 days of the event.

NOTE: State Health Plan premiums are paid a month in advance.

 

When can I make changes to my plan?

Employees can make changes to their benefits during open enrollment. The changes made during open enrollment will become effective the beginning of the next plan year.

If an employee experiences a qualifying life event (QLE) during the year, an employee may add or drop coverage outside of open enrollment. Supporting documentation is required and the change to benefits must take place within 30 days of the event date. Employees who have experienced a valid QLE must make any necessary changes and upload the required supporting documentation in eBenefits within 30 days of the event.

NOTE: State Health Plan premiums are paid a month in advance.

 

When does coverage end?

If an employee separates between the 1st and the 15th of the month, their State Health Plan coverage will terminate on the last day of the month in which their employment ends. If an employee separates between the 16th and the last day of the month, their State Health Plan coverage will terminate on the last day of the month following the month in which their employment ends.

Eligible employees will receive information regarding COBRA-Continuation following separation from the University. If eligible, a COBRA notice will be mailed to the address on file upon separation. To view the cost of COBRA coverage, click here.

 

 Helpful Resources