State Employee Health Plan Bills

The NC General Assembly is considering numerous bills related to the State Employee Health Plan, which covers 660,000+ state employees, teachers and dependents throughout the state.  Most of these bills have been filed in response to the overwhelming deficit in the program and the urgent need to contain costs.  The bills are as follows:

(1) SB 287: Adopted by the Sente, this bill provides $250 million to cover the current shortfall, and nearly $400 million for the 2009-2010 and 2010-2011 fiscal years.  In addition, it estabilshes a “comprehensive wellness initiative” focusing on smoking cessation and weight management.  Essentially, state employees not enrolled in smoking cessation or weight management programs will not be permitted to enroll in the plans 90/10 plan–and instead will be relegated to the 80/20 plan.  Prescription drug copayments have been increased, with significant incentives to use generics.  Specialty medications may be transferred to a specialty vendor–this provision is opposed by the NC pharmacists.  Charges for routine eye exams will no longer be covered expenses.  There are technical changes related to definitions of “dependent.”  Transplant and bariatric coverage may be restricted to specific providers.  In addition, the terms of the administrative contract (now between Blue Crossand the state health plan) will become public record.  

Other bills impacting the plan include

-HB 438 permitting the plan to change its “plan year.

-SB 1037 requiring state employees to obtain an annual physical exam.

-SB 519 permitting enrollment in the plan on the first day of employment.


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