2025 Benefit Information: High Deductible Health Plan
2025 Benefit Information: High Deductible Health Plan
Starting Jan. 1, 2025, the State health Plan is transitioning Third-Party Administrator (TPA) services from Blue Cross NC to Aetna.
Members that are currently enrolled and are still eligible did not need to take action during Open Enrollment which was held Sept. 30-Oct. 25, 2024, unless they need to update their dependents. Members were automatically re-enrolled in the High Deductible Health Plan (HDHP) at the current coverage level (for example, employee only). If you disenrolled yourself from coverage, your enrolled dependents will also no longer covered under the HDHP.
Aetna Health Concierge (Customer Service) at 833-690-1037 is open! Representatives are available Monday through Friday 8am-5pm. Representatives can assist members with finding a provider or benefit-related questions. Please note that representatives are not able to look up your current claims.
Important Highlights About Your 2025 Benefits
- No premium increases for the 7th year in a row with no increase in deductibles!
- No benefit changes.
- The formulary (drug list), which determines what medications are covered and what tier they fall under, changes on a quarterly basis, so there is a possibility that you will have changes in your prescription coverage in 2025. Please refer to your Benefits Booklet for complete coverage details.
- Preferred and non-preferred insulin continues to be $0 for a 30-day supply!
- Preventive Services remain free!
- You will receive a new ID card for 2025. Your 2024 ID card will not work after Dec. 31, 2024.
Pharmacy Resources
CVS Caremark is the State Health Plan’s Pharmacy Benefit Manager.
The State Health Plan utilizes a custom, closed formulary (drug list). The formulary indicates which drugs are excluded from the formulary and not covered by the Plan. All other drugs that are on the formulary are grouped into tiers. Your medication’s tier determines your portion of the drug cost.
These documents and tools include information based on the 2024 formulary and are subject to change prior to January 1, 2025.