2025 Transition to Aetna as TPA
State Health Plan Third-Party Administrator Transitions to Aetna Jan. 1, 2025
This page serves as the official State Health Plan information source for members seeking details regarding the transition from Blue Cross NC to Aetna on Jan. 1, 2025. This page will provide the most accurate, up-to-date information regarding this transition.
2025 Third-Party Administrator Transition to Aetna
These short videos gives you a brief overview about this change and answers some questions you may have. We’re here to help you navigate through this change and make it as seamless as possible!
Aetna Welcome Video
2025 TPA Transition Information Video
Frequently Asked Questions
Medical benefits in the Base PPO Plan (70/30) and the Enhanced PPO Plan (80/20) are not changing in 2025. Copays, deductibles and premiums are also not changing. Your pharmacy benefit administrator or PBM is currently CVS Caremark. 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. Members are not required to fill prescriptions at CVS.
Aetna has a robust national network. Aetna’s Find a Provider Tool is available by clicking Find a Doctor.
The Clear Pricing Project (CPP) is still available for 2025 and CPP providers are noted in the Aetna Provider Tool. Please note that CPP providers had to re-sign up with Aetna, so some providers may have chosen not to re-sign as a CPP Provider.
Regardless of the action members took during Open Enrollment, all members will be receiving a new ID card from Aetna or Humana (Medicare Advantage members). ID cards will be mailed at the end of November into early December 2024. Members should begin using this new card effective Jan. 1, 2025. Your old ID card will not work after Jan. 1, 2025.
When members receive their new Aetna ID card, instructions will be available for how to register for Aetna’s member portal.
Telemedicine is a service some providers offer in lieu of an in-person visit. The applicable copay would apply for such visit. Teledoc Health is service that offers telemedicine with certain providers and is offered by Aetna for the applicable office visit copay.
Blue Connect will be available for 18 months after Jan. 1, 2025. The secure chat function will also remain available for 18 months after Jan. 1, 2025. Members who have never established a Blue Connect account will have up to 6 months after Jan. 1, 2025, to create a Blue Connect account. Members will still be able to link to Blue Connect in eBenefits until March 31, 2025.
Blue Cross NC Customer Service at 888-234-2416 will also remain open for 18 months after Jan. 1, 2025.
Access to Blue365 Program: Every year, at the one-year mark of the member’s registration, members are required to reauthenticate their Blue365 membership. If they are no longer a Blue Cross NC member, they will not be able to reauthenticate and their access to the program will be blocked. For example, someone that registered on 3/21 will get that reauthorization email on that same date every year to authenticate their membership. Once they don’t reauthenticate they are unsubscribed and removed from the program so they will not receive that authentication email again.
Gym Discount Programs: When a member joins Active & Fit Direct or Fitness Your Way, they sign a direct contract with Active & Fit Direct or Tivity which gives them access to their network. If they don’t reauthenticate with Blue365, while they lose access to Blue365, it doesn’t impact the contract they have with either of those partners unless they terminate their contract directly with them.
Yes. Aetna offers Life Mart, which is a similar program. You will be able to access those services after Jan. 1, 2025, but you will need to register when you receive your new Aetna ID card.
Aetna will honor authorizations for 90 days that they receive from Blue Cross NC that are currently in place. This will give your provider time to request a new authorization through Aetna if needed.
Beginning Dec. 1 providers will need to start submitted requests to Aetna. If members have questions or concerns, Aetna Health Concierge at 833-690-1037 is available to assist.
Members in this situation do not need to take any action unless their provider is out-of-network, in which case the provider may be required to complete a transition of care form with Aetna.
Yes, you must complete a form and submit it to Aetna once you receive your ID card and have your new member ID card number. There is a section in the Aetna member portal to load this information. Members will need to fill out the form and submit it to Aetna, which will have to be provided once a year. This form will also be available on the Plan’s website.
The State Health Plan’s Aetna Account Management team is in North Carolina with 600 associates. They are dedicated to serving the State Health Plan. However, Aetna, is a nationwide company with existing processes and locations. These are dedicated to certain functions, such as receipt of claims or correspondence. This approach allows Aetna to provide you with an enhanced member experience. You may see addresses in El Paso, TX or Lexington, KY on materials like ID cards and EOBs. Providers that work with Aetna are familiar with them. Continuing to use them helps prevent any disruption to your services.
Members will receive a letter from Blue Cross NC in January 2025, which is a required Notice of Creditable Coverage. Blue Cross NC is required to send these letters as members will no longer be on a Blue Cross NC plan, no action is necessary.