Summary (tl;dr)

The North Carolina State Health Plan Board of Trustees has approved significant changes for 2027, including a 5% premium increase for most members and the implementation of a new tiered provider network designed to control rising healthcare costs and ensure the plan's long-term sustainability.

Essential Background

The North Carolina State Health Plan, which provides health coverage for nearly 750,000 state employees, teachers, and retirees, has been grappling with a projected $500 million deficit for 2026 and a history of escalating healthcare expenditures. State Treasurer Brad Briner highlighted the urgent need for a cohesive strategy to address these financial challenges and ensure the plan's long-term viability and affordability.

The Full Story

On July 10, 2026, the North Carolina State Health Plan Board of Trustees voted to enact major reforms taking effect in 2027. Key among these decisions is a 5% increase in premiums for the majority of the plan's members. Additionally, the board approved a new four-tier provider network structure: preferred, access, non-preferred, and out-of-network. Under this new system, members who choose "preferred providers," which currently include UNC Health and Novant Health, will benefit from lower premiums, copays, deductibles, and out-of-pocket costs. Conversely, members opting for non-preferred providers will face significantly higher costs. The board also approved Blue Cross NC to take over from Aetna as the third-party administrator for the plan, effective January 1, 2028, a move anticipated to save up to $1 billion.

Why It Matters

These changes are critical for the hundreds of thousands of state employees, retirees, and their families across North Carolina, directly influencing their healthcare expenses and choices of providers. While a premium increase will affect most members, the new tiered network offers a pathway to potential savings, with those utilizing preferred providers possibly saving thousands of dollars annually. The reforms are intended to incentivize members to seek care from high-quality, lower-cost providers, thereby addressing the plan's financial pressures and reducing its reliance on state appropriations. Ultimately, these measures aim to bolster the long-term affordability and sustainability of the State Health Plan amidst rising national healthcare costs.

Geographic Location

• Department of State Treasurer, Raleigh, Wake County, North Carolina, United States (State Health Plan Board of Trustees meeting where changes were approved)