N.C. State Health Plan to Offer Emergency Benefits in Response to COVID-19

A stethoscope on top of a tablet.

The State Health Plan’s board of trustees recently authorized the treasurer and executive administrator to take actions within their authority to preemptively address and quickly respond to COVID-19 for the benefit of plan members.

The board resolution called the ongoing outbreak a fluid, rapidly evolving situation that the plan is monitoring closely and for which the plan is evaluating appropriate actions daily.

The board action allows the plan to respond quickly and as needed to the fast-developing coronavirus outbreak without having to schedule Board votes on particular action that may be needed. Plan officials are required to communicate all actions to the board as soon as practicable and provide a financial reporting of COVID-19 actions once comprehensive, verified financial information is available. This authority remains in place until rescinded by the board.

“We remain committed to the health and well-being of those who teach, protect and serve. I applaud this fast action by the board of trustees to help us prepare for the coronavirus,” said Folwell. “This ensures that the plan will be able to respond flexibly and quickly to any challenge posed by this outbreak.”

The board acted after noting Gov. Roy Cooper’s March 10 Executive Order No. 116 declaring a state of emergency to coordinate responses to prevent the spread of COVID-19 in North Carolina, and the World Health Organization’s March 11 declaration of COVID-19 as a pandemic.

Subsequent to the board action, the plan made following changes to medical and pharmacy benefits for the State Health Plan 80/20, 70/30 and High Deductible Health Plan:

Medical Benefit Enhancements:

  • Expanded virtual access to doctors – Visits to doctors that previously required a face-to-face encounter can now be performed virtually so long as they are a medical necessity and meet criteria. This will further encourage the use of virtual visits and allow doctors to monitor members at home, minimizing the spread of infection and easing the burden on emergency rooms.
  • Waived prior authorizations for covered services related to COVID-19 that are ordered by a physician, medically necessary, and consistent with CDC guidance related to COVID-19.
  • Eliminated the Member Cost-share for COVID-19 testing to ensure there are no cost barriers to testing.

Pharmacy Benefit Enhancements:

  • Increased access to maintenance medications by waiving the early medication refill limits on 30-day prescription maintenance medications. Member cost sharing will apply as normal.
  • Waived CVS home delivery charges for medications so that members do not have to leave their homes to pick-up their medications.

The board’s full resolution may be found here. Plan actions to protect its members to date may be found on the website under Coronavirus.

The State Health Plan, a division of the Department of State Treasurer, provides health care coverage to more than 727,000 teachers, state employees, retirees, current and former lawmakers, state university and community college personnel, and their dependents.