Indemnity Plan

This program is sponsored by the State Health Plan of North Carolina. The third-party administrator is Blue Cross / Blue Shield of North Carolina.

The State Health Plan will terminate this plan effective June 30, 2008. No NEW enrollments are being accepted into this plan. Please see the Preferred Provider Organization for health care coverage.

The State Health Plan's Indemnity Plan offers comprehensive major medical coverage and prescription drug benefits. The plan can be used as either primary or secondary coverage.

All permanent full-time employees who work 30 or more hours per week are eligible for coverage. The University pays 100 percent of employee coverage. Dependent coverage is also available at group rates. Spouses and legally dependent children up to age 19 (or to age 26 if a full-time student) are eligible.

All permanent part-time employees who work 20-29 hours per week are eligible for coverage, but are not eligible for the University contribution and pay 100 percent of the cost of coverage.

Premiums:

Premiums for this plan are paid through a combination of University and employee contributions as a pre-tax payroll deduction. Premiums are paid one month in advance of coverage. For example, premiums withheld in January pay for coverage for the month of February. The monthly premiums for the Indemnity Plan are:

Coverage Option	Employee	Employee/ Child(ren)	Family
Employee Contribution	$ 0.00	$ 223.00	$ 534.88
University Contribution	357.72	357.72	357.72
Total Contribution	$ 357.72	$ 580.72	$ 892.60

 

If you are paid on a monthly basis, the full monthly contribution is deducted from each paycheck. If you are paid on a biweekly basis, half of your monthly contribution is deducted from the first two paychecks of the month.

Deductibles and Co-Pays:

The employee is responsible for a $450 per plan year deductible per insured (up to $1,350 per family). Until your deductible is met, you are responsible for the entire amount of the allowable charges. The Plan Year runs from July 1 to June 30 (fiscal year).

After your deductible has been met, you pay a coinsurance rate of 20 percent of the eligible expenses, up to the maximum out-of-pocket amount of $2,000 per insured (up to $6,000 per family).

Prescription drug co-payments are as follows:

You must enroll within 30 days of your date of hire, a qualifying family status change or during annual enrollment. You may be subject to certain waiting periods if you are a late enrollee.

The Indemnity Plan covers 80 percent of allowable charges for most medical expenses. When you reach your maximum out-of-pocket amount, the plan covers 100 percent of the remaining charges. Indemnity Plan coverage includes:

• routine wellness exams and other physician services.
• maternity care
• immunizations for prevention of contagious diseases
• surgery, medical supplies, diagnostic and therapuetic radiological services.
• chiropractic and therapy services with a $25 per visit copayment
• emergency room care with a $200 per visit copayment

The plan offers lower rates for physician services through its CostWise program. See your benefits guide for details on coverage of these and other services.

All claims must be filed within 18 months from the date of service.

Medical claims should be mailed to the State Health Plan, Claims Processing Contractor, PO Box 30025, Durham, NC 27702-3025. BC/BS can be reached at 800-422-4658.

Prescription drug claims should be mailed to Medco, PO Box 14711, Lexington, KY 40512. Medco can be reached at 800-336-5933.

Appeals must be submitted within 60 days of receiving a denial or benefits decision.

If you have questions about the benefits offered through this plan, please contact your department's Benefits Specialist.

If you have questions about a claim, or have experienced problems in receiving a reimbursement, contact Blue Cross / Blue Shield at the address listed below.

Blue Cross and Blue Shield of North Carolina
Customer Services
PO Box 30111
Durham, NC 27702-3111
Phone: 800-422-4658

The Benefits Administration Department, Office of Human Resources, is responsible for reviewing and revising as needed the content of this page.

The information contained in this website is not a contract and is subject to change. It should be understood that explanations in this summary cannot alter, modify or otherwise change the controlling legal documents or general statutes in any way, nor can any right accrue by reason of any inclusion or omission of any statement in this presentation. The most current information will always be found at the benefit carrier's home page. The Office of Human Resources designs these pages to be as current as possible; however, the benefit information provided herein is always subject to change.