RALEIGH — North Carolina State Treasurer Dale Folwell announced that the State Health Plan and Aetna, the plan’s new third party administrator, will be hitting the road to meet with members about benefits and “enhanced programs” that will begin Jan. 1, 2025.
Per a press release from Folwell’s office, the road tour will give State Health Plan (SHP) members the chance to ask questions and learn more about the transition. Flu shots will be available at road tour stops for members while supplies last.
The road tour will begin in Raleigh at the treasurer’s office on July 25. The next stop will include the General Assembly in Raleigh on Aug. 22, followed by stops in Charlotte, Wilmington, Asheville, Winston-Salem, Fayetteville and other locations. The SHP 2025 open enrollment period is Sept. 30 through Oct. 25, and members will receive information in the mail this summer.
Webinars, telephone town halls and other in-person events will be part of the road tour, with details found at shpnc.org/upcoming-events.
“We’re thrilled to offer teachers, state employees and others who serve our state the ability to meet directly with representatives of Aetna,” Folwell said in a press release. “With the litigation behind us, we are focusing on providing a seamless transition for members. The new contract reflects a partnership with Aetna not only focusing on transparency and lowering costs, but also providing high-quality and accessible health care.”
The road tour follows the conclusion of legal challenges to the selection of Aetna as the third party administrator (TPA).
Blue Cross and Blue Shield of North Carolina (BCBSNC), which has been the TPA for more than 40 years, sued over the change to Aetna, citing issues with the procurement process and criticizing the bidding process, but a judge ruled BCBSNC failed to prove any errors that would have changed the outcome.
In a 72-page order, Administrative Law Judge Melissa Owens Lassiter upheld the decision to award the TPA contract to Aetna, finding that the SHP followed its request for proposal (RFP) policies, methodologies and legal requirements.
“Blue Cross did not demonstrate by a preponderance of the evidence that, but for the supposed errors by the Plan, Blue Cross would have or would likely have been awarded the TPA Contract,” Lassiter wrote in part of the decision.
Lassiter’s July 8 decision is final.
Jim Bostian, North Carolina market president for Aetna, said in a statement to North State Journal that the company is “thrilled to begin serving those who teach, protect and otherwise serve North Carolina.”
“Since the contract decision was first announced in December 2022, we have been working on the impending, seamless transition at full speed all while demonstrating in court that the transition to Aetna is in the best interests of the State Health Plan and its members,” Bostian said. “To date, over 800 Aetna employees have contributed nearly 60,000 work hours to this implementation.”
The RFP process began in August 2022, and the TPA award was announced months later in mid-December.
United Healthcare also participated in the RFP process and initially protested the decision to award the TPA to Aetna but later dropped its complaint.
Around the time Aetna was named the winner, Folwell’s office estimated $140 million in administrative savings by making the change.
BCBSNC said in a statement it would not appeal the ruling.
“While disappointed in the outcome, Blue Cross NC will not appeal the court’s ruling regarding the State Health Plan’s RFP process,” the BCBSNC statement says. “While we will continue to provide the highest level of service throughout the current agreement, we know that our relationship with North Carolina’s teachers, public safety officers, and state employees is guided by something far more meaningful than a contract.”
Folwell was glad to have the dispute finalized so the state can move forward with Aetna.
“We are pleased that Blue Cross NC is choosing not to appeal the well-reasoned opinion of Judge Melissa Owens Lassiter of the Office of Administrative Hearings,” he said in a statement. “The members of the State Health Plan and taxpayers like them deserve to have this uncertainty ended. We will continue to be relentless in our pursuit of improving benefits for teachers and state employees in a cost-effective manner for taxpayers.”
