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State Health Plan Will Have Split Certificates in 2014

The State Health Plan (SHP) has awarded the Medicare Advantage business to UnitedHealthcare and Humana for their Medicare-primary retirees for 2014.  This means that if the Medicare-primary retiree has a spouse or dependents under the age of 65 covered on their current SHP policy, those family members will have their own individual ID cards with the State Health Plan administered by Blue Cross and Blue Shield of North Carolina (BCBSNC) as of January 1, 2014.

Here are the two split certificate scenarios that you may encounter with your SHP patients beginning in 2014:

  • The Medicare-primary family member(s) join UnitedHealthcare or Humana, and the remaining non-Medicare family member(s) remain with the State Health Plan, which is administered by BCBSNC.    (Medicare-primary spouses and dependents must follow the election of the Medicare-primary subscriber if all members are 65 or older.)

 

  • The Medicare-primary family member(s) can choose to decline automatic enrollment in the UnitedHealthcare or Humana plans during Open Enrollment in October 2013 and remain with BCBSNC on the traditional 70/30 plan, while the remaining family member(s) move to either the enhanced 80/20 plan or the 85/15 consumer-directed health plan. Remaining family members must all be on the same plan.

Individual ID Cards

With these split certificates, each person (regardless of age) will receive their own ID card. The State Health Plan began issuing individual ID cards for its members, including spouses and dependents, during the July 1, 2013, renewal.  These individual ID cards also include the name of any chosen primary care physician or practice. 

Effective January 1, 2014, spouses and dependents on a split certificate will be listed as the subscriber on their individual ID cards. It’s important to note that only family members on the same plan type will be included in any family deductible and/or coinsurance accumulators.

 If you have any questions, please contact the Provider Blue LineSM at 1.800.214.4844.